“The first diagnosis of the coronavirus in the United States occurred in mid-January, in a Seattle suburb not far from the hospital where Dr. Francis Riedo, an infectious-disease specialist, works. When he heard the patient’s details—a thirty-five-year-old man had walked into an urgent-care clinic with a cough and a slight fever, and told doctors that he’d just returned from Wuhan, China—Riedo said to himself, “It’s begun.”…
Epidemiology is a science of possibilities and persuasion, not of certainties or hard proof. “Being approximately right most of the time is better than being precisely right occasionally,” the Scottish epidemiologist John Cowden wrote, in 2010. “You can only be sure when to act in retrospect.” Epidemiologists must persuade people to upend their lives—to forgo travel and socializing, to submit themselves to blood draws and immunization shots—even when there’s scant evidence that they’re directly at risk…
The lead spokesperson should be a scientist. Dr. Richard Besser, a former acting C.D.C. director and an E.I.S. alumnus, explained to me, “If you have a politician on the stage, there’s a very real risk that half the nation is going to do the opposite of what they say.” During the H1N1 outbreak of 2009—which caused some twelve thousand American deaths, infections in every state, and seven hundred school closings—Besser and his successor at the C.D.C., Dr. Tom Frieden, gave more than a hundred press briefings. President Barack Obama spoke publicly about the outbreak only a few times, and generally limited himself to telling people to heed scientific experts and promising not to let politics distort the government’s response. “The Bush Administration did a good job of creating the infrastructure so that we can respond,” Obama said at the start of the pandemic, and then echoed the sohco by urging families, “Wash your hands when you shake hands. Cover your mouth when you cough. I know it sounds trivial, but it makes a huge difference.” At no time did Obama recommend particular medical treatments, nor did he forecast specifics about when the pandemic would end…
Constantine told me that he understands why politicians “want to be front and center and take the credit.” And he noted that Seattle has many of “the same problems here you see in Congress, with the partisanship and toxicity.” But, he said, “everyone, Republicans and Democrats, came together behind one message and agreed to let the scientists take the lead.”…
Today, Washington State has less than two per cent of coronavirus cases in the U.S. At EvergreenHealth, hospital administrators have stopped daily crisis meetings, because the rate of incoming patients has slowed. They have empty beds and extra ventilators. The administrators remain worried, but are cautiously optimistic. “It feels like we might have stopped the tsunami before it hit,” Riedo told me. “I don’t want to tempt fate, but it seems like it’s working. Which is what makes it so much harder when I look at places like New York.”…
The initial coronavirus outbreaks in New York City emerged at roughly the same time as those in Seattle. But the cities’ experiences with the disease have markedly differed. By the second week of April, Washington State had roughly one recorded fatality per fourteen thousand residents. New York’s rate of death was nearly six times higher.
There are many explanations for this divergence. New York is denser than Seattle and relies more heavily on public transportation, which forces commuters into close contact. In Seattle, efforts at social distancing may have been aided by local attitudes—newcomers are warned of the Seattle Freeze, which one local columnist compared to the popular girl in high school who “always smiles and says hello” but “doesn’t know your name and doesn’t care to.” New Yorkers are in your face, whether you like it or not. (“Stand back at least six feet, playa,” a sign in the window of a Bronx bodega cautioned. “covid-19 is some real shit!”) New York also has more poverty and inequality than Seattle, and more international travellers. Moreover, as Mike Famulare, a senior research scientist at the Institute for Disease Modeling, put it to me, “There’s always some element of good luck and bad luck in a pandemic.”
It’s also true, however, that the cities’ leaders acted and communicated very differently in the early stages of the pandemic. Seattle’s leaders moved fast to persuade people to stay home and follow the scientists’ advice; New York’s leaders, despite having a highly esteemed public-health department, moved more slowly, offered more muddied messages, and let politicians’ voices dominate….
Today, New York City has the same social-distancing policies and business-closure rules as Seattle. But because New York’s recommendations came later than Seattle’s—and because communication was less consistent—it took longer to influence how people behaved. According to data collected by Google from cell phones, nearly a quarter of Seattleites were avoiding their workplaces by March 6th. In New York City, another week passed until an equivalent percentage did the same. Tom Frieden, the former C.D.C. director, has estimated that, if New York had started implementing stay-at-home orders ten days earlier than it did, it might have reduced covid-19 deaths by fifty to eighty per cent. Another former New York City health commissioner told me that “de Blasio was just horrible,” adding, “Maybe it was unintentional, maybe it was his arrogance. But, if you tell people to stay home and then you go to the gym, you can’t really be surprised when people keep going outside.”
More than fifteen thousand people in New York are believed to have died from covid-19. Last week in Washington State, the estimate was fewer than seven hundred people. New Yorkers now hear constant ambulance sirens, which remind them of the invisible viral threat; residents are currently staying home at even higher rates than in Seattle. And de Blasio and Cuomo—even as they continue to squabble over, say, who gets to reopen schools—have become more forceful in their warnings. Rasmussen said, “It seems silly, but all these rules and sohcos and telling people again and again to wash their hands—they make a huge difference. That’s why we study it and teach it.” She continued, “It’s really easy, with the best of intentions, to say the wrong thing or send the wrong message. And then more people die.” (A)
“You relish the little things here in Seattle: Toilet paper is back on some shelves, the hoarders sated for the moment. Instead of making vodka, distilleries are rolling out hand sanitizer. The dreaded daily number of new coronavirus cases shows that while the curve is not yet flat, the rate has gone both down and up on different days this week, carrying our hopes on the bumpy ride.
As for the tally of the dead: Instead of doubling every five days in Washington State, as it was just two weeks ago, now it doubles roughly every nine — a horrific number still, but that movement is in the right direction.
We are not necessarily your city’s future, but a likely version of your future if you do the right thing. Washington State had the first known case of Covid-19 in the United States, on Jan. 19; the first reported death, more than a month after that; and the first full-blown outbreak. We’re well ahead of the rest of the nation in our cycle of denial, panic, action.
Social distancing started early. Testing has been broad, though more help from the federal government is needed. A communal fight or flight instinct has moved into something more settled. Even as the president floats an idea that could sacrifice the elderly to keep Wall Street happy, we take care of our own. We will not throw Grandma from the train.
“There really is no middle ground,” said Bill Gates, whose foundation has put up $100 million to blunt the impact of the Covid-19 pandemic. “It’s very tough to say to people, ‘Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies in the corner.’ ”
President Trump’s talk of opening the United States for business by Easter is greeted in this precinct of sanity as the heartless bluster of a career con man. The public radio station in Seattle, KUOW, has stopped airing Trump’s live briefings because the volume of misinformation he puts out cannot be corrected in real time.” (B)
“…on Jan. 15, at the international airport south of Seattle, a 35-year-old man returned from a visit to his family in the Wuhan region. He grabbed his luggage and booked a ride-share to his home north of the city.
The next day, as he went back to his tech job east of Seattle, he felt the first signs of a cough — not a bad one, not enough to send him home. He attended a group lunch with colleagues that week at a seafood restaurant near his office. As his symptoms got worse, he went grocery shopping near his home.
