CORONOVIRUS TRACKING Links to Parts 1-44

CORONOVIRUS TRACKING

Links to Parts 1-44

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

POST 44.  September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

August 31, 2020


 [JM1]

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POST 43. August 22, 2020. CORONAVIRUS.” “We’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

to read all POSTS in chronological order, highlight and click on

I used to teach a case study course on COMPLEX PROBLEMS: situations where the decision-maker must integrate or reconcile at least two competing priorities that may not be linear or complementary; having to reach agreement on goals while simultaneously evaluating options; where goals are clear but political support is not; where the definition of the problem keeps changing and consensus has to constantly be reestablished; where there are so many variables it is difficult to determine the actual possible outcomes; and, various combinations/ permutations of the above.

So here is a late-summer discombobulated collage of the COMPLEX PROBLEM OF CORONAVIRUS: successes; failures; conundrums; oxymorons; contradictions; unknown unknowns; and kerfuffles.

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“Looking back to the early days of the coronavirus pandemic, the White House coronavirus task force coordinator said Monday she wished the United States had gone into a stricter lockdown.

“I wish that when we went into lockdown (in March), we looked like Italy,” Dr. Deborah Birx said Monday. “When Italy locked down, I mean, people weren’t allowed out of their houses (without a pass). Americans don’t react well to that kind of prohibition.”…

Gov. Asa Hutchinson, Birx said she has learned what Americans are willing to do to combat the virus, and that officials must meet people where they are.

Birx cited the strategy Arizona has used to reduce the rising number of cases. People were still able to go to malls and restaurants at reduced capacity, but gyms and bars were closed, mask mandates were implemented, and gatherings of more than 10 people were prohibited…

“Tens of thousands of lives can be saved if we wear masks, and we don’t have parties in our backyards … taking those masks off,” Birx said.

Jared Kushner, a White House senior adviser, disagreed, saying President Donald Trump was “very forward-leaning” when he and the task force issued 15-day guidelines in mid-March.

“This was done at the time to make sure that we had enough hospital capacity and supplies, so that we didn’t end up like Italy, where there were people dying on gurneys in waiting rooms,” Kushner told CNN’s Wolf Blitzer.

He complimented the President on the administration’s response to a ventilator shortage, repeating the White House line that no American who needed a ventilator didn’t get one.

“So, I think we have done much better than Italy with regards to how we handled this initially,” he said.” (A)

“White House coronavirus advisor Dr. Anthony Fauci said the U.S. is currently “in the middle of a very serious historic pandemic,” adding that he has concerns about some regions seeing upticks of coronavirus….

Fauci said he is “not pleased with how things are going.” “We certainly are not where I hope we would be, we are in the middle of very serious historic pandemic,” he added. “When you look at other parts of the country – this is the thing that’s disturbing to me – is that we’re starting to see the inkling of the upticks in the percent of the tests that are positive. We know now, from sad past experience, that that’s a predictor that you’re going to have more surges.” (B)

“Even as reality continues to intrude, President Trump has either largely dismissed or ignored his science and medical advisers. And the result is that the economy, the one thing he seems to care most about, and which he hoped would escort him to a second term, has been devastated.

As both history and data from today demonstrate, health and the economy are not antagonistic; they are dance partners, with public health taking the lead. The safer people feel, the more they will engage in economic activity…

Indeed, a Morgan Stanley model predicts that under current policies the U.S. is currently on track to have 150,000 new cases a day later this year. And that number is not even a worst case. If we do suffer case counts anything like those, dramatic growth in the economy simply won’t happen.

Bad as the virus has been this summer, it actually spreads better in low temperatures, and when temperatures fall, more people will be inside in poorly ventilated areas where transmission is also more likely. If the U.S. goes into the fall with new daily cases in the tens of thousands, as they are now, then the numbers could explode and the Morgan Stanley prediction could come true. Considering our containment efforts to date, there is little reason for optimism.

If that occurs, the economy will not come back. Jerome Powell, the chairman of the Federal Reserve, said as much recently. “The path forward for the economy is extraordinarily uncertain and will depend in large part on our success in keeping the virus in check,” he said at a July 29 news conference. He added: “A full recovery is unlikely until people are confident that it is safe to re-engage in a broad range of activities.”..

Bringing the economy back requires precisely the same three measures that controlling the virus does: First, better compliance with social distancing, wearing masks, personal hygiene and avoiding crowds; second, finally — finally — getting the supply chain and personnel infrastructure in place to support the necessary testing and contact tracing; and, third, the bitter medicine of regional shutdowns…

Without active, aggressive White House leadership we cannot achieve that and — reality again — there isn’t the slightest hint that will happen. But in 1918 leadership came from cities and states. If governors and mayors act aggressively, especially if they act jointly, we can still make significant progress.” (C)

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“If you’re heading to a gym lately, you might be asked to wash your hands, have an infrared gun pointed at your head and wait for an army of workers to sanitize every surface before you touch a machine — all in the name of safety.

But how much of a difference do these kinds of measures make when it comes to coronavirus transmission?

The evidence is mixed, some experts say. And measures might not always be there for the reasons you think.

Take temperature checks, which are currently being performed at several Canadian airports. Some businesses, like the Apple Store, have also been checking customers before they enter.

“We know that this is not effective,” said Colin Furness, an infectious disease epidemiologist with the University of Toronto.

“I mean, really, just as a screening tool it’s not effective at all.”

Given that people can spread the virus before ever showing symptoms, he said, checking someone’s temperature is definitely not a guarantee that they’re healthy. Illnesses other than COVID-19 can raise a person’s temperature, too.

“And if you really want to get on that plane, you take a Tylenol and you’ll glide right past that temperature check,” Furness said.

Even the U.S. Food and Drug Administration notes that non-contact thermometers aren’t a very good screening tool.

“Even when the devices are used properly, temperature assessment may have limited impact on reducing the spread of COVID-19 infections,” the agency wrote on their website.

“Some studies suggest that temperature measurements alone may miss more than half of infected people.”…(D)

“Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday that temperature checks are unreliable for detecting coronavirus symptoms in people entering businesses and other establishments as infrared thermometers have been embraced as part of safety protocol for reopenings.

Fauci made the comments during a Facebook Live broadcast with Walter Reed Medical Center, and was referencing the popular infrared thermometers that take a person’s body temperature by aiming the device at their forehead.

“We have found at the [National Institutes of Health] that it is much, much better to just question people when they come in and save the time, because the temperatures are notoriously inaccurate many times,” Fauci said.

Hot summer weather also causes inaccurate readings, Fauci said, adding that his own readings have gone as high as 103 before entering a building’s air-conditioning.

Prior to Fauci’s comments, measures like temperature screenings—along with spraying disinfectant in public transportation, or walking through hand sanitizer showers—had been criticized as “safety theater,” meaning they are not proven to stem the spread of the virus…

“All in all, temperature screening may catch some cases of the Covid-19 coronavirus. But it could miss many others,” wrote public health expert Bruce Y. Lee for Forbes in July. “Thus, be skeptical whenever anyone tries to assure you that things are safe just because they are doing temperature and symptom screening.”” (L)

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“Health experts in New York City thought that coronavirus cases would be rising again by now. Their models predicted it. They were wrong.

New York State has managed not only to control its outbreak since the devastation of the early spring, but also to contain it for far longer than even top officials expected.

Now, as other places struggle to beat back a resurgence and cases climb in former success-story states like California and Rhode Island, New York’s leaders are consumed by the likelihood that, any day now, their numbers will begin rising.

The current levels of infection are so remarkable that they have surprised state and city officials: Around 1 percent of the roughly 30,000 tests each day in the city are positive for the virus. In Los Angeles, it’s 7 percent, while it’s 13 percent in Miami-Dade County and around 15 percent in Houston.

The virus is simply no longer as present in New York as it once was, epidemiologists and public health officials said.

“New York is like our South Korea now,” said Dr. Thomas Tsai of the Harvard Global Health Institute.

But nothing is static about the viral outbreak, experts cautioned. The question now is whether the state, where 32,000 people have died of the virus, can keep from being overwhelmed by another wave, as threats loom from arriving travelers, struggles with contact tracing and rising cases just over the Hudson River in New Jersey…

In more than a dozen interviews, epidemiologists, public health officials and infectious disease specialists said New York owed its current success in large part to how New Yorkers reacted to the viciousness with which the virus attacked the state in April.

State officials shut down schools and businesses, sacrificing jobs and weakening the economy to save lives. Adherence to mask wearing has been strong. Many vulnerable New Yorkers are still sheltering in their apartments. Others decamped to second homes.

And, critically, Gov. Andrew M. Cuomo and Mayor Bill de Blasio reopened cautiously, deciding in late June against allowing indoor dining and bars after seeing those activities connected to outbreaks in other states.

“People in New York have taken matters much more seriously than in other places,” said Dr. Howard Markel, a historian of epidemics at the University of Michigan. “And all they’re doing is reducing the risk. They’re not extinguishing the virus.”

Still a resurgence is all but inevitable, public health experts said…

And even at the currently low levels, the number of new virus cases in New York City — 386 reported positive on Tuesday out of 46,185 tested, according to state data — is still too great for its contact tracers to effectively determine where people are becoming infected, said Dr. Barbot. The new norms of behavior have to continue for the foreseeable future, she said.” (E)

“We’ve known from the beginning how the end will arrive. Eventually, the coronavirus will be unable to find enough susceptible hosts to survive, fading out wherever it briefly emerges.

To achieve so-called herd immunity — the point at which the virus can no longer spread widely because there are not enough vulnerable humans — scientists have suggested that perhaps 70 percent of a given population must be immune, through vaccination or because they survived the infection.

Now some researchers are wrestling with a hopeful possibility. In interviews with The New York Times, more than a dozen scientists said that the threshold is likely to be much lower: just 50 percent, perhaps even less. If that’s true, then it may be possible to turn back the coronavirus more quickly than once thought.

The new estimates result from complicated statistical modeling of the pandemic, and the models have all taken divergent approaches, yielding inconsistent estimates. It is not certain that any community in the world has enough residents now immune to the virus to resist a second wave.

But in parts of New York, London and Mumbai, for example, it is not inconceivable that there is already substantial immunity to the coronavirus, scientists said.

“I’m quite prepared to believe that there are pockets in New York City and London which have substantial immunity,” said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. “What happens this winter will reflect that.”

“The question of what it means for the population as a whole, however, is much more fraught,” he added.

Herd immunity is calculated from the epidemic’s so-called reproductive number, R0, an indicator of how many people each infected person spreads the virus to.

The initial calculations for the herd immunity threshold assumed that each community member had the same susceptibility to the virus and mixed randomly with everyone else in the community.

“That doesn’t happen in real life,” said Dr. Saad Omer, director of the Yale Institute for Global Health. “Herd immunity could vary from group to group, and subpopulation to subpopulation,” and even by postal codes, he said.

For example, a neighborhood of older people may have little contact with others but succumb to the virus quickly when they encounter it, whereas teenagers may bequeath the virus to dozens of contacts and yet stay healthy themselves. The virus moves slowly in suburban and rural areas, where people live far apart, but zips through cities and households thick with people.

Once such real-world variations in density and demographics are accounted for, the estimates for herd immunity fall. Some researchers even suggested the figure may be in the range of 10 to 20 percent, but they were in the minority…

“We are still nowhere near back to normal in our daily behavior,” said Virginia Pitzer, a mathematical epidemiologist at the Yale School of Public Health. “To think that we can just stop doing all that and go back to normal and not see a rise in cases I think is wrong, is incorrect.” “ (F)

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“Of all the ways to describe the fraught decision to reopen schools during a pandemic, Gov. Ron DeSantis of Florida, a former Navy prosecutor, chose an especially dramatic example when he compared the commitment of teachers and administrators to the resolve of Navy SEALs given the mission to go after Osama bin Laden.

“Just as the SEALs surmounted obstacles to bring Osama bin Laden to justice, so, too, would the Martin County school system find a way to provide parents with a meaningful choice of in-person instruction or continued distance learning — all in, all the time,” he said, citing the leader of a local school district.

He meant for the line to be inspirational. But perhaps unintentionally, Mr. DeSantis also highlighted an undeniable truth in Florida since students began returning to classrooms last week: There will be virus casualties.

In one of the states hardest hit by the coronavirus pandemic, 13 counties reopened their schools last week in accordance with a statewide order for all schools to offer in-person instruction by the end of the month. At least three districts soon reported positive coronavirus tests among students or teachers, and with the state expected to hit the 10,000-death mark this week, there is a move among some local school officials to try to delay reopenings — a pushback that has been met with threats of a loss in state funding and a reminder that the road back will not be an easy one.

“If you have a Covid case or you have symptoms, don’t panic,” the state education commissioner, Richard Corcoran, told Florida school superintendents last week. “We are going to have cases, and that’s OK.”..

Mr. DeSantis has spent weeks promoting school openings, holding events with administrators, teachers and parents who say they are eager to go back to the classroom. The benefits of opening outweigh the health risks in most of the state, Mr. DeSantis says, and it is up to each district to decide how its reopening will work in practice…

Gov. Ron DeSantis of Florida has likened reopening schools to a military operation, highlighting an undeniable truth: There will be virus casualties.” (G)

“The Los Angeles Unified School District on Sunday unveiled a plan to provide regular COVID-19 testing and contact tracing to school staff, students and their families.

