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…”

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“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)

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