Days later, after the man became the first person in the United States to test positive for the coronavirus, teams from federal, state and local agencies descended to contain the case. Sixty-eight people — the ride-share driver at the airport, the lunchmates at the seafood restaurant, the other patients at the clinic where the man was first seen — were monitored for weeks. To everyone’s relief, none ever tested positive for the virus.
But if the story ended there, the arc of the coronavirus’s sweep through the United States would look much different.
As it turned out, the genetic building block of the virus detected in the man who had been to Wuhan would become a crucial clue for scientists who were trying to understand how the pathogen gained its first, crucial foothold.
Working out of laboratories along Seattle’s Lake Union, researchers from the University of Washington and the Fred Hutchinson Cancer Research Center rushed to identify the RNA sequence of the cases from Washington State and around the country, comparing them with data coming in from around the world.
Using advanced technology that allows them to rapidly identify the tiny mutations that the virus makes in its virulent path through human hosts, the scientists working in Washington and several other states made two disconcerting discoveries.
The first was that the virus brought in by the man from Wuhan — or perhaps, as new data has suggested, by someone else who arrived carrying a nearly identical strain — had managed to settle into the population undetected.
Then they began to realize how far it had spread. A small outbreak that had established itself somewhere north of Seattle, they realized as they added new cases to their database, was now responsible for all known cases of community transmission they examined in Washington State in the month of February.
And it had jumped.
A genetically similar version of the virus — directly linked to that first case in Washington — was identified across 14 other states, as far away as Connecticut and Maryland. It settled in other parts of the world, in Australia, Mexico, Iceland, Canada, the United Kingdom and Uruguay. It landed in the Pacific, on the Grand Princess cruise ship.
The unique signature of the virus that reached America’s shores in Seattle now accounts for a quarter of all U.S. cases made public by genomic sequencers in the United States.
With no widespread testing available, the high-tech detective work of the researchers in Seattle and their partners elsewhere would open the first clear window into how and where the virus was spreading — and how difficult it would be to contain.
Even as the path of the Washington State version of the virus was coursing eastward, new sparks from other strains were landing in New York, in the Midwest and in the South. And then they all began to intermingle….
There was minimal coronavirus testing in the United States during February, leaving researchers largely blind to the specific locations and mutations of the spread that month. The man who had traveled from Wuhan was not at the dance, nor was anyone else known to have traveled into the country with the coronavirus. But researchers learned that the virus by then was already spreading well beyond its point of origin — and all the cases of community transmission that month were part of that same genetic branch.
There was another spreading event. On the Saturday after the dance, a group of friends packed the living room of a one-bedroom apartment in Seattle, sharing homemade food and tropical-themed drinks.
Over the following days, several people began coming down with coronavirus symptoms. “Among people who attended, four out of every 10 got sick,” said Hanna Oltean, an epidemiologist with the Washington State Department of Health.
Several people passed on the virus to others. By late March, the state health department had documented at least three generations of “transmission occurring before anyone was symptomatic,” Ms. Oltean said.
By then, it was becoming clear that there were probably hundreds of cases already linked to the first point of infection that had been spreading undetected. It left a lingering question: If the virus had this much of a head start, how far had it gone?
The large outbreak on the Grand Princess, a researcher said, could probably be traced to a single person linked to the Washington State cluster….
A group of cases throughout the Midwest, first surfacing in early March, appears to have roots in Europe. A group of cases in the South, which emerged around the same time, on March 3, appears like a more direct descendant from China.
But of all the branches that researchers have found, the strain from Washington State remains the earliest and one of the most potent.
It has surfaced in Arizona, California, Connecticut, the District of Columbia, Florida, Illinois, Michigan, Minnesota, New York, North Carolina, Oregon, Utah, Virginia, Wisconsin and Wyoming, and in six countries…
One of the enduring mysteries has been just how the virus managed to gain its first, fatal foothold in Washington.
Did the contact tracers who followed the steps of the man who had traveled from Wuhan miss something? Did he expose someone at the grocery store, or touch a door handle when he went to the restaurant near his office?
In recent days, the sequencing of new cases has revealed a surprising new possibility. A series of cases in British Columbia carried a genetic footprint very similar to the case of the Wuhan traveler. That opened up the possibility that someone could have carried that same branch of the virus from Wuhan to British Columbia or somewhere else in the region at nearly the same time. Perhaps it was that person whose illness had sparked the fateful outbreak.
But who? And how? That would probably never be known.” (C)
JULY 13, 2020
For the first time in months, there was a 24-hour period in which no one in New York City died of the coronavirus.
The New York City Department of Health and Mental Hygiene reported zero deaths on Saturday, but that number could change as death data can lag and new deaths could be confirmed retroactively at any point. The city’s first confirmed coronavirus death was March 11.
Mayor Bill de Blasio called the milestone a statement about “how this city fights back and people do not ever give in.”
“It’s something that should make us hopeful, but it’s very hard to take a victory lap because we know we have so much more ahead. This disease is far from beaten,” de Blasio said during a news conference Monday. “And we look around the country and we look at what so many other Americans are going through and so many other states and cities hurting so bad right now. So no one can celebrate, but we can at least take a moment to appreciate that every one of you did so much to get us to this point.”..
On Monday, the city reported a 2% positivity rating for coronavirus testing. Fifty-six patients were admitted to the hospital, and 279 patients were in intensive care units.” (D)
JULY 16, 2020
“In what seems like almost a lifetime ago, America’s coronavirus story started in January in Washington State, with the nation’s first confirmed case followed by an early outbreak that spread with alarming ferocity.
But swift lockdown measures were credited with holding down illnesses and deaths. By June, nail salons and bars had begun to reopen, even as the virus began to rage in Texas, Arizona and Florida. Washington still had relatively low case numbers, and some counties were even contemplating a return to movie theaters and museums.
Now, those plans are on hold.
The coronavirus is once again ravaging Washington, and the number of cases has hit grim new milestones. Since the middle of June, the state has reported an average of 700 new cases per day — the highest levels since the start of the pandemic. More than 45,000 people have been infected, and over 1,400 have died.
“If these trends were to continue, we would have to prepare to go back to where we were in March,” Gov. Jay Inslee said recently.
Six months after the coronavirus first reached the United States, the state that was on the initial front line — a state that locked down early and hard — is only now beginning to see how complicated and lengthy the fight may be.
A lot of things are going wrong at once. Young people, less likely to die of the virus and undoubtedly weary of social distancing measures, have been driving a spike in new infections in the Seattle area. And an outbreak here in Yakima County that began powering its way through agriculture workers in the spring has now spread widely through a community that has not embraced self-isolation and masking to the degree that many Seattleites have.
Yakima, the eighth-most populous county, now has the second-highest number of cases. While the county cannot be blamed for hot spots elsewhere, Yakima does show how the virus can simmer along at a seeming lull — until a new outbreak suddenly surges through an entire region, challenging officials to stitch together cohesive policies for a patchwork of different problems.
“It’s really important for people to understand that their individual behaviors, everyone’s individual behaviors, collectively have a big impact on transmission,” said Dr. Kathy Lofy, Washington’s health officer. “We can increase testing, we can do case and contact investigations, we can do outbreak response, but those activities only get us so far.”
