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]

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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.

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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]

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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,”

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CORONOVIRUS TRACKING Links to Parts 1-32

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.”


 [JM1]

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

To read Posts 1-31 in chronological order, highlight and click on

And…

“A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms….received$509 million in government funds… that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.”

Also…Overuse of Antibiotics. Candida auris. Ebola.

“They prepared for the worst and hoped for the best, and that was exactly what they got. That’s what Maureen Tarrant said about Presbyterian St. Luke’s Medical Center and Rocky Mountain Hospital for Children’s preparations during the novel coronavirus outbreak. Tarrant has been the CEO of the hospitals since 2014.

“Our hospital was never overwhelmed with COVID patients,” she said.

Tarrant credits the state and city leaders for taking steps early to prepare area hospitals.

“We all saw the stories of some of the more densely populated areas, such as Queens, New York,” Tarrant explained. “Colorado and Denver have not been like that.”

In turn, Tarrant said something else happened.

“I think we had an unintended consequence: I think we made people afraid to come back to the hospital,” she said.

Revenues are down at the hospital, she said. The emergency department alone has seen between a third and a half of its normal volume…

The key to a hospital rebound, according to Tarrant, is to remind people that hospitals are still safe and not as chaotic as you would think.

“If we think about celebrating the heroes and the healthcare workers, the nurses and the doctors, the last thing we would ever want is for them to suffer personally with financial consequences,” Tarrant said.” (A)

“Most hospitals and outpatient clinics have made changes designed to keep patients and staff members safe. Many are testing patients and certain workers. In many hospitals, Covid-19 patients are kept in separate units. Masks are usually mandated for both patients and clinicians. Cleaning protocols have been turbocharged. As a result, experts say, the risk of acquiring Covid-19 when going into a hospital is very low.

But one of the common safety measures — banning visitors, even close family members — is a huge reason for patients’ fear and apprehension.

“The hospital was an ominous, nerve-racking and scary place for patients even before Covid,” said Dr. Lisa VanWagner, a transplant hepatologist at Northwestern Medicine in Chicago. “Now you take a stressful situation like a pandemic and you tell people that they cannot have their normal support system while they’re in the hospital, and that really magnifies those fears.”..

Health system administrators are redoubling their efforts to convince patients that it’s safe to come into hospitals and outpatient clinics, even as testing for hospital personnel and patients remains spotty.

“Our goal is to spend almost all our marketing dollars over the next year around the safety of our institution,” said Dr. Stephen Klasko, chief executive of Jefferson Health, a 14-hospital system based in Philadelphia.” (B)

“As the virus spread, visits to emergency rooms in the United States decreased 42 percent over four weeks in April, compared to the same period in 2019, according to a new analysis released Wednesday by the C.D.C. The declines were greatest among children 14 and younger, women and in geographic areas like the Northeast.

While there were high numbers of emergency room visits because of the virus, including an increase in visits related testing for infectious diseases and for pneumonia, these were outweighed by the steep declines in visits that typically make up trips to the emergency room.

The C.D.C. also noted that there had been a recent rebound in visits, but the volume of visits remained significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with a year earlier.

The agency’s report highlights the months long decline in general hospital care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in Covid-19 patients. While hospitals have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid them….

While E.R. treatment for complaints of minor ailments were far fewer this year, agency officials pointed to a more disconcerting drop in the number of people seeking emergency care for chest pain, including those undergoing a heart attack. There were also declines in children requiring emergency help for conditions like asthma.

C.D.C. officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources.” (C)

“As the U.S. continues to battle the novel coronavirus outbreak, fears over a second wave of cases have been looming over the country.

While there is no doubt that more cases will continue to emerge in the months ahead, it’s not too late for America to prevent a second wave of COVID-19, according to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and member of the White House COVID-19 task force.

Speaking to Newsweek, Fauci says: “It’s in our hands. We can prevent a second wave if we respond to the inevitable infections we’ll see in the fall and winter…

We have four months to prevent a second wave

While many states are beginning to report a plateau in daily cases, yet more are still dealing with daily increases in new COVID-19 patients.

Fauci says whether or not these ongoing new cases will become a wave will depend on whether “we prepare ourselves from now through June, July, August and September.”