The plan will begin Monday in a measured fashion, with the first test provided to staff already working at schools and their children. The program will then be expanded to provide testing to all staff and students over time, with a goal in the early phase to establish a baseline, the district said in a release.

The goal is to implement the program to help get students back into school for in-person instruction as the district is set to begin the school year with virtual learning.

“Extraordinary circumstances call for extraordinary actions, and while this testing and contact tracing effort is unprecedented, it is necessary and appropriate,” Superintendent Austin Beutner said in a statement. “This will provide a public health benefit to the school community, as well as the greater Los Angeles area.”

“This program will also provide significant education benefits for students by getting them back to school sooner and safer and keeping them there. We hope this effort also will provide learnings which can benefit other school systems and communities across the nation as we all combat this pandemic,” Beutner added.

The program is in collaboration with scientists from the University of California Los Angeles (UCLA), Stanford University, Johns Hopkins University, Microsoft and healthcare companies Anthem Blue Cross and Health Net.

Stanford, UCLA and Johns Hopkins will provide a strategic interpretation of the evidence on testing and epidemiological modeling services pro bono. Microsoft will provide an app that will allow school administrators and health officials to track insights into trends and potential risks to help manage COVID-19 exposures and cases.

Beutner did not identify the source of funding for the program. The plan to test all students and staff will cost roughly $300 per student over a year, close to $150 million, according to the Los Angeles Times. The district has received hundreds of millions of state and federal dollars for its coronavirus response efforts, the newspaper noted.

Last month the Los Angeles school district, along with San Diego, said they will start instruction in August virtually amid an outbreak of the virus across California.” (H)

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“HENDERSONVILLE, N.C. — The coronavirus entered Cherry Springs Village quietly, then struck with force. Nearly every staff member and resident of the long-term care facility would become infected.

They needed help — fast — and the county responded: It sent in a “strike team” of medical workers, emergency responders, clergy and others, in what is becoming a new model for combating Covid-19 in residential care centers.

Nurses and doctors from hours away came to aid sick residents and replace staff who had contracted the virus. They set up oxygen and IV drips, to avoid sending residents with milder illness to overburdened hospitals.

Members of the county’s emergency management department conducted rapid testing of all staff and residents. The Henderson County Rescue Squad, a volunteer paramedic group, erected decontamination tents outside for staff to safely remove protective gowns, masks and other equipment after shifts, and educated them on proper use and removal of the garments.

Chaplains and therapists came from a nearby hospice to provide emotional support to families and staff, who sometimes witnessed several residents die in one day. A public relations employee was dispatched to communicate with family members about ill loved ones and the situation inside.

Covid strike teams apply an emergency response model traditionally used in natural disasters like hurricanes and wildfires to combating outbreaks in long-term care facilities. Composed of about eight to 10 members from local emergency management departments, health departments, nonprofit organizations, private businesses — and at times, the National Guard — the teams are designed to bring more resources and personnel to a disaster scene.”  (I)

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“Without a vaccine or a highly successful treatment, widespread testing is seen as a cornerstone for fighting a pandemic in which as many as 40 percent of infected people do not show symptoms and may unknowingly spread the virus. Testing a lot of people is crucial to seeing where the virus is going and identifying hot spots before they get out of hand. Experts see extensive testing as a key part of safely reopening schools, businesses and sports.

The nation’s testing capacity has expanded from where it was only a few months ago, but public health experts believe it must grow far more to bring the virus under control.

The Harvard Global Health Institute has suggested the country needs at least 1 million tests per day to slow the spread of the virus, and as many as 4 million per day to get ahead of the virus and stop new cases. Some experts view that goal as too ambitious, and others say the benchmark should focus not on a particular number of tests but on the percent of people testing positive.

Yet there is broad consensus that the current level of testing is inadequate and that any decrease in testing is a worrisome move in the wrong direction.

“There is a reasonable disagreement about what that number ought to be, but all of them are way ahead of where we are right now,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “There is no expert that I know of that thinks that our testing infrastructure right now meets the needs of the American people.”

Adm. Brett P. Giroir, the assistant secretary for health and the Trump administration’s virus testing czar, said that conducting millions of tests per day was not realistic. The administration has asked states to test at least 2 percent of their populations each month, or the equivalent of about 220,000 people per day nationally, which Admiral Giroir said would be enough to identify rising hot spots.

“We are doing the appropriate amount of testing now to reduce the spread, flatten the curve, save lives,” he told reporters on Thursday.

He said the government was already testing large numbers of asymptomatic people, and he described an effort to strategically deploy tests, including to those who are hospitalized and in nursing homes. “You do not beat the virus by shotgun testing everyone all the time,” Admiral Giroir said, adding: “Don’t get hung up on a number.”

Admiral Giroir also cited a decline in known cases in states like Florida as an indication that testing is sufficient. But experts say the rate of people testing positive in places like Florida remains high, suggesting too little testing.” (J)

“Earlier this summer, Trump administration officials hailed a new strategy for catching coronavirus infections: pooled testing.

The decades-old approach combines samples from multiple people to save time and precious testing supplies. Federal health officials like Dr. Anthony S. Fauci and Adm. Brett Giroir said pooling would allow for constant surveillance of large sectors of the community, and said they hoped it would be up and running nationwide by the time students returned to school.

But now, when the nation desperately needs more tests to get a handle on the virus’s spread, this efficient approach has become worthless in many places, in part because there are simply too many cases to catch.

Pooled testing only works when the vast majority of batches test negative, among other drawbacks with the procedure. If the proportion of positives is too high, more pools come up positive — requiring each individual sample to then be retested, wasting precious chemicals.

Nebraska’s state public health laboratory, for example, was a pooling trailblazer when it began combining five samples a test in mid-March, cutting the number of necessary tests by about half.

But the lab was forced to halt its streak on April 27, when local positivity rates — the proportion of tests that turn up positive — surged past 10 percent. With that many positives, there was little benefit in pooling.

“It’s definitely frustrating,” said Dr. Baha Abdalhamid, the assistant director of the laboratory. In combination with physical distancing and mask wearing, pooling could have helped keep the virus in check, he added. But the pooling window, for now, has slammed shut.

Still, the strategy has made significant headway in some parts of the country. In New York, where test positivity rates have held at or below 1 percent since June, universities, hospitals, private companies and public health labs are using the technique in a variety of settings, often to catch people who aren’t feeling sick, said Gareth Rhodes, an aide to the governor and a member of his virus response team. Last week, the State University of New York was cleared to start combining up to 25 samples at once.” (K)

“Gov. Phil Murphy has vetoed a coronavirus bill that would have expanded testing in New Jersey, while also signing five into law. One new law gives student-athletes more leeway with physical testing amid the crisis.

Murphy vetoed a bill that would have allowed licensed pharmacists to order and administer COVID-19 tests authorized and approved by the federal Food and Drug Administration.

Under the bill (S2436), in order to administer the test, the pharmacy must ensure that personal protection equipment is distributed to all pharmacy staff and that proper social distancing protocols are observed…

Murphy also wants to make sure that administering a test includes “collecting or overseeing the collection of a specimen and causing the specimen to be sent to a laboratory with the capacity to perform the test.”  (M)

“Today, the U.S. Food and Drug Administration posted a new template for commercial developers to help them develop and submit emergency use authorization (EUA) requests for COVID-19 diagnostic tests that can be performed entirely at home or in other settings besides a lab, such as offices or schools, and that could be available without a prescription.

“The FDA continues to help facilitate innovation in test development, thereby enhancing Americans’ access to COVID-19 tests,” said FDA Commissioner Stephen M. Hahn, M.D. “The recommendations provided today are intended to help get tests to market that are simple enough to use at home, similar to a pregnancy test. We hope that with the innovation we’ve seen in test development, we could see tests that you could buy at a drug store, swab your nose or collect saliva, run the test, and receive results within minutes at home, once these tests become available. These types of tests will be a game changer in our fight against COVID-19 and will be crucial as the nation looks toward reopening.”” (N)

________________

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and expert on infectious diseases for four decades, delivered some blunt messages to the American public during an online video interview with actor Matthew McConaughey. In an election year, the doctor asked the American people NOT to politicize the coroanvirus pandemic.

In response to a question about the politicization of the virus, he compared the pandemic to other challenging times in U.S. history. “Our country has been through very, very difficult situations. We’ve been through a Depression, we’ve been through a World War. We pulled together through 9/11.” But, he added, if you are not taking precautions, “You are part of the problem rather than the solution.”…

In the absence of a vaccine, Fauci told McConaughey that social distancing, regular hand washing and face masks are the only alternatives as “herd immunity” — where those who are immune protect the most vulnerable in the population — is not feasible for coronavirus. That requires a very high level of population immunity for COVID-19, and for the virus to not mutate.

Island nations and Asian countries, such as New Zealand, Singapore and South Korea, managed to control coronavirus. These countries shut down decisively, avoiding the worst of the pandemic, and carried out more effective contact tracing to prevent community spread. Warmer island nations, he said, may have better weathered COVID-19 as people spend more time outside.

Fauci also said that aiming for 100% herd immunity, which Sweden attempted before reversing their policy, instead of maintaining safety procedures and waiting for a vaccine in early 2021, would have dire consequences. “If everyone contracted it, a lot of people are going to die,” he said. “You’re talking about a substantial portion of the population.”” (O)

“The director of the Centers for Disease Control and Prevention (CDC) is “hopeful” that the COVID-19 pandemic will be over by spring next year, as reports emerged that a top Food and Drug Administration (FDA) official threatened to resign if approval for a coronavirus vaccine was rushed…

“I’m hopeful that the steps we take to prevent COVID are going to prevent flu and other respiratory viruses, Redfield said. “People are going to realize this is the year to get flu vaccine and we’ll begin to see our nation get through this pandemic.”

“As we then—and I do anticipate it will happen—begin to deploy an efficacious and safe COVID vaccine, then hopefully when you and I talk next spring we’ll have this pandemic behind us.”

Redfield’s comments came as Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, told Reuters he would resign if the Trump administration pressured the agency to approve a COVID vaccine before it has been proven to be safe and effective.” “(Y)

_____________

“Joe Biden, the presumptive Democratic nominee for president, called for a nationwide mask mandate on Thursday, drawing a sharp contrast with President Donald Trump, who rarely wears a mask himself and opposes such mandates.

“Every single American should be wearing a mask when they’re outside for the next three months at a minimum,” Biden said at a press appearance in Wilmington, Delaware. “Every governor should mandate mandatory mask wearing. The estimates by the experts are that it will save over 40,000 lives in the next three months. Forty thousand lives, if people act responsibly.”

“It’s not about your rights. It’s about your responsibilities as an American,” said Biden, flipping the script on Republicans who argue that mandates infringe on an individual’s right not to wear one.” (R)

“President Donald Trump on Thursday rejected former Vice President Joe Biden’s call for a national mask mandate to combat the coronavirus, accusing the Democratic candidate for president of politicizing the outbreak and of shunning science in combating the pandemic.

“It’s a shameful situation for anybody to try and score political points while we’re working to save lives and defeat the pandemic,” Trump said during a White House press briefing…

However, Trump claimed that Biden “wants to shut down our economy and close our schools and grind society to a halt.” Trump, who has repeatedly said lockdowns intended to prevent the further spread of the virus would inflict more harm than good, told reporters that Biden is “in favor of locking all Americans in their basements for months on end.”  (S)

“President Donald Trump has found a new doctor for his coronavirus task force — and this time there’s no daylight between them.

Trump last week announced that Dr. Scott Atlas, a frequent guest on Fox News Channel, has joined the White House as a pandemic adviser. Atlas, the former chief of neuroradiology at Stanford University Medical Center and a fellow at Stanford’s conservative Hoover Institution, has no expertise in public health or infectious diseases.

But he has long been a critic of coronavirus lockdowns and has campaigned for kids to return to the classroom and for the return of college sports, just like Trump.

“Scott is a very famous man who’s also very highly respected,” Trump told reporters as he introduced the addition. “He has many great ideas and he thinks what we’ve done is really good.”

Atlas’ hiring comes amid ongoing tensions between the president and Drs. Anthony Fauci, the nation’s top infectious diseases expert, and Deborah Birx, the task force’s coordinator. While Birx remains closely involved in the administration’s pandemic response, both she and Fauci have publicly contradicted the rosy picture the president has painted of a virus that has now killed more than 167,000 people in the United States and infected millions nationwide.

Atlas, the sole doctor to share the stage at Trump’s pandemic briefings this past week, has long questioned polices that have been embraced by public health experts both in the U.S. and abroad. He has called it a “good thing” for younger, healthy people to be exposed to the virus, while falsely claiming children are at near “zero risk.”

In an April op-ed in The Hill newspaper, Atlas bemoaned that lockdowns may have prevented the development of “natural herd immunity.”

“In the absence of immunization, society needs circulation of the virus, assuming high-risk people can be isolated,” he wrote.

In television appearances, Atlas has called on the nation to “get a grip” and argued that “there’s nothing wrong” with having low-risk people get infected, as long as the vulnerable are protected.

“It doesn’t matter if younger, healthier people get infected. I don’t know how often that has to be said. They have nearly zero risk of a problem from this,” he said in one appearance. “When younger, healthier people get infected, that’s a good thing,” he went on to say, “because that’s exactly the way that population immunity develops.”

While younger people are certainly at far lower risk of developing serious complications from the virus, they can still spread it to others who may be more vulnerable, even when they have no symptoms. And while their chances of dying are slim, some do face severe complications, with one study finding that 35% of young adults had not returned to normal health two weeks to three weeks after testing positive.

