POST 35. June 29, 2020. CORONAVIRUS. VP Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

To read POSTS 1-35 in chronological order highlight and click on http://doctordidyouwashyourhands.com/2020/06/coronovirus-tracking-links-to-parts-1-35/

“The number of new U.S. cases this last week surged dangerously high, to levels not ever seen in the course of the pandemic, especially in states that had rushed to reopen their economies. The result has been a realization for many Americans that however much they have yearned for a return to normalcy, their leaders have failed to control the coronavirus pandemic. And there is little clarity on what comes next.”

“At least five states Friday reported single-day records of Covid-19 cases, adding to the growing concern over case tally spikes that has sent many states backpedaling on their reopening plans.”

“In the White House coronavirus task force’s first press conference in two months on Friday, Vice President Mike Pence stuck to happy talk and falsely claimed that the United States had “flattened the curve” as new cases rise.

Pence, who once said the US’s coronavirus outbreak would be “behind us” by Memorial Day, described the nation’s testing and prevention efforts as “a national accomplishment” and expressed optimism while acknowledging a “precipitous” increase in cases in the South.

Less than 24 hours before Pence’s appearance on Friday, the US reported more than 39,000 new COVID-19 cases, a record single-day increase.

Pence attributed the rise in reported cases to increased testing. “We want the American people to understand that it’s almost inarguable that more testing is generating more cases,” Pence said.

But medical experts and high-profile figures like Bill Gates have pushed back on that claim, citing a rise in the percentage of positive tests as evidence that increased testing alone is not inflating the number of new cases.

Even the director of the Centers for Disease Control and Prevention, Robert Redfield, acknowledged on Thursday that the actual number of COVID-19 infections was likely 10 times what the test results indicated.

Pence claimed that the US had flattened the curve, though new daily cases have increased in recent weeks.

“We slowed the spread. We flattened the curve. We saved lives,” Pence said.

Pence was flanked by Dr. Anthony Fauci and Dr. Deborah Birx, who have recently been less visible at White House events — they were appearing in their official capacity on the task force on Friday for the first time in two months.

Fauci and Birx wore masks, while Pence did not. (A)

“At least five states Friday reported single-day records of Covid-19 cases, adding to the growing concern over case tally spikes that has sent many states backpedaling on their reopening plans.

Florida, Georgia, Idaho, Tennessee and Utah all reported their highest-ever daily caseloads, according to their state’s health departments. And Florida, seen possibly as the next US epicenter, beat that record again Saturday with 9,585 cases.

And it is not just those states seeing rising numbers. The national number of daily coronavirus case reports reached a new high Friday as well, at almost 40,000, according to data from Johns Hopkins University, and 32 states are seeing the number of new cases grow from the prior week.

But the governor of Texas, the nation’s second most populous state, “paused” his state’s phased reopening plan and ordered further restrictions on businesses including bars.

And at least nine other states have announced they are not moving ahead to their next reopening phases: Arizona, Arkansas, Delaware, Idaho, Louisiana, Maine, Nevada, New Mexico and North Carolina.

Metropolitan areas across the US seeing exponential growth in cases means the nation will likely see a “dramatic increase” in the virus’ trajectory, Dr. Peter Hotez, a professor and dean of tropical medicine at Houston’s Baylor College of Medicine told CNN.

“At least in the metro areas, we’ve got people wearing masks now, the bars are closed and we’ve got some advocacy coming out of the county judge and the mayor,” he said of Texas. “I don’t know how much this will really slow this incredibly aggressive rise. It’s like trying to stop a train coming down the tracks.” (B)

“Pence boasted that “we flattened the curve” — though the curve for the number of new confirmed cases has headed sharply upward again in June after a decline and then plateau in April and May.

Pence said that “what we’re observing today” in Sun Belt states is that many young people who “have no symptoms” are testing positive — though Texas, Arizona, and Florida communities willing to report data keep hitting new highs for people with symptoms serious enough that they need to be hospitalized.

Pence described the Sun Belt situation as particular “outbreaks” occurring in “specific counties” and “specific communities” — declining to emphasize that, as expert Dr. Peter Hotez noted on CNN after the briefing, the places experiencing a “massive resurgence” include some of the most populous counties in the country.

“This is a tragedy, and what’s more, it’s not presented as a tragedy — it’s presented as, ‘We’re doing a pretty good job and now there are a couple of hotspots.’ These are not ‘hotspots’ — these are the largest metropolitan areas in the United States,” said Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas.

Pence also claimed that “all 50 states” are “opening up safely and responsibly” — even though about 30 states were experiencing increases in the rate of new cases, and though states reopened without having met the administration’s recommended safety milestones.

And Pence claimed that “to one extent or another, the volume of new cases coming in is a reflection of a great success in expanding testing across the country” — yet many states are seeing rising percentages of positive tests, which are indicative of genuinely rising levels of infection in the community.” (C)

“…..Dr. Anthony S. Fauci, the country’s top infectious diseases expert, also warned that outbreaks in the South and West could engulf the country…

European Union officials said the bloc was ready to bar most travelers from the U.S. and other countries considered too risky because they have not controlled the outbreak.

And for the first time, some U.S. governors were backtracking on reopening their states, issuing new restrictions for parts of the economy that had resumed.”  (D)

“The shifting assessments of the nation’s handling of the virus stretched to the highest levels of the federal government, where Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, made clear that the standard approach to controlling infectious diseases — testing sick people, isolating them and tracing their contacts — was not working. The failure, he said, was in part because some infected Americans are asymptomatic and unknowingly spreading the virus but also because some people exposed to the virus are reluctant to self-quarantine or have no place to do so.

In a brief interview on Friday, he said officials were having “intense discussions” about a possible shift to “pool testing,” in which samples from many people are tested at once in an effort to quickly find and isolate the infected.

Dr. Fauci also issued an urgent warning that while coronavirus infections were spiking mostly in the South, those outbreaks could spread to other regions…

From Miami to Los Angeles, mayors were contemplating slowing or reversing their plans to return cities to public life. On Friday, San Francisco announced it was delaying plans to reopen zoos, museums, hair salons, tattoo parlors and other businesses on Monday, citing a spike in new cases. “Our numbers are still low but rising rapidly,” Mayor London Breed wrote on Twitter, adding, “I know people are anxious to reopen — I am too. But we can’t jeopardize the progress we’ve made.”

Mayor Carlos Gimenez of Miami-Dade County said late Friday that he would sign an emergency order closing beaches from July 3 to July 7, citing the surge of cases and fears about mass gatherings during the holiday weekend. Parks and beaches will be closed to fireworks displays, and gatherings of more than 50 people, including parades, will be banned.

“The closure may be extended if conditions do not improve,” he said in a statement, adding, “I have decided that the only prudent thing to do to tamp down this recent uptick is to crack down on recreational activities that put our overall community at higher risk.”

The decisions in Texas and Florida to revert to stronger restrictions represented the strongest acknowledgment yet that reopening had not gone as planned in two of the nation’s most populous states, where only days ago their Republican governors were adamantly resisting calls to close back down.

On Thursday, Gov. Greg Abbott of Texas placed the state’s reopening on pause, while remaining firm that going “backward” and closing down businesses was “the last thing we want to do.”

But by Friday, he did just that, ordering bars closed and telling restaurants to limit themselves to 50 percent capacity rather than 75 percent.

“If I could go back and redo anything, it probably would have been to slow down the opening of bars,” Mr. Abbott said in an interview with KVIA-TV in El Paso on Friday evening…

In Arizona, Gov. Doug Ducey has held out on setting new limits in his state, even as cases there surged past 66,000, with an average of 2,750 new cases per day. He warned this week that hospitals were likely to hit surge capacity soon but he has remained opposed to backtracking on reopening.

“This is not another executive order to enforce, and it’s not about closing businesses,” he said this week. “This is about public education and personal responsibility.”

Still, shutting down businesses again in Arizona is not out of the question, Daniel Ruiz, the state’s chief operating officer, said in an interview on Friday.

“We want to treat that like a last resort,” Mr. Ruiz said. “It’s a tool in the toolbox, but it’s something that we’re going to use very judiciously.”

California, which had the first stay-at-home order in the nation this spring, has surpassed 200,000 cases, and on Friday, Mr. Newsom announced new restrictions on Imperial County, which has the state’s highest rate of infection. The county has exceeded its hospital capacity so severely that some 500 patients have had to be moved to beds elsewhere, and hospitals as far away as the Bay Area have been seeing Imperial County patients.

“This disease does not take a summer vacation,” said Mr. Newsom, noting that at least 15 of California’s 58 counties were being monitored closely as the virus surges.

In Los Angeles County, health officials estimate that every 400th person may currently be infected. Mayor Eric Garcetti of Los Angeles said he planned to wait three to five days before deciding whether to pull back on the city’s reopening.

“We’re not in the red zone but we’re in the yellow zone,” the mayor said in an interview on Friday.

From case counts to hospitalizations, he said, the city’s metrics are moving in the wrong direction, in part because of a patchwork of responses in neighboring areas.

Mr. Garcetti said he would like health officials in the state, the county and the surrounding region to come to a consensus strategy.

“If you don’t move together, there’s no point in being the lone holdout,” he said. “If you don’t have an entire region working together, who cares if you keep your gyms closed?” (E)

“At a time when his poll numbers now call into question whether he can win a second term in November, Mr. Trump faces the prospect that his efforts to boost the economy by shrugging off the virus have backfired. Rather than head into the summer with a country on the mend, the president will be forced to explain how his response to the coronavirus contributed to a resurgence of it that may force some Americans back into a painful shutdown…

All spring, Mr. Trump expressed his impatience and annoyance with the social distancing measures that various states, and his own aides, were taking…

He has been enabled by a handful of advisers, some of whom share his desire to focus on the economy and some of whom are afraid of the president’s reaction if they press him too hard about the public health crisis unfolding once again in large chunks of the country.

The White House chief of staff, Mark Meadows, has been among the chief proponents of keeping the administration’s public health experts largely out of sight, according to several senior administration officials.

But he is not alone. Even though they are aware that Mr. Trump’s mishandling of the virus presents a threat to his re-election, his campaign advisers agreed to his demand for the rally last Saturday at an arena in Tulsa, Okla., hoping the adulation he would receive there would snap the president out of a funk he has been in for months.

But at least eight staff members — including two Secret Service agents — tested positive for the virus before the rally, which was lightly attended and attracted none of the overflow crowd that Mr. Trump’s advisers had promised. Since then, dozens of campaign aides who were in Oklahoma for the event have been told to quarantine.

His advisers are now trying to figure out how to give Mr. Trump the traveling road show he wants while acknowledging the widespread fears about the coronavirus and allowing for proper health measures. At the same time, the White House has stopped employing the health checks it had been using for several weeks, like temperature checks for people entering the complex.

One of the states where the cases are rising drastically is Florida, where Mr. Trump insisted the Republican National Convention at the end of August be relocated to meet his desire for a large-scale event free of social distancing measures. As of now, Republicans hope to put on a show celebrating Mr. Trump, the first lady and Mr. Pence with three nights of crowds as large as 12,000 people in Jacksonville.

Some of the president’s political allies have signaled in recent days that they intend to take the threat of the virus more seriously.

Speaking to a group of health care workers in Morehead, Ky., Senator Mitch McConnell, Republican of Kentucky and the majority leader, held up a simple face mask.

“Until we find a vaccine, these are really important,” the senator said. “This is not as complicated as a ventilator. This is a way to indicate that you want to protect others. We all need during this period until we find a vaccine to think of us as protecting not only ourselves but others.”

And Representative Liz Cheney, Republican of Wyoming, had a not-so-subtle message for Mr. Pence in a tweet she posted not long after the vice president refused to wear a mask during the task force briefing on Friday. Her tweet included a picture of her father, former Vice President Dick Cheney.

“Dick Cheney says WEAR A MASK,” she wrote, adding the hashtag: #realmenwearmasks.

But if anything, Mr. Trump, Mr. Pence and the rest of the senior members of the administration have seemed determined in the past 24 hours to embrace a previrus political reality — even if the medical facts contradict it.”  (F)

“The Trump administration is ending funding and support for local COVID-19 testing sites around the country this month, as cases and hospitalizations are skyrocketing in many states.

The federal government will stop providing money and support for 13 sites across five states which were originally set up in the first months of the pandemic to speed up testing at the local level.

Local officials and public health experts expressed a mixture of frustration, resignation, and horror at the decision to let federal support lapse.

Texas will be particularly hard hit by the decision. The federal government gives much-needed testing kits and laboratory access to seven testing sites around Texas. But in the state, which is seeing new peaks in cases, people still face long lines for testing that continues to fail to meet overwhelming demand…

As the pandemic began to batter the United States in March, the Department of Health and Human Services and the Federal Emergency Management Agency began to deploy Community-Based Testing Sites around the country.

The sites provide testing kits and contract with laboratories and a call center to notify patients of their results. The federal government covers the costs of the contracts, while providing staff.

The Trump administration previously attempted to end support for the testing sites running under the same program in early April. The government reversed the move after a public outcry, extending the sites. The extension is now coming to an end.

Out of a starting number of 41 sites, 13 remain in operation across five states. In addition to Texas’ seven, Illinois and New Jersey each have two, while Colorado and Pennsylvania each have one.

The aid for testing takes a financial burden off of cities and states already buckling under a budget crunch from the pandemic, while boosting testing capacity.

An HHS spokeswoman told TPM that the program aimed to “develop and bring initial testing capabilities to socially vulnerable locations across the country” and said that states were expected to “transition” to control testing by June 30…

Testing is an area “where the federal government has the greatest capacity to be helpful,” Gary Slutkin, a former WHO epidemiologist and the CEO Of CURE Violence, told TPM.

“Testing is absolutely essential to everything from diagnosis and treatment to management of the epidemic itself,” Slutkin added. “The withholding of this essential tool for controlling this problem is cruel — it inhibits the ability of a country or a city or a community or a person or healthcare provider to know what to do.” (G)

“In a filing with the U.S. Supreme Court, the Trump administration has reaffirmed its position that the Affordable Care Act in its entirety is illegal because Congress eliminated the individual tax penalty for failing to purchase medical insurance.