“We have four months to make sure we have in place the system, the test, the capability, the manpower to do the kind of identification, isolation and contact tracing as cases begin to reappear in the fall, because they will reappear….

“I think it’s highly unlikely that we will eradicate COVID-19. The only disease in humans that we’ve ever eradicated is smallpox. We’ve eliminated polio from many areas of the world. For example, polio is eliminated in the U.S. and U.K. and the only cases that are around are vaccine-related cases.

“So it is conceivable that we will be able to eliminate it in the sense of getting enough herd immunity together with the vaccine that we have very few cases. And certainly we can control it, and we have been getting it under some control in some areas,” Fauci says…

The novel coronavirus is more likely to be with us for another season or two, depending when a vaccine is ready, with the second season expected to be much milder than the first, especially if there is a vaccine, Fauci explains.

“If we have a vaccine by next winter, that would be a game changer but there’s no guarantee we’ll have it. But if we don’t have a vaccine, we’ll have another season of it and hopefully by the following season, we will have a vaccine.”..

Looking at the trajectory of the outbreak, could America have done anything different to fight the virus?

“Of course. Nobody’s perfect. Anybody could have done better. Look at the U.K., they were going to go for herd immunity and that backfired on them,” Fauci told Newsweek.

“If you look at the death per capita in Sweden, compared to the death per capita in other Scandinavian countries, Sweden got hit worse. I think their decision to go for herd immunity speaks for itself.

“I declared that herd immunity [as a COVID-19 combat strategy] was absurd at the very beginning here in the U.S., saying ‘Are you kidding me? Do you know how many people are gonna die if you wait for herd immunity to come in?’ So that was not a good call [in Sweden],” Fauci says.” (E)

“Even after a vaccine is discovered and deployed, the coronavirus will likely remain for decades to come, circulating among the world’s population…

“This virus is here to stay,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago. “The question is, how do we live with it safely?”

Combating endemic diseases requires long-range thinking, sustained effort and international coordination. Stamping out the virus could take decades — if it happens at all. Such efforts take time, money and, most of all, political will…

The challenge in this pandemic is few such shortcuts remain to push U.S. leaders and the public into forward-thinking actions. The CDC has been sidelined by the White House and blocked from holding public briefings. Meanwhile, the Trump administration has made clear its priority is restarting the economy.

Increasingly, leading experts believe many Americans won’t make the shift toward long-range thinking until the virus spreads more widely and affects someone they know.

“It’s like people who drive too fast. They come upon the scene of an accident, and for a little while, they drive more carefully, but soon they’re back to speeding again,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

“Contrast that with people who have lost someone to drunk driving,” he said. “It mobilizes them and becomes a cause for them. Eventually, everyone is going to know someone who got infected or died from this virus.

“That’s what it may take.” (F)

Surge capacity is a hospital’s ability to adequately care for a significant influx of patients.7 Since 2011, the American College of Emergency Physicians has published guidelines calling for hospitals to have a surge capacity accounting for infectious disease outbreaks, and demands on supplies, personnel, and physical space.7 Even prior to the development of COVID-19, many hospitals faced emergency department crowding and strains on hospital capacity.8…

To prepare for the increased number of seriously and critically ill patients, individual hospitals and regions must perform a needs assessment. The fundamental disease process of COVID-19 is a contagious viral pneumonia; treatment hinges on four major categories of intervention: spatial isolation (including physical space, beds, partitions, droplet precautions, food, water, and sanitation), oxygenation (including wall and portable oxygen, nasal canulae, and masks), mechanical ventilation (including ventilator machines, tubing, anesthetics, and reliable electrical power) and personnel (including physicians, nurses, technicians, and adequate personal protective equipment).10 In special circumstances and where available, extra corporeal membrane oxygenation may be considered.10 The necessary interventions are summarized in Table 1.