When the virus first came to Washington, the eastern part of the state was not hit as badly as Seattle, a liberal city with legions of tech workers who dutifully stayed home. But lockdown measures were not as effective in Yakima, a much less affluent county where more than 60 percent of people work in meat- or fruit-packing plants or other essential jobs.
The county is home to a large Hispanic population, which officials have said is more at risk for the coronavirus because of crowded living conditions where the virus can easily spread or limited access to health care. Many people live paycheck to paycheck, and if they were able to get up and go to work, they did.
By mid-May, people who worked in Yakima’s fruit-packing facilities had started to get sick. Terrified of working on crowded assembly lines or in warehouses that were not regularly cleaned, many went on strike, even as the virus spread outside the buildings’ walls.
The Matson Fruit Company in Selah, Wash. More than 60 percent of people in Yakima work in meat- or fruit-packing plants or other essential jobs.Credit…Jovelle Tamayo for The New York Times
Cases hit a peak in early June, according to Dr. Teresa Everson, the health officer for the Yakima Health District, just as more workers were cramming into processing facilities for the beginning of Washington’s busy cherry-picking season.
Still, only a third of those in the county wore masks, according to one survey from health officials. In the past few weeks, infectious people have gone to at least 20 family gatherings, 15 birthday parties, two baby showers and two weddings, Dr. Everson said. Some businesses were even reluctant to work with her office, which was trying to track cases and do contact tracing.
“There are a few large employers that persistently do not return our phone calls and do not want to work with us,” Dr. Everson said…
Just a few weeks ago, the state was confident that it could reopen schools in the fall, allowing many parents to go back to work and fuel the state’s economic recovery. But amid mounting opposition from educators and health experts, those plans look increasingly unlikely. And on Tuesday, Mr. Inslee said that no counties would be allowed to loosen lockdown restrictions for at least two weeks.
In Seattle, still the heart of the state’s outbreak, many people are resigned to the precautions they envision for the foreseeable future. On July 4, families wearing masks grilled tortillas, played on swings and enjoyed the parks — many feet away from anyone else. Salons took customers’ temperatures before letting them in. At Target, people lined up six feet apart at the cashier.
“Mask usage is changing very rapidly in my state,” he said. “What we’re asking people to do, they are doing.”” (E)
“New York, once the center of the coronavirus pandemic, has so successfully stemmed the outbreak that its death and hospitalization rates have plummeted and it has among the lowest infection rates in the country.
But the state and its neighbors are facing a disquieting new threat: Can they keep the virus suppressed when it is raging across the South and West?
Officials and public health experts are especially concerned that infected travelers from any of the nearly 40 states where the outbreak is spiking could set off new clusters in New York. Gov. Andrew M. Cuomo on Monday imposed more restrictions on travelers from states with high infection rates, but it is not all clear that they will be followed — or are even enforceable.
Tens of thousands of people enter New York daily through its airports, highways and train stations, and compliance largely depends on the whims of visitors and of residents returning home.
Mr. Cuomo has warned it is almost inevitable that the virus will seep back into the state, much the way it came to New York through flights from Europe in February. He has also raised concerns that some New Yorkers might let their guard down and blamed local governments for not enforcing mask-wearing and social-distancing measures.
But his focus lately has been on trying to keep the virus from re-entering New York: Travelers from 22 states where cases have increased must now quarantine for two weeks upon arrival in New York. And beginning Tuesday, travelers arriving at New York airports will be required to fill out a form with their personal information and planned whereabouts, or face a $2,000 fine.
Epidemiologists said they were skeptical that the measures would work.
“I think it’s going to be incredibly hard to keep the virus out of New York State,” said Isaac Weisfuse, a former New York City deputy health commissioner. “I think that these types of travel restrictions may be somewhat helpful, but we should assume that they’re not going to be airtight.”
But Dr. Weisfuse, an adjunct professor at Cornell University’s master of public health program, and other epidemiologists said New York was better positioned to deal with a surge in cases this time around.
They said that government officials had a better understanding of the virus and that doctors in New York had learned invaluable lessons from treating the disease. People in New York, where more than 400,000 people were infected and more than 30,000 died, are keenly aware of the risks and, for the most part, of the importance of wearing masks. The state has also dramatically ramped up its testing capacity, processing about 60,000 tests per day.
“I don’t anticipate that in New York, we’re going to have a second wave that is going to look like what we have in Texas and Florida,” said Dr. W. Ian Lipkin, director of the Center for Infection and Immunity at the Mailman School of a Public Health at Columbia University. “We can’t become complacent, and I don’t think we will. I am cautiously optimistic.”
In July, New York averaged about 10 virus-related deaths a day, a huge drop from the 799 deaths over a 24-hour period at the peak of the outbreak in April. About 790 people are hospitalized, down from nearly 19,000 people a few months ago when hospitals were nearly overrun.
But New York officials are readying for a spike, however big or small, as states like Florida continue to report record number of cases — more than 12,000 on Monday — and others, like California, impose sweeping rollbacks of their reopening plans, forcing many businesses to close again.
Officials in New York — unlike in Connecticut and New Jersey, which also implemented a quarantine requirement — have sought to proactively enforce the quarantine order. The state instituted fines of up to $10,000 and made it legal to order people to self-isolate, if necessary.
But no fines or mandatory isolation orders have been issued in New York City since the order took effect on June 25, according to a city spokeswoman. Instead, both state and city officials have urged travelers to take the order seriously and are hoping visitors will comply voluntarily, as with similar executive orders mandating masks and social distancing.
Mr. Cuomo himself has acknowledged the difficulty of enforcing the mandate and the government’s limited reach, likening enforcement to “trying to catch water in a screen.”
“New York’s problem is we have the infection coming from other states back to New York,” Mr. Cuomo, a third-term Democrat, said on Monday, noting the state is not “a hermetically sealed bubble.”
Officials estimate about 12,000 people visit New York daily from the states on the quarantine list, which is updated regularly according to certain virus health metrics. The quarantine currently applies to travelers from a broad swath of mostly the West and South where cases have skyrocketed, including California, Florida and Texas. On Tuesday, Minnesota, New Mexico, Ohio and Wisconsin were added to the list and Delaware was removed.” (F)
“Monday brings a new stage of activity to the city, allowing some places to reopen outdoors, while many activities inside, like restaurant dining, will still be forbidden.
Mayor Bill de Blasio said the city would allow some outdoor entertainment venues like zoos and botanical gardens to reopen with limited capacities but that restrictions would remain on indoor activities.