Solicitor General Noel Francisco, the government’s chief advocate before the Supreme Court, said in a brief that the other provisions of Obamacare are impossible to separate from the individual mandate and that “it necessarily follows that the rest of the ACA must also fall.”…

The case before the high court began with a lawsuit brought by 20 states, led by Texas, calling for the elimination of the ACA. It has been consolidated for argument with another case brought by 17 states, led by California, seeking to preserve the law. The court is likely to hear the case in the fall…

Eliminating the ACA would end medical insurance for more than 20 million Americans. It would also end widely popular provisions of the law, such as extending parents’ coverage to children up to the age of 26 and prohibiting insurance companies from denying coverage based on preexisting conditions.

Trump and congressional Republicans have long said they want to “repeal and replace” Obamacare but have yet to offer legislation addressing what would take its place.” (H)

“When he travels to locations where the virus is surging, every venue the President enters is inspected for potential areas of contagion by advance security and medical teams, according to people familiar with the arrangements. Bathrooms designated for the President’s use are scrubbed and sanitized before he arrives. Staff maintain a close accounting of who will come into contact with the President to ensure they receive tests.

While the White House phases out steps such as temperature checks and required mask-wearing in the West Wing — changes meant to signal the country is moving on — those around the President still undergo regular testing…

Even as Trump attempts to move on, the protective bubble around him has grown thicker. Aides say the steps are necessary to allow the President — by all definitions an essential worker — to continue leading the country amid the pandemic.

But people familiar with the matter say the precautions also stem from Trump’s own insistence that he not contract the disease and his heightened awareness of how a sick President would affect both the country’s view of him and his ability to command a response to the pandemic.

After Trump told aides at the beginning of the outbreak he must avoid getting sick at all costs, efforts to prevent him from contracting the virus have progressively become more intensive and wide-ranging. Early steps such as keeping more hand sanitizer nearby eventually evolved into an intensive safety apparatus, including the testing regimen requiring dozens of staffers.

So far the efforts appear to have been effective, at least at preventing the President from contracting the virus. But events of the past week have also underscored the primacy of Trump himself to the safety measures, with the safety of staffers who compose his massive footprint coming second…

This week, the CDC updated its list of who is at increased risk for getting severely ill from Covid-19, removing a specific age threshold and instead warning Americans that the risk steadily increases with age. The CDC also added to its list of underlying conditions that increase the risk of severe illness, to include obesity and serious heart conditions.

Trump, who turned 74 on June 14, is considered obese, according to the results of his last physical, which showed he weighed 244 pounds and stands 6 feet 3 inches tall. The results from his first physical while in office indicated he also had a common form of heart disease….

The President has told officials repeatedly that he cannot get sick, and he grew upset when he learned last month that one of the military valets who handles his food and drink had come down with the disease. Trump asked how it was possible that someone with such intimate access to his person could have contracted the virus, and in the days following the revelation appeared cautious around people he did not know well, people familiar with his reaction said.

Trump appeared genuinely alarmed when people close to him contracted the disease, seeing in their experiences a fate he was adamantly working to avoid for himself. He raised repeatedly his friend Stanley Chera, a New York real estate developer who Trump had been friends with for decades. Trump described his surprise at Chera’s descent from contracting the virus to entering a coma to eventually succumbing to the disease.

Later, Trump was surprised again to learn that one of his closest foreign allies, British Prime Minister Boris Johnson, had fallen seriously ill from the virus, at one point being admitted to an intensive care unit in London. Trump asked for frequent updates on Johnson’s deteriorating condition and later asked to speak with him as soon as he was on his way to recovery.

Trump, who has long defined himself as a germaphobe, openly chastised aides who coughed or sneezed in his presence even before the virus. But amid the pandemic, any signs of respiratory sickness have been met with glares from the President. When Dr. Deborah Birx, the White House coronavirus response coordinator, told a briefing she’d had a fever and self-quarantined, Trump jokingly backed away.

When Polish President Andrzej Duda, Trump’s first foreign visitor in months, came to the White House this week, he and his entire delegation were administered coronavirus tests, as were the US officials who participated in the meeting.

For months, anyone who comes into close proximity with the President has been administrated a coronavirus test, though the Abbott Laboratories product used by the White House has raised concerns for high rates of false negatives.

Trump, who in the 1980s and ’90s openly discussed his success in avoiding a sexually transmitted disease — “It’s Vietnam,” he told Howard Stern, “It is very dangerous. So I’m very, very careful” — also took the controversial step of taking a round of hydroxychloroquine in a bid to prevent coronavirus.

Though the drug has not been proven to prevent infection with coronavirus, Trump had publicly touted its benefits and he announced midway through his round that he was taking it. Later, his doctor said Trump’s medical team used an electrocardiogram to closely monitor the President’s heart while he was taking the drug since some studies have suggested it could cause severe heart problems.” (I)

“There are far too few trained staff assigned to infection control. IPs do not even have time to document and report infections let alone evaluate patients and conduct training.

Judging when we have won the war against the coronavirus is not as simple as setting a benchmark of having no positive tests for SARS-CoV-2 (the virus which causes COVID-19) in the United States for two or four consecutive weeks. Because SARS-CoV-2 is an RNA virus, genetic drift may well occur which changes its viral capsule. Similar to the coronavirus which causes the common cold, vaccine production will be challenging at best. The virus has already jumped to the Southern Hemisphere. In all probability, it will be back in the Fall. The 1918 Spanish flu epidemic, a devastating second wave of infections wreaked havoc on the United States. And if these dire predictions do not occur and I hope they do not, we will certainly be hit with another novel virus in the future which creates similar risks.

The good news is that we have the technology and know-how to confront and substantially mitigate these epidemics. What we have lacked is the willpower to implement this knowledge. We will have won when the following takes place:

1. When we no longer neglect stockpiling needed equipment and supplies…

2. When we have a national public reporting laboratory infrastructure for all dangerous pathogens. Currently, we have a patchwork of laboratory systems in place with lack of a comprehensive public reporting…

3. When we have enough trained and supported infection preventionists (IPs).There are far too few trained staff assigned to infection control…

4. When we have developed more respect for infectious disease. The most important intervention to prevent transmission of almost any pathogen is handwashing…

5. When we have improved and larger physical plants to service patients… We also need support for environmental services, negative airflow rooms and centralized sterilizing systems for the ventilated air.

6. When we have redundancy in our healthcare facilities. In between epidemics we need to have employed staff with little to do and empty hospital beds…

7. When our leaders stop politicizing public health and rely on scientists to make public policy. Throughout a history of epidemics there has been a desire for governments to avoid accountability…

8. When we have healthcare, that is centered on patients and not on profits. We have to stop running a lean system and build a healthcare infrastructure so we can adapt and effectively confront future waves of this epidemic…

When the healthcare system meets all of these goals then I would consider it has won. If we are unable to rapidly transform our system and correct these flagrant deficiencies, then the worse projections from the Imperial College projections of 2.2 million United States citizen fatalities may come to pass.” (J)

“The number of new U.S. cases this last week surged dangerously high, to levels not ever seen in the course of the pandemic, especially in states that had rushed to reopen their economies. The result has been a realization for many Americans that however much they have yearned for a return to normalcy, their leaders have failed to control the coronavirus pandemic. And there is little clarity on what comes next.

“There has to be a clear coherent sustained communication, and that has absolutely not happened,” said Dr. William Schaffner, an infectious diseases specialist at Vanderbilt University in Nashville. “We’ve had just the opposite and now it’s hard to unring a whole series of bells.”

There was “real hubris” on the part of public health officials at the very start, Dr. Schaffner said, that the United States could lock down and contain the virus as China had. That futile hope helped create an unrealistic expectation that the shutdown, while intense, would not be for long, and that when it was lifted life would return to normal.

That expectation was reinforced by President Trump, who has downplayed the severity of the crisis, refused to wear a mask and began calling for states to open even as the virus was surging. A lack of federal leadership also meant that states lacked a unified approach.

With no clear message from the top, states went their own ways. A number of them failed to use the shutdown to fully prepare to reopen in a careful manner. As Americans bought precious time trying to keep the virus at bay, experts advised that states urgently needed to establish a robust system for tracking and containing any new cases — through testing, monitoring and contact tracing. Without this, the pandemic would simply come roaring back.

Testing and contact tracing efforts were ramped up, but not enough in some places. Even states that did embark on ambitious plans to do contact tracing struggled. Health officials in Massachusetts, which has one of the country’s most established tracing programs, said in May that only about 60 percent of infected patients were picking up the phone.

Just as the country needed to stay shut down longer, many states — mostly with Republican governors — took their foot off the brake, and Mr. Trump cheered them on.

In early May, when more than half of U.S. states had begun reopening parts of their economies, most failed to meet the nonbinding criteria recommended by the Trump administration itself to resume business and social activities.

The White House’s nonbinding guidelines suggested that states should have a “downward trajectory” of either documented coronavirus cases or of the percentage of positive tests.

Yet most states that were reopening failed to adhere to even these ill-defined recommendations. They had case counts that were trending upward, positive test results that were rising, or both, raising concerns among public health experts…

Dr. Schaffner offered a bleak prognosis for the country’s next chapter with the virus. He said he did not expect the country to return to a full lockdown, so in order to contain the infection people would have to begin to change behaviors in ways that were uncomfortable, unfamiliar — wearing masks, not gathering in large groups indoors, staying six feet apart.

“The only alternative until we have a vaccine is all of these behavioral interventions that we know work,” he said. But, he added, “The governors are all on different pages. It is no wonder that the average person is confused.” (K)

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter

CORONOVIRUS TRACKING Links to Parts 1-35

CORONOVIRUS TRACKING

Links to Parts 1-35

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

June 28, 2020


 [JM1]

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

to read POSTS 1-34 in chronological order, highlight and click on

WEDNESDAY

“Dr. Anthony S. Fauci told Congress on Tuesday that he was seeing a “disturbing surge” of infections in some parts of the country, as Americans ignore social distancing guidelines and states reopen without adequate plans for testing and tracing the contacts of those who get sick…

“The virus is not going to disappear,” said Dr. Fauci, the nation’s top infectious disease expert, who testified that the virus was not yet under control in the United States…

More than three months after Mr. Trump declared an emergency because of the virus, Dr. Fauci said the picture was a “mixed bag,” with some bright spots, but also some dark ones and many unknowns. Some states like New York are “doing very well” in controlling the spread of the virus, but the surge in other states is “very troublesome to me,” he said.

“The next couple of weeks are going to be critical in our ability to address those surges that we are seeing in Florida, in Texas, in Arizona and other states,” Dr. Fauci added…

In somber tones, all four of the doctors testifying on Tuesday made clear that the United States was hardly out of danger. Despite talk of a so-called second wave of the pandemic, Dr. Fauci said the nation was still in the middle of the first wave. Dr. Redfield said the crisis had “brought this nation to its knees,” cautioning that when it coincides with flu season this year, hospitals and health workers would face a tremendous strain. Getting a flu shot, he said, would be imperative.” (A)

“As more and more hospitals publicly report that their ICU beds are full, the state changed its guideline for tracking who is in its ICU beds — a change that will mask the true number of people in Florida’s intensive care units as the state struggles to keep pace with the coronavirus pandemic.

Some hospitals in the state may be using their ICU beds for non-critical-care coronavirus patients — people who need isolation but don’t need the most intensive level of care. And late Tuesday, at least a half-dozen South Florida hospitals had filled their ICU beds.

To ensure hospitals are not overwhelmed, Florida’s Agency for Health Care Administration Secretary Mary Mayhew has repeatedly said the state needs to keep a close eye — in real time — on how many ICU beds are available regardless of how sick the people are in those beds.

But now, instead of reporting the number of COVID-19 patients occupying ICU beds, the Department of Health wants hospitals to report only the number of COVID patients in those beds who are receiving ICU-level of care. The change could reduce the number of occupied ICU beds being reported to the state…

Still, the Department of Health’s change in reporting has some critics skeptical. Santa Rosa Beach attorney Daniel W. Uhlfelder has been keeping a close eye on re-openings, testing and hospitalizations. Uhlfelder has been appearing as the Grim Reaper to discourage continued reopening during the pandemic.

“I don’t believe in the coincidence of the timing,” Uhlfelder said. “Why in the middle of a global pandemic are those guidelines being modified the week when cases are skyrocketing? If we can’t have confidence in the numbers, how are we going to have confidence in the process?” (B)

“Baptist Health confirmed that the ICU at its hospital in Homestead is at capacity.

Baptist Health confirmed that Homestead Hospital’s intensive care unit is at capacity due in part to coronavirus and more patients having elective surgeries, officials said Tuesday.

Baptist Health officials said they are able to transfer patients to other hospitals in their system to manage capacity. Regular beds can also be converted to ICU and acute care beds if needed, they added.

Baptist Health currently has 286 coronavirus-positive patients and persons under investigation at hospitals across its system. Over 1,350 COVID-19 positive patients have been discharged across the system to date.” (C)

“As the number of patients hospitalized (in Houston) with the coronavirus has reached record highs 12 days in a row, Gov. Greg Abbott and other health officials have stressed that the state has “abundant” capacity to care for them.

Statewide, there were 14,260 available hospital beds and nearly 1,500 intensive care unit beds as of Tuesday.

But regionally, some hospital officials are reporting that intensive care units — for seriously ill patients, like those on ventilators — are near or over capacity, and local leaders have warned that hospitals could get overwhelmed if the number of infections keeps climbing…

The governor struck a newly urgent tone Monday in a televised press conference to say COVID-19 was “spreading at an unacceptable rate” and that multiple metrics to gauge the virus’ spread and severity had significantly increased. Epidemiologists have attributed upticks in infections and hospitalizations to changes in behavior, including lax mask use and less social distancing.