Emergency, critical care, nursing, and medical leadership should consider what sort of space, personnel, and supplies will be needed to care for a large volume of patients with contagious viral pneumonia at the same time as other hospital patients. Attention should also be given to potential need for morgue expansion. Hospitals must be proactive in procuring supplies and preparing for demands on beds and physical space. Specifically, logistics coordinators should start stockpiling ventilators, oxygen, respiratory equipment, and personal protective equipment. Reallocating supplies from other regions of the hospital such as operating rooms and ambulatory surgery centers may be considered. These resources, particularly ventilators and ventilator supplies, are already in disturbingly limited supply, and they are likely to be single most important limiting factor for survival rates. To prevent regional shortages, stockpiling efforts should ideally be aided by state and federal governments. The production and acquisition of ventilators should be immediately and significantly increased.

Hospitals must additionally prepare for demands for physical space and beds. Techniques to maximize space and bed availability (see Table 2) include discharging patients who do not require hospitalization, and canceling elective procedures and admissions. Additional methods would be to utilize unconventional preexisting spaces such as hallways, operating rooms, recovery rooms, hallways, closed hospital wards, basements, lobbies, cafeterias, and parking lots. Administrators should also consider establishing field hospitals or field wards, such as tents in open spaces and nearby roads. Medical care performed in unconventional environments will need to account for electricity, temperature control, oxygen delivery, and sanitation.”  (G)

“COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic. A user of COVID-19Surge can produce estimates of the number of COVID-19 patients that need to be hospitalized, the number requiring ICU care, and the number requiring ventilator support. The user can then compare those estimates with hospital capacity, using either existing capacity or estimates of expanded capacity.” (H)

Dr. Tom Frieden, the former director of the US Centers for Disease Control and Prevention, laid out “10 plain truths” about Covid-19 on Wednesday as he spoke at a House Appropriations Committee hearing on the pandemic response.

“In my 30 years in global public health, I’ve never seen anything like this,” Frieden, who now serves as president and CEO of Resolve to Save Lives, said. “It’s scary. It’s unprecedented.”

Here are the 10 truths, according to Frieden:

1. “It’s really bad” in New York City

“Even now with deaths decreasing substantially, there are twice as many deaths from Covid-19 in New York City as there are on a usual day from all other causes combined,” Frieden said…

2. It’s “just the beginning”

Frieden said as bad as things seem now, he thinks we’re still in the beginning phases of the pandemic…

3. Data is a “very powerful weapon against this virus”

Frieden explained that data being used to monitor trends can help stop clusters before they turn into outbreaks. Data, he said, can help stop outbreaks from turning into epidemics…

4. We need to “box the virus in”

While stay-at-home orders slowed the spread of the virus and flattened the curve in states such as New York and California, the virus continues to spread throughout the country with approximately 30,000 new cases a day for nearly a month….

5. We must find the balance…

The economy doesn’t have to come at the expense of public health. Dr. Frieden said it is necessary to find the balance between restarting our economy and letting the virus run rampant.

6. Protect the “frontline heroes”

“We must protect the health care workers and other essential staff, or the frontline heroes of this war,” Frieden said…

7. Protect our most vulnerable people, too

Eight out of 10 deaths reported in the US have been from adults that are 65 years old and older, according to the CDC. And people with weak immune systems and underlying conditions such as asthma, heart disease, high blood pressure or diabetes are at more risk.

8. Governments and private companies need to work together

Both government and industry must collaborate to make “massive continued investments in testing and distributing a vaccine as soon as possible,” Frieden said…

9. We must not neglect non-Covid health issues

While the coronavirus pandemic has flooded and overwhelmed many hospitals with patients across the world, people are no longer suddenly immune to other diseases and sicknesses. Many elective procedures have been canceled or postponed, and patients with other illnesses wait in fear as they put treatment on hold. Many are too scared to venture out and visit hospitals out of fear of contracting the virus.

10. Preparedness is paramount

“Never again,” Frieden said. “It is inevitable that there will be future outbreaks. It’s not inevitable that we will continue to be so underprepared.” (I)

“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.

3. When we have enough trained and supported infection preventionists (IPs).

4. When we have developed more respect for infectious disease.

5. When we have improved and larger physical plants to service patients.

6. When we have redundancy in our healthcare facilities.

7. When our leaders stop politicizing public health and rely on scientists to make public policy.

8. When we have healthcare, that is centered on patients and not on profits.” (J)

“Much of the rationale for the flattening of the curve, to make space for patients with the novel coronavirus. But multiple health experts say this has an unexpected second order effect — leading to Americans neglecting their health concerns, which have done anything but subside.