But Atlas’ thinking closely aligns with Trump’s perspective on the virus, which he has played down since its earliest days. While Trump eventually supported the lockdowns that once helped slow the disease’s spread, he has since pressured states to reopen schools and businesses as he tries to revive a battered economy before the November election.” (T)

“Last week, just as the Food and Drug Administration was preparing to issue an emergency authorization for blood plasma as a Covid-19 treatment, a group of top federal health officials including Dr. Francis S. Collins and Dr. Anthony S. Fauci intervened, arguing that emerging data on the treatment was too weak, according to two senior administration officials.

The authorization is on hold for now as more data is reviewed, according to H. Clifford Lane, the clinical director at the National Institute of Allergy and Infectious Diseases. An emergency approval could still be issued in the near future, he said.

Donated by people who have survived the disease, antibody-rich plasma is considered safe. President Trump has hailed it as a “beautiful ingredient” in the veins of people who have survived Covid-19.

But clinical trials have not proved whether plasma can help people fighting the coronavirus.

Several top health officials — led by Dr. Collins, the director of the National Institutes of Health; Dr. Fauci, the government’s top infectious disease expert; and Dr. Lane — urged their colleagues last week to hold off, citing recent data from the country’s largest plasma study, run by the Mayo Clinic. They thought the study’s data to date was not strong enough to warrant an emergency approval.

“The three of us are pretty aligned on the importance of robust data through randomized control trials, and that a pandemic does not change that,” Dr. Lane said in an interview on Tuesday.

The drafted emergency authorization leaned on the history of plasma’s use in other disease outbreaks and on animal research and a spate of plasma studies, including the Mayo Clinic’s program, which has given infusions to more than 66,000 Covid-19 patients thanks to financing from the federal government…”  (U)

“Anthony Fauci, the top U.S. infectious disease specialist, said he’s preparing for extended talks with Scott Atlas, President Donald Trump’s newest pandemic adviser who’s been pushing for schools to reopen…

Fauci, a public health expert who has led the U.S. National Institute of Allergy and Infectious Diseases since 1984, said he’s already had brief discussions with Atlas. He hopes to “get a feel of where we are with regard to these issues, and do we differ and if so, how much,” he said Tuesday in a Twitter interview with Bloomberg QuickTake.

Meeting with Atlas will provide an opportunity for the two to exchange views directly, said Fauci, who said he would keep an open mind on the issues.

“I’ve always been of the bent to go right to the source and have an open, honest conversation,” he said. “Hopefully we can come to some sort of agreement, if you want to call it that.”” (V)

“Dr. Scott Atlas, President Trump’s newest coronavirus adviser, is pressing the case for ensuring that schools are open.

“There’s nothing more important than educating our children. In fact, we are the only nation of the Western European and our peer nations … that are somehow sacrificing our children out of our own fear,” Atlas told the Washington Examiner.” (Z)

“Michael Caputo, HHS assistant secretary, told Texas-based News West 9 that the hospital COVID-19 data reporting system will not be transitioning back to the CDC, despite statements made by White House coronavirus official Deborah Birx, MD, earlier this week….

However, Mr. Caputo refuted the change and said the data collection process will stay with HHS after all. An HHS spokesperson clarified that the “interim system” Dr. Birx referred to in her statement was the manual data collection process and that the CDC is working on an automated process that will send the data to the HHS data platform, HHS Protect.” (X)

______________________________________________________________________________

“We asked six experts — including scholars from Vanderbilt, Harvard, and Johns Hopkins University — to set an agenda for Biden and Harris’ first day in office, should they win. Here’s what they came up with.

1. Give the CDC its authority back

Almost every expert mentioned the same priority: restoring the authority of the Centers for Disease Control and Prevention, which is headquartered in Atlanta.

2. Institute daily press briefings

If elected, Biden has said, he intends to place one of his first calls to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Multiple experts said a Biden-Harris administration should put Fauci in front of the public on day one.

3. Mandate universal mask-wearing

During their first public address under a Biden-Harris administration, Fauci and his fellow experts should issue a universal mask mandate, Schaffner said. Research clearly shows that face masks can prevent coronavirus transmission and save lives.

4. Ramp up testing

The US is already testing more people per capita than almost any other nation: around 204 daily tests for every 100,000 people. But it also represents a quarter of the world’s coronavirus cases — meaning its testing capacity is still relatively limited. The weekly average of daily tests is now 13% lower than it was at the end of July, according to data from The COVID Tracking Project.

5. Use the Defense Production Act

Experts also hope Biden will more fully utilize the Defense Production Act, which allows the president to require businesses to prioritize the federal government’s supply-chain needs. The law also restricts companies from hoarding or price gouging critical supplies.

6. Appoint Ron Klain as testing czar

One of Biden’s first priorities should be to appoint strong leaders, Gates said.

“There are lots of people who are involved in the global response to Ebola and smallpox and polio, who would love to help out the US bring this thing to a close,” he said.

7. Develop a federal dashboard with live data

In January, researchers at Johns Hopkins University developed a live dashboard to track coronavirus cases. For a while, the tool was one of the sole resources for measuring the scope of the US outbreak. It’s still one of the most prominent and widely used.

8. Convene scientific experts to come up with a new response plan

Finally, experts called for a new national strategy led by a panel of scientific experts.

“The key will be to rely on scientific understanding, not wishful thinking,” Dr. Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health, said…

“Our big challenge has been that we’ve pitted the economy against health,” Levine added. “That administration, if it were to be elected, needs to bring those two together.” (Q)

________________

“As some parts of America gingerly begin to open up after months of near total lockdown, people have questions. Will it be safe to take a train? A plane? Visit the hair salon? An indoor restaurant?

There are many knowable parameters in the equation: your health; the prevalence of cases where you live; the safety precautions being taken any place you want to visit. But the final answer may depend on your individual risk tolerance for exposure to infectious disease.

Most Americans alive today have never before had to make that self-assessment.

In the past, deadly outbreaks of plague, flu and polio were regular occurrences. Up until the mid to late 20th century there were mumps, measles and chickenpox to contend with.

In a world of effective antibiotics and antivirals and other treatments, deaths or even serious illnesses from infectious disease seem nearly incomprehensible. So our fear is enormous, and our risk tolerance for exposure is just about zero…

Covid-19 is a very serious disease. But it is not the Black Death, which killed up to half of Europe in the 14th century. A vaccine, when and if it arrives, will be a big help. But in the meantime, we have science. We know what causes Covid-19. We are learning more about how to detect, prevent and treat it every day.

So instead of taking your temperature and checking your pulse oximeter reading twice a day, it may be time to take stock of your risk tolerance. In those places where governments, businesses and administrators have set the stage properly, we can — with sensible precautions — begin to live again.” (P)

“Critics accuse Fauci of “mistakes.” They take one Fauci statement, often out of context, and then blast him when something happens to disprove that statement. The most repeated example of this is when Fauci, and others, advised the public against wearing masks in early 2020. There was a shortage of masks at that time, and healthcare workers might not have been able to get them. Statements made early on during a crisis need to be revised as we learn more, and this pandemic is unlike anything we have seen in our lifetimes.

But critics use such statements to undermine valued experts like Fauci. This makes it impossible for us to solve problems. If we don’t listen to the people who have the most education, training and knowledge, and if we place trust in people who are ignorant and refuse to learn, we ensure that our response to the crisis will continue to fail, as it has for this country.” (AA)

____________

“Former Vice President Joe Biden said in an exclusive interview with ABC “World News Tonight” Anchor David Muir on Friday that as president, he would shut the country down to stop the spread of COVID-19 if the move was recommended to him by scientists.

“I would shut it down; I would listen to the scientists,” Biden told Muir Friday, alongside his running mate, Sen. Kamala Harris, D-Calif., during their first joint interview since officially becoming the Democratic Party’s presidential and vice presidential nominees.

Biden also criticized what he argued is the “fundamental flaw” of the Trump administration’s response to the coronavirus pandemic, that the nation cannot begin to recover economically until the virus and public health emergency is under control.

“I will be prepared to do whatever it takes to save lives because we cannot get the country moving, until we control the virus,” Biden said. “That is the fundamental flaw of this administration’s thinking to begin with. In order to keep the country running and moving and the economy growing, and people employed, you have to fix the virus, you have to deal with the virus.” (BB)

__________

“Well folks, we’ve done it. It took a lot of grit, activism, and cooperation, but we’ve achieved something great as a nation. We’ve created an unyielding market for Bobblehead Faucis.

We’re now almost half a year into the coronavirus pandemic and every other developed country in the world has been able to flatten the curve, some to the point where life looks almost like the Before Times. Idiots. The first rule of Bobblehead Fauci economics is to create an environment so politically and biologically toxic that the only solace people can find is in a $25 hunk of wobbling plastic molded after the septuagenarian tasked with leading a divided nation through a pandemic that disproportionately kills members of his own age group.

The market is so strong right now that the original Bobblehead Fauci is completely sold out, and the proceeds helped raise over $200,000 for frontline healthcare workers.”  (W)

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CORONOVIRUS TRACKING Links to Parts 1-43

CORONOVIRUS TRACKING

Links to Parts 1-43

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

August 22, 2020


 [JM1]

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POST 42. CORONAVIRUS. August 11, 2020. . “I think that if future historians look back on this period, what they will see is a tragedy of denial….

to read all POSTS in chronological order, highlight and click on

I think that if future historians look back on this period, what they will see is a tragedy of denial. Everything we needed to do to have lowered the infection rate on coronavirus … we had this technology. There’s nothing fancy about face masks, right? And even ventilators — OK, they’re expensive — but … that technology existed. But we didn’t use it, or we didn’t use it as effectively as we could have because we weren’t willing to be honest about what we were facing…”

“There’s no business case for stockpiling a billion face masks. But there is a scientific and public health case. We didn’t listen to that scientific and public health case because we were so enthralled in this notion that the market would solve all our problems. And I think that’s the big thing that historians will look back on and see as this sort of colossal error that ended up being very, very costly.” (A)

“Dr. Deborah L. Birx, the Trump administration’s coronavirus coordinator, said on Sunday that the nation was in a “new phase” of the coronavirus epidemic that was much more sprawling across the country than last spring’s outbreaks in major cities like New York and Seattle.

She recommended that people living in communities where cases are surging should consider wearing a mask at home, if they live with someone who is especially vulnerable because of age or underlying medical conditions.

“What we are seeing today is different from March and April — it is extraordinarily widespread,” she said on CNN’s “State of the Union” news program. “It’s into the rural as equal urban areas. So everybody who lives in a rural area, you are not immune.”

Dr. Birx emphasized the significance of asymptomatic transmission, and said that the White House coronavirus task force was working to make sure Americans in affected communities understood this risk. “If you have an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you’re positive if you have individuals in your home with comorbidities,” like respiratory problems or diabetes…

In some communities seeing recent outbreaks, household transmission has been a huge factor, public health experts say…

Admiral Giroir defended the nation’s testing program, noting it has exponentially been increased in recent months although there are still delays in getting results. He said that both testing and contact tracing efforts were crucial responses, but not particularly helpful in large, communitywide outbreaks.

“When you have a widespread, multifocal outbreak where many people are asymptomatic, testing and tracing are of limited utility versus public health policy measures like mask-wearing, like closing indoor crowded spaces,” Admiral Giroir said. “So, yes, contact tracing is important, but it’s much less important right now than the public policy mitigation measures.”” (C)

“Speaker Nancy Pelosi (D-Calif.) on Monday doubled down on questioning the credibility of Deborah Birx, the physician coordinating the White House’s coronavirus task force, arguing that she has been “enabling” President Trump to spread disinformation about the coronavirus.

“I don’t have confidence in anyone who stands there while the president says, swallow Lysol, it’s going to cure your virus. It’ll kill you and you won’t have the virus anymore,” Pelosi said during an interview with CNN’s Jim Sciutto.

“There has to be some responsibility. So if the president is saying these things, who’s advising him that this is OK and enabling that to happen while millions of people have died?” Pelosi said.

Pelosi’s comments come as Birx also faced criticism earlier Monday from Trump, who attacked her for acknowledging that the coronavirus pandemic is “extraordinarily widespread” across the U.S.

Trump suggested that Birx was trying to “counter” Pelosi’s previous criticism…

Pelosi reiterated during an appearance on ABC’s “This Week” on Sunday that she lacked confidence in Birx, saying “I think the president is spreading — spreading disinformation about the virus and she is his — she is his appointee.”

Pelosi said Monday that Birx came up during the meeting with Mnuchin and Meadows during a discussion about contact tracing.

“What happened is that we had a conversation about how we stop the virus. And when we did, they were making contentions about how tracing isn’t a valuable thing, we shouldn’t do it. I said, well that’s not what most scientists say. And they said, well we’ll bring a scientist to say that. I said, sure, [if] it’s not Dr. Birx,” Pelosi said in the CNN interview.”  (D)

Dr. Deborah Birx on Sunday strongly defended her record amid criticism from House Speaker Nancy Pelosi that she doesn’t have confidence in the White House coronavirus task force coordinator’s handling of the pandemic.

On “State of the Union,” Birx told CNN’s Dana Bash that she has “tremendous respect” for Pelosi, but criticized a New York Times article last month that reported she had painted an optimistic view of the pandemic to the White House during a critical period in getting control of the virus.