Abbott spokesperson John Wittman said hospitals in Houston and Austin have been “emphatic” that beds will be available for coronavirus patients. He also said the governor has made clear that “he will utilize tools as necessary to ensure hospitals will provide beds for anyone who tests positive for COVID-19.”

“To be clear, in Houston, the percentage of beds occupied by COVID patients is currently 12.9%. In Austin, the percentage of beds occupied by COVID patients is 10.2%,” Wittman said…

Abbott said he “was assured and reassured consistently” by hospital executives across the state that “they had the capability and the flexibility” to treat all coronavirus patients. “They know how to ratchet back on the number of people who are being admitted for nonessential surgical procedures, to make sure that beds are going to be available for anybody who tests positive for COVID-19.”

Texas officials said Monday that all hospitals are in a “pre-surge state” — still using their staffed beds and not yet turning to emergency expansion plans — and that the state stands ready to assist them. A plan categorizing how hospitals will respond to shrinking capacity shows them doubling up patients in rooms, using nontraditional care areas to treat coronavirus patients and then expanding to nearby buildings. In the most extreme circumstances, they may stand up alternate care sites, like pop-up hospitals.” (D)

“Almost all intensive care unit beds at Houston hospitals were occupied on Wednesday as Texas reported a record number of statewide patient admissions related to the novel coronavirus.

During a City Council meeting Wednesday morning, Houston Mayor Sylvester Turner said 97 percent of the city’s ICU beds were filled. A report from the Texas Medical Center (TMC) said 27 percent of those beds were occupied by COVID-19 patients.

According to data published earlier this week by the TMC, a network of health care and research institutions based in Houston, 90 percent of the city’s ICU beds were filled as of Monday. Virus patients accounted for more than one-quarter of those occupancies.

The TMC’s latest report incorporated ICU admission numbers from seven affiliate hospitals in the Houston area: CHI St. Luke’s Health, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital and University of Texas Medical Branch. The hospitals can collectively admit 1,330 ICU patients at regular capacity, when 70 to 80 percent of total beds are typically occupied, according to the TMC.

The TMC’s Monday report noted that an additional 373 beds could become available under its “sustainable surge” plan, a procedure that would indefinitely increase ICU capacities as needed during the pandemic. Another 504 beds could be added to Houston ICUs under an emergency “unsustainable surge” plan, which the TMC would implement to address a “significant, temporary” influx of patients, according to its report…

On Monday, the Houston Health Department said hospitalizations due to the virus had increased 177 percent throughout the surrounding county since May 31. It also noted a 64 percent increase in ICU patients who had tested positive for the virus.”  (E)

“Texas Children’s Hospital is now admitting adult patients, to help other Houston hospital ICUs and acute care units that have reached patient capacity amid the COVID-19 surge, the hospital said in a statement.

“Yes, Texas Children’s is admitting adult patients,” the statement read. “We are committed to doing our part to assist the city as the number of COVID-19 cases continues to rise…

The measure marks the first time during the pandemic that Texas Children’s has accommodated a COVID-19 surge plan that was prepared in April.”  (F)

“Dr. Marc Boom, the CEO of Houston Methodist, which has over 3,000 beds across eight medical centers including 907 beds at its flagship hospital, said his facilities are not at the tipping point but all hospitals in the city have seen cases triple over the last few weeks. Harris County, Texas, which includes Houston, has seen 8,324 new COVID-19 cases since the beginning of June, averaging about 362 new cases a day, according to data from the county health department.

“I think what’s happened and watching it around our community people have completely let their guard down,” Boom told “GMA.”

Boom said it’s been frustrating seeing people ignore medical professionals calls for social distancing, face coverings and other precautions over the last few weeks. Texas lifted its stay at home order on April 30.

“Somewhere around Memorial Day people just sort of sighed a breath of relief and said, ‘Hey, I’m going to act like it’s summer. I’m going to act like this thing was never here,’ and we’re paying the price for that now,” he said…

Boom said the increase in coronavirus patients hasn’t yet led to a peak in ICU beds at Houston Methodist’s facilities.” (G)

“Arizona reported another record day for COVID-19 hospitalizations along with another big increase in new cases Monday, as the virus continues its rapid spread through the state ahead of President Donald Trump’s visit Tuesday.

Inpatient beds, ICU beds, ventilators in use and emergency department visits for suspected and confirmed COVID-19 patients all hit their highest-ever numbers Sunday, according to hospital data released by the Arizona Department of Health Services Monday.

The highest jump came in inpatient beds, with 1,992 beds occupied by suspected and confirmed COVID-19 patients Sunday, compared with 1,942 Saturday.

As of Sunday, 82% of current inpatient beds and 84% of ICU beds were in use for COVID-19 and other patients.

More than 1,000 new cases have been reported on each of the past 13 days, with more than 2,000 new cases reported on each of the past five days, according to state data. While increased testing over the past month has contributed to an increase in numbers, the percentage of those tests coming back positive has spiked sharply since mid-May, indicating a sharp increase in community spread.”  (H)

“Meanwhile, 84 percent of intensive care unit beds were in use at Arizona hospitals and 83 percent of inpatient beds were in use as of Monday, according to the data.

“Each day I’ve been going into work over the last month is worse, and what I mean by worse is … just overwhelmed with COVID patients,” said Dr. Frank LoVecchio, who works in several Arizona hospitals in emergency medicine and public health…

LoVecchio said they had their highest number of intubations last week and based on what medical professionals have learned from colleagues in New York and around the country and from medical journals, “the last thing you want to do is put these patients on a ventilator, but you can’t just let them die if they can’t get enough oxygen in them.”

“We don’t want to do that but despite that we have our highest number of patients on ventilators, our highest numbers of patients who are intubated this last week or so,” he said. “We have the highest number of patients in the intensive care unit.”

LoVecchio said facilities were also beginning to fall short in staffing of nurses and respiratory technicians, who help manage the ventilators.” (I)

THURSDAY

“The News Service of Florida reported Friday that during a June 16 call, state Surgeon General Scott Rivkees asked hospital officials to change how they were reporting available ICU beds in the state’s “Emergency Status System” and to only include patients who required what he described as an “intensive level of care.”..

The change in reporting switches the emphasis from the number of available beds to the acuity and illnesses of the patients in the beds, a move DeSantis spokeswoman Helen Aguirre Ferre defended on Twitter.

“There is a difference between the number of critical care patients needing an ICU bed as opposed to those occupying an ICU bed for COVID quarantining which is why @GovRonDeSantis is ensuring the data accurately reflects that difference. Smart!” she tweeted.

If hospitals are using ICU beds for patients who aren’t in critical care, it could at least partly be because of state decisions.

To abate the spread of COVID-19 in nursing homes and slow the death rate among long-term care residents, Florida regulators in May required nursing homes that did not have advanced health-care capabilities to transfer residents with COVID-19 to hospitals.

It also required nursing homes that could not properly isolate residents to transfer them to hospitals or to one of seven state-designated COVID-19 long-term care facilities. Those seven facilities can hold a maximum of 529 residents.

According to state data, 2,640 residents have been transferred, which means the majority of them have been transferred to hospitals.

At a news conference Tuesday in Orlando, DeSantis defended Rivkees’ decision to switch reporting requirements, saying hospitals that told his administration “they were just using their ICU wing as their COVID wing.” (J)

“On MSNBC’s Morning Joe Tuesday morning, Dr. Vin Gupta, a pulmonologist who treats COVID patients in Washington state, said it was stunning and puzzling what Rivkees had ordered.

“That’s data manipulation. Let’s be clear on that,” he said. “That’s fudging the data so they can report better numbers.”

Some hospitals, such as Palm Beach Gardens and JFK medical centers, have recently reported having no open ICU beds in general as COVID cases have surged in the past week. The number of ICU beds with COVID patients is not released to the public.

Palm Beach County hospitals Tuesday afternoon had 23% of adult ICU beds available after dipping as low as 18% last week.

Gupta said that with Palm Beach County and other places opening up more rapidly, officials now don’t know what surge capacity they have in local hospitals.

“This has huge implications and is really concerning,” Gupta said.

Dr. Larry Bush, an infectious disease specialist at Wellington Regional Medical Center, said the state, in changing ICU reporting requirements, is “trying to make it look less severe.”

But he said that there are patients in ICU beds who are not required to be there because immediate-care beds are filled up with COVID patients.

He said at Wellington Regional there are two or three people in ICU who, if they could, would be transferred to the immediate-care floor.

Bush said hospitals can’t send seniors from nursing homes back until they test negative twice even if they show no signs of illness.

Inversely, those COVID patients on ventilators are staying in ICU beds for weeks.

“You are not opening up beds,” he said. “Usually, it’s an in-and-out situation but the ‘out’ has slowed down because they are lingering.”…

DeSantis, at his news conference in Orlando on Tuesday, said the state just wanted to get a truer picture of serious COVID cases in the hospital ICUs.

“Some of the hospitals had told us they were just using their ICU wing as their COVID wing,” he said. “The surgeon general just wanted to know, ’OK, if you are doing that, how many (serious cases) are actually there or not?”” (K)

“Gino Santorio, CEO of Broward Health, said the new guidelines for reporting will affect smaller hospitals, rather than the bigger health systems in South Florida that have isolated areas for general and intensive-care COVID patients.

“What is happening is a couple of hospitals in the state have made their ICUs the dedicated COVID-19 units to isolate the patients. In those scenarios, the positive patients would be sent to the dedicated unit in the ICU whether they needed intensive care or not,” Santorio said.

He said the state and individual hospitals still need to track how many ICU beds are filled, regardless of why, to know whether the spike in cases is followed by more hospitalizations. Hospitals like Broward Health are able to add ICU beds if needed by converting general beds, he said.

On Tuesday, a half-dozen South Florida hospitals had completely filled their ICU beds, according to information the hospitals report into the Emergency Surveillance System managed by the Agency for Health Care Administration. Those hospitals include Coral Gables Hospital and Homestead Hospital in Miami-Dade County; Broward Health North in Broward County; and St. Mary’s Medical Center, Lakeside Medical Center and Bethesda Medical Center West in Palm Beach County.

Some counties, like Miami-Dade, have required their hospitals to report their daily COVID-19 hospitalizations and discharges to the mayor. On Tuesday, Miami-Dade hospitals reported admitting 103 new patients and discharging 92.

At Tuesday’s news briefing in Orlando, doctors from Orlando Health said patients coming to the hospital with COVID-19 are not as sick as they were earlier in the pandemic and less likely to need ICU care.

“Not only do we have the capacity to take care of all our community, we haven’t tapped into our surge capability,” said Dr. George Ralls, a vice president of Orlando Health.

Still, the Department of Health’s change in reporting has some critics skeptical. Santa Rosa Beach attorney Daniel W. Uhlfelder has been keeping a close eye on re-openings, testing and hospitalizations. Uhlfelder has been appearing as the Grim Reaper to discourage continued reopening during the pandemic.

“I don’t believe in the coincidence of the timing,” Uhlfelder said. “Why in the middle of a global pandemic are those guidelines being modified the week when cases are skyrocketing? If we can’t have confidence in the numbers, how are we going to have confidence in the process?”” (L)

“Texas recorded an all-time daily high of 5,489 new Covid-19 cases on Tuesday as hospitals neared capacity in Houston…

Houston’s Texas medical center, often referred to as the largest medical center in the world, showed its ICU beds were at 97% of normal capacity. The hospital has maximum capacity for nearly 1,000 more ICU beds if it activates its plans for public health emergencies.

The surge in cases in Texas and increase in hospitalizations has been accompanied by a higher rate of positive tests. These are indicators cases are not increasing just because more people are being tested.

The head of the Houston Methodist hospital system, Dr Marc Boom, wrote in an email to employees on Friday: “We appear to be nearing the tipping point.”

In the email, seen by the Texas Tribune, Boom continued: “Should the number of new cases grow too rapidly, it will eventually challenge our ability to treat both Covid-19 and non-Covid-19 patients.””  (M)

Anxiety is setting in for Texas hospital officials as the number of coronavirus patients has surged in the last few days.

“Currently we have room, but things have to change. This is not good,” said Dr. Faisal Masud, medical director of critical care medicine at the Houston Methodist hospital system. “The explosion of patients all across, that explosion has to slow down.”…

“I think we can manage right now, but if this trajectory is what it was the last 10 days,” said Masud, “when we literally had almost a tripling of our cases — we can’t do that for a couple of weeks at all.”…

In a statement Wednesday, the Texas Hospital Association said that hospitals are reserving 15 percent of bed capacity for COVID-19 patients and could slow or pause non-COVID-related procedures to increase capacity.

But they also warned in a statement that “if this trend continues, it is not sustainable.”

‘Tremendous stress’ of balancing coronavirus, other patients..

Masud, who oversees eight hospitals in the Houston Methodist system, said facilities are under “tremendous stress” as they try to deal with the jump in cases, while trying to treat patients who have been waiting for procedures they should have had three months ago.

“We owe it to the non-COVID patient also,” he said. “To me a patient is a patient. If you have a person or a loved one who has a heart attack, am I not supposed to provide care to them?”

While capacity is often discussed in terms of beds, Masud said more COVID-19 patients mean more strain on personnel and equipment. The hospital system also is helping out county hospitals…

Treating COVID-19 does not just involve finding an available bed, he said, noting that “you can have a bed in the Marriott.” Providing care to pandemic patents requires nurses, therapies, critical care physicians and other people and equipment.

Adding to the strain, some hospitals have furloughed personnel because of the stop or slowdown of elective procedures, which generate revenue.

“A lot of the personnel that are needed now are having to be hired back or find more people — that means more of the PPE, we need more of that coming in,” said Diana Fite, president of the Texas Medical Association and an emergency care physician…

The medical personnel interviewed Wednesday were eager to make public pleas for people to return to more cautious mindsets about coronavirus…

“If we don’t do something different today, we won’t have a choice,” Masud said.” (N)

“As the number of patients hospitalized with the coronavirus has reached record highs 12 days in a row, Gov. Greg Abbott and other health officials have stressed that the state has “abundant” capacity to care for them…

The governor struck a newly urgent tone Monday in a televised press conference to say COVID-19 was “spreading at an unacceptable rate” and that multiple metrics to gauge the virus’ spread and severity had significantly increased. Epidemiologists have attributed upticks in infections and hospitalizations to changes in behavior, including lax mask use and less social distancing.