California was the first state to implement a mandatory stay-at-home order, opted early on to adopt a proactive approach, rather than face the risk of being overwhelmed. Los Angeles has become the epicenter of the virus, logging the highest number of cases of the state’s 58 counties,

University of California Los Angeles’ Health System, which operates four hospitals and 180 clinics in Southern California, was fully prepared to handle the surge in novel coronavirus cases, but never saw unmanageable demand, according to president Johnese Spisso, who also serves as CEO of the UCLA Hospital System….

“What we learned is the public was very frightened of hospitals and clinics. We had to do a lot of outreach education. We worked together as a hospital community in Los Angeles to educate the public and to tell them it’s time to come back for the health care they have put on pause. We were especially concerned as a tertiary medical center, reduction we saw even in our emergency departments in heart attacks and strokes. We know COVID did nothing to cure those, so we were very concerned people weren’t presenting for the care that’s needed. We very quickly began to see that as we opened back up, who really should have been coming in a lot sooner,” she said.

‘Life may be on pause. Your health isn’t.’

Earlier this month, UCLA Health teamed up with five of the largest nonprofit health care networks across Los Angeles to launch BetterTogether.Health, a campaign to encourage community members to put health first and access care when needed. 

UCLA Health, Providence, Keck Medicine of USC, Kaiser Permanente, Dignity Health and Cedars-Sinai, which collectively serve 8.4 million Angelenos, launched public service announcements with themes that include, “Life may be on pause. Your health isn’t.,” “Thanks L.A. for doing your part” and “Get care when you need it.”

Beyond the impact on individuals who neglected their non-coronavirus related health concerns, this fear has inevitably impacted the bottom line of hospital systems.

UCLA Hospital System was forced to tap financial reserves to close a gap of more than $85 million as of mid-May. The system, which employs 30,000 people, reported a $140 million revenue loss, which was partially offset by $55 million in federal aid, which covered about one-third of losses from March and April.

“In the month of April, we had a revenue drop that isn’t sustainable, which is why we’ve been anxious to return to our normal business of health care so that we can really meet our mission for the community. So our health system — like so many [others] in the country — has really had to weather some extreme economic losses,” she said.” (K)

“Patients’ hesitation about seeking care in the midst of a pandemic means that healthcare facilities need to work extra hard to assure them that they are taking the necessary precautions to ensure their safety…

Rush University System for Health has instituted several changes, including removing reading material from waiting rooms and providing visual cues and markings to indicate how far apart people must stand while waiting in lines and in elevators to maintain social distancing, said Dr. Ranga Krishnan, CEO of the Chicago-based system.

Tacoma, Wash.-based CHI Franciscan has increased testing and screening and requires everyone in their facility to wear masks.

“We understand that many patients are concerned and are heeding stay-at-home orders carefully. That said, it’s especially important for patients experiencing an emergency to seek care as soon as possible,” said Michael H. Anderson, MD, CHI Franciscan’s CMO. “There can be serious, long-term impacts for delaying care, and it’s essential that they come to the emergency room as soon as they can.”

Nemours Children’s Health System in Jacksonville, Fla., is directly involving patients in the conversation about returning for care. At Nemours, leaders have asked for suggestions from the families of their pediatric patients.

“It is important to directly elicit patient and family perspectives about their fears as they seek healthcare and to ask for suggestions that would increase their comfort level in doing so,” said Peggy Greco, PhD, medical director of patient experience at Nemours.

Parents have asked that specific information about screening practices, cleaning routines and patient volume restrictions be shared with them, Tina Arcidiacono, Nemours’ administrative director of patient experience said. They also wanted details about managing their safety during clinic and hospital visits.

Nemours has now made sure that all those who make contact with families are providing the information the families need, including specific processes in place to ensure their safety.” (Q)

“The true cost of this epidemic will not be measured in dollars; it will be measured in human lives and human suffering. In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.” (S)

“A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms like the Carlyle Group.