We are moving forward with Phase 4 on Monday. Now, the state of New York is finishing some work today into this afternoon on the specifics, and they’ll have a formal announcement later on. But I can give you the broad outlines now of what we’ve talked about with the state. Let’s focus first on outdoors, again, outdoors has proven to be the area where we’re seeing a lot of things work successfully. So, we’re going to restart the low-risk outdoor arts and entertainment activities. This means things like botanical gardens and zoos, for example. They can reopen but at reduced capacity, 33 percent capacity. Production of movies, TV shows — that can proceed. The, obviously, something that matters to a lot of us, sports coming back. But again — without audiences. Indoors is where we have concerns. Some indoor activities can exist with the proper restrictions. But there’s going to be care when it comes to indoors. Each and every situation is going to be looked at very carefully, very individually. So some will not resume in Phase 4, certainly not right away. That continues to be, first of all, indoor dining. That could have started earlier. We’ve said that’s not happening. That continues to not happen. That is very high risk. And we’ve seen that around the country. Museums, not yet. Malls, not yet. Still closed for now. We’ve got to strike a balance, and we’ve got time to look at the evidence, watch what’s happened around the country, watch what’s happening here in the city, and make further decisions on some of these pieces. And we’ll do that very carefully with the state of New York.
Amid concerns about a coronavirus resurgence, New York City will enter a limited fourth phase of reopening on Monday, allowing some art and entertainment venues, like zoos and botanical gardens, to open for outdoor activities at a limited capacity, officials announced on Friday.
But stringent restrictions will remain on indoor activities: Gyms, malls, movie theaters and museums will remain shuttered, and indoor dining will still not be allowed.
“We’ve got to strike a balance, and we’ve got time to look at the evidence,” Mayor Bill de Blasio said at a news conference. “Watch what’s happening around the country, watch what’s happening here in the city and make further decisions on some of these pieces, and we will do that very carefully with the State of New York.”
Officials are increasingly concerned about the possibility that visitors from other states will spread the virus in New York, once the epicenter of the pandemic. Last month, Gov. Andrew M. Cuomo put in place an executive order that requires travelers from states with high infection rates to quarantine for 14 days upon arrival.
But Mr. Cuomo said on Friday that the order might not be enough to fend off the virus, and reiterated that he was troubled by reports of New Yorkers, especially young people, letting their guard down and eschewing social-distancing and mask-wearing measures.
The governor announced new regulations on Thursday meant to crack down on outdoor drinking and mingling outside bars and restaurants. The new rules ban establishments from selling alcohol to customers who do not also buy food.
“It is inevitable that there will be a second wave,” Mr. Cuomo, a third-term Democrat, said in a conference call with reporters on Friday. “But the second wave is going to be the confluence of the lack of compliance and the local governments’ lack of enforcement, plus the viral spread coming back from the other states. It is going to happen.”
He added, “Just because it is not there today does not mean it’s not going to happen.”
New York City is the last part of the state to enter the final phase of reopening — a feat Mr. Cuomo described as “a hallmark.” Phase 4 permits groups of up to 50 people and indoor religious gatherings to operate at one-third of maximum capacity. Restrictions will also be eased to allow the resumption of outdoor film production and professional sports without audiences.
But concerned about the virus’s spreading more rapidly in dense and crowded New York City, Mr. Cuomo said that Phase 4 of reopening in the city would not restore any additional indoor activities — even though other regions of the state further along in reopening have done so, for example, by allowing indoor dining at up to half capacity.
Museums have also been permitted to open in upstate areas, and malls have been allowed to get back to business as long as they put in place specialized air filtration systems that can filter out virus particles.
The lack of uniformity in what is being allowed in different parts of the state has raised complaints from some buiness owners and patrons. Mr. Cuomo said the state would revisit the city’s relatively curtailed Phase 4 as the “facts change.”
The limits on indoor dining were a devastating blow for the city’s thousands of restaurants, many of which were expecting to supplement revenues from outdoor dining with the expected return of indoor dining at a reduced capacity.
Many restaurants are not making enough money with just takeout and outdoor dining, and are struggling to pay their current and back rent. Restaurants in neighborhoods like Midtown Manhattan that have been emptied of office workers are struggling more than those in residential neighborhoods.
“Extending the time frame for outdoor dining is critical, but long term, it won’t sustain the industry without financial support that needs to come from the federal government,” said Andrew Rigie, the executive director of the New York City Hospitality Alliance.
The cautious approach also upended the plans of several cultural institutions in New York City, including the Metropolitan Museum of Art and the Museum of the City of New York, both of which had announced intentions to reopen in a few weeks.
Still, four city zoos and the New York Botanical Garden have already announced they will open to the public at limited capacity by the end of the month.
Those openings are sure to give New York an added semblance of normalcy, even as small businesses and restaurants have struggled to operate on slim margins since the broad shutdown in mid-March.
Offices, hair salons, barbershops and construction sites have all opened, albeit with restrictions on capacity, strict cleaning requirements and mandatory social distancing.
More than 8,600 restaurants have set up outdoor dining operations, Mr. de Blasio said. The city will close off an additional 40 blocks to allow even more dining capacity, the mayor said, and extend the use of sidewalks and streets for outdoor dining through Oct. 31.
“A lot of people thought that ‘How could this place, this crowded, energetic place, possibly do shelter in place or social distancing or face coverings?’” said Mr. de Blasio, a Democrat. “Well, you proved to the world it could be done the right way, and that’s why we are now on the verge of Phase 4.” (G)
“State health officials confirmed 742 new coronavirus cases in Washington on Wednesday and 17 additional deaths linked to COVID-19.
According to the Department of Health, at least 372 patients are currently hospitalized with COVID-19 illnesses across Washington — an increase of 19 from the day before. Dr. Kathy Lofy, the state health officer, said the daily average for hospital admissions, while still well below the peak, is about double where it was in mid-May. The state continues to closely monitor hospital activity and occupancy, coordinate transfers and reprioritize distribution of protective gear to frontline workers as needed.
More than 4,884 new illnesses have been confirmed in Washington over the last seven days, representing a statewide case rate of 561.4 per 100,000 residents, according to the Centers for Disease Control and Prevention’s case tracker. The highest rate of cases by population continues to be seen in central Washington counties, particularly in Franklin, Adams and Yakima.
While a portion of the increase can be attributed to recent boosts in testing, other concerning trends continue to play a role.
“While we are doing more testing, we know that the number of cases is not simply due to more testing, but also a rate of increase in disease transmission as well,” said John Wiesman, the state secretary of health.
In King County, the effective reproductive number, a figure used to estimate how many people are infected by someone with the illness, is at 1.7 — above the target of one.
Wiesman said the state’s guidance on preventing the spread remains the same but must be followed by all to be effective: keep physical distance from others, interact with as few people as possible, maintain a “personal bubble” of a few people and wear face coverings in public spaces.
At least 43,046 people have now tested positive for COVID-19 in Washington. Nearly 734,000 Washingtonians have been tested for the virus, with 5.9 percent of tests coming back positive.
During a weekly telebriefing with reporters Wednesday, state health leaders pointed to early success in mask use in three counties where transmission rates have been alarmingly high.
Before the governor’s statewide mandate requiring masks inside businesses went into effect this month, it was required in just three counties with a large increase in cases: Benton, Franklin and Yakima. As the rules were put in place, the state asked each county to conduct surveys to track how well residents were complying with the directive.
A few weeks ago, Benton and Franklin counties had a 58 percent compliance rate. In the last week, that figure grew to 95 percent. In Yakima County, just 35 percent of those surveyed said they wore face coverings when the survey began. The latest results showed their rate of compliance also grew to 95 percent.