Abbott spokesperson John Wittman said hospitals in Houston and Austin have been “emphatic” that beds will be available for coronavirus patients. He also said the governor has made clear that “he will utilize tools as necessary to ensure hospitals will provide beds for anyone who tests positive for COVID-19.”..

While large swaths of the state are not reporting surges in hospitalized coronavirus patients, health experts and local officials predict a coming crush in some urban areas if the growth in cases doesn’t slow down.

“What we had before was a ripple compared to what we’re about to experience,” said Dr. David Persse, health authority for the Houston Health Department…

Abbott said he “was assured and reassured consistently” by hospital executives across the state that “they had the capability and the flexibility” to treat all coronavirus patients. “They know how to ratchet back on the number of people who are being admitted for nonessential surgical procedures, to make sure that beds are going to be available for anybody who tests positive for COVID-19.”

Texas officials said Monday that all hospitals are in a “pre-surge state” — still using their staffed beds and not yet turning to emergency expansion plans — and that the state stands ready to assist them. A plan categorizing how hospitals will respond to shrinking capacity shows them doubling up patients in rooms, using nontraditional care areas to treat coronavirus patients and then expanding to nearby buildings. In the most extreme circumstances, they may stand up alternate care sites, like pop-up hospitals.

The number of available beds statewide, which is updated daily by the Department of State Health Services, included on Monday 1,303 pediatric beds and 380 psychiatric beds housed in general hospitals, said agency spokesperson Chris Van Deusen. The available bed numbers don’t include beds at psychiatric facilities, alternate care sites or those that “could be brought online but aren’t actually staffed yet,” he said….

Facilities treating coronavirus patients could face challenges that go beyond bed space — like staffing shortages.

Some hospitals have already turned to contract nurses or extended employees’ hours, in part because of a rising number of staff members in quarantine after possible exposure to the virus, said Maureen Milligan, president and chief executive officer of the Teaching Hospitals of Texas. There’s burnout among some employees, including medical staff, she said.” (O)

“Gov. Greg Abbott issued two executive orders mandating that the state’s health care facilities postpone elective medical procedures and suspending regulations to allow hospitals to treat two patients in one room in an effort to combat the spread of Covid-19.

He also announced the creation of a “strike force” to help Texas procure medical supplies and said that he was deploying the National Guard to help providers organize testing areas and assist hospitals in creating more bed space.

Abbott has grown increasingly aggressive in responding to the pandemic, following the lead of Texas cities and counties and other states around the country. Texas, however, still lags in testing capabilities.

State officials said at Sunday’s news conference that Texas was in the early stages of the outbreak and that the measures were intended to help boost hospital capacity, supplies and medical staff as more people fall critically ill.

Hospitals could face fines and providers could face jail if they don’t comply with the order postponing elective procedures. The “strike force” includes former Republican state Rep. John Zerwas, an anesthesiologist, as well as an executive from Austin-based Dell Technologies. Abbott added that the state had funds to pay for protective equipment and other supplies needed to help treat patients, but couldn’t find supplies.

The governor said that the state wasn’t prepared to strengthen restrictions on people’s movement and issue shelter-in-place rules, but added that he would consider stricter measures if people don’t follow his earlier order banning gatherings of more than 10 people. Several cities and counties already have imposed stricter bans on gatherings.

“The only thing that matters right now is public health and safety,” said Abbott. (P)

“There are more than three times as many confirmed COVID-19 cases in Arizona today as there were one month ago. Public health experts say the virus isn’t slowing down.

The state reports about 88% of Arizona’s hospital ICU beds are in use as of Tuesday. Joshua LeBaer with the Biodesign Institute at ASU warns that at the rate cases are rising, some Arizona hospitals will reach capacity within the next few weeks.

“It’s important to remember that what we’re looking at here is an exponential curve, so things can go up very quickly,” LeBaer said in a call with reporters.

LeBaer said the state needs to consider every possible tool to slow the spread, including expanding contact tracing and increasing compliance with mask mandates. He also said the state should be testing more than just the people who show symptoms.

“We should be testing many more asymptomatic individuals, because we know that people without symptoms can still spread this virus, and we need to get results back to those people very quickly,” LeBaer said.

LeBaer said many tests take up to a week for results. So people may be spreading the disease before they know they’re positive.” (Q)

“As the spread of the coronavirus in Arizona reaches unprecedented levels, nurses and hospital workers have shared on social media how the COVID-19 pandemic is stretching them thin. While Gov. Doug Ducey has focused on increasing hospital beds and recently allowing for local mask-wearing regulations, hospital workers shared that their trained staff is already overworked. 

Tucson nurse Ben Gerkin wrote on Facebook on June 14 that he works at a COVID-19 Intensive Care Unit. What he has seen is unlike anything in nearly 10 years as a registered nurse.

“I have never looked around my 100% full ICU and genuinely thought that there is the possibility of NO survivors,” Gerkin wrote. “Hospitals are at the point where we can’t accept all patients and are making decisions based on if they have the chance of survival. We are also not able to provide all treatment modalities such as dialysis on all patients based on futility of the situation.” (R)

“CDC Director Robert Redfield on Thursday said the number of coronavirus infections in the U.S. could be 10 times higher than the confirmed case count — meaning a total of more than 20 million.

“Our best estimate right now is for every case reported there were actually 10 other infections,” Redfield said during a call with reporters, referencing data from antibody tests that show who has been exposed to the virus.” (S)

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter

CORONOVIRUS TRACKING Links to Parts 1-34

CORONOVIRUS TRACKING

Links to Parts 1-34

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!


 [JM1]

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter

POST 33. June 23, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

to read Posts 1-33 in Chronological order, highlight and click on

“You may think you look silly to wear a mask on your face on a fine late spring day, but you look even sillier in a hospital gown,” -Governor Murphy of New Jersey

“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” -Winston Churchill

APPENDIX. Metrics to Guide Reopening New York

“Epidemiologists define the herd immunity threshold for a given virus as the percentage of the population that must be immune to ensure that its introduction will not cause an outbreak. If enough people are immune, an infected person will likely come into contact only with people who are already immune rather than spreading the virus to someone who is susceptible.

Herd immunity is usually discussed in the context of vaccination. For example, if 90% of the population (the herd) has received a chickenpox vaccine, the remaining 10% (often including people who cannot become vaccinated, like babies and the immunocompromised) will be protected from the introduction of a single person with chickenpox.

But herd immunity from SARS-CoV-2 is different in several ways:

1) We do not have a vaccine. As biologist Carl Bergstrom and biostatistician Natalie Dean pointed out in a New York Times op-ed in May, without a widely available vaccine, most of the population – 60%-85% by some estimates – must become infected to reach herd immunity, and the virus’s high mortality rate means millions would die.

2) The virus is not currently contained. If herd immunity is reached during an ongoing pandemic, the high number of infected people will continue to spread the virus and ultimately many more people than the herd immunity threshold will become infected – likely over 90% of the population.

3) The people most vulnerable are not evenly spread across the population. Groups that have not been mixing with the “herd” will remain vulnerable even after the herd immunity threshold is reached.

For a given virus, any person is either susceptible to being infected, currently infected or immune from being infected. If a vaccine is available, a susceptible person can become immune without ever becoming infected.

Without a vaccine, the only route to immunity is through infection. And unlike with chickenpox, many people infected with SARS-CoV-2 die from it…

An ongoing pandemic doesn’t stop as soon as the herd immunity threshold is reached. In contrast to the scenario of a single person with chickenpox entering a largely immune population, many people are infected at any given time during an ongoing pandemic.

When the herd immunity threshold is reached during a pandemic, the number of new infections per day will decline, but the substantial infectious population at that point will continue to spread the virus. As Bergstrom and Dean noted, “A runaway train doesn’t stop the instant the track begins to slope uphill, and a rapidly spreading virus doesn’t stop right when herd immunity is attained.”

If the virus is unchecked, the final percentage of people infected will far overshoot the herd immunity threshold, affecting as many as 90% of the population in the case of SARS-CoV-2.” (A)

“But for things to return to normal, the only real strategy is to bring down the number of susceptible people. This is the reason why vaccination can wipe a disease out. It effectively reduces the susceptible population. Without a vaccine, though, the only other way to derive immunity is to have the disease. For COVID-19, rough estimates suggest that we need up to 60% of the population to have had the disease to achieve herd immunity.

So although we are slowly descending from the peak of the first small ridge of the epidemic, without the large number of people gaining immunity through having the disease, the mountain metaphor is unhelpful. The laws of epidemic gravity won’t help to pull us down on this descent…

A better analogy would be to the decelerating influence of a parachute. Social distancing and other measures have slowed the spread to a point at which the impact of the disease is currently manageable. But cut the parachute too early, before the danger is averted, and the outbreak will accelerate again.” (B)

“In epidemiology, the idea of slowing a virus’ spread so that fewer people need to seek treatment at any given time is known as “flattening the curve.” It explains why so many countries are implementing “social distancing” guidelines — including a “shelter in place” order that affects 6.7 million people in Northern California, even though COVID-19 outbreaks there might not yet seem severe…

The curve takes on different shapes, depending on the virus’s infection rate. It could be a steep curve, in which the virus spreads exponentially (that is, case counts keep doubling at a consistent rate), and the total number of cases skyrockets to its peak within a few weeks. Infection curves with a steep rise also have a steep fall; after the virus infects pretty much everyone who can be infected, case numbers begin to drop exponentially, too.

The faster the infection curve rises, the quicker the local health care system gets overloaded beyond its capacity to treat people…

A flatter curve, on the other hand, assumes the same number of people ultimately get infected, but over a longer period of time. A slower infection rate means a less stressed health care system, fewer hospital visits on any given day and fewer sick people being turned away…

…in 1918, …a strain of influenza known as the Spanish flu caused a global pandemic. To see how it played out, we can look at two U.S. cities — Philadelphia and St. Louis…

In Philadelphia, city officials ignored warnings from infectious disease experts that the flu was already spreading in the community. The city instead moved forward with a massive parade that gathered hundreds of thousands of people together, Harris said.

“Within 48, 72 hours, thousands of people around the Philadelphia region started to die,” Harris said. Ultimately, about 16,000 people from the city died in six months.

In St. Louis, meanwhile, city officials quickly implemented social isolation strategies. The government closed schools, limited travel and encouraged personal hygiene and social distancing. As a result, the city saw just 2,000 deaths — one-eighth of the casualties in Philadelphia.

The city, now known for its towering Gateway Arch, had successfully flattened the curve.” (C)

“The national picture is highly instructive. While the country as a whole has successfully flattened the curve, it has yet to show the extended period of decline necessary to declare ourselves out of the woods — a “squashing” of the curve. The same applies to most states. While a small number have sustained a long squashing period, most are still rising and falling day by day…

Your garden-variety epidemic has four acts. First, it grows very slowly (the first yellow block), resembling a low, linear curve, even though exponential growth is marshaling its forces.

After that, cases spike dramatically (red), infecting more and more individuals every day and registering wide public attention. There are two scenes in this second act. In the beginning, more people test positive every day than the day before. This is the hallmark of exponential growth, when the number of cases is not only growing but accelerating. At some point—in this case, around April 1 nationally, though the data is too noisy to pin down a precise date—that acceleration slows, at what’s known as an “inflection point.” The number of daily cases continue to grow compared to the previous day, but not as rapidly as before. The sooner policy interventions like school closings and stay-at-home orders are put in place, the sooner one reaches this critical midpoint.

Then, in Act Three, the curve flattens (yellow again), with approximately the same number of new infections reported every day. This is the phase that, early on, all of us were hoping for: the celebrated “flattening of the curve.” But it is not the end of the play. A flattened curve suggests some measure of control over the situation, but no one should be too happy with a large number of new infections every day, even if that number is constant. Furthermore, if a given country or state relaxes social distancing measures while still in the yellow phase, it could easily re-enter red territory.

Ideally, a flattened curve leads to a squashed one in Act Four (green). This is the moment when there are fewer new positive cases today than there were yesterday. The longer the fourth act can be drawn out, the closer we come to the final exeunt.

In tidy, computer simulations of an epidemic, the drama ends here after a very, very long fourth act. This is not the case with COVID-19. Across the country, states are seeing what might have been the final descent reverse as cases begin to climb again. What we now face is what will happen in Act Five.

Nationally, the U.S. has returned to a flattened curve (yellow again), where cases are neither spiking nor declining. This opening scene in Act Five is not ideal, but worse would be to return to a spike, as has occurred in several states. Take, for example, Tennessee:

Rather than progressing from flattening to a decline, Tennessee has returned to Act Two, with cases growing, despite intermittent good days…

Tennessee is one of the states that has seen a backlash to isolation measures in recent weeks, and it’s tempting to blame the regression on the protests. However, the latency time of infections from the COVID-19 virus is too long for such a neat correlation.

Again, it might be tempting to blame an apparent mid-April regression on local protests against social distancing orders. But in actuality, what appears to be an organic spike is more likely to be a rise in known cases due to an influx of test kits in Ohio. After reporting that Ohio’s curve had flattened two weeks ago, Cleveland’s ABC News affiliate now suggests that an increase in testing, with a particular focus on state prisons, is responsible for the return to rising cases.

In Georgia, meanwhile, where an abrupt easing of some public restrictions on businesses garnered both celebration and contempt, there is no sign of an extended decline that, from a public health standpoint, warrants such a liberation—or, as of yet, a sufficient lapse of time to know how damaging the reopenings may be.