But it is not just another deep-pocketed investor hunting for high returns. It is the Providence Health System, one of the country’s largest and richest hospital chains. It is sitting on nearly $12 billion in cash, which it invests, Wall Street-style, in a good year generating more than $1 billion in profits.

And this spring, Providence received at least $509 million in government funds, one of many wealthy beneficiaries of a federal program that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.

With states restricting hospitals from performing elective surgery and other nonessential services, their revenue has shriveled. The Department of Health and Human Services has disbursed $72 billion in grants since April to hospitals and other health care providers through the bailout program, which was part of the CARES Act economic stimulus package. The department plans to eventually distribute more than $100 billion more.

So far, the riches are flowing in large part to hospitals that had already built up deep financial reserves to help them withstand an economic storm. Smaller, poorer hospitals are receiving tiny amounts of federal aid by comparison.

Twenty large recipients, including Providence, have received a total of more than $5 billion in recent weeks, according to an analysis of federal data by Good Jobs First, a research group. Those hospital chains were already sitting on more than $108 billion in cash, according to regulatory filings and the bond-rating firms S&P Global and Fitch. A Providence spokeswoman said the grants helped make up for losses from the coronavirus.

Those cash piles come from a mix of sources: no-strings-attached private donations, income from investments with hedge funds and private equity firms, and any profits from treating patients. Some chains, like Providence, also run their own venture-capital firms to invest their cash in cutting-edge start-ups. The investment portfolios often generate billions of dollars in annual profits, dwarfing what the hospitals earn from serving patients.

Many of these hospital groups, including Providence, are set up as nonprofits, which generally don’t have to pay federal taxes on their billions of dollars of income.

By contrast, hospitals that serve low-income patients often have only enough cash on hand to finance a few weeks of their operations.” (D)

Providence Health & Services, the $5.2 billion-a-year behemoth of Oregon health care, plans sweeping pay cuts and other cost-cutting moves that will hit doctors and other health care employees.

At least 1,800 Providence employees will be impacted by the reductions. Compensation reductions will range from 5% to 50%.

About 1,200 employees got the word late Monday that they were among those caught up in the expense reduction plans, Providence confirmed Monday evening. That’s on top of 600 other employees who got hit with mandatory furloughs or other pay reductions in May.

The more than 600 employees of the Providence Medical Group, most of them physicians, will have their compensation reduced by 10% to 17%. Physician assistants, occupational and physical therapists and others also will be subject to the cuts.

Providence officials said the pay cuts will last only through a single quarter of this year. Earlier memos suggested that the reductions could extend longer if Providence’s financial results didn’t improve. But the nonprofit confirmed Monday that salaries will be restored after three months…

The Providence doctors say privately that given their employer’s enormous financial resources, it shouldn’t need to lean on employees to stay afloat. Providence’s Oregon operation alone listed $4.7 billion in total assets at the end of 2019. More than $806 million of it was in cash and cash equivalents.” (O)

“The New York Times analyzed tax and securities filings by 60 of the country’s largest hospital chains, which have received a total of more than $15 billion in emergency funds through the economic stimulus package in the federal CARES Act.

The hospitals — including publicly traded juggernauts like HCA and Tenet Healthcare, elite nonprofits like the Mayo Clinic, and regional chains with thousands of beds and billions in cash — are collectively sitting on tens of billions of dollars of cash reserves that are supposed to help them weather an unanticipated storm. And together, they awarded the five highest-paid officials at each chain about $874 million in the most recent year for which they have disclosed their finances…

Dr. Rod Hochman, the chief executive of the Providence Health System, for instance, was paid more than $10 million in 2018, the most recent year for which records are available. Providence received at least $509 million in federal bailout funds.

A spokeswoman, Melissa Tizon, said Dr. Hochman would take a voluntary pay cut of 50 percent for the rest of 2020. But that applies only to his base salary, which in 2018 was less than 20 percent of his total compensation.” (Q)

“HHS announced June 9 that it is making additional distributions from the provider relief fund created under the Coronavirus Aid, Relief and Economic Security Act.

3. HHS is distributing an additional $10 billion to safety-net hospitals. To qualify, hospitals must have average uncompensated care per bed of at least $25,000, profitability of 3 percent or less and a Medicare Disproportionate Payment Percentage of 20.2 percent or greater.