The state secretary of health said preliminary findings in Yakima County have coincided with a nearly 60 percent drop in transmission rates since early June.
A recent report from the Bellevue-based Institute for Disease Modeling shows significant progress must be made to curb the spread of the coronavirus if schools are to successfully reopen in the fall.
According to researchers, efforts to reduce spread in school buildings will not sufficiently suppress transmission on its own, if the rate of infection remains where it is now.
The report finds that community-wide mitigation efforts, including limited mobility, must improve before schools open in September, or risk triggering “exponential growth” in COVID-19 activity.
“Under a scenario in which mobility in the community increases to 80% of pre-COVID levels, none of the mitigating strategies in schools we explored would be able to reduce the effective reproductive number to one or below, meaning the epidemic will grow,” the authors wrote.” (H)
“Washington could be in for another round of coronavirus restrictions, Gov. Jay Inslee said Thursday, during a news conference where he announced a limit of 10 people at social gatherings in Washington counties that are further along in the reopening process.
Inslee’s announcement came as Washington set a new record for confirmed cases of the new coronavirus, with state health officials Thursday reporting 1,267 new cases and six additional deaths. The tally clocked in at nearly twice the average number of cases per day in the past two weeks.
Throughout Friday, on this page, we’ll be posting Seattle Times journalists’ updates on the outbreak and its effects on the Seattle area, the Pacific Northwest and the world. Updates from Thursday can be found here, and all our coronavirus coverage can be found here.
Washington Gov. Jay Inslee added a new state rule this week as COVID-19 cases surge in the state: There will now be a 10-person limit on social gatherings for counties that are in the third phase of Washington’s four-part coronavirus reopening plan.” (I)
“Under the “Safe Start” plan, individual counties are able to apply to the secretary of health to move between the phases or add new business activities. Counties are currently prohibited from applying to a new phase until at least July 28.
When applications are allowed, they must be submitted by a county executive. If a county does not have a county executive, it must be submitted with the approval of the County Council/Commission.
The Secretary of Health evaluates each application based on how their data compares to certain targets. Click here for a complete breakdown.
An individual county’s ability to respond to outbreaks, increased deaths, health system capacity and other factors are also considered.
The Secretary of Health can approve the plans as submitted, approve with modifications or can deny the application.
Here’s a breakdown of what is allowed in each phase:
Phase 1
High-risk populations: Continue to stay home, stay healthy.
Outdoor: Some outdoor recreation (hunting, fishing, golf, boating, hiking).
Gatherings: Religious organizations can now hold outdoor services with up to 100 people. Proper social distancing should be practiced and attendees should wear face coverings.
Travel: Only essential travel.
Business/Employers: Essential businesses open, including existing construction that meets agreed-upon criteria, landscaping, automobile sales, retail (curb-side pick-up orders only), car washes, pet walkers.
Phase 2
High-risk populations: Continue to stay home, stay healthy.
Outdoor: All outdoor recreation involving fewer than five people outside your household (camping, beaches, etc.)
Gatherings: Gather with no more than five people outside your household per week. Indoor religious gatherings can be held at 25% capacity or with less than 50 people, whichever is less.
Travel: Limited non-essential travel within proximity of your home.
Business/Employers: Remaining manufacturing, new construction, in-home/domestic services (nannies, housecleaning, etc.), retail (In-store purchases allowed with restrictions), real estate, professional services/office-based businesses (telework remains strongly encouraged), hair and nail salons/barbers, restaurants <50% capacity, with table sizes no larger than 5.
Phase 3
High-risk populations: Continue to stay home, stay healthy.
Outdoor: Outdoor group recreational sports activities (5-50 people), recreational facilities at <50% capacity (public pools, etc.). Beginning Monday, gatherings in phase three will be capped at no more than 10 people.
Gatherings: Allow gatherings with no more than 50 people.
Travel: Resume non-essential travel.
Business/Employers: restaurants <75% capacity/table size no larger than 10, bars at <25% capacity, movie theaters at <50% capacity, government (telework remains strongly encouraged), libraries, museums, all other business activities not yet listed except for nightclubs and events with greater than 50 people.
Phase 4
High-risk populations: Resume public interactions, with physical distancing
Outdoor: Resume all recreational activity.
Gatherings: Allow gatherings >50 people.
Travel: Continue non-essential travel.
Business/Employers: Nightclubs, concert venues, large sporting events, resume unrestricted staffing of worksites, but continue to practice physical distancing and good hygiene.
The state is using certain metrics to evaluate when and how to lift various restrictions. The five metrics being used are: COVID 19 disease activity; testing capacity and availability; case and contact investigations; risk to vulnerable populations, and health care system readiness.” (J)
“Leaving the nation’s coronavirus fight to individual states has created gaping holes in the public health response that have allowed the infection rate to soar and death rates to rise once again.
While countries like New Zealand and Germany have taken a unified national approach to fighting the virus — and are enjoying the fruits of a successful mitigation strategy — the Trump administration’s federalist philosophy has helped create chaos across the South and West.
Cash-strapped cities and states trying to create their own testing, tracing and public awareness campaigns from scratch are desperate for federal support as they grapple with questions about whether it’s safe for people to return to school and work, along with bars and beaches.
“Every governor is out there on his or her own working to build the same programs that are being built next door,” said Reed Schuler, a senior advisor to Democratic Washington Gov. Jay Inslee. “The federal government’s efforts range from a little bit of backup to not even being present.”
This dangerous new chapter of the coronavirus outbreak is intensifying calls from politicians and public health experts across the country for a set of national strategies to combat the virus.
The nursing home industry has been pushing for looser regulations for years. And they got what they wanted at the start of the pandemic. But now, advocates say lax standards are fueling the virus’ spread.
Arkansas’ entire congressional delegation — all Republicans — wrote Vice President Mike Pence this week asking the federal government to address shortages of chemical reagents needed to analyze coronavirus tests.
And New York Gov. Andrew Cuomo, a Democrat, expressed his frustration with the federal government’s pandemic response on Tuesday. “The White House doesn’t get it,” he tweeted. “Until we control this virus as a nation, the economy can’t fully recover. Where is the national plan?”
Rep. Greg Stanton (D-Ariz.), who represents hard-hit Maricopa County, expressed similar frustration. “How can you have national success without having a national plan?” he said. “How do you fight the worst pandemic in 100 years without a coordinated strategy?”
A White House official rejected such criticism. “We’re in a much better position now than we were at the beginning of the pandemic in terms of [personal protective equipment], ventilators, testing capacity, and vaccine and therapeutics development,” the official said.
The situation today is not as dire as it was in March and April in some ways. There are no shortages of ventilators, and doctors have more experience treating the virus. The country’s testing capacity has grown exponentially, and the death rate is lower thanks to concerted efforts to protect seniors and other vulnerable groups.
But with cases still rising, public health experts say much more federal support and leadership are needed to bring the outbreak under control — and keep it that way.
“We shut down the country for three months and we could have used that time for all kinds of planning and preparing, and we did not use it at all,” said David Eisenman, the director of the UCLA Center for Public Health and Disasters.