It remains to be seen how Act Five plays out for the country at large. One can be cautiously optimistic that, should a supermajority of states endure the unpleasantness of every available intervention even as the curve flattens and declines, this will eventually conclude as a tragicomedy, not as Hamlet.” (D)

“The United States, meanwhile, is moving to open up on the basis of a vaguely articulated assumption that settling for mitigation is good enough.

One reason for the pressure to open up is that while widespread orders to shelter in place have clearly succeeded in slowing the spread of infection, they’re not bringing case volumes down quickly. Authorities fear the economic pain of prolonged shutdowns, and it seems like the mass public is growing impatient and starting to bend the rules.

But the reality is that the United States has not really tried the strategies that have made suppression successful. To accomplish that, America would need to invest in expanding the volume of tests, invest in more contact tracers, and create centralized quarantine facilities so that infected people aren’t simply sent home to infect the rest of their household.

Since the US didn’t spend April doing that, trying to achieve suppression — along the lines of Taiwan, Hong Kong, Korea, and New Zealand — would necessarily involve more delay and more economic pain. But doing so would save potentially tens or hundreds of thousands of lives and almost certainly lead to a better economic outcome by allowing activity to truly restart.” (E)

More people will die if states that reopened their economies too quickly and are reporting spikes in cases don’t take actions to prevent further spread, New York Gov. Andrew Cuomo said during his final daily press briefing on Friday.

The number of new deaths over the next four weeks is expected to accelerate in nine states compared to last month, according to forecasts published by the U.S. Centers for Disease Control and Prevention.

The coronavirus has killed more than 30,900 people in New York, the most of any state in the nation, according to data from Johns Hopkins University.

Cuomo issues dire warning about states reopening too quickly from Covid-19 lockdowns

More people will die if states that reopened their economies too quickly and are reporting spikes in cases don’t take actions to prevent further spread of Covid-19, New York Gov. Andrew Cuomo said during his final daily press briefing on Friday.

“More people will die and it doesn’t have to be that way. Forget the politics, be smart, open the economy intelligently and save lives at the same time. That’s what we showed works in New York,” Cuomo said during his final briefing.

Cuomo’s final daily coronvirus press briefing comes over 100 days after the beginning of the state’s response to the outbreak. New York confirmed its first coronavirus death, an 82-year old New York woman with pre-existing health issues, on March 14.

Since then, the coronavirus has killed more than 30,900 people in New York, the most of any state in the nation, according to data from Johns Hopkins University. The coronavirus has killed more than 118,400 people in the U.S., according to Hopkins data…

In the days leading up to his final press briefing on Friday, New York had reported record-low hospitalizations from Covid-19 and consistently recorded less than 50 daily deaths.

“Over the past three months we have done the impossible,” Cuomo said. “We’ve reopened the economy and we’ve saved lives because it was never a choice between one or the other. It was always right to do both.” “ (F)

“Gov. Phil Murphy on Tuesday spelled out the reasons for why New Jersey isn’t ready to fully reopen just yet, even as the state’s case and hospitalization numbers have declined sharply. He also announced during a news conference that New Jersey has 470 additional coronavirus cases and 51 more deaths…

But Murphy said he’s worried about a resurgence of the virus, especially if more indoor facilities reopen and as the region moves closer to fall, when COVID-19 is expected to return in the colder weather and if no vaccine is developed. The rate of transmission outdoors is 1/19 of what it is inside, Murphy said.

“This virus, by its very nature, is going to come back,” Murphy said…

Murphy also noted that hospitals and the state’s health care system are still too taxed to deal with a complete reopening…

“Our health care system is regaining capacity to meet the challenges ahead. We know there will be more COVID-19 hospitalizations,” he said. “Our hospitals are in a better, stronger position to care.”

Murphy, however, said New Jersey still has “too many people in our hospitals,” especially since the state’s numbers are among the highest in the nation.

“The only thing that will push these numbers down is slowing the spread of COVID-19,” Murphy said “That is why social distancing must remain our top priority.”

Murphy said he dined on Monday as New Jersey reopened outdoor dining and indoor retail, but he said he saw too many people not wearing masks. Read more: NJ’s Big Reopen Day: Here’s What You Can Do In Coronavirus Crisis

“You may think you look silly to wear a mask on your face on a fine late spring day, but you look even sillier in a hospital gown,” Murphy said.” (N)

“Arizona, Florida, California, South Carolina and Texas all reported record-high single-day increases in coronavirus cases on Thursday as states continue to ramp up testing and the virus reaches new communities.

Arizona health officials reported 2,519 confirmed cases on Thursday, surpassing the previous single-day high of 2,392 reported on Tuesday. Florida officials announced 3,207 new cases Thursday morning, shattering the state’s previous single-day high of 2,783 new cases also reported on Tuesday. California officials reported Thursday 4,084 new cases that were confirmed on Wednesday…

The record-setting numbers come amid an ongoing tide of new infections and increasing hospitalizations reported among a slew of states across the American South and West. Some states now seeing a rise in infections were among the first and most aggressive to reopen.

New cases have risen rapidly in Arizona and some hospitals are nearing capacity. The state reported a record-number of patients in ICU beds on Thursday, accounting for 84% of the state’s capacity.

On Wednesday, Arizona Gov. Doug Ducey addressed the recent surge and announced new policies that allow local officials to require that residents wear masks in public and in businesses after a slew of health specialists wrote a public letter asking the Republican governor to do so.

In making the announcement, the governor also acknowledged that the virus is spreading more quickly than is acceptable. He had previously said that officials expected cases to rise after the state eased restrictions and reopened businesses on May 15.

“I said two weeks ago that there is not a trend here,” Ducey said Wednesday evening while presenting a chart of daily new cases across the state. “Looking at the last two weeks of data, there is a trend. And the trend is headed in the wrong direction and the actions we’re going to take are intended to change that direction and reverse this trend.”

Ducey asked Arizonans to practice social distancing and recommended they wear a mask. He also announced plans to continue to ramp up testing as well as contact tracing, a process whereby health officials contact infected people and try to identify the source of infection as well as other people who might have been infected…

“We want to slow and contain the spread,” he said Wednesday. “We have successfully slowed the spread of Covid-19 in the past. We’re going to successfully slow Covid-19 again.”..

Earlier Thursday, former Food and Drug Administration Commissioner Dr. Scott Gottlieb told CNBC that some states now seeing a resurgence in cases are “on the cusp of losing control.”

“These are outbreaks. We’re seeing doubling times now falling under 10 days,” Gottlieb said on CNBC’s “Squawk Box.” “These are on the cusp of getting out of control. I think these states still have a week or two to take actions to try to get these under control.”

He added that he’s concerned about “the lack of political will” for officials to continue to implement proven interventions like social distancing and mask wearing.

“I’m more concerned than I was three weeks ago heading into the fall,” he said. “Unless we get comfortable taking some common sense measures, where we can, some limited measures, we’re going to be stuck with a lot more spread.” (G)

“As Florida reported another record day of new confirmed COVID-19 cases on Friday, with 3,822, Gov. Ron DeSantis pushed back against suggestions that the state may become the next epicenter of the nation’s coronavirus pandemic and that it’s quickly running out of hospital beds to care for patients.

At a news conference in Miami with local hospital executives and state and local leaders, DeSantis said that most of the state’s new cases have been found among younger people with milder symptoms and insisted that Florida has plenty of hospital beds available.

“A lot of the people who are testing positive now are not symptomatic,” he said.

DeSantis said the state has also ramped up testing of residents and staff at Florida nursing homes and assisted living facilities, requiring testing every two weeks for every staff member of a long-term care facility in the state.

“That will help us prevent the introduction of this virus into those facilities,” he said.

When it comes to hospital beds, the governor said the state has “twice as much capacity in the hospitals throughout the state of Florida today than before the pandemic began and that’s with having elective surgeries, which have been going on since the beginning of March [actually May].”

Mary Mayhew, secretary of Florida’s Agency for Health Care Administration, which regulates hospitals, accused the news media of overlooking the ability for hospitals to boost the number of staffed beds to handle a surge of patients.

“Our hospitals have an incredible ability to rapidly increase their capacity,” she said. “That is often overlooked by the media as they focus on current capacity.”

But the agency’s statewide hospital bed dashboard provides the data that national media have cited when reporting that Florida’s hospitals are running out of room at the same time that the state is reporting record numbers of new COVID-19 cases. The dashboard does not reflect hospitals’ ability to boost capacity.

Mayhew said there are more than 15,000 hospital beds currently unfilled statewide, which equals 25% below capacity — the same number reported by the agency’s dashboard.

“The trends are absolutely favorable,” Mayhew said. “The acuity is down.”…

The Florida Medical Association, the state’s largest and most politically influential physicians group, wants local governments to do more than crack down on social distancing, though.

On Friday, the group’s president issued a statement urging Floridians to use face masks to reduce spread of COVID-19, and calling on local officials to adopt regulations requiring face masks in public places.

“The science is clear,” said Ronald F. Giffler, the FMA president and Pompano Beach physician. “Asymptomatic infected individuals can release infectious aerosol particles while breathing and speaking. Not wearing a mask or face covering increases exposure.””  (H)

“As Florida health officials report another record single-day increase in cases of the novel coronavirus, new data shows hospitals across the state have filled most or all available beds in their respective intensive care units.

Numerous Florida medical facilities reported dwindling ICU bed availability on Thursday, with several reporting no availability at all, according to the latest report published by Florida’s Agency for Health Care Administration (AHCA). Palm Beach County was among those statewide regions where the availability of beds was most scarce. An accompanying report from AHCA shows about 75 percent of available hospital beds statewide are currently occupied.

The AHCA’s data showed two of Palm Beach County’s 17 hospitals have already filled all ICU beds, while several other medical centers reported limited availability. One hospital in Miami-Dade County has also reached its ICU bed capacity as of Thursday, and the majority of hospitals have filled more than half of beds in intensive care units. Palm Beach and Miami-Dade counties have reported two of Florida’s most severe local virus outbreaks.

More than 12,500 people have been hospitalized with virus infections in Florida since the start of the pandemic, according to the state’s Department of Health (DOH). The number accounts for all patients admitted to medical facilities, so Thursday’s daily total is unclear.

AHCA released its most recent data regarding Florida’s hospital and ICU beds as the state sees a substantial spike in virus cases. Florida confirmed its highest daily increase in positive diagnoses on Thursday, surpassing four single-day records set throughout the past week. The DOH’s latest update confirms 3,207 new cases identified since Wednesday, bringing Florida’s total to 85,926 diagnoses overall. Almost 17,000 people have tested positive for the coronavirus in Florida over the last seven days…

The latest figures reported by Florida’s DOH on Thursday showed the state’s total virus case count had more than tripled since reopening procedures were first initiated on May 4. Governor Ron DeSantis permitted all state regions to enter Phase 2 of Florida’s reopening plan on June 5, allowing bars, movie theaters and other entertainment venues to begin operating. Most other establishments, including personal care services, gyms, restaurants and retailers, reopened with some limitations in place when DeSantis effected Phase 1.”  (I)

“Crystal Stickle, interim president of the Florida Hospital Association, said some Florida hospitals are better equipped than others to keep their positive patients in one area. “All hospitals handle it differently. As long as they have dedicated staff and keep the door closed and properly identify a room with a coronavirus patient, I would not consider that an alarming practice” she said.

Holy Cross has an entire floor for patients with COVID-19 with an adjacent dedicated ICU. “We are trying to keep patients as safe as possible,” Gorensek said. A patient may need to wait in isolation within the emergency room until a test result returns before getting X-rays or scans. In an emergency, a nurse will whisk them from the ER to surgery and return them to the COVID-designated floor.

“We have had patients come in with a heart attack or stroke in the mildly early stages, and we have picked up the virus and have been able to avoid exposure,” she said.

With the presence of the virus more difficult to detect, South Florida hospitals have become more wary of incoming patients. In mid-May, Gov. Ron DeSantis allowed hospitals to reopen for elective services after prohibiting them for eight weeks during the peak of the coronavirus crisis. Now that patients are returning for hip replacements and colonoscopies, hospitals tout their efforts to keep a separation between the well and the sick.

At the five Tenet Health hospitals in Palm Beach County, anyone who comes in for elective surgery must be tested in advance, said Maggie Gill, CEO of Tenet’s Palm Beach Health Network. A positive result means the hospital will postpone the procedure for 14 days, and test again.

Of course, emergency procedures can’t wait. “We have patients in the hospital who are symptomatic, some who are asymptomatic, and some awaiting discharge. It’s a mix,” Gill said during a news briefing with DeSantis Friday. ”We have the capacity, PPE (Personal Protective Equipment), trained staff, and we are smarter in terms of how we manage patients today than we were in March.”

Dr. Larry Bush, an infectious disease specialist at Wellington Medical Center, said he, too, has learned how to better treat and identify the virus. “We are testing everyone admitted, putting them in one area, and observing anyone who comes in for something else but develops respiratory issues,” he said, adding that the screening has paid off. “We found three people with COVID who were not admitted for that.” (J)

“At least three hospitals in Palm Beach County, Florida, are out of intensive care beds as the number of coronavirus cases in the state spikes dramatically, according to a report Thursday.

Hospitals in the county — including Palms West Hospital, Palm Beach Gardens Medical Center and Wellington Regional Medical Center — had zero adult ICU beds left on Thursday, as nearby areas reported few open, according to NBC affiliate WPTV, which cited state health data.

In total, 18 percent of critical-care beds were open in the county while fewer were available in other parts of Florida, according to the state Agency for Health Care Administration, which tracks hospital bed availability.

But Wellington Regional Medical Center disputed the state data, saying there were in fact eight available ICU beds at the hospital, according to WPTV.

“Our critical care bed availability is greater than the Palm Beach County average reported by the Agency for Healthcare Administration,” a spokesman said. “In the event we see a surge of cases that need to be hospitalized, our hospitals have plans in place to continue providing care safely, and include the ability to increase our critical care capacity.”

Only 9 percent of the beds were left in nearby St. Lucie County, 12 percent were open in Okeechobee County, and 63 percent were up for grabs in Martin County, according to the report.