“I have tremendous respect for the speaker, and I have tremendous respect for her long dedication to the American people,” Birx said, adding, though, that she could have “brought forth the data” to back up her analysis had the Times spoken with her.

“I have never been called pollyannish, or nonscientific, or non-data driven,” Birx said. “And I will stake my 40-year career on those fundamental principles of utilizing data to really implement better programs to save more lives.”…

Asked by Bash if it was time to reset the federal government response to the pandemic, Birx said, “I think the federal government reset about five to six weeks ago when we saw this starting to happen across the South.” Roughly six weeks ago, however, Vice President Mike Pence, who heads the coronavirus task force, declared in a Wall Street Journal op-ed that the US is “winning the fight” and there “isn’t a ‘second wave.'””  (E)

President Trump on Monday publicly criticized Deborah Birx, the doctor who is coordinating the White House’s coronavirus response, suggesting she was hurting him after she bluntly acknowledged that the pandemic is widespread across the United States.

Trump targeted Birx over a weekend response to criticism from Speaker Nancy Pelosi (D-Calif.), who questioned Birx’s credibility in responding to the pandemic. He appeared to call Birx’s response to Pelosi’s criticism “pathetic.”

“So Crazy Nancy Pelosi said horrible things about Dr. Deborah Birx, going after her because she was too positive on the very good job we are doing on combatting the China Virus, including Vaccines & Therapeutics,” Trump tweeted. “In order to counter Nancy, Deborah took the bait & hit us. Pathetic!”

The tweet marks the latest instance of Trump undercutting one of his administration’s top health officials in the middle of a pandemic, but it is the first time he has publicly criticized Birx.” (F)

Dr. Anthony S. Fauci, the nation’s top infectious disease specialist, agreed on Monday with his colleague Dr. Deborah Birx that the United States has entered a “new phase” of the coronavirus pandemic, in which the virus is now spreading uncontrolled in some states by asymptomatic people — comments that drew fire from President Trump.

Dr. Fauci said Dr. Birx had been referring to the “inherent community spread” that is occurring in some states, adding: “When you have community spread, it’s much more difficult to get your arms around that and contain it.”

Speaking during a news conference with Gov. Ned Lamont of Connecticut, Dr. Fauci called the community spread “insidious” and noted that it was happening outside of confined spaces like nursing homes and prisons.

In backing up Dr. Birx, the Trump administration’s coronavirus response coordinator, Dr. Fauci indirectly put himself at odds with the president. Earlier on Monday, Mr. Trump had called Dr. Birx “pathetic” on Twitter and suggested that her comments about a “new phase” were an effort to curry favor with Speaker Nancy Pelosi.

At an evening news conference, Mr. Trump appeared to temper his comments about Dr. Birx. “She’s a person I have a lot of respect for,” he said, while defending his administration’s response to the virus…

But other Republicans piled on. “Dr. Birx, like Dr. Fauci, has been wrong much more than she has been right on COVID-19, & their destructive prescriptions have led to the devastation of countless American lives,” Representative Andy Biggs, Republican of Arizona, wrote on Twitter…

On Monday morning, shortly after Mr. Trump tweeted about her, Dr. Birx told governors on a weekly briefing call that a lack of masks at large gatherings in homes was “a critical issue,” pointing to spikes in many Southern states.

Mr. Trump has also criticized Dr. Fauci, despite his claims that the two have a “very good relationship.” In a tweet on Saturday responding to news reports that Dr. Fauci had linked the recent surge in cases to inadequate lockdowns, Mr. Trump tweeted: “Wrong!””  (G)

“I’ve gone to your rallies. I’ve talked to your people. They love you. They listen to you. They listen to every word you say. They hang on your every word,” Swan said. “And so when they hear you say, ‘everything’s under control. Don’t worry about wearing masks,’ I mean, these are people — many of them are older people.”

“Well, what’s your definition of control?” Trump replied, adding: “I think it’s under control.”

“How? A thousand Americans are dying a day,” Swan said.

“They are dying. That’s true. And you — it is what it is,” Trump said emphatically. “But that doesn’t mean we aren’t doing everything we can. It’s under control as much as you can control it.”” (H)

Dr. Anthony Fauci and Dr. Deborah Birx, two key members of the White House coronavirus task force, have warned nine major cities across the country over their high COVID-19 testing positivity rates.

Birx, coordinator of the White House task force, first raised concerns about the high positivity rates in Atlanta; Baltimore; Boston; Chicago; Detroit; Kansas City, Missouri; Portland, Oregon; Omaha, Nebraska; and Washington, D.C.; in a Wednesday call with state and local officials. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), was asked about the remarks in an interview with CNN on Thursday morning, and he explained that the test positivity rate is “a pretty good predictor” or “indicator” that surges in new infections are coming.

“So what Dr. Birx is saying is now is the time to accelerate the fundamental preventive measures that we all talk about,” Fauci explained. “Masks, social distancing, avoiding crowds, outdoors greater than indoors, washing hands, etc. Those kind of simple things can actually prevent that uptick from becoming a surge.” Fauci emphasized that the heightened positivity rate “is a predictor of trouble ahead.”

In her Wednesday remarks to local officials, Birx raised particular concerns about the situations in Atlanta and Baltimore. “We are concerned that both Baltimore and Atlanta remain at a very high level,” she said.

“This outbreak is different from the March, April outbreak in that it’s in both rural and urban areas,” she cautioned…

Increasing rates of positive COVID-19 tests within a specific area generally correlate with an increase in community spread. If community spread rises unchecked, the novel coronavirus outbreak can quickly spiral out of control leading to overwhelmed hospitals and making it difficult to curb the spread of the pandemic.”  (I)

“Within public health circles, debate is raging over how much blame Dr. Birx bears for the virus’s spread. Some say Mr. Trump is responsible, but, they add, the dangerous misinformation he has spread has often gone uncorrected by Dr. Birx.

“Trump is like the reverse Midas,” said Gregg Gonsalves, a longtime AIDS activist and assistant professor of epidemiology at the Yale School of Public Health. “Everybody who is in his orbit, if they’ve had any integrity, it gets leeched away from them like some parasite.”

But some say Dr. Birx is at least partly responsible for mismanaging the government’s response. A report issued by the State Department’s inspector general in February relayed criticism of her AIDS program leadership team, which was called “dictatorial” and “autocratic.” She has been critical of the Centers for Disease Control and Prevention, and some public health experts view her as partly responsible for sidelining the agency.

Some also fault her for offering unduly rosy assessments of the pandemic — both in public and in private. In April, she told officials in the White House Situation Room that the United States was in good shape…

In interviews with AIDS activists and public health experts, Dr. Birx drew unfavorable comparisons with the outspoken Dr. Fauci, in whose lab she trained. Mr. Gonsalves, who has long known both of them, said he wrote in March to Drs. Birx, Fauci and Redfield, as well as Adm. Brett P. Giroir, who oversees coronavirus testing, complaining that they were “parroting the president.” Only Dr. Fauci replied.

“Debbie is now in the position where she’s saying to the emperor that those new clothes look fantastic,” Mr. Gonsalves said…

Dr. Birx has drawn criticism for what she has said — and what she has not said. She remained virtually silent while Mr. Trump suggested from the White House lectern that exposure to ultraviolet light or household disinfectants might cure Covid-19. Her lavish praise for the president on the Christian Broadcasting Network in March still rankles.

“He’s been so attentive to the scientific literature and the details and the data,” she said then.

Dr. Ashish Jha, the director of the Harvard Global Health Institute, who has known Dr. Birx for at least a decade and regards her as “a genuinely smart and caring person,” initially gave her the benefit of the doubt on that interview.

“A bunch of people in the public health world just lost their minds on that one, but I said, ‘Look, if she has to praise the president to get him to do the right thing, I can live with that,’” Dr. Jha said. But now, he said, “she has to ask herself whether she’s being effective in protecting the American people, and I would argue at this point that it is not clear that she is.””  (J)

White House coronavirus task force coordinator Deborah Birx is warning of an uptick in coronavirus cases in nine U.S. cities.

“Many of the Sun Belt states have made substantial progress with their mitigation efforts,” Birx told state and local officials on Wednesday, according to a copy of the call obtained the Center for Public Integrity, referring to a slew of Southern states that experienced surges earlier this summer.

But Birx said that the percentage of coronavirus tests coming back positive is increasing in nine U.S. cities as well as California’s Central Valley.

“We are concerned that both Baltimore and Atlanta remain at a very high level. Kansas City, Portland, Omaha, of course what we talked about in the Central Valley,” Birx said. “We are seeing a slow uptick in test positivity in cases in places like Chicago, Boston and Detroit and D.C.”

Birx also said that Nebraska and California have moved into the red category, with more than 10 percent of tests coming back positive. And she noted that while Los Angeles saw improvements, there was significant movement of the virus up California’s Central Valley.

Birx noted that the virus has entered a new phase, “in that it’s in both rural and urban areas.”

In another call obtained by the Center for Public Integrity last month, Birx warned of an uptick in 12 other U.S. cities, including Miami, New Orleans, Las Vegas, San Jose, St. Louis, Indianapolis, Minneapolis, Cleveland, Nashville, Pittsburgh, Columbus and Baltimore.

Thursday morning, Anthony Fauci, the nation’s leading infectious disease expert and member of the White House coronavirus task force, said that the infection rate is a “pretty good predictor” for potential surges.

“We’ve seen that in the Southern states as predictors,” Fauci said on CNN.  “This is a predictor of trouble ahead.”

“You’ve got to get that base line down,” he added. “Everybody on the team of American citizens need to pull together. Because we’re all in this together.”” (K)

“But on a personal level, the attack also represented a surprisingly direct assault on one of the most recognizable scientific faces on the team of officials Trump regularly puts before the cameras to describe the White House coronavirus strategy.

She has a very difficult job right now, because she’s dealing with someone who is not evidence-based

Birx, a scientist whose signature scarves are the subject of a dedicated Instagram account, was always known to be stepping on to a political tightrope by taking her current White House role. But now former allies and critics of Birx suggest that the renowned global Aids researcher, health official, medical doctor and army colonel has sacrificed her public mission for a more personal one – staying on Trump’s good side.

Birx’s defenders forcefully rebut that contention, saying her public guidance throughout the coronavirus pandemic has been reliable. They theorize, based on their personal experiences of working with her, that her private guidance of the president and his team has steered the administration in a useful direction, even if that is not always publicly evident.

“She has a very difficult job right now, because she’s dealing with someone who is not evidence-based, and is not understanding what needs to be done to address this pandemic,” said Kenneth Mayer, a professor of medicine and global health at Harvard who worked closely with Birx for years as a member of the scientific advisory committee of the President’s Emergency Plan for Aids Relief (Pepfar). “It’s hard.”” (L)

‘To this point, Dr. Anthony Fauci during a recent Q&A session at the Brown University School of Public Health articulated that the first coronavirus vaccine might only be 60% effective, if not lower. Not one to mince words, Fauci said that the probability of a coronavirus vaccine being 98% effective is “not great.”

“You’ve got to think of the vaccine as a tool to be able to get the pandemic to no longer be a pandemic,” Fauci explained, “but to be something that’s well controlled.”

That said, Fauci said a coronavirus vaccine that is only 50% effective would still be acceptable and liable to be given the green light by the FDA…

There’s also a chance the first coronavirus vaccine may not even be able to prevent someone from being infected in the first place. Rather, it may only prevent an individual from experiencing some of the coronavirus’ more severe symptoms.

Efficacy aside, Fauci earlier this week said that the United States — in a best-case scenario — would have tens of millions of COVID-19 vaccine doses ready to go by early 2021. If that actually pans out, Fauci anticipates that life in the United States will return to normal by the middle of next year at the soonest.” (M)

(Dr. Stephen Hahn, the Commissioner of the Food and Drug Administration)

“Many medical experts — including members of his own staff — worry about whether Dr. Hahn, despite his good intentions, has the fortitude and political savvy to protect the scientific integrity of the F.D.A. from the president. Critics point to a series of worrisome responses to the coronavirus epidemic under Dr. Hahn’s leadership, most notably the emergency authorization the agency gave to the president’s favorite drug, hydroxychloroquine, a decision it reversed three months later because the treatment did not work and harmed some people.” (N)

“President Donald Trump on Wednesday maintained that the coronavirus is “going away” and continued to push for schools to reopen since the virus “doesn’t have much of an impact” on children.

Trump applauded the country’s coronavirus vaccine and therapeutic development, saying it has had “tremendous success” and is “ready to deliver them literally as soon” as they’re approved.

When it comes to the coronavirus, he said children are able to “throw it off very easily.”

“It’s going away. It’ll go away. Things go away. No question in my mind that it will go away,” Trump said during a White House press briefing…

“We think we’re going to have the vaccines before the end of the year, maybe long before the end of the year,” Trump said. “ (O)

“And on Wednesday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and the most senior public health official on the taskforce, said: “I don’t think we’re going to eradicate this from the planet … because it’s such a highly transmissible virus that that seems unlikely.”

And despite Trump claiming in an interview with Axios released on Monday that coronavirus is under control in the US, Fauci on Wednesday spoke of a much longer timescale to achieve that.

“I hope and feel it’s possible that by the time we get through 2021 and go around for another cycle, that we’ll have this under control … Do I think we’re going to have a much, much better control one full year from this winter? I think so,” Fauci said in an interview with Reuters.

Fauci said he was cautiously optimistic about US progress toward developing a successful and safe vaccine and achieving mass distribution next year.