Once-isolated outbreaks have grown into a national calamity concentrated in the South and Sunbelt where governors took early victory laps. Now the virus is spreading northward into the heartland and industrial Midwest, erasing the progress made in March, April and May while the country was locked down.
With the death toll rising, several governors have reimposed restrictions on businesses and public life — a move they once described as a last resort. School districts in Arizona, California and North Carolina are delaying their return to in-person learning, despite the president’s threats to cut federal funding for districts that don’t fully reopen.
In many ways, the White House has positioned itself as a consultant to states as they battle the virus. Federal officials, including Vice President Mike Pence, have warned that the government’s Strategic National Stockpile is only a stopgap — and that states themselves are primarily responsible for securing masks, gowns, gloves and chemicals for testing on the open market.
Pence, White House coronavirus coordinator Deborah Birx and others have also gone on listening tours in states where cases are climbing the fastest. Federal officials have also worked to increase the country’s testing capacity from hundreds of thousands to millions of samples per week.
But the lack of stronger federal oversight has made it hard to maintain some of those gains.
Commercial labs like Quest Diagnostics, which are handling about half of all tests, have not been able to keep up with the spike in demand. It now takes a week for people to get their results in some places, and labs say they are having trouble getting basic supplies.
Oregon Gov. Kate Brown says her state’s testing capacity has been overwhelmed by the recent surge in infections. The state is now averaging more than 270 new coronavirus cases a day — a three-fold increase compared with a month ago.
“We could certainly use an assist from our federal partners,” Brown said. But her administration has been frustrated by the lukewarm responses it has received from the Trump administration.
Her next-door neighbor, Inslee, is one of several governors to call for a national testing strategy. In recent weeks, Washington state has struggled to buy enough swabs to collect patient samples and chemical reagents to test them.
And the federal government’s failure to fully use the Defense Production Act to increase available supplies and coordinate their distribution has put states like Washington in the “horrible position” of competing against one another, Schuler said.
“We have an obligation to the residents of Washington to ensure our labs are fully supplied, but we don’t want it to come at the expense of a less successful state,” he said.
In its letter this week to Pence, the Arkansas congressional delegation said that the ongoing shortages of testing reagents have prompted the state to consider abandoning its requirement for people to be tested for Covid-19 before undergoing elective surgery.
The testing problems are also hampering the country’s scattered and overwhelmed contact tracing efforts. Nationwide, there are fewer than a third of the 100,000 contact tracers that the Association of State and Territorial Health Officials estimates are necessary to contain the outbreak.
Nearly six months into the pandemic, some states are still struggling to get their programs off the ground. Others have abandoned location-tracking apps that were supposed to help scale contact tracing to unprecedented levels.
“You need federal leadership, and that’s been lacking,” said former CDC Director Tom Frieden, who, for months has been calling for the federal government to expand testing and provide support for people asked to quarantine at home.
Eisenman said the federal government should have used the spring lockdown to appoint expert commissions to address issues such as setting up contact tracing, distributing testing supplies and returning children to school safely.
Testing and contact tracing are the cornerstones of the test-trace-isolate strategy that governments have used to thwart infectious disease outbreaks since the 19th century. But many understaffed and underfunded local health departments have not been able to adequately expand the small workforces they usually use to track outbreaks of measles and sexually transmitted infections to combat the coronavirus pandemic.
Alabama only has about 200 contact tracers to investigate the more than 1,000 coronavirus cases diagnosed there each day. Most of those workers have been reassigned from other public health duties, such as restaurant inspections and immunizations. They are currently trading off in 10-day rotations between tracking coronavirus cases and their other work — meaning both are suffering. And with schools in the state set to reopen next month, the burden will only increase.
Ricardo Franco, an assistant professor of medicine at the University of Alabama at Birmingham, says the shortage of tracers is allowing the state’s outbreak to spiral out of control.
“If you asked me what we need, I would say we should have 5,000 contact tracers,” he said. “That would be the responsible thing to do.”
Washington state, which was among the first states hit by the virus, says that only 7 percent of the gowns, gloves and face shields it has handed out came from the federal government. The state has had to compete with other states and countries to purchase the rest itself.
“It’s jaw dropping that after what we’ve been through, we didn’t have hundreds of millions of face masks and other PPE stockpiled around the country,” said Irwin Redlener, founding director for the National Center for Disaster Preparedness at Columbia University.
Even as governors who once scoffed at fears they reopened their economies too quickly begin to reimpose restrictions, the White House is still struggling to put out a consistent message about the threat posed by the virus and how best to combat it.
Trump on Monday attacked his own administration’s public health officials, retweeting messages that suggested the CDC is lying about the virus and concern about the pandemic is overblown for political reasons, prompting top officials to defend themselves on national television.
John Henderson, president and CEO of The Texas Organization of Rural & Community Hospitals, said the lack of coordinated national coronavirus messaging has been compounded in states like Texas where governors, following Trump’s lead, took a laissez faire approach until cases skyrocketed.
“There’s just been a leadership void at the federal level,” he said. “We have pushed everything down to the states and then conservative states, like Texas, have just pushed all that decision-making down to the local level. … Every day that we go with a crisis and without a plan is another day lost.” (K)
“White House Press Secretary Kayleigh McEnany on Thursday emphasized that schools reopening this fall shouldn’t be contingent on science surrounding coronavirus, but then claimed the “science is on our side here” as the pandemic continues unabated.
In response to a question about what President Donald Trump would say to parents who have kids in school districts that may be online-only, McEnany said: “The president has said unmistakably that he wants schools to open. And when he says open, he means open in full, kids been able to attend each and every day at their school.
“The science should not stand in the way of this,” she added, saying it is “perfectly safe” to fully reopen all classrooms.
McEnany then claimed “science is on our side,” citing one study that said the risk of critical illness is less than the seasonal flu in children. She also quoted former Stanford Neuroradiology Chief Dr. Scott Atlas, who has appeared on Fox News to call the debate around reopening schools “hysteria.”
“We encourage localities and states to just simply follow the science, open our schools,” she continued.
The Trump administration has been pushing to reopen schools under the premise that children under the age of 18 “are at very low risk” if they catch the virus.
Some experts have expressed concerns about returning to classrooms because of the risk students could carry the virus home to older relatives. Education professionals have also expressed worry they may be in harms way.” (L)
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.”
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 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 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)
Note: THERE ARE NO LONGER ADS ON THIS WEB SITE! Just text…
“Dr. Camilla Rothe was about to leave for dinner when the government laboratory called with the surprising test result. Positive. It was Jan. 27. She had just discovered Germany’s first case of the new coronavirus.
But the diagnosis made no sense. Her patient, a businessman from a nearby auto parts company, could have been infected by only one person: a colleague visiting from China. And that colleague should not have been contagious.
The visitor had seemed perfectly healthy during her stay in Germany. No coughing or sneezing, no signs of fatigue or fever during two days of long meetings. She told colleagues that she had started feeling ill after the flight back to China. Days later, she tested positive for the coronavirus.
Scientists at the time believed that only people with symptoms could spread the coronavirus. They assumed it acted like its genetic cousin, SARS.