4. The payments to safety-net hospitals will occur this week, and each hospital will receive between $5 million and $50 million, HHS said.” (R)

__________________________

“With few treatment options, doctors turned to a familiar intervention: broad-spectrum antibiotics, the shot-in-the dark medications often used against bacterial infections that cannot be immediately identified. They knew antibiotics were not effective against viruses, but they feared the patients could be vulnerable to life-threatening secondary bacterial infections.

“During the peak surge, our antibiotic use was off the charts,” said Dr. Teena Chopra, the hospital’s director of epidemiology and antibiotic stewardship. She and other doctors across the United States who liberally dispensed antibiotics in the early weeks of the pandemic said they soon realized their mistake.

Now, doctors nationwide are seeking to draw lessons from their overuse of antibiotics, a practice that can spur resistance to lifesaving drugs as bacteria mutate and outsmart the drugs. Antimicrobial resistance is a mounting threat that claims 700,000 lives annually — a global health crisis that has been playing out in slow motion behind the scenes while the coronavirus took center stage.

In recent weeks, public health experts have been warning that the same government inaction that helped foster the rapid spread of the coronavirus could spur an even deadlier epidemic of drug-resistant infections. The United Nations warns such an epidemic could kill 10 million by 2050 if serious action is not taken.

The pipeline for new antimicrobial drugs has become perilously dry. Over the past year, three American antibiotic developers with promising drugs have gone out of business, and most of the world’s pharmaceutical giants have abandoned the field.

Legislation in Congress to address the broken antibiotics marketplace has failed to gain traction in recent years, but public health experts are hoping the coronavirus pandemic can help break the political logjam in Washington.” (L)

“A fresh outbreak of the deadly Ebola virus has flared up in the Democratic Republic of Congo, a country that was already contending with the world’s largest measles epidemic, as well as the coronavirus.

Congo’s health ministry said that the new Ebola outbreak has killed four people, and infected at least two more, in Mbandaka, a city of 1.2 million people on the country’s western side. A fifth person died on Monday, according to UNICEF, the United Nations agency for children.

Less than two months ago, Congo was about to declare an official end to an Ebola epidemic on the eastern side of the country that had lasted nearly two years and killed more than 2,275 people. Then, with just two days to go, a new case was found, and the outbreak could not be declared over. But officials say it is in its final stages.

It is unclear how Ebola emerged in Mbandaka, which is about 750 miles west of the nearly-vanquished outbreak on the country’s eastern edge. Congo (formerly known as Zaire) is the largest country in sub-Saharan Africa, and has been under travel restrictions to prevent the spread of the coronavirus.” (M)

“Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. Currently, C. auris cases have been reported globally from >30 countries. Most reported infections involve critically ill patients in hospitals, mainly in intensive care unit settings. Infection with C. auris is associated with high mortality rates, and it is often resistant to multiple classes of antifungal drugs. Despite the rapid global spread, it is difficult to predict the actual burden of the infection as the standard laboratory methods fail to correctly identify the fungi. Longer stays in healthcare facilities, use of tracheostomies and percutaneous endoscopic gastrostomy tubes, ventilators in clinical care units and mobile equipment in healthcare settings are shown as major risk factors of C. auris infection. Due to its propensity to cause outbreaks and its antifungal resistance, C. auris poses a risk for patients in healthcare facilities. The emergence of pan-resistant C. auris strains in some areas is an alarming signal for the disease with limited treatment options, high mortality rates, and the ability of the pathogen to spread easily in healthcare settings. In this regard, susceptibility testing on clinical isolates, mainly for patients treated with echinocandins, is needed. Increasing awareness about C. auris infection and advancing the diagnostic methods are also essential for early detection and control of the deadly fungal infection.” (N)

Prequels

PART 2. May 13, 2019. CANDIDA AURIS. “In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?…

EBOLA. PART 13. Ebola Treatment Centers are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S.

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CORONOVIRUS TRACKING Links to Parts 1-31

CORONOVIRUS TRACKING

Links to Parts 1-31

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,”

June 9, 2020


 [JM1]

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