In total, more than 75 percent of adult ICU beds were occupied in Florida Thursday, according to the local station WCTV.

The alarming uptick in cases comes after Florida was hit by a record number of new infections — 2,783 new cases in a single day — earlier this week, and as scientists predict the state could become a new epicenter for the pandemic.

Earlier this week, Palm Beach County Emergency Management Director Bill Johnson said the area is “not in a crisis mode” but that a “surge plan” will go into effect.” (K)

“The White House coronavirus task force has been out of public view as President Donald Trump has shown an urgency to move past the pandemic, downplay recent surges in Covid cases in some states, and get Americans back to work.

But the nation’s top infectious disease expert, Dr. Anthony Fauci, has been warning Americans about the risk of further spread of the virus.

On Wednesday, Fauci, the director of the National Institute of Allergy and Infectious Diseases, joined the US Department of Health and Human Services’ podcast “Learning Curve” and gave his expertise on the pandemic and the vaccine development process.

He also defended the stay-at-home orders as having saved “millions of lives,” and drew attention to anti-science bias and the disproportionate impact the virus is having on the black community.

“One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don’t believe science and they don’t believe authority,” Fauci said.

“So when they see someone up in the White House, which has an air of authority to it, who’s talking about science, that there are some people who just don’t believe that — and that’s unfortunate because, you know, science is truth,” Fauci said.

“It’s amazing sometimes the denial there is. It’s the same thing that gets people who are anti-vaxxers, who don’t want people to get vaccinated, even though the data clearly indicate the safety of vaccines,” Fauci added. “That’s really a problem.”

Trump has frequently disregarded expert advice — and often the guidance of his own administration — during the pandemic. He long touted the use of the anti-malarial drug hydroxychloroquine as a treatment for Covid-19 despite a lack of medical evidence, and the Food and Drug Administration revoked its emergency use authorization for the drug earlier this week. His suggestion that ingesting disinfectant in April was a potential treatment — he later said he was joking — was quickly denounced by medical experts. And he has refused to wear face masks in public despite widespread beliefs that doing so slows the spread of the virus.” (L)

“Just when many cities around the world were reopening after closing down due to COVID-19, their citizens going into a bright summer weekend, the grim headlines brought a hard reality: “The World Health Organization issued a dire warning on Friday that the coronavirus pandemic is accelerating, and noted that Thursday was a record for new daily cases—more than 150,000 globally,” reports the New York Times. “The world is in a new and dangerous phase,” said Dr. Tedros Adhanom Ghebreyesus, the Director-General of the W.H.O. “Many people are understandably fed up with being at home. Countries are understandably eager to open up their societies and their economies. But the virus is still spreading fast. It is still deadly and most people are still susceptible.”

According to the paper’s database, “81 nations have seen a growth in new cases over the past two weeks, while only 36 have seen declines.”

“The pandemic is accelerating,” said Dr. Tedros. “More than 150,000 new cases of COVID-19 were reported to WHO yesterday—the most in a single day so far,” he said.

In the United States, California, Arizona, South Carolina, Texas and Florida had record-high single-day increases in cases yesterday. Florida, for one, has “all the markings of the next large epicenter of coronavirus transmission,” and risks being the “worst it has ever been,” according to a model by scientists at Children’s Hospital of Philadelphia and the University of Pennsylvania…

Governor Ron DeSantis pointed to “overwhelmingly Hispanic” people to blame for the rise in cases. “Some of these guys go to work in a school bus, and they are all just packed there like sardines, going across Palm Beach County or some of these other places, and there’s all these opportunities to have transmission,” DeSantis said during a press conference in Tallahassee.

Experts, including Florida Agriculture Commissioner Nikki Fried, disagreed, saying the farmworkers left weeks ago.”  (M)

“Peter Navarro, the White House director of trade and manufacturing policy, said in an interview on Sunday that the White House was working to prepare for the possibility of a second wave of the coronavirus in the fall, though he said it wouldn’t necessarily come.

“We are filling the stockpile in anticipation of a possible problem in the fall,” Mr. Navarro told Jake Tapper on the CNN program “State of the Union.” “We’re doing everything we can.”

The comments come in contrast to President Trump’s repeated assertions that the virus will “go away” and his questioning of its ability to last into the fall and winter.

But if anything, the virus is gaining ground. Nationwide, cases have risen 15 percent over the last two weeks. Cases are rising in 18 states across the South, West and Midwest. Seven states hit single-day case records yesterday, and five others hit a record earlier in the week.

Florida and South Carolina had their third straight day breaking single-day records, and Missouri and Nevada both hit their records on Saturday — increases that came as the United States reported more than 30,000 new infections on both Friday and Saturday, its highest totals since May 1.

Florida reported 4,049 new cases on Saturday, bringing the state’s total to about 94,000 cases and more than 3,000 deaths; South Carolina reported 1,155 new cases; Missouri 375; and Nevada 452. Arizona, Utah and Montana also hit records.

California, Texas, Alabama, Oklahoma and Oregon hit records last week as well.

At the same time, overall deaths have dropped dramatically. The 14-day average was down 42 percent as of Saturday.” (O)

APPENDIX

Metrics to Guide Reopening New York

Governor Cuomo outlined guidelines that will help regions create individual plans based on facts and data to reopen New York.

Map of the 10 regions of the state and a list of counties within each region.

The state will monitor core factors to determine if a region can reopen.

The loosening of restrictions in New York will be considered on a regional basis, based on the following criteria. These criteria are designed to allow phased reopenings to begin in each region only if:

The infection rate is sufficiently low;

The health care system has the capacity to absorb a potential resurgence in new cases;

Diagnostic testing capacity is sufficiently high to detect and isolate new cases; and

Robust contact-tracing capacity is in place to help prevent the spread of the virus.

Regional Control Rooms

The regional control room will monitor regional metrics during the reopening process. These regional control rooms will monitor the hospitalization rate, death rate, number of new hospitalizations, hospital bed capacity, ICU bed capacity, testing and contact tracing within its region during reopening and alert the state if the region’s metrics no longer meet the reopening guidelines and adjust the reopening plan for that region accordingly.

Monitoring New Infections

The first key to reopening is continuing to control the rate of transmission of COVID-19, which limits infections and ensures that healthcare facilities are not overwhelmed.

Metric #1: Decline in Total Hospitalizations

The Centers for Disease Control and Prevention (CDC) recommends that reopening be dependent on a downward trajectory of hospitalizations and infections over a 14-day period. Before a phased re-opening begins, a region must experience a sustained decline in total net hospitalizations – the total number of people in the hospital each day, calculated on a three-day rolling average – over the course of a 14-day period. Alternatively, regions that have seen few COVID cases overall will satisfy this metric if the daily net increase in total hospitalizations (measured on a three-day rolling average) has never exceeded 15.

Metric #2: Decline in Deaths

Before reopening, a region must experience a sustained decline in the three-day rolling average of daily hospital deaths over the course of a 14-day period. Alternatively, regions that have seen few COVID cases overall will satisfy this metric if the three-day rolling average of daily new hospital deaths has never exceeded 5.

Metric #3: New Hospitalizations

In addition to monitoring the decline in disease trajectory, it’s important to monitor the absolute level of infection in each region. This is because it’s possible for a region that has seen a high level of infections – for example, New York City – to see a sustained decline in hospitalizations and deaths over a 14-day period, while still having an underlying infection rate that is too high to allow for a safe phased re-opening.

A phased re-opening for each region will be conditioned on the occurrence of fewer than two new hospitalizations per 100,000 residents (measured on a three-day rolling average).

Health Care Capacity

This pandemic has made clear that having enough hospital capacity is critical. Upon the recommendations of public health experts, every region must have the healthcare capacity to handle a potential second surge in cases – regions must have at least 30 percent of their total hospital and ICU beds available at all times.

Metric #4: Hospital Bed Capacity

In addition to ensuring that disease progression is contained, guidance from both the CDC and World Health Organization (WHO) require that regional health system capacity remain sufficient to absorb a potential resurgence of new cases. Phased re-openings will therefore be conditioned on the hospital bed capacity in each region. Regions must have at least 30 percent of their total hospital beds available before a phased re-open can begin.

Metric #5: ICU Bed Capacity

Nearly 30% of hospitalizations for COVID-19 ultimately require critical care. It is therefore critical that regional health care systems not only maintain sufficient bed capacity for a potential resurgence in cases, but also achieve sufficient capacity for ICU beds specifically. Accordingly, regions must have at least 30 percent of their ICU beds available before a phased re-opening can begin.

In addition, to ensure nurses and doctors have the personal protective equipment (PPE) they need, every hospital must also have at least 90 days of PPE stockpiled. The State is working with the hospitals, nursing homes, and other facilities to develop a timeline to build a robust stockpile. We can’t afford to risk another scramble for PPE while medical personnel are left under-protected.

Diagnostic Testing and Contact Tracing Capacity

The key to controlling the virus is aggressive testing and tracing, so that hotspots can quickly and effectively be isolated.

New York has worked hard to scale up testing at rates higher than any state or country in the world. Hospitalization rates are important, but testing identifies the full rate of spread. Regions can watch that rate move, and adjust their reopening strategies as needed.

Widespread testing is also key to effective contact tracing. This allows health officials to identify asymptomatic carriers, who are spreading the virus undetected, and isolate them before they infect others.

Metric #6: Diagnostic Testing Capacity

Widespread diagnostic testing is a key lynchpin on which our ability to contain the spread of the virus depends. Testing is critical to identifying new infections, isolating them, and tracing their contacts. Phased re-openings will depend on the ability of each region to achieve 30 tests per 1,000 people per month, consistent with the recommendation of Dr. Deborah Birx of the White House Coronavirus Task Force. New York scaled up testing at rates higher than any state or country in the world. The State is committed to continuing to rapidly expand our capacity statewide to help all regions meet this threshold.

Metric #7: Contact Tracing Capacity

The CDC and WHO also recommend that robust contact tracing programs be in place before local governments consider easing restrictions. Contact tracing helps prevent the spread of COVID-19 by rapidly interviewing positive patients; identifying their close contacts; interviewing and alerting those contacts to the risk of infection; and instructing those contacts to quarantine or isolate for 14 days, to be sure they don’t spread COVID-19 to others. The New York State Department of Health (DOH) has partnered with former New York City Mayor Michael Bloomberg, the Johns Hopkins University School of Public Health, and Vital Strategies to recruit and train an army of contact tracers to meet the needs of each region statewide, including from State, City and County Health Departments. In collaboration with these partners, DOH has established region-specific thresholds for the number of contact tracers required, based on the characteristics within each region.

Contact tracing helps prevent the spread of COVID-19 through four key steps:

First, labs report positive cases of COVID-19 to contact tracers on a daily basis via a state reporting system.

Contact tracers then interview positive patients to identify people they may have been in contact with over the past 14 days. Based on the results of the interview, tracers will advise the positive individual to get tested, and either isolate or quarantine themselves for the following 14 days to prevent further spread of the virus.

The contact tracer then notifies and interviews each contact of the original positive individual to alert them to their risk of infection, and instructs those contacts to quarantine or isolate for 14 days to prevent further spread.

Finally, the contact tracer monitors those contacts by text throughout the duration of their quarantine or isolation to see if the contacts are showing any symptoms.

Members of the tracing team will also work with any individual being traced who needs social services assistance, such as housing, food, or medicine, while they are quarantined or isolated.

Ongoing Monitoring

Once a phased reopening begins, it is essential that the rate of transmission be carefully monitored and remain under control. Each region must appoint an oversight institution as its “control room” to monitor the regional infection rate during the phased reopening. This team of local elected officials, as well as hospital and state representatives, will monitor the above metrics and other key indicators, and can slow or shut off reopening if indicators are problematic. This team will also monitor business’ compliance with reopening guidelines and ensure that local officials are enforcing these rules when necessary.

Phased Reopening of Business

Each region will reopen businesses in phases, with at least two weeks in between each phase. This allows state and local leaders to monitor the effects of the reopening and ensure hospitalization and infection rates are not increasing before moving to the next phase and permitting more economic activity.

The phase-in plan prioritizes businesses considered to have a greater economic impact and inherently low risks of infection for the workers and customers, followed by other businesses considered to have less economic impact, and those that present a higher risk of infection spread.

Additionally, when phasing-in reopenings, regions must not open attractions or businesses that would draw a large number of visitors from outside the local area.

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter

CORONOVIRUS TRACKING Links to Parts 1-33

CORONOVIRUS TRACKING

Links to Parts 1-33

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)


 [JM1]

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”

to read Posts 1-32 in chronological order highlight and click on

“Supporters of President Donald Trump will soon be able to attend one of his signature, raucous campaign rallies again after a months long hiatus because of the coronavirus pandemic — but first, they must agree not to sue the campaign if they contract the virus after the event.

But the fine print on the registration page for the June 19 event underscores the continued health risks associated with reviving the “Make America Great Again” rallies, which pack thousands of supporters into arenas for hours at a time — doors for next week’s rally open four hours before Trump is set to begin, for instance.

Right above a red “register” button on the page, the site includes a short disclaimer, informing attendees that “by clicking register below, you are acknowledging that an inherent risk of exposure to COVID-19 exists in any public place where people are present.”

The disclaimer goes on to warn that by attending the rally, attendees and their guests “voluntarily assume all risks related to exposure to COVID-19” and agree not to hold the campaign, Tulsa’s BOK Center or a slew of other related parties “liable for any illness or injury.”

The page makes no mention of any social-distancing requirements or other safety precautions that will be in place at the rally, nor does it note the CDC’s recommendation that Americans wear face coverings while indoors in situations where social distancing might be difficult.” (A)

“President Trump plans to speak at the West Point Military Academy’s graduation this week, a White House spokesman said Tuesday — though the ceremony flouts Gov. Cuomo’s social distancing directives and more than a dozen cadets have tested positive for the coronavirus.

Spokesman Judd Deere said Trump’s commencement speech Saturday is about celebrating the “amazing accomplishments” of the roughly 1,000 cadets expected at West Point’s upstate New York campus.