“People who know much more about coronaviruses than I do were absolutely sure,” recalled Dr. Rothe, an infectious disease specialist at Munich University Hospital…
Interviews with doctors and public health officials in more than a dozen countries show that for two crucial months — and in the face of mounting genetic evidence — Western health officials and political leaders played down or denied the risk of symptomless spreading. Leading health agencies including the World Health Organization and the European Center for Disease Prevention and Control provided contradictory and sometimes misleading advice. A crucial public health discussion devolved into a semantic debate over what to call infected people without clear symptoms.
The two-month delay was a product of faulty scientific assumptions, academic rivalries and, perhaps most important, a reluctance to accept that containing the virus would take drastic measures. The resistance to emerging evidence was one part of the world’s sluggish response to the virus.
It is impossible to calculate the human toll of that delay, but models suggest that earlier, aggressive action might have saved tens of thousands of lives. Countries like Singapore and Australia, which used testing and contact-tracing and moved swiftly to quarantine seemingly healthy travelers, fared far better than those that did not….
It is also painfully clear that time was a critical commodity in curbing the virus — and that too much of it was wasted.” (A)
“Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.
The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.
But as the deadly virus spread from China with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.
The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.
The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”…
Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.
The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.” (G)
“By using ventilators more sparingly on Covid-19 patients, physicians could reduce the more-than-50% death rate for those put on the machines, according to an analysis published Tuesday in the American Journal of Tropical Medicine and Hygiene.
The authors argue that physicians need a new playbook for when to use ventilators for Covid-19 patients — a message consistent with new treatment guidelines issued Tuesday by the National Institutes of Health, which advocates a phased approach to breathing support that would defer the use of ventilators if possible.
As the pandemic has flooded hospitals with a disease that physicians had never before seen, health care workers have had to figure out treatment protocols on the fly. Starting this month, a few physicians have voiced concern that some hospitals have been too quick to put Covid-19 patients on mechanical ventilators, that elderly patients in particular may have been harmed more than helped, and that less invasive breathing support, including simple oxygen-delivering nose prongs, might be safer and more effective.
The new analysis, from an international team of physician-researchers, supports what had until now been mainly two hunches: that some of the Covid-19 patients put on ventilators didn’t need to be, and that unusual features of the disease can make mechanical ventilation harmful to the lungs.
“This is one of the first coherent, comprehensive, and reasonably clear discussions of the pathophysiology of Covid-19 in the lungs that I’ve seen,” said palliative care physician Muriel Gillick of Harvard Medical School, who was one of the first to ask if ventilators were harming some Covid-19 patients, especially elderly ones. “There is mounting evidence that lots of patients are tolerating fairly extreme” low levels of oxygen in the blood, suggesting that such hypoxemia should not be equated with the need for a ventilator.
But using low levels of blood oxygen (hypoxemia) as a sign that a patient needs mechanical ventilation can lead physicians astray, they argue, because low blood oxygen in a Covid-19 patient is not like low blood oxygen in other patients with, for instance, other forms of pneumonia or sepsis.
The latter typically gasp for breath and can barely speak, but many Covid-19 patients with oxygen levels in the 80s (the high 90s are normal) and even lower are able to speak full sentences without getting winded and in general show no other signs of respiratory distress, as their hypoxemia would predict.
Related: With ventilators running out, doctors say the machines are overused for Covid-19
“In our personal experience, hypoxemia … is often remarkably well tolerated by Covid-19 patients,” the researchers wrote, in particular by those under 60. “The trigger for intubation should, within certain limits, probably not be based on hypoxemia but more on respiratory distress and fatigue.”…
There is a growing recognition that some Covid-19 patients, even those with severe disease as shown by the extent of lung infection, can be safely treated with simple nose prongs or face masks that deliver oxygen.The latter include CPAP (continuous positive airway pressure) masks used for sleep apnea, or BiPAP (bi-phasic positive airway pressure) masks used for congestive heart failure and other serious conditions. CPAP can also be delivered via hoods or helmets, reducing the risk that patients will expel large quantities of virus into the air and endanger health care workers. (B)
Targeting the kidneys. “Despite attempts to move away from ventilators, some COVID-19 patients still need them. As the pandemic has progressed, it’s become apparent that coronavirus patients on ventilators need special care.
When patients are put on a ventilator, they’re often given diuretics to get rid of extra fluid in the body. Lungs that need help need to be “dry” to function properly. When they’re wet, “they can’t move oxygen as well,” Denson said.
But the coronavirus has since proved it’s not a simple respiratory illness. It can affect the lungs, the brain, the blood and, critically for patients on ventilators, the kidneys.
Unlike lungs, kidneys prefer to be hydrated. The longer patients are kept dehydrated, their chances of kidney failure increase. Denson said he’s changed his treatments for COVID-19 patients to give additional hydration if they’re showing damage to the kidneys.
“I’m targeting the kidneys a little bit more,” he said. “I’m less aggressive up front getting people dry, and I’m more willing to use fluids if needed.”
It’s a balancing act that requires extreme attention on the part of ICU doctors and their staff. Too much hydration hurts the lungs. Too little hurts the kidneys. “It’s a constant battle,” Denson said.
Medications. When doctors faced the first surge of severely ill COVID-19 patients, no drugs had been shown to work against the virus, making treatment more challenging. As a result, doctors were willing to try certain medications based on limited evidence.
Early on in the pandemic, the drug hydroxychloroquine emerged as a potential treatment, following two studies that suggested it might be beneficial. As a result, many patients were given the drug, which is already approved for malaria and rheumatoid arthritis. But doctors soon found the drug was not useful in treating COVID-19, and subsequent research has shown it does not appear to help.
Now, doctors in ICUs are turning to the drug remdesivir. It’s not a cure, but it’s the only treatment that’s been shown in a clinical trial to have an effect on the illness so far.” (C)
“The Strategic National Stockpile, a once little-known resource, has turned into a political tug-of-war as states scramble for gowns, masks, ventilators and other equipment during the coronavirus pandemic.
But it was never intended to be able to meet massive, simultaneous demand from 50 states, its former director said.
“The Strategic National Stockpile is great as a fallback” that can be tapped after private sector supplies and state and local government supplies are exhausted, said Greg Burel, who is now president and principal consultant at Hamilton Grace, a consulting firm focused on preparedness and response.
“From what I’ve been seeing, and you’ve probably seen the same thing, it seems like almost from day one, everybody’s turned and looked at the SNS,” Burel said in an interview with POLITICO.
President Donald Trump has blamed the Obama administration for not refilling the reserve. “The previous administration, the shelves were empty. The shelves were empty,” Trump said last week.
However, the stockpile has also been underfunded for years, including during the Trump administration. The latest congressional appropriations enacted in November allotted about $700 million.
“What we had told Congress at the time though is that to get everything on the shelf that we wanted on the shelf at the time, that we needed a little over $1 billion in one appropriation and then we could smooth that out over the years,” Burel said.
The Trump administration’s official budget request for the SNS in fiscal 2020 was $705 million, or $95 million more than Congress approved for the prior year.
During the Obama administration, annual funding levels ranged around $500 million to $600 million. The Trump administration initially followed that pattern, requesting $575 million for the stockpile for both fiscal 2018 and 2019.