“Historically, if you get a vaccine that has a moderate to high degree of efficacy, and you combine with that prudent public health measures, we can put this behind us,” he said.

He added: “We may need to go through a season of it, and then by the next season if we have a vaccine it won’t be a pandemic, it won’t be immobilizing the world, it won’t be destroying the economy.”” (P)

“After months of butting heads with his medical experts, including the government’s top infectious disease official, Dr. Anthony Fauci, President Trump introduced a new adviser to the administration during his coronavirus briefing on Monday, Dr. Scott Atlas, whose views on Covid-19 and school reopenings more closely match the president’s.

A senior fellow at Stanford University’s Hoover Institution, a conservative think tank, Atlas is not an infectious disease expert — he’s board-certified in diagnostic radiology, which means he specializes in reading and interpreting imaging like X-rays, CT scans and MRIs, and he served as a professor and chief of neuroradiology at Stanford University Medical Center from 1998 to 2012…

Atlas has recently appeared as a guest on Trump’s preferred news channel, Fox, calling on school districts and colleges to open their doors for in-person instruction and railing against the “frenzy” around mass testing…

“Scott is a very famous man who’s also very highly respected,” Trump said on Monday. “He’s working with us and will be working with us on the coronavirus. And he has many great ideas.”” (Q)

“Nearly three dozen current and former members of a federal health advisory committee, including nine appointed or reappointed by the health secretary, Alex M. Azar II, are warning that the Trump administration’s new coronavirus database is placing an undue burden on hospitals and will have “serious consequences on data integrity.”

The advisers, all current or former members of the Healthcare Infection Control Practices Advisory Committee, issued their warning in a previously unpublished letter shared with The New York Times.

The letter was made public as both hospital officials and independent data experts around the country were reporting kinks in the new system, which critics say is undermining the government’s ability to understand the course of the pandemic. The Covid Tracking Project, a respected and widely used resource, identified “major problems” with the new Department of Health and Human Services system in late July, and reported this week that “the federal data continue to be unreliable.”

The concern grows out of an order, issued last month by Mr. Azar, for hospitals to send daily reports about virus cases to a private vendor that transmits them to a central database in Washington instead of the Centers for Disease Control and Prevention, which had previously housed the data.

The information, including patient and hospital bed counts, helps guide the government’s response to the pandemic, informing critical health care decisions like how to allocate scarce supplies, including ventilators or the drug Remdesivir, approved as a treatment for Covid-19 patients…

“The U.S. cannot lose their decades of expertise in interpreting and analyzing crucial data,” the authors wrote, adding that the C.D.C.’s experts, from its Division of Healthcare Quality Promotion, must “be allowed to continue their important and trusted work.”” (R)

“I’m pretty much fighting two wars: A war against COVID and a war against stupidity,” Dr. Varon, MD, CMO and chief of critical care at United Memorial Medical Center in Houston, told NBC News. “And the problem is the first one, I have some hope about winning. But the second one is becoming more and more difficult.”  (B)

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CORONAVIRUS TRACKING Links to Posts 1-42

CORONOVIRUS TRACKING

Links to Parts 1-42

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

August 13, 2020


 [JM1]

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POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.” (2)

to read POSTS 1-41 in chronological order, highlight and click on

“Someone will have to decide which of the world’s 7.8 billion people gets first crack at returning to a more normal life. Infectious disease experts and medical ethicists say this exceptionally complex decision must weigh not only who is most at risk from the virus and who is most likely to spread it, but also who is most important for maintaining the medical and financial health of a nation as well as its safety…

Arthur Caplan, a bioethicist at New York University, said the rush to bring vaccines to market likely will leave many questions unanswered at first about how well they work in different groups. He sees the first public doses as an extension of clinical trials. That will require careful tracking of recipients. “We keep acting as if the race to get FDA approval is the end of things,” he said. “I would say it’s just the start.”..

Traditionally, the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends who should get vaccines, and it has been discussing since April how to divvy up a new coronavirus shot. It is unclear whether officials from the Trump administration’s Operation Warp Speed on vaccine development will want in on the decision as well. “It’s a black box,” said Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia. He thinks Warp Speed will probably focus on distribution. The National Academy of Medicine, at the behest of the National Institutes of Health, has also created an expert panel to study the issue.

At the panel’s first meeting on Friday, Victor Dzau, the academy’s president, said he expected final recommendations by late September to early October. CDC Director Robert Redfield stressed that it was important for Americans to see vaccine allocation as “equitable, fair, and transparent.”

National Institutes of Health Director Francis Collins, who has faced some criticism for potentially adding to decision-making confusion, said this issue is so thorny, we can benefit from extra “deep thinkers.”

“This is going to be controversial,” he said. “Not everybody is going to like the answer.”

Caplan favors an independent commission that includes both scientists and representatives of affected communities, such as people with disabilities and children. Whoever makes the decisions, he said, “it’s got to be trustworthy.”..

Who goes first?

Priorities need to consider the multiple public health roles vaccines can play, said William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center. Typically, younger people mount the strongest immune response, said Schaffner, who represents the National Foundation for Infectious Diseases as a liaison to ACIP. They are currently catching COVID-19 at higher rates and spreading it to other, more vulnerable populations. Vaccinating them could weaken the chain of transmission.

Older people and those with chronic health problems are clearly getting sickest, but vaccines tend to be less effective in these groups. A third group are “the people in society that are responsible for its most essential functions,” Schaffner said: medical workers, police and firefighters, those who make, sell and distribute food.

Schaffner said it’s important not to create such narrow categories that vaccine sits unused in refrigerators. “Vaccine does not prevent disease,” he said. “Immunization prevents disease.”” (A)

“Last month, National Institutes of Health Director Francis Collins called the National Academy of Medicine asking for help: Would the esteemed group be interested in developing guidelines for who should get the first doses of a coronavirus vaccine?

“It will allow the public to know it’s transparent, it’s not political,” said Dr. Victor Dzau, the academy’s president who told Collins that his organization was up to the task. “The American public will want to know how are you making that decision? Why am I not getting it first?”

After months of missteps and criticism across the political spectrum on everything from testing to personal protective equipment, the Trump administration is aiming to prove it can roll out a coronavirus vaccine quickly and fairly to millions of Americans as soon as one is ready. That means tackling thorny challenges like deciding who is first in line for vaccination, securing millions of glass vials and syringes and convincing Americans to get inoculated.

The administration is making moves that experts applaud like tapping top health officials and industry experts to lead vaccine plans rather than politicians, but they are still concerned that the overall effort — dubbed Operation Warp Speed — remains shrouded in secrecy. And the administration’s response to the rest of the pandemic has not inspired confidence.

“It’s sort of being handled like a secret weapon, which is never good,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “Transparency is always good.”

Once a vaccine is approved, every American won’t be able to get it at once. That sets up the unenviable task of deciding, amid a deadly pandemic, who is most vulnerable to the disease and who is most essential to inoculate quickly.

“People are a little uneasy about the government calling the shots here,” NIH’s Dr. Collins told a Senate panel earlier this month.

Experts will have to consider vulnerable populations like those in assisted-living facilities or prisons, people working in close quarters like meat packing plants and how to assess Americans with preexisting conditions.

The National Academy of Medicine hopes to have its recommendations publicly available in August or September.

A second panel of vaccine advisers for the Centers for Disease Control and Prevention — the Advisory Committee on Immunization Practices (ACIP) — is also coming up with a set of guidelines. It’s still unclear whether the administration will select one set of recommendations over the other or take both into account when making its final decisions.

Last month, the ACIP convened electronically in a little-noticed meeting to discuss who counts as an essential worker, where teachers should fall in the priority list, vaccinations for pregnant women and whether race and ethnicity should factor into priority considerations.

“If we fail to address this issue of racial and ethnic groups as a high risk in prioritization, whatever comes out of our group will be looked at very suspiciously and with a lot of reservation,” Dr. José Romero, the panel’s chairman, said….

Once a vaccine is available, it could still take six months to a year to vaccinate enough of the population to slow the spread…

The CDC and Pentagon are working in tandem to deliver the vaccine across America, though they haven’t offered many details about how they plan to do so….

Convincing minority communities that have experienced higher rates of hospitalization and fatality to get vaccinated is a top concern. Experts said that will have to involve community outreach through organizations people already trust, such as faith-based organizations.

“There’s a lot of work that needs to be done in terms of making sure we that engage them earlier to gain their trust,” Dzau of the National Academy of Medicine said. “There are two ways that people can look at it. One is, are we the guinea pig? Or, two, we should get it first because we are more at risk.””  (B)

Why do we need more than one vaccine?

We’ll benefit from several vaccines, said Pulendran, because no single company could meet demand. In addition, the vaccines may differ, working better in some people than others.

“If we’ve got three acceptable vaccines, we’ll get the vaccine to more people,” said Ernst. “Maybe not everybody will get the best vaccine for somebody in their demographic. But assuming they’re equally safe and differ in efficacy only a modest amount, you’re better off being vaccinated than having no vaccine at all.”

Why first isn’t always best

Remember the Salk vs.Sabin polio vaccine debate? We started with Salk’s version, then shifted to Sabin’s. Now, with more information, we’re back to Salk’s.

Imagine that our first vaccine is only 50% effective. (The U.S. Food and Drug Administration, in an apparent effort to encourage vaccine companies, says that’s good enough for licensing, for now.) That will still leave some people, such as the elderly and those with high-risk medical conditions, perilously exposed.

If we’re lucky, vaccines will get better over time.

“It may not be the ultimate vaccine, but it’s the first iteration that can be improved upon,” said Pulendran.

“50% effective” sounds like more mask-wearing. Why can’t we do better?..

Who’s first in line?

If you’re an average healthy adult, you’ll likely be last in line. Health care workers and people at high medical risk would likely be first, Dr. Francis Collins, director of the National Institutes of Health, said Friday.

But there are other considerations. The military, students, underrepresented minorities, “essential workers” or people who volunteered for research may get priority too. If there’s an explosive local outbreak, vaccinating everyone nearby would limit the spread…

How will it be distributed?

Companies have said they’ll defer to the federal government. But experts, noting the disastrous distribution of PPE and tests, say we should look to the multi-channel distribution model of flu vaccines. They say it should be available from governments and doctors — but also directly from the companies, via CVS, Walgreens and other local pharmacies.

“It’s still inconceivable that we’ll be able to get vaccines to 330 million in three to six months,” Dr. Robert Wachter, chair of the Department of Medicine at UC San Francisco, tweeted this past week. During the 2009 swine flu epidemic, he noted, we vaccinated about one-quarter of all Americans — and that took six months.

Vaccinating 80 to 100 million of the nation’s most vulnerable people, including healthcare workers, “might be do-able by mid-’21,” he said.

Not everybody wants one.

Even people who believe in vaccines are showing reluctance to get the COVID-19 vaccine. They worry that politics are creating undue pressure, and corners will be cut in the rush to produce. Only about half of Americans say they would get a COVID-19 vaccine, according to a May poll from The Associated Press-NORC Center for Public Affairs Research. One-third weren’t sure and one-fifth would refuse, citing safety concerns.

If a vaccine is 50% effective, and 50% of the population gets vaccinated, then only 25% of the population is protected, said Ernst.

That’s far short of the 70% protection needed to stop this pandemic. The only solution is to make a better vaccine — and convince more people to take it.

“We’re not going to get this disease under control by just vaccinating health care workers and kindergarten teachers,” said Ernst.

“We need to be thinking about how are we going to convince people to comply with vaccinations,” he said, “so that we’ve got a sufficient amount of the population covered to actually get COVID-19 under control.” (C)

“Federal health officials are already trying to decide who will get the first doses of any effective coronavirus vaccines, which could be on the market this winter but could require many additional months to become widely available to Americans.

The Centers for Disease Control and Prevention and an advisory committee of outside health experts in April began working on a ranking system for what may be an extended rollout in the United States. According to a preliminary plan, any approved vaccines would be offered to vital medical and national security officials first, and then to other essential workers and those considered at high risk — the elderly instead of children, people with underlying conditions instead of the relatively healthy.

Agency officials and the advisers are also considering what has become a contentious option: putting Black and Latino people, who have disproportionately fallen victim to Covid-19, ahead of others in the population.

In private meetings and a recent public session, the issue has provoked calls for racial justice. But some medical experts are not convinced there is a scientific basis for such an option, foresee court challenges or worry that prioritizing minority groups would erode public trust in vaccines at a time when immunization is seen as crucial to ending the pandemic.

“Giving it to one race initially and not another race, I’m not sure how that would be perceived by the public, how that would affect how vaccines are viewed as a trusted public health measure,” said Claire Hannan, executive director of the Association of Immunization Managers, a group represented on the committee.

While there is a standard protocol for introducing vaccines — the C.D.C. typically makes recommendations and state and local public health departments decide whether to follow them — the White House has pressed the agency at times to revise or hold off on proposals it found objectionable. President Trump, who has been pushing to reopen schools, fill workplaces and hold large public events, has been acutely focused on the political consequences of public health guidance…

To speed distribution, the most promising vaccines will start being made even before they have cleared the final stages of clinical trials and been authorized for public use by the Food and Drug Administration.

But there will be a gap between the first doses coming off the manufacturing lines and a stockpile large enough to vaccinate the U.S. population. “I would say months,” Dr. José R. Romero, the chairman of the Advisory Committee on Immunization Practices, predicted.