The West Point event is at odds with Cuomo’s Sunday announcement that capacity for graduations in New York must be limited to 150 people due to the pandemic. The order also doesn’t take effect until June 26, so West Point is bucking the start date too.

However, West Point can skirt state orders since it’s not subject to New York law as a U.S. military facility.” (B)

“Vice President Mike Pence on Wednesday evening tweeted, and then deleted, a photo showing a large group of President Donald Trump’s reelection campaign staff not wearing face masks or social distancing, two recommendations of the coronavirus task force that Pence leads.

“Stopped by to see the great men and women of the Trump-Pence Team today!” the tweet read. “Thank you for all of the hard work, keep it up!”

The message was accompanied by a photo of Pence and the campaign staff giving a thumbs up sign.

Vice President Mike Pence on June 10: “Stopped by to see the great men and women of the Trump-Pence Team today!” Pence said in a tweet. “Thank you for all of the hard work, keep it up!”

The photo appeared to be from the campaign’s Arlington, Virginia, office — Pence was not scheduled to travel on Wednesday and had no public events on his schedule. In the photo, no one, including the vice president appeared to be wearing a face mask and the group far exceeded the 10-person gathering limit outlined in Virginia’s phase one coronavirus guidelines.” (C)

“President Trump announced Wednesday that he will resume his campaign rallies soon, and the gatherings will take place in a handful of states currently battling surges of new covid-19 infections.

His first rally in months is set for June 19 in Tulsa, which is located in a county that has reported a gradual uptick of new cases since the beginning of June. The president also mentioned campaign stops in states that have seen sharp increases in new cases and hospitalizations: Florida, Texas, Arizona and North Carolina.

Meanwhile, more than a dozen states are showing new highs in the number of positive coronavirus cases or hospitalizations, according to Washington Post data, a few weeks after lifting restrictions on most businesses and large gatherings.” (D)

“The White House’s top economic advisers on Friday shrugged off concerns of a potential “second wave” of the coronavirus, reflecting President Donald Trump’s eagerness to continue reopening broad swaths of the country even as cases of Covid-19 are spiking in more than a dozen states.

“There is no emergency. There is no second wave. I don’t know where that got started on Wall Street,” Larry Kudlow, director of the National Economic Council, told “Fox & Friends.”

Kudlow previously claimed in late February that the federal government had “contained” the threat of a domestic coronavirus outbreak “pretty close to airtight” — an assessment which proved to be direly wrong.

Although Kudlow acknowledged Friday he is “not the health expert” within the administration, he said he had spoken with top public health officials “at some length” Thursday evening. “They are saying there is no second spike. Let me repeat that. There is no second spike,” he said.

“What you do have is certain spots are seeing a little bit of a jump up. Some small metropolitan areas are seeing it. The CDC and the health people are all over it. They’ve sent some task forces out to deal with it,” Kudlow added, partly attributing increases in Covid-19 cases to expanded testing availability.

Kevin Hassett, another economic adviser to the White House, told Fox News he had spoken to Dr. Deborah Birx, the administration’s coronavirus response coordinator, earlier Friday morning, and conceded “there are some embers flaring up in a few places.”

Hassett specifically cited incoming data from Arizona and South Carolina as “some cause for concern,” but remained largely dismissive of the notion of a second wave of the coronavirus.

“For sure, the battle is not over,” he said. “But the trends that have been so positive in recent weeks, we’ve not deviated sharply from them — although there are some hot spots around the country.”” (E)

“When throngs of tourists and revelers left their homes over Memorial Day weekend, public health experts braced for a surge in coronavirus infections that could force a second round of painful shutdowns.

Two weeks later, that surge has hit places like Houston, Phoenix, South Carolina and Missouri. Week-over-week case counts are on the rise in half of all states. Only 16 states and the District of Columbia have seen their total case counts decline for two consecutive weeks.

But instead of new lockdowns to stop a second spike in cases, states are moving ahead with plans to allow most businesses to reopen, lifting stay-at-home orders and returning to something that resembles normal life.

“There is no — zero — discussion of re-tightening any measures to combat this trend. Instead, states are treating this as a one-way trip. That sets us up for a very dangerous fall, but potentially even for a dangerous summer,” said Jeremy Konyndyk, a senior fellow at the Center for Global Development who oversaw the U.S. Agency for International Development’s Office of Foreign Disaster Assistance during the Obama administration.

The moves suggest that many Americans — anxious to end two-plus months of lockdowns, smarting from the devastating economic toll they have already suffered and focused on the social justice protests that have roiled the nation — are ready to put the coronavirus behind them.

Even as case curves bend upward again, little action has been taken to counter the reversal.

“There are places that I suspect a lot of people are shrugging their shoulders and just rushing forward,” said David Rubin, who runs the PolicyLab at Children’s Hospital of Philadelphia. “I just worry that they might lose control of their epidemic, and that’s what you have to worry about these days.”…

A virus once dismissed as not a serious threat to the nation and later acknowledged as a public health emergency is now becoming just another daily worry to be absorbed.

“One fear is that the U.S. will accept tens of thousands of deaths, as from gun violence, unlike other countries,” said Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration.

“It’s not just lives. Unless we protect lives, we won’t get livelihoods back,” said Frieden, who now runs Resolve to Save Lives, a global health nonprofit.

The race to reopen comes even as new research shows the lockdowns were working. The dramatic steps Americans took to stop the virus saved an estimated 5 million infections through April 6, according to research by the Global Policy Lab at the University of California-Berkeley.”  (F)

“Protests aside, American officials at all levels of government seem completely oblivious to the situation in civilized countries or the arguments about test, track, and isolate. They reacted in blind panic to the pandemic, and then when it became costly to keep containment measures going, they are blindly relaxing them long before the virus has been controlled….

However, there is a darker possibility. Officials could be pursuing a different strategy to defeat the virus: herd immunity. If roughly two-thirds of the population contracts the virus (and if the resulting antibodies are both universal and long-lasting, which is not at all clear), then statistically the virus will not find enough new victims to perpetuate itself, and will eventually die out. The New York Times reports that even as Trump urges states to re-open, his own analysts behind the scenes are predicting 200,000 daily new cases and 3,000 deaths per day by the end of June — which is what someone pursuing a herd immunity strategy would do. The problem is that, as scientists Carl T. Bergstrom and Natalie Dean explain in the Times, it will take months for the statistics to shake out, and the eventual infection rate will rise well past two-thirds — likely about 80-90 percent. With a U.S. population of about 330 million and the most recent estimates of infection fatality rate of about 1 percent, that means something like 2.6 to 3 million Americans dying.

…Even if Trump is not actively aiming at herd immunity, there is no indication that he is even considering the test, track, and isolate option, let alone starting to construct the elaborate and efficient bureaucracy that would be needed. Neither is there any sign that he would be capable of doing such a thing even if he wanted to. Absent major developments, it seems highly likely we are going to keep bumping along with moderate levels of new infection for months or even years.” (G)

“As a mask-less Donald Trump moves full speed ahead to reopen the U.S. economy, Dr. Anthony Fauci, the White House coronavirus response team’s leading expert, has seemingly been benched from TV. The National Institute of Allergy and Infectious Diseases director gave his last television news hit two and a half weeks ago, a CNN segment in which he shrugged off the critics “disagreeing” with his cautious approach and calling for his firing as just “part of the game.” Fauci added that he won’t let attacks stop him from relaying to the American people “information that I feel is necessary to make…prudent decisions” amid the global pandemic that has taken over 93,000 lives in the U.S. “I feel I have a moral obligation to give the kind of information that I am giving,” he said…

Fauci has instead been sent down to the minors, as it were. On Thursday, he made a cameo on actor Julia Roberts’s Instagram livestream, a relatively less-serious outlet that he nonetheless used to stress “that physical separation is working to a certain extent. So now is not the time to tempt fate and pull back completely.” (H)

“Dr. Anthony Fauci, one of the most prominent members of the White House coronavirus task force, said on Monday that he has not spoken to or met with President Donald Trump in two weeks.

Fauci, the director of the National Institute of Allergy and Infectious Diseases, added that that his contact with the President has become much less frequent.

Their last interaction was May 18, when Trump invited Fauci to provide medical context during a teleconference with the nation’s governors. The Task Force last met on May 28 and last held a White House press briefing on May 22.

News that the pair haven’t communicated in two weeks comes during a critical period in the US coronavirus response as all 50 states have relaxed social distancing measures even as the virus’ death toll continues to climb. As of Monday, at least 1.79 million Americans have contracted the virus and at least 104,300 have died, according to data from Johns Hopkins University.

Throughout the pandemic, Fauci has been a rare source of frank honesty from within the White House coronavirus task force, holding firm with an at times overly optimistic President.

This was on full display last week when he called for a cautious approach to reopening the US and implored Americans to wear face masks in public, comments that are at odds with Trump’s push to have America quickly return to normalcy.

“I want to protect myself and protect others, and also because I want to make it be a symbol for people to see that that’s the kind of thing you should be doing,” Fauci said during an interview on CNN’s “Newsroom.”

But his willingness to refute Trump has garnered sustained criticism from the President’s allies in conservative media and fueled questions about the pair’s working relationship.”  (I)

“In a wide-ranging talk to biotech executives, Dr. Anthony S. Fauci delivered a grim assessment of the devastation wrought around the world by the coronavirus.

Covid-19 is the disease that Dr. Fauci always said would be his “worst nightmare” — a new, highly contagious respiratory infection that causes a significant amount of illness and death.

“In a period of four months, it has devastated the whole world,” Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Tuesday during a conference held by BIO, the Biotechnology Innovation Organization. “And it isn’t over yet.”

His discussion with a moderator was conducted remotely and recorded for presentation to conference participants. Although he had known that an outbreak like this could occur, one aspect has surprised him, he said, and that is “how rapidly it just took over the planet.”

An efficiently transmitted disease can spread worldwide in six months or a year, but “this took about a month,” Dr. Fauci said. He attributed the rapid spread to the contagiousness of the virus, and to extensive world travel by infected people…

The differences, he said, include Covid’s broad range of severity, from no symptoms at all to critical illness and death, with lung damage, intense immune responses and clotting disorders that have caused strokes even in young people, as well as a separate inflammatory syndrome causing severe illness in some children.

“Oh my goodness,” Dr. Fauci said. “Where is it going to end? We’re still at the beginning of really understanding.”” (J)

“White House health advisor Dr. Anthony Fauci said he has “no doubt” that Americans who aren’t wearing face masks, especially in large crowds, are increasing the risk of spreading the coronavirus.

“When you have crowds of people together and you have the lack of wearing a mask that increases the risk of there being transmissibility. I have no doubt about that,” he said during an interview Friday on CNBC’s “Halftime Report.” “When we see that not happening, there is a concern that that may actually propagate the further spread of infection.”

The comment came a day after CDC Director Robert Redfield told lawmakers he was worried Americans aren’t following the agency’s advice as states begin to reopen after shuttering businesses and limiting activities as part of social distancing measures intended to curb the spread of the virus.

Crowds of people, some without masks, have been seen in recent weeks at protests, over the Memorial Day holiday and, Redfield noted, at the SpaceX launch over the weekend.

The CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain.

“We will continue to message as well we can,” Redfield told the House Appropriations Committee during a hearing on the coronavirus. “We’re going to encourage people that have the ability to require to wear masks when they are in their environment to continue to do that.”…

Fauci said earlier this week that there are at least four trials for potential vaccines that he is either directly or indirectly involved in. He said that by the beginning of 2021 “we hope to have” a couple million doses.

On Friday, Fauci said he hopes Americans won’t be “reluctant” to take the vaccine that could be potentially lifesaving.

“Unfortunately there’s … kind of a trend of anti-science and with that anti-vaccine in this country, which is really unfortunate, because for the most part it’s really based on misinformation,” he said. “But I would hope that as we get a vaccine available for us here in the United States and even worldwide, that given the potential and real seriousness of this outbreak now and in the future, that people will not be reluctant to take a vaccine that’s potential is lifesaving for them.”” (K)

““I don’t want people to think that any of us feel that staying locked down for a prolonged period of time is the way to go,” said the head of the National Institute of Allergy and Infectious Diseases.

He added that since cases are no longer exploding in many areas of the country, it is time to “seriously look” at reopening the economy.

He cautioned, however, that states should not rush reopening: “Please proceed with caution,” he said.

During a Senate hearing last week, Fauci warned of serious consequences if states ignore federal reopening guidelines and said that even in the “best of circumstances,” new cases will accompany relaxed restrictions.” (L)

“On Friday, Dr. Anthony Fauci, the Director of the National Institute for Allergies and Infectious Diseases, returned from his media hiatus with two key interviews and a seemingly substantial change in tune. The scientist and member of President Trump’s coronavirus task force, who has long been advocating a cautious approach to the country’s reopening, delivered some made-for-headline soundbites that raised lots of eyebrows, including his statement that extended stay-at-home orders could cause the U.S. ‘irreparable damage.’

“I don’t want people to think that any of us feel that staying locked down for a prolonged period of time is the way to go,” Fauci to CNBC’s Meg Tirrell on the networks show Halftime Report.

Similarly, in an interview with NPR, Fauci sounded a bit more upbeat regarding a possible vaccine being available by the end of this year.

“I think it is conceivable, if we don’t run into things that are, as they say, unanticipated setbacks, that we could have a vaccine that we could be beginning to deploy at the end of this calendar year, December 2020, or into January, 2021,” he Fauci on NPR’s “Morning Edition” on Friday.

While both of the statements from the nation’s leading scientist give reason for optimism, the question remains: what has made Dr. Fauci sound more like White House talking points than the voice of candor that we have become accustomed to hearing?  Even as the nation continues to grapple with an uncontrolled pandemic that has killed over 96,000 Americans, Fauci’s comments about reopening sounded very similar to the messaging that President Trump and his allies have been pushing for the past several weeks about the need to more aggressively open the country.