With the stockpile now quickly burning through badly needed supplies, Congress included $16 billion for the SNS in H.R. 748 (116), the $2 trillion coronavirus virus relief package that passed last month.
Burel noted that the added money won’t go that far because of the many ventilators that the SNS has sent to states that will need to be replaced or repaired at great expense when the current crisis is over. In addition, the stockpile’s pre-crisis supplies of masks, gloves and other personal protective equipment are nearly, if not completely, gone.
“There are a large number of materials that we have invested in for a number of years that by the end of this event will be completely gone,” Burel said. “A bunch of that $16 billion is just going to be eaten up with replacing what’s going out, recovering what’s gone out, cleaning it and putting back on the shelves — and then to manage a future vaccine campaign.”…
All of the SNS supplies that are “clearly useful in this particular event” have probably been distributed through allocations based on each state’s population, Burel said. But Burel said there is no reason to doubt the stockpile still has supplies for its original mission, responding to the chemical, biological and nuclear events….
The coronavirus pandemic has exposed the need for all elements of the emergency response network to keep more supplies on hand, Burel said.
That potentially means both manufacturers and hospitals keeping 60 to 90 days’ worth of personal protective equipment on hand, as well as state and local governments beefing up their own supplies.
Congress should also “fully fund” the SNS to ensure it has the supplies it needs to respond to pandemics and other threats, although it will never be able to respond to all eventualities, Burel said.
The emergency response veteran also said he favors producing more of the material in the United States and supplementing that with imported supplies.
“There has to be that swell of safety stock. We can’t fight this kind of pandemic event that has disrupted the supply chain beyond what the normal usage is unless there is some stock somewhere,” Burel said.”” (D)
“How many people are likely to die in the United States of Covid-19? How many hospital beds is the country going to need? When will case numbers peak?
To answer those questions, many hospital planners, media outlets, and government bodies — including the White House — relied heavily on one particular model out of the many that have been published in the past two months: the University of Washington’s Institute for Health Metrics and Evaluation (IHME).
The model first estimated in late March that there’d be fewer than 161,000 deaths total in the US; in early April, it revised its projections to say the total death toll through August was “projected to be 60,415” (though it acknowledged the range could be between 31,221 and 126,703).
The model has been cited often by the White House and has informed its policymaking. But it may have led the administration astray: The IHME has consistently forecast many fewer deaths than most other models, largely because the IHME model projects that deaths will decline rapidly after the peak — an assumption that has not been borne out.
On Wednesday, the US death count passed the 60,000 mark that the IHME model had said was the likely total cumulative death toll. The IHME on April 29 released a new update raising its estimates for total deaths to 72,433, but that, too, looks likely to be proved an underestimate as soon as next week. Even its upper bound on deaths — now listed as 114,228 by August — is questionable, as some other models expect the US will hit that milestone by the end of May, and most project it will in June.
One analysis of the IHME model found that its next-day death predictions for each state were outside its 95 percent confidence interval 70 percent of the time — meaning the actual death numbers fell outside the range it projected 70 percent of the time. That’s not great! (A recent revision by IHME fixed that issue; more on this below.)
This track record has led some experts to criticize the model. “It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to making projections about Covid-19, Harvard epidemiologist Marc Lipsitch told reporters.
But if that’s the case, how has it risen to such prominence among policymakers? Other models have done better than IHME’s at predicting the course of the epidemic, and many of them use approaches epidemiologists believe are more promising. Yet it’s the IHME model that has generally guided policymakers, for the most part, in the direction of focusing on a return to normal.
One potential explanation for its outsize influence: Some of the factors that make the IHME model unreliable at predicting the virus may have gotten people to pay attention to it. For one thing, it’s more simplistic compared to other models. That means it can be applied in ways more complicated models could not, such as providing state-level projections (something state officials really wanted), which other modelers acknowledged that they didn’t have enough data to offer.
Meanwhile, its narrow confidence intervals for state-by-state estimates meant it had quotable (and optimistic) topline numbers. A confidence interval represents a range of numbers wherein the model is very confident the true value will lie. A narrow range that gives “an appearance of certainty is seductive when the world is desperate to know what lies ahead,” a criticism of the IHME model published in the Annals of Internal Medicine argued. But the numbers and precise curves the IHME is publishing “suggests greater precision than the model is able to offer.”
The criticism of the IHME model, and an emerging debate over epidemiology models more broadly, has brought to light important challenges in the fight against the coronavirus. Good planning requires good projections. Models are needed to help predict resurgences and spot a potential second wave. Dissecting what the IHME model got wrong, what other models got right, and how the public and policymakers read these models is essential work in order to create the best pandemic plans possible.
What’s wrong with the IHME model of the coronavirus?” (E)
“When it became clear coronavirus had made its way to the United States in late January and was likely to spread around the country, many Americans purchased masks as a way to protect themselves from the disease. After all, they were told the virus is a respiratory illness that enters the body through the nose and mouth. They took proactive measures to protect themselves from getting sick.
But on Feb. 29, U.S. Surgeon General Jerome Adams took to Twitter to shame individuals doing their best to keep themselves out of clinics and the hospital. Keep in mind, this was more than two weeks before the federal government announced official social distancing and stay-at-home guidelines on March 16.
“Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!” he screamed through his keyboard.
We were told then that masks don’t work and that Americans shouldn’t be wearing them. At the same time, government officials were telling us they needed personal protective equipment (PPE) for doctors, nurses and others working in hospitals with cases of the disease. This PPE included masks. The illogical argument being made at the time was that masks protect doctors, but not the general public.
This argument appears to have been made in order to prevent a run on medical grade masks used by those on the front lines treating the disease, but the logic then, and now, made no sense. Masks only protect doctors? Really?
“The masks are important for someone who’s infected to prevent them from infecting someone else. Now, when you see people and look at the films in China, South Korea or whatever everybody is wearing a mask. Right now in the United States, people should not be walking around with masks,” Anthony Fauci told “60 Minutes” on March 8. “There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people ‘feel a little better’ and it might even block a droplet but it’s not providing the perfect protection the people think that it is. And often, there are unintended consequences. People keep fiddling with the mask and they keep touching their face.”
“When you think masks you should think of health care providers needing them, and people who are ill,” Fauci continued. “I’m not against it, if you want to do it. It can lead to a shortage for people who really need it.”
Again, masks work as protection for health care providers, but not regular people exposed to the disease at the grocery store?
Then on April 6, “in the middle of an outbreak” and the height of stay-at-home orders, federal government officials stressed a mask was not a replacement for social distancing, but could help protect people from getting sick or spreading the disease to others.
“CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission,” the Centers for Disease Control and Prevention published. “The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.” “(F)
“Lines for coronavirus tests have stretched around city blocks and tests ran out altogether in at least one site on Monday, new evidence that the country is still struggling to create a sufficient testing system months into its battle with Covid-19.
At a testing site in New Orleans, a line formed at dawn. But city officials ran out of tests five minutes after the doors opened at 8 a.m., and many people had to be turned away.
In Phoenix, where temperatures have topped 100 degrees, residents have waited in cars for as long as eight hours to get tested.
And in San Antonio and other large cities with mounting caseloads of the