The committee, which reports to the C.D.C. director, has long played a key role in determining how to implement new vaccines. The group includes 15 voting members selected by the health secretary who come from immunology, infectious disease and other medical specialties, 30 nonvoting representatives from across the health field, and eight federal officials focused on vaccines. Still, it operates largely out of sight.

Dr. Romero is among four committee members who have been deliberating on the plans since this spring alongside doctors at the C.D.C., representatives from the health field, ethicists and other outside consultants. In June, they briefed the full committee on their work, offering a glimpse of the questions being considered.

As they come up with a multitiered schedule for the first 1.2 million vaccine doses and then the next 110 million, they have focused on who should be considered essential workers, what underlying conditions should be taken into account and what kinds of living environments — nursing homes, homeless shelters — put people at high risk. Among the questions: What should be done about pregnant women? Should teachers go toward the front of the line? Should prisoners be in a top tier?

But for the broader committee, questions of whether to prioritize race and ethnicity sparked the most debate.

Black and Latino people have become infected with the virus at three times the rate of whites, and have died nearly twice as frequently. Many of them have jobs that keep them from working at home, rely on public transportation or live in cramped homes that increase their risk of exposure. They are more likely to suffer from underlying health problems, including diabetes and obesity, that raise the risk of hospitalization and death. Not only do the groups have less access to health services, they have a documented history of receiving unequal care.” (H)

“But let’s suppose that health care workers and people with underlying medical conditions use up the first doses of the available vaccine. Should some be held in reserve for Black and Latino people? What about bus drivers and train conductors? Perhaps teachers or schoolchildren should get it so they can return to classrooms with peace of mind.

If shortages happen, most of the nation will have no chance to get the initial lots of a vaccine under the C.D.C.’s plan. And as the United States combats a soaring number of coronavirus cases, rising demand for drugs and maybe ventilators is expected. They, too, will need a fair system of distribution.

One solution that is starting to attract the attention of public health experts is a so-called weighted lottery, which gives everyone a chance at access, although some get a better shot than others.

Doctors and ethicists rank patients, deciding which groups should be given preference and how much. First-responders, for example, may be weighted more heavily than, say, very sick patients who are unlikely to recover.

The goal is to prevent haphazard or inequitable distribution of a treatment or vaccine when there isn’t enough to go around. Such a system has already been used in allocations of remdesivir, the first drug shown to be effective against the coronavirus.

“This is all very new,” said Dr. Douglas White, an ethicist and vice chairman of the department of critical medicine at the University of Pittsburgh, which began using a weighted lottery last month to distribute remdesivir.

Patients have accepted the results, even when they lost in the lottery and ended up being denied the drug, he added.

“I speculate that is because we are very transparent about the reason and the ethical framework that applies to everyone who comes into hospital, whether that is the hospital president or someone who is homeless,” he said.

To allocate the drug, Pittsburgh doctors decided that the lottery would give preference to health care workers and emergency medical workers. The doctors also weighted the odds to favor people from economically disadvantaged areas, who tend to be mostly Black and Hispanic.

People with other illnesses and limited life spans, like end-stage cancer patients, had the odds weighted against them, giving them a smaller chance to win in the lottery. The system did not consider age, race, ethnicity, quality of life, ability to pay or whether a patient has a disability.

The lottery began in early June, Dr. White said: “We had 64 patients. We had to make the supply of remdesivir last at least two weeks. We only had enough to treat one in four patients.”

They had a brief respite from the lottery when cases began falling and supplies of remdesivir seemed adequate. But on Sunday, with cases rising again and enough remdesivir for only about half the patients who could be helped by taking it, the hospital system was forced to go back to a lottery….

Still, in principle, lottery data about a vaccine can be as useful as randomized clinical trial data, Dr. Pathak said.

“We would like to get people to think ahead about how vaccines are allocated,” he said. “There is no way we can vaccinate everybody, so we have to think about what’s fair and what’s just.”” (D)

“TA: Given that equitable distribution of vaccines is, at least in part, a question of ethics, how can computer models help us arrive at a solution?

Swann: It’s an interesting intersection, isn’t it? We can think of problems in terms of our objectives, which in this case might include efficiency (speed), effectiveness (avert deaths), and equity across the population. In public health, equity can be defined in different ways, including geographically (urban and rural) or by population (pro-rata). It can also be defined in terms of outcomes. For example, right now we know that communities of color, including African Americans, Hispanics, and Native Americans, are experiencing much higher rates of COVID-19 mortality than whites, and we know that people who are older or have high-risk medical conditions are also experiencing greater mortality than others.

Computer models can do many things to help with equitable distribution of vaccines. One really important role is to project the impact of different vaccination scenarios or strategies. For example, if there are limited vaccines, what is the impact of vaccinating essential workers, or ones who might interact with a vulnerable group (e.g., nursing home workers)? If there is a group at lower direct risk (e.g., children) who have significant contact with people at risk (parents or grandparents), what would be the impact of vaccinating them? If a vaccine requires two doses, or if immunity wanes after a time period, what strategies can avert the most hospitalizations and deaths? Which strategies would be most effective at reducing the disparities in COVID-19 outcomes associated with communities of color? These are just a few examples of many different decisions where humans could be aided by input from computer models.” (I)

“Nationwide distribution of any coronavirus vaccine will be a “joint venture” between the Centers for Disease Control and Prevention, which typically oversees vaccine allocation, and the Department of Defense, a senior administration official said today.

The Department of Defense “is handling all the logistics of getting the vaccines to the right place, at the right time, in the right condition,” the official said in a call with reporters, adding that CDC will remain in charge of tracking any side effects that emerge post-vaccination and “some of the communications through the state relationships [and] the state public health organizations.”

The plan breaks with the longstanding precedent that CDC distributes vaccines during major outbreaks — such as bad flu seasons — through a centralized ordering system for state and local health officials.

“We believe we’ve actually combined the best of both,” the official said. A second senior administration official stressed the agencies would be working as “one team” to distribute hundreds of millions of doses if any of the vaccines in development are approved in the coming months.

Private companies are also likely to join the effort. The first official said the government is bringing in people to integrate CDC IT capabilities with “some new applications that we’re going to need that the CDC never had.”

The background: The Pentagon will be guiding not just distribution logistics but also manufacturing and “kitting,” the process of safely packaging a vaccine with its necessary equipment such as syringes and needles.

“The DoD is handling all of those logistics — that is where their comparative advantage is,” said the first senior official. “And the CDC, some of their IT systems, relationships with the states following post-vaccination will belong to them.”…

State and local government groups have already raised concerns about Pentagon involvement and using new methods in coronavirus vaccine distribution. The CDC “already leads and maintains a highly effective system of vaccine ordering and distribution,” groups including the Association of State and Territorial Health Officials wrote in June. “With time of the essence we strongly recommend against designing new and untested systems of vaccine distribution.”

The state and local officials also questioned whether military involvement in vaccine administration would undermine already shaky public confidence in vaccines.”  (G)

“Executives from four companies in the race to produce a coronavirus vaccine — AstraZeneca, Johnson & Johnson, Moderna Therapeutics and Pfizer — told lawmakers on Tuesday that they are optimistic their products could be ready by the end of 2020 or the beginning of 2021. All four companies are testing vaccines in human clinical trials.

Three of the firms — AstraZeneca, Johnson & Johnson and Moderna — are getting federal funds for their vaccine development efforts. AstraZeneca and Johnson & Johnson pledged to the lawmakers that they would produce hundreds of millions of doses of their vaccines at no profit to themselves. Moderna, however, which has been granted $483 million from the government to develop its product, made no such promise.

“We will not sell it at cost,” said Dr. Stephen Hoge, the president of Moderna.

Many Democratic lawmakers have argued that federal funding for vaccine development should include provisions to guarantee affordability and guard against profiteering.

At the Congressional hearing on Tuesday, some House members raised concerns about Pfizer’s decision to reject federal funds, suggesting it could lead to price-gouging and a lack of transparency… (E)

“On June 26, a small South San Francisco company called Vaxart made a surprise announcement: A coronavirus vaccine it was working on had been selected by the U.S. government to be part of Operation Warp Speed, the flagship federal initiative to quickly develop drugs to combat Covid-19.

Vaxart’s shares soared. Company insiders, who weeks earlier had received stock options worth a few million dollars, saw the value of those awards increase sixfold. And a hedge fund that partly controlled the company walked away with more than $200 million in instant profits.” (F)

“The Serum Institute, which is exclusively controlled by a small and fabulously rich Indian family and started out years ago as a horse farm, is doing what a few other companies in the race for a vaccine are doing: mass-producing hundreds of millions of doses of a vaccine candidate that is still in trials and might not even work.

But if it does, Adar Poonawalla, Serum’s chief executive and the only child of the company’s founder, will become one of the most tugged-at men in the world. He will have on hand what everyone wants, possibly in greater quantities before anyone else.

His company, which has teamed up with the Oxford scientists developing the vaccine, was one of the first to boldly announce, in April, that it was going to mass-produce a vaccine before clinical trials even ended. Now, Mr. Poonawalla’s fastest vaccine assembly lines are being readied to crank out 500 doses each minute, and his phone rings endlessly.

National health ministers, prime ministers and other heads of state (he wouldn’t say who) and friends he hasn’t heard from in years have been calling him, he said, begging for the first batches.

“I’ve had to explain to them that, ‘Look I can’t just give it to you like this,’” he said.

With the coronavirus pandemic turning the world upside down and all hopes pinned on a vaccine, the Serum Institute finds itself in the middle of an extremely competitive and murky endeavor. To get the vaccine out as soon as possible, vaccine developers say they need Serum’s mammoth assembly lines — each year, it churns out 1.5 billion doses of other vaccines, mostly for poor countries, more than any other company…

But right now it’s not entirely clear how much of the coronavirus vaccine that Serum will mass-produce will be kept by India or who will fund its production, leaving the Poonawallas to navigate a torrent of cross-pressures, political, financial, external and domestic.

India has been walloped by the coronavirus, and with 1.3 billion people, it needs vaccine doses as much as anywhere. It’s also led by a highly nationalistic prime minister, Narendra Modi, whose government has already blocked exports of drugs that were believed to help treat Covid-19, the disease caused by the coronavirus.

Adar Poonawalla, 39, says that he will split the hundreds of millions of vaccine doses he produces 50-50 between India and the rest of the world, with a focus on poorer countries, and that Mr. Modi’s government has not objected to this.” (J)

“First we have to look at the global level. The private sector is really driving the vaccine development process, rather than government or academic labs. Major efforts are underway to figure out how private industrial developers can make vaccines available at an affordable price to all countries, particularly low and middle-income countries. It’s a bit like the ventilator supply situation we’ve all faced, but on steroids. Initially there will be scarce supply of the vaccine, governments will be scrambling to procure it, and, unless these efforts work, the winners will be fairly predictable: countries that have the resources.

On the next level, some wealthy countries will likely end up with substantial amounts of vaccine. Over time, if all goes well, these countries will have to decide how much product they’re going to keep and how much, if any, they’re willing to share with other countries where the vaccine may be in very short supply. These are complex questions of ethics, and they’re wrapped up in geopolitics, and also national politics.

There’s a term called vaccine nationalism—where countries understand their obligations to be primarily, if not exclusively, to their own residents. Although there is an expectation that countries with the resources and production capacity will meet their own health needs first, should they ignore the needs of people living in other countries with severe economic constraints? From an ethics perspective, a balance must be struck.” (K)

“As soon as the first COVID-19 vaccines get approved, a staggering global need will confront limited supplies. Many health experts say it’s clear who should get the first shots: health care workers around the world, then people at a higher risk of severe disease, then those in areas where the disease is spreading rapidly, and finally, the rest of us. Such a strategy “saves the most lives and slows transmission the fastest,” says Christopher Elias, who heads the Bill & Melinda Gates Foundation’s Global Development Division. “It would be ludicrous if low-risk people in rich countries get the vaccine when health care workers in South Africa don’t,” adds Ellen ‘t Hoen, a Dutch lawyer and public health activist.

Yet money and national interest may win out. The United States and Europe are placing advance orders for hundreds of millions of doses of successful vaccines, potentially leaving little for poorer parts of the world. “I’m very concerned,” says John Nkengasong, director of the Africa Centres for Disease Control and Prevention.

To avoid such a scenario, the World Health Organization and other international organizations have set up a system to accelerate and equitably distribute vaccines, the COVID-19 Vaccines Global Access (COVAX) Facility, which seeks to entice rich countries to sign on by reducing their own risk that they’re betting on the wrong vaccine candidates. But the idea has been put together on the fly, and it’s unclear how many rich countries will join.” (L)

“As scientists and pharmaceutical companies work at breakneck speed to develop a vaccine for the novel coronavirus, public health officials and senior U.S. lawmakers are sounding alarms about the Trump administration’s lack of planning for its nationwide distribution.

The federal government traditionally plays a principal role in funding and overseeing the manufacturing and distribution of new vaccines, which often draw on scarce ingredients and need to be made, stored and transported carefully.

There won’t be enough vaccine for all 330 million Americans right away, so the government also has a role in deciding who gets it first, and in educating a vaccine-wary here public about its potential life saving merits.

Right now, it is unclear who in Washington is in charge of oversight, much less any critical details, some state health officials and members of Congress told Reuters…

Health officials and lawmakers say they worry that without thorough planning and coordination with states, the vaccine distribution could be saddled with the same sort of disruptions that led to chronic shortages of coronavirus diagnostic tests and other medical supplies…

Some state public health officials, meanwhile, say their entreaties to the Trump administration have been unanswered.