Unsurprisingly Fox News and other conservative media outlets that have been critical of Dr. Fauci over the past several weeks jumped on the scientist’s assessment. “Extended stay-at-home orders could cause ‘irreparable damage’”screamed headlines on Fox’s website and across social media. The prevailing sense that Fauci had come to his senses seems to be the mood of many ‘reopen’ advocates, after weeks of Fauci being under fire from politicians, protestors, and conservative commentators…

In the effort to walk a tightrope between advocating health policy and navigating reelection politics, it wouldn’t be surprising if Fauci feels pressure to modulate his message in order dampen the partisan fires that have been building around him. But by doing so, he prompts an even more troubling question – is our science being sacrificed for soundbite politics? And if so, who are we to look to for scientific leadership in the next phase of the pandemic?

All eyes will be on Dr. Fauci during the coming days as an America that has endured a sobering spring tries to make sense of what the summer will bring. Will Fauci fall victim to partisan pressure or will he outfox those who would like to see him modify his message to the satisfaction of a President increasingly anxious about his reelection?

Not only does the country’s reopening hang in the balance, but so does Dr. Fauci’s credibility.” (M)

“Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, expressed support for the World Health Organization on Thursday in a significant break from President Donald Trump, who announced last month that the US would terminate its relationship with the world’s leading public health body.

“I’ve been dealing with the WHO now for four decades. I have a number of colleagues I have interacted with and continue to. I have a very good relationship with the director general of WHO,” Fauci told CBC News. “The WHO is an imperfect organization. It certainly has made some missteps, but it has also done a lot of good. The world needs a WHO.”

Trump’s decision to end the US’ relationship with the WHO amid a global pandemic drew quick criticism from both sides of the aisle. His move followed a years-long pattern of skepticism of world organizations, with the President claiming in nearly every circumstance that the US was being taken advantage of.

“Because they have failed to make the requested and greatly needed reforms, we will be today terminating our relationship with the World Health Organization and redirecting those funds to other worldwide and deserving, urgent global public health needs,” Trump said last month.

But Fauci said Thursday, “I would hope that we would continue to benefit from what the WHO can do — at the same time that they continue to improve themselves.”

His comments echo the message from the director of the US Centers for Disease Control and Prevention, Dr. Robert Redfield, who said last week that his agency continues to collaborate closely with WHO, despite Trump’s statements.

“I feel confident that the public health partnership that we have — although it may be modified in some way at a political level — I don’t think it’s going to be modified in terms of our public health efforts,” Redfield said during a House Appropriations hearing on the Covid-19 response.”  (N)

“Although Fauci’s every utterance is now examined with the same care as pronouncements of the pope, his words weren’t exactly earth-shattering. He said that if there are careless reopenings, “we will start to see little spikes that might turn into outbreaks.” Does anyone doubt that’s a possibility?

No serious person would argue that there are no hazards to reopening, only that some level of risk is worth taking to begin to ease the nation’s economic calamity.

Fauci is an important voice in this debate, if only one voice. He is neither the dastardly bureaucratic mastermind imposing his will on the country that his detractors on the right make him out to be, or the philosopher-king in waiting that his boosters on the left inflate him into. He’s simply an epidemiologist, one who brings considerable expertise and experience to the table, but at the end of the day, his focus is inevitably and rightly quite narrow…

As a breed, epidemiologists tend to focus on the worst case. They don’t want to be wrong and contribute to some deadly pathogen getting loose when their entire job is to keep that from happening. So, they are naturally cautious. This, too, is as it should be. You probably don’t want a risk-taking epidemiologist any more than you want a highly creative, envelope-pushing accountant.

For all these reasons, you wouldn’t choose an epidemiologist to run your country, either. And Fauci isn’t.

Trump has remained completely undomesticated in the White House. The idea that he has now, as some of his supporters imply, been seduced, bullied or otherwise manipulated by a mild-mannered, nearly 80-year-old doctor is bonkers. The reason Trump issued his shutdown guidance was that the prospect of uncontrolled spread of the virus was too risky to contemplate.

Since populist critics of the shutdowns don’t want to criticize Trump, let alone say that they think he blew one of the most consequential decisions of his presidency, they focus their ire on the director of the National Institute of Allergy and Infectious Diseases instead.

In the attention-getting exchange between Sen. Rand Paul, R-Kentucky, and Fauci at the Senate hearing, both were right. Sen. Paul is obviously correct that we shouldn’t elevate one person as the authority to whom everyone submits, and Fauci was right that he’s a scientist who doesn’t even try to give advice on matters outside his ambit.

Part of the right’s hostility to Fauci is an understandable reaction to progressives putting him on a pedestal. His views should be taken seriously, but they can’t be determinative.

If Trump really did fire Fauci, some other meddlesome epidemiologist would emerge soon enough. If Fauci didn’t exist, we’d have to invent him.” (O)

“In an interview with ABC News Chief White House Correspondent Jonathan Karl on “Powerhouse Politics” podcast, Fauci said he understands the urge people have to participate in the political process. But he also said the safest bet is to avoid congregating in large groups.

“You know, it’s a danger to the people who are trying to control the demonstration,” he said of the recent political protests. “And it’s a danger to the people who are demonstrating. So at the end of the day, it is a risky procedure.”

When asked whether his advice also applies to Trump’s plans to resume campaign rallies next week, Fauci said yes: “I am consistent. I stick by what I say.”

The “best way that you can avoid — either acquiring or transmitting infection — is to avoid crowded places, to wear a mask whenever you’re outside. And if you can do both, avoid the congregation of people and do the mask, that’s great,” he said.

“If you’re going to be in a situation where — beyond your control there’s a lot of people around you — make sure you wear a mask,” he said. (P)

“Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said a recent increase in coronavirus cases in a number of states is not necessarily a “second spike.”

“However, when you start to see increases in hospitalization, that’s a surefire situation that you’ve got to pay close attention to,” Fauci told CNN on Friday.

Fauci also said there may not be a so-called second wave of Covid-19 cases as some health experts are predicting.

“It is not inevitable that you will have a so-called ‘second wave’ in the fall or even a massive increase if you approach it in the proper way,” he said.” (Q)

“FAUCI:..New York is a big state, it is a heterogeneous State and parts of New York, particularly in areas such as in Buffalo and other Upstate areas have actually done reasonably well. What we’re doing right now, we’re seeing in New York is doing a careful, step-wise re-entry to trying to get normality, according to the guidelines. You know there’s a gateway guidelines. There’s the Phase 1, Phase 2, Phase 3, so hopefully what will see is a return to normality in a careful, very measured way.”

2 ON YOUR SIDE: As we look around the country, we are seeing a spike in several states that have already reopened, while here in New York, where we have had a methodical, phased-in approach, we have not seen the same thing so far. What do you see from those numbers? Did we just peak earlier than them, or is a slower approach making a difference?

FAUCI: One of the things we need to be aware of and I think people get confused, but I think you are making a good point. Different parts of the country, we have a very large country that’s very heterogeneous. The difference even within a state between the metropolitan area and upper Upstate New York, between Detroit and Casper, Wyoming, between New Orleans and a place in Montana, so it really depends on what the level of infection is when you start going down.

And the dynamics are going down, and you get that slope going down, and you carefully reopen, you’re going to see some infections for sure because it hasn’t disappeared. It’s how you handle them that’s going to determine whether a little blips are actually going to turn into a resurgence, and I think that New York, you know, under the governor, under the mayor of the city, and the cities in Upstate New York area ware of the kind of things that you need to do with the physical separation. Continue to wear masks, continue to wash your hands, and when the cases come up, you do identification isolation and contact tracing, and you have the resources to do that, so hopefully you’ll be successfully able to make that gradual transition to opening up more and more.” (R)

“Anthony Fauci cautioned states on Friday to rethink their reopening strategies if they see increases in the number of people hospitalized with Covid-19, adding that although he hasn’t spoken to President Donald Trump about next week’s campaign rally in Oklahoma, he is urging everyone who attends to wear a mask.

“When you start seeing more hospitalizations, that’s a surefire sign that you’re in a situation where you’re going in the wrong direction,” Fauci, the director of the National Institute of Allergy and Infectious Diseases, told CNN’s Wolf Blitzer on “The Situation Room” on Friday.

Many states have loosened restrictions that began in March to stop the spread of the virus. But the lack of a vaccine, as well as more people congregating in public places and recent protests for racial justice in major cities, has troubled experts. Since Memorial Day, the number of coronavirus hospitalizations has gone up in at least a dozen states, according to data CNN aggregated from the Covid Tracking Project from May 25 to June 9.

As states reopen, “you are going to see blips of infections” but identification, isolation and contact tracing are key, Fauci said Friday. He also warned states not to skip over some of the reopening guidelines the federal government has outlined.

“If you leapfrog over different phases, you increase the risk that you’re going to have the kind of resurgences that we’re seeing in certain of the states,” he said.” (S)

‘As people eagerly anticipate a return to the Before Time, without masks and with other people, Dr. Anthony Fauci has a reality check.

Fauci, the director of the National Institute of Allergy and Infectious Diseases spoke to the Telegraph about prospect of a second wave. “We were successful in suppressing the virus in cities where there were major outbreaks—New York, Chicago, Detroit, New Orleans,” he explained. “But we’re seeing several states, as they try to reopen and get back to normal, starting to see early indications [that] infections are higher than previously.

He continued “The question is will they have the capability to do the appropriate and effective isolation, and contact tracing, to prevent this increase from becoming a full blown outbreak? I’m concerned it’s happening. I hope the individual states can blunt that. It [the virus] could go on for a couple of cycles, coming back and forth. I would hope to get to some degree of real normality within a year or so. But I don’t think it’s this winter or fall, we’ll be seeing it for a bit more.”

“It’s going to be really wait and see. I don’t think there’s going to be an immediate pull back for those kinds of restrictions,” Fauci emphasized. “My feeling, looking at what’s going on with the infection rate, I think it’s more likely measured in months rather than weeks… It is not inevitable that you will have a so-called ‘second wave’ in the fall, or even a massive increase, if you approach it in the proper way.’ “ (T)

“Of the United States’ most populous states where cases are on the rise, Florida reported its highest daily total of new cases on Friday, reaching 1,902 new cases. Texas hit its new daily high this week, while California, the nation’s most populous state, reported its highest daily total last week — although the state almost surpassed that record on Friday.

Several Southern states, most of which began easing social-distancing restrictions and reopening some businesses in late April or early May, are also seeing increasing cases. North Carolina, Alabama, South Carolina and Arkansas all reported record highs in new cases on Friday, while Tennessee reported 20 new deaths, the state’s highest toll for one day.” (U)

“The public health community has for years known with certainty that another major pandemic was on the way, and then another one after that—not if but when. Mother Nature has always had the upper hand, and now she has at her disposal all the trappings of the modern world to extend her reach. The current crisis will eventually end, either when a vaccine is available or when enough of the global population has developed immunity (if lasting immunity is even possible), which would likely require some two-thirds of the total population to become infected. Neither of those ends will come quickly, and the human and economic costs in the meantime will be enormous.

Yet some future microbial outbreak will be bigger and deadlier still. In other words, this pandemic is probably not “the Big One,” the prospect of which haunts the nightmares of epidemiologists and public health officials everywhere. The next pandemic will most likely be a novel influenza virus with the same devastating impact as the pandemic of 1918, which circled the globe two and a half times over the course of more than a year, in recurring waves, killing many more people than the brutal and bloody war that preceded it.

Examining why the United States and the world are in this current crisis is thus not simply a matter of accountability or assigning blame. Just as this pandemic was in many ways foretold, the next one will be, as well. If the world doesn’t learn the right lessons from its failure to prepare and act on them with the speed, resources, and political and societal commitment they deserve, the toll next time could be considerably steeper. Terrible as it is, COVID-19 should serve as a warning of how much worse a pandemic could be—and spur the necessary action to contain an outbreak before it is again too late….

Microbes do not respect borders, and they manage to figure out workarounds to restrictions on international air travel.

A universal influenza vaccine would require a monumental scientific effort, on the scale of the billion-dollar annual investment that has gone into fighting HIV/AIDS. The price tag would be enormous, but since another population-devouring flu pandemic will surely visit itself on the globe at some point, the expense would be justified many times over. Such a vaccine would be the greatest public health triumph since the eradication of smallpox.

Of course, no single nation can fight a pandemic on its own. Microbes do not respect borders, and they manage to figure out workarounds to restrictions on international air travel. As the Nobel Prize–winning molecular biologist Joshua Lederberg warned, “The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow.” With that insight in mind, there should be a major, carefully coordinated disaster drill every year, similar to the military exercises the United States holds with its allies, but with a much broader range of partners. These should involve governments, public health and emergency-response institutions, and the major medically related manufacturing industries of various nations that will need to work together quickly when worldwide disease surveillance—another vital component of pandemic preparedness—recognizes an outbreak.

The world was able to eradicate smallpox, one of the great scourges of history, because the two superpowers, the United States and the Soviet Union, both committed to doing so, following an appeal at the 1958 convening of the World Health Assembly, the decision-making body of the WHO. Today’s tense geopolitics makes such a common commitment hard to achieve. But without it, there is little chance of adequate preparation for the next pandemic. The current global health architecture is far from sufficient. It has little hope of containing an even more threatening outbreak. Instead, something along the lines of NATO will be necessary—a public-health-oriented treaty organization with prepositioned supplies, a deployment blueprint, and an agreement among signatories that an epidemic outbreak in one country will be met with a coordinated and equally vigorous response by all. Such an organization could work in concert with the WHO and other existing institutions but act with greater speed, efficiency, and resources.

It is easy enough to dismiss warnings of another 1918-like pandemic: the next pandemic might not arise in our lifetimes, and by the time it does, science may have come up with robust medical countermeasures to contain it at lower human and economic cost. These are reasonable possibilities. But reasonable enough to collectively bet our lives on? History says otherwise.” (V)

Prequel

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

Share on LinkedInShare on Google+Share on FacebookTweet about this on Twitter