“We have not heard anything from the federal government since April 23,” Danielle Koenig, health promotion supervisor for the Washington State Department of Health, said in an email.

That is when her agency received preliminary guidance on vaccine planning from the CDC.

Immunization experts along with state and local public health officials sent a letter here to Operation Warp Speed on June 23 pleading for fresh guidance.

States need to know promptly if the federal government will pay for the vaccines, as it did during the H1N1 outbreak in 2009, the letter says. Will alcohol swabs, syringes and personal protective equipment be included? What about record-keeping and refrigeration to store the vaccine and who will deliver it?

So far, there’s been no official response, said Claire Hannan, executive director of the Association of Immunization Managers, one of four organizations that signed the letter.

“We urgently await federal, state and local collaborative discussions to identify challenges and plan solutions. A vaccination campaign of this magnitude is unprecedented and it’s going to take more than an army,” Hannan said on Tuesday, referring to Trump’s repeated statements that the U.S. military stands ready to deliver vaccines.

Trump insists everything is in place.

“We’re all set to march when it comes to the vaccine,” Trump said at a White House briefing on Thursday. “… And the delivery system is all set. Logistically we have a general that’s all he does is deliver things whether it is soldiers or other items.

“We are way ahead on vaccines, way ahead on therapeutics and when we have it we are all set with our platforms to deliver them very, very quickly,” Trump said. (M)

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POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

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“Someone will have to decide which of the world’s 7.8 billion people gets first crack at returning to a more normal life. Infectious disease experts and medical ethicists say this exceptionally complex decision must weigh not only who is most at risk from the virus and who is most likely to spread it, but also who is most important for maintaining the medical and financial health of a nation as well as its safety…

Arthur Caplan, a bioethicist at New York University, said the rush to bring vaccines to market likely will leave many questions unanswered at first about how well they work in different groups. He sees the first public doses as an extension of clinical trials. That will require careful tracking of recipients. “We keep acting as if the race to get FDA approval is the end of things,” he said. “I would say it’s just the start.”..

Traditionally, the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends who should get vaccines, and it has been discussing since April how to divvy up a new coronavirus shot. It is unclear whether officials from the Trump administration’s Operation Warp Speed on vaccine development will want in on the decision as well. “It’s a black box,” said Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia. He thinks Warp Speed will probably focus on distribution. The National Academy of Medicine, at the behest of the National Institutes of Health, has also created an expert panel to study the issue.

At the panel’s first meeting on Friday, Victor Dzau, the academy’s president, said he expected final recommendations by late September to early October. CDC Director Robert Redfield stressed that it was important for Americans to see vaccine allocation as “equitable, fair, and transparent.”

National Institutes of Health Director Francis Collins, who has faced some criticism for potentially adding to decision-making confusion, said this issue is so thorny, we can benefit from extra “deep thinkers.”

“This is going to be controversial,” he said. “Not everybody is going to like the answer.”

Caplan favors an independent commission that includes both scientists and representatives of affected communities, such as people with disabilities and children. Whoever makes the decisions, he said, “it’s got to be trustworthy.”..

Who goes first?

Priorities need to consider the multiple public health roles vaccines can play, said William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center. Typically, younger people mount the strongest immune response, said Schaffner, who represents the National Foundation for Infectious Diseases as a liaison to ACIP. They are currently catching COVID-19 at higher rates and spreading it to other, more vulnerable populations. Vaccinating them could weaken the chain of transmission.

Older people and those with chronic health problems are clearly getting sickest, but vaccines tend to be less effective in these groups. A third group are “the people in society that are responsible for its most essential functions,” Schaffner said: medical workers, police and firefighters, those who make, sell and distribute food.

Schaffner said it’s important not to create such narrow categories that vaccine sits unused in refrigerators. “Vaccine does not prevent disease,” he said. “Immunization prevents disease.”” (A)

“Last month, National Institutes of Health Director Francis Collins called the National Academy of Medicine asking for help: Would the esteemed group be interested in developing guidelines for who should get the first doses of a coronavirus vaccine?

“It will allow the public to know it’s transparent, it’s not political,” said Dr. Victor Dzau, the academy’s president who told Collins that his organization was up to the task. “The American public will want to know how are you making that decision? Why am I not getting it first?”

After months of missteps and criticism across the political spectrum on everything from testing to personal protective equipment, the Trump administration is aiming to prove it can roll out a coronavirus vaccine quickly and fairly to millions of Americans as soon as one is ready. That means tackling thorny challenges like deciding who is first in line for vaccination, securing millions of glass vials and syringes and convincing Americans to get inoculated.

The administration is making moves that experts applaud like tapping top health officials and industry experts to lead vaccine plans rather than politicians, but they are still concerned that the overall effort — dubbed Operation Warp Speed — remains shrouded in secrecy. And the administration’s response to the rest of the pandemic has not inspired confidence.

“It’s sort of being handled like a secret weapon, which is never good,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “Transparency is always good.”

Once a vaccine is approved, every American won’t be able to get it at once. That sets up the unenviable task of deciding, amid a deadly pandemic, who is most vulnerable to the disease and who is most essential to inoculate quickly.

“People are a little uneasy about the government calling the shots here,” NIH’s Dr. Collins told a Senate panel earlier this month.

Experts will have to consider vulnerable populations like those in assisted-living facilities or prisons, people working in close quarters like meat packing plants and how to assess Americans with preexisting conditions.

The National Academy of Medicine hopes to have its recommendations publicly available in August or September.

A second panel of vaccine advisers for the Centers for Disease Control and Prevention — the Advisory Committee on Immunization Practices (ACIP) — is also coming up with a set of guidelines. It’s still unclear whether the administration will select one set of recommendations over the other or take both into account when making its final decisions.

Last month, the ACIP convened electronically in a little-noticed meeting to discuss who counts as an essential worker, where teachers should fall in the priority list, vaccinations for pregnant women and whether race and ethnicity should factor into priority considerations.

“If we fail to address this issue of racial and ethnic groups as a high risk in prioritization, whatever comes out of our group will be looked at very suspiciously and with a lot of reservation,” Dr. José Romero, the panel’s chairman, said….

Once a vaccine is available, it could still take six months to a year to vaccinate enough of the population to slow the spread…

The CDC and Pentagon are working in tandem to deliver the vaccine across America, though they haven’t offered many details about how they plan to do so….

Convincing minority communities that have experienced higher rates of hospitalization and fatality to get vaccinated is a top concern. Experts said that will have to involve community outreach through organizations people already trust, such as faith-based organizations.

“There’s a lot of work that needs to be done in terms of making sure we that engage them earlier to gain their trust,” Dzau of the National Academy of Medicine said. “There are two ways that people can look at it. One is, are we the guinea pig? Or, two, we should get it first because we are more at risk.””  (B)

Why do we need more than one vaccine?

We’ll benefit from several vaccines, said Pulendran, because no single company could meet demand. In addition, the vaccines may differ, working better in some people than others.

“If we’ve got three acceptable vaccines, we’ll get the vaccine to more people,” said Ernst. “Maybe not everybody will get the best vaccine for somebody in their demographic. But assuming they’re equally safe and differ in efficacy only a modest amount, you’re better off being vaccinated than having no vaccine at all.”

Why first isn’t always best

Remember the Salk vs.Sabin polio vaccine debate? We started with Salk’s version, then shifted to Sabin’s. Now, with more information, we’re back to Salk’s.

Imagine that our first vaccine is only 50% effective. (The U.S. Food and Drug Administration, in an apparent effort to encourage vaccine companies, says that’s good enough for licensing, for now.) That will still leave some people, such as the elderly and those with high-risk medical conditions, perilously exposed.

If we’re lucky, vaccines will get better over time.

“It may not be the ultimate vaccine, but it’s the first iteration that can be improved upon,” said Pulendran.

“50% effective” sounds like more mask-wearing. Why can’t we do better?..

Who’s first in line?

If you’re an average healthy adult, you’ll likely be last in line. Health care workers and people at high medical risk would likely be first, Dr. Francis Collins, director of the National Institutes of Health, said Friday.

But there are other considerations. The military, students, underrepresented minorities, “essential workers” or people who volunteered for research may get priority too. If there’s an explosive local outbreak, vaccinating everyone nearby would limit the spread…

How will it be distributed?

Companies have said they’ll defer to the federal government. But experts, noting the disastrous distribution of PPE and tests, say we should look to the multi-channel distribution model of flu vaccines. They say it should be available from governments and doctors — but also directly from the companies, via CVS, Walgreens and other local pharmacies.

“It’s still inconceivable that we’ll be able to get vaccines to 330 million in three to six months,” Dr. Robert Wachter, chair of the Department of Medicine at UC San Francisco, tweeted this past week. During the 2009 swine flu epidemic, he noted, we vaccinated about one-quarter of all Americans — and that took six months.

Vaccinating 80 to 100 million of the nation’s most vulnerable people, including healthcare workers, “might be do-able by mid-’21,” he said.

Not everybody wants one.

Even people who believe in vaccines are showing reluctance to get the COVID-19 vaccine. They worry that politics are creating undue pressure, and corners will be cut in the rush to produce. Only about half of Americans say they would get a COVID-19 vaccine, according to a May poll from The Associated Press-NORC Center for Public Affairs Research. One-third weren’t sure and one-fifth would refuse, citing safety concerns.

If a vaccine is 50% effective, and 50% of the population gets vaccinated, then only 25% of the population is protected, said Ernst.

That’s far short of the 70% protection needed to stop this pandemic. The only solution is to make a better vaccine — and convince more people to take it.

“We’re not going to get this disease under control by just vaccinating health care workers and kindergarten teachers,” said Ernst.

“We need to be thinking about how are we going to convince people to comply with vaccinations,” he said, “so that we’ve got a sufficient amount of the population covered to actually get COVID-19 under control.” (C)

“Federal health officials are already trying to decide who will get the first doses of any effective coronavirus vaccines, which could be on the market this winter but could require many additional months to become widely available to Americans.

The Centers for Disease Control and Prevention and an advisory committee of outside health experts in April began working on a ranking system for what may be an extended rollout in the United States. According to a preliminary plan, any approved vaccines would be offered to vital medical and national security officials first, and then to other essential workers and those considered at high risk — the elderly instead of children, people with underlying conditions instead of the relatively healthy.

Agency officials and the advisers are also considering what has become a contentious option: putting Black and Latino people, who have disproportionately fallen victim to Covid-19, ahead of others in the population.

In private meetings and a recent public session, the issue has provoked calls for racial justice. But some medical experts are not convinced there is a scientific basis for such an option, foresee court challenges or worry that prioritizing minority groups would erode public trust in vaccines at a time when immunization is seen as crucial to ending the pandemic.

“Giving it to one race initially and not another race, I’m not sure how that would be perceived by the public, how that would affect how vaccines are viewed as a trusted public health measure,” said Claire Hannan, executive director of the Association of Immunization Managers, a group represented on the committee.

While there is a standard protocol for introducing vaccines — the C.D.C. typically makes recommendations and state and local public health departments decide whether to follow them — the White House has pressed the agency at times to revise or hold off on proposals it found objectionable. President Trump, who has been pushing to reopen schools, fill workplaces and hold large public events, has been acutely focused on the political consequences of public health guidance…

To speed distribution, the most promising vaccines will start being made even before they have cleared the final stages of clinical trials and been authorized for public use by the Food and Drug Administration.

But there will be a gap between the first doses coming off the manufacturing lines and a stockpile large enough to vaccinate the U.S. population. “I would say months,” Dr. José R. Romero, the chairman of the Advisory Committee on Immunization Practices, predicted.

The committee, which reports to the C.D.C. director, has long played a key role in determining how to implement new vaccines. The group includes 15 voting members selected by the health secretary who come from immunology, infectious disease and other medical specialties, 30 nonvoting representatives from across the health field, and eight federal officials focused on vaccines. Still, it operates largely out of sight.

Dr. Romero is among four committee members who have been deliberating on the plans since this spring alongside doctors at the C.D.C., representatives from the health field, ethicists and other outside consultants. In June, they briefed the full committee on their work, offering a glimpse of the questions being considered.

As they come up with a multitiered schedule for the first 1.2 million vaccine doses and then the next 110 million, they have focused on who should be considered essential workers, what underlying conditions should be taken into account and what kinds of living environments — nursing homes, homeless shelters — put people at high risk. Among the questions: What should be done about pregnant women? Should teachers go toward the front of the line? Should prisoners be in a top tier?

But for the broader committee, questions of whether to prioritize race and ethnicity sparked the most debate.

Black and Latino people have become infected with the virus at three times the rate of whites, and have died nearly twice as frequently. Many of them have jobs that keep them from working at home, rely on public transportation or live in cramped homes that increase their risk of exposure. They are more likely to suffer from underlying health problems, including diabetes and obesity, that raise the risk of hospitalization and death. Not only do the groups have less access to health services, they have a documented history of receiving unequal care.” (H)

“But let’s suppose that health care workers and people with underlying medical conditions use up the first doses of the available vaccine. Should some be held in reserve for Black and Latino people? What about bus drivers and train conductors? Perhaps teachers or schoolchildren should get it so they can return to classrooms with peace of mind.

If shortages happen, most of the nation will have no chance to get the initial lots of a vaccine under the C.D.C.’s plan. And as the United States combats a soaring number of coronavirus cases, rising demand for drugs and maybe ventilators is expected. They, too, will need a fair system of distribution.

One solution that is starting to attract the attention of public health experts is a so-called weighted lottery, which gives everyone a chance at access, although some get a better shot than others.

Doctors and ethicists rank patients, deciding which groups should be given preference and how much. First-responders, for example, may be weighted more heavily than, say, very sick patients who are unlikely to recover.

The goal is to prevent haphazard or inequitable distribution of a treatment or vaccine when there isn’t enough to go around. Such a system has already been used in allocations of remdesivir, the first drug shown to be effective against the coronavirus.

“This is all very new,” said Dr. Douglas White, an ethicist and vice chairman of the department of critical medicine at the University of Pittsburgh, which began using a weighted lottery last month to distribute remdesivir.

Patients have accepted the results, even when they lost in the lottery and ended up being denied the drug, he added.

“I speculate that is because we are very transparent about the reason and the ethical framework that applies to everyone who comes into hospital, whether that is the hospital president or someone who is homeless,” he said.

To allocate the drug, Pittsburgh doctors decided that the lottery would give preference to health care workers and emergency medical workers. The doctors also weighted the odds to favor people from economically disadvantaged areas, who tend to be mostly Black and Hispanic.

People with other illnesses and limited life spans, like end-stage cancer patients, had the odds weighted against them, giving them a smaller chance to win in the lottery. The system did not consider age, race, ethnicity, quality of life, ability to pay or whether a patient has a disability.

The lottery began in early June, Dr. White said: “We had 64 patients. We had to make the supply of remdesivir last at least two weeks. We only had enough to treat one in four patients.”

They had a brief respite from the lottery when cases began falling and supplies of remdesivir seemed adequate. But on Sunday, with cases rising again and enough remdesivir for only about half the patients who could be helped by taking it, the hospital system was forced to go back to a lottery….

Still, in principle, lottery data about a vaccine can be as useful as randomized clinical trial data, Dr. Pathak said.

“We would like to get people to think ahead about how vaccines are allocated,” he said. “There is no way we can vaccinate everybody, so we have to think about what’s fair and what’s just.”” (D)

“TA: Given that equitable distribution of vaccines is, at least in part, a question of ethics, how can computer models help us arrive at a solution?

Swann: It’s an interesting intersection, isn’t it? We can think of problems in terms of our objectives, which in this case might include efficiency (speed), effectiveness (avert deaths), and equity across the population. In public health, equity can be defined in different ways, including geographically (urban and rural) or by population (pro-rata). It can also be defined in terms of outcomes. For example, right now we know that communities of color, including African Americans, Hispanics, and Native Americans, are experiencing much higher rates of COVID-19 mortality than whites, and we know that people who are older or have high-risk medical conditions are also experiencing greater mortality than others.

Computer models can do many things to help with equitable distribution of vaccines. One really important role is to project the impact of different vaccination scenarios or strategies. For example, if there are limited vaccines, what is the impact of vaccinating essential workers, or ones who might interact with a vulnerable group (e.g., nursing home workers)? If there is a group at lower direct risk (e.g., children) who have significant contact with people at risk (parents or grandparents), what would be the impact of vaccinating them? If a vaccine requires two doses, or if immunity wanes after a time period, what strategies can avert the most hospitalizations and deaths? Which strategies would be most effective at reducing the disparities in COVID-19 outcomes associated with communities of color? These are just a few examples of many different decisions where humans could be aided by input from computer models.” (I)

“Nationwide distribution of any coronavirus vaccine will be a “joint venture” between the Centers for Disease Control and Prevention, which typically oversees vaccine allocation, and the Department of Defense, a senior administration official said today.

The Department of Defense “is handling all the logistics of getting the vaccines to the right place, at the right time, in the right condition,” the official said in a call with reporters, adding that CDC will remain in charge of tracking any side effects that emerge post-vaccination and “some of the communications through the state relationships [and] the state public health organizations.”

The plan breaks with the longstanding precedent that CDC distributes vaccines during major outbreaks — such as bad flu seasons — through a centralized ordering system for state and local health officials.

“We believe we’ve actually combined the best of both,” the official said. A second senior administration official stressed the agencies would be working as “one team” to distribute hundreds of millions of doses if any of the vaccines in development are approved in the coming months.

Private companies are also likely to join the effort. The first official said the government is bringing in people to integrate CDC IT capabilities with “some new applications that we’re going to need that the CDC never had.”

The background: The Pentagon will be guiding not just distribution logistics but also manufacturing and “kitting,” the process of safely packaging a vaccine with its necessary equipment such as syringes and needles.

“The DoD is handling all of those logistics — that is where their comparative advantage is,” said the first senior official. “And the CDC, some of their IT systems, relationships with the states following post-vaccination will belong to them.”…

State and local government groups have already raised concerns about Pentagon involvement and using new methods in coronavirus vaccine distribution. The CDC “already leads and maintains a highly effective system of vaccine ordering and distribution,” groups including the Association of State and Territorial Health Officials wrote in June. “With time of the essence we strongly recommend against designing new and untested systems of vaccine distribution.”

The state and local officials also questioned whether military involvement in vaccine administration would undermine already shaky public confidence in vaccines.”  (G)

“Executives from four companies in the race to produce a coronavirus vaccine — AstraZeneca, Johnson & Johnson, Moderna Therapeutics and Pfizer — told lawmakers on Tuesday that they are optimistic their products could be ready by the end of 2020 or the beginning of 2021. All four companies are testing vaccines in human clinical trials.

Three of the firms — AstraZeneca, Johnson & Johnson and Moderna — are getting federal funds for their vaccine development efforts. AstraZeneca and Johnson & Johnson pledged to the lawmakers that they would produce hundreds of millions of doses of their vaccines at no profit to themselves. Moderna, however, which has been granted $483 million from the government to develop its product, made no such promise.

“We will not sell it at cost,” said Dr. Stephen Hoge, the president of Moderna.

Many Democratic lawmakers have argued that federal funding for vaccine development should include provisions to guarantee affordability and guard against profiteering.

At the Congressional hearing on Tuesday, some House members raised concerns about Pfizer’s decision to reject federal funds, suggesting it could lead to price-gouging and a lack of transparency… (E)

“On June 26, a small South San Francisco company called Vaxart made a surprise announcement: A coronavirus vaccine it was working on had been selected by the U.S. government to be part of Operation Warp Speed, the flagship federal initiative to quickly develop drugs to combat Covid-19.

Vaxart’s shares soared. Company insiders, who weeks earlier had received stock options worth a few million dollars, saw the value of those awards increase sixfold. And a hedge fund that partly controlled the company walked away with more than $200 million in instant profits.” (F)

“The Serum Institute, which is exclusively controlled by a small and fabulously rich Indian family and started out years ago as a horse farm, is doing what a few other companies in the race for a vaccine are doing: mass-producing hundreds of millions of doses of a vaccine candidate that is still in trials and might not even work.

But if it does, Adar Poonawalla, Serum’s chief executive and the only child of the company’s founder, will become one of the most tugged-at men in the world. He will have on hand what everyone wants, possibly in greater quantities before anyone else.

His company, which has teamed up with the Oxford scientists developing the vaccine, was one of the first to boldly announce, in April, that it was going to mass-produce a vaccine before clinical trials even ended. Now, Mr. Poonawalla’s fastest vaccine assembly lines are being readied to crank out 500 doses each minute, and his phone rings endlessly.

National health ministers, prime ministers and other heads of state (he wouldn’t say who) and friends he hasn’t heard from in years have been calling him, he said, begging for the first batches.

“I’ve had to explain to them that, ‘Look I can’t just give it to you like this,’” he said.

With the coronavirus pandemic turning the world upside down and all hopes pinned on a vaccine, the Serum Institute finds itself in the middle of an extremely competitive and murky endeavor. To get the vaccine out as soon as possible, vaccine developers say they need Serum’s mammoth assembly lines — each year, it churns out 1.5 billion doses of other vaccines, mostly for poor countries, more than any other company…

But right now it’s not entirely clear how much of the coronavirus vaccine that Serum will mass-produce will be kept by India or who will fund its production, leaving the Poonawallas to navigate a torrent of cross-pressures, political, financial, external and domestic.

India has been walloped by the coronavirus, and with 1.3 billion people, it needs vaccine doses as much as anywhere. It’s also led by a highly nationalistic prime minister, Narendra Modi, whose government has already blocked exports of drugs that were believed to help treat Covid-19, the disease caused by the coronavirus.

Adar Poonawalla, 39, says that he will split the hundreds of millions of vaccine doses he produces 50-50 between India and the rest of the world, with a focus on poorer countries, and that Mr. Modi’s government has not objected to this.” (J)

“First we have to look at the global level. The private sector is really driving the vaccine development process, rather than government or academic labs. Major efforts are underway to figure out how private industrial developers can make vaccines available at an affordable price to all countries, particularly low and middle-income countries. It’s a bit like the ventilator supply situation we’ve all faced, but on steroids. Initially there will be scarce supply of the vaccine, governments will be scrambling to procure it, and, unless these efforts work, the winners will be fairly predictable: countries that have the resources.

On the next level, some wealthy countries will likely end up with substantial amounts of vaccine. Over time, if all goes well, these countries will have to decide how much product they’re going to keep and how much, if any, they’re willing to share with other countries where the vaccine may be in very short supply. These are complex questions of ethics, and they’re wrapped up in geopolitics, and also national politics.

There’s a term called vaccine nationalism—where countries understand their obligations to be primarily, if not exclusively, to their own residents. Although there is an expectation that countries with the resources and production capacity will meet their own health needs first, should they ignore the needs of people living in other countries with severe economic constraints? From an ethics perspective, a balance must be struck.” (K)

“As soon as the first COVID-19 vaccines get approved, a staggering global need will confront limited supplies. Many health experts say it’s clear who should get the first shots: health care workers around the world, then people at a higher risk of severe disease, then those in areas where the disease is spreading rapidly, and finally, the rest of us. Such a strategy “saves the most lives and slows transmission the fastest,” says Christopher Elias, who heads the Bill & Melinda Gates Foundation’s Global Development Division. “It would be ludicrous if low-risk people in rich countries get the vaccine when health care workers in South Africa don’t,” adds Ellen ‘t Hoen, a Dutch lawyer and public health activist.

Yet money and national interest may win out. The United States and Europe are placing advance orders for hundreds of millions of doses of successful vaccines, potentially leaving little for poorer parts of the world. “I’m very concerned,” says John Nkengasong, director of the Africa Centres for Disease Control and Prevention.

To avoid such a scenario, the World Health Organization and other international organizations have set up a system to accelerate and equitably distribute vaccines, the COVID-19 Vaccines Global Access (COVAX) Facility, which seeks to entice rich countries to sign on by reducing their own risk that they’re betting on the wrong vaccine candidates. But the idea has been put together on the fly, and it’s unclear how many rich countries will join.” (L)

“As scientists and pharmaceutical companies work at breakneck speed to develop a vaccine for the novel coronavirus, public health officials and senior U.S. lawmakers are sounding alarms about the Trump administration’s lack of planning for its nationwide distribution.

The federal government traditionally plays a principal role in funding and overseeing the manufacturing and distribution of new vaccines, which often draw on scarce ingredients and need to be made, stored and transported carefully.

There won’t be enough vaccine for all 330 million Americans right away, so the government also has a role in deciding who gets it first, and in educating a vaccine-wary here public about its potential life saving merits.

Right now, it is unclear who in Washington is in charge of oversight, much less any critical details, some state health officials and members of Congress told Reuters…

Health officials and lawmakers say they worry that without thorough planning and coordination with states, the vaccine distribution could be saddled with the same sort of disruptions that led to chronic shortages of coronavirus diagnostic tests and other medical supplies…

Some state public health officials, meanwhile, say their entreaties to the Trump administration have been unanswered.

“We have not heard anything from the federal government since April 23,” Danielle Koenig, health promotion supervisor for the Washington State Department of Health, said in an email.

That is when her agency received preliminary guidance on vaccine planning from the CDC.

Immunization experts along with state and local public health officials sent a letter here to Operation Warp Speed on June 23 pleading for fresh guidance.

States need to know promptly if the federal government will pay for the vaccines, as it did during the H1N1 outbreak in 2009, the letter says. Will alcohol swabs, syringes and personal protective equipment be included? What about record-keeping and refrigeration to store the vaccine and who will deliver it?

So far, there’s been no official response, said Claire Hannan, executive director of the Association of Immunization Managers, one of four organizations that signed the letter.

“We urgently await federal, state and local collaborative discussions to identify challenges and plan solutions. A vaccination campaign of this magnitude is unprecedented and it’s going to take more than an army,” Hannan said on Tuesday, referring to Trump’s repeated statements that the U.S. military stands ready to deliver vaccines.

Trump insists everything is in place.

“We’re all set to march when it comes to the vaccine,” Trump said at a White House briefing on Thursday. “… And the delivery system is all set. Logistically we have a general that’s all he does is deliver things whether it is soldiers or other items.

“We are way ahead on vaccines, way ahead on therapeutics and when we have it we are all set with our platforms to deliver them very, very quickly,” Trump said. (M)

M.Trump planning for U.S. rollout of coronavirus vaccine falling short, officials warn, by Richard Cowan, https://www.reuters.com/article/health-coronavirus-usa-vaccine/trump-planning-for-us-rollout-of-coronavirus-vaccine-falling-short-officials-warn-idUSL2N2EV0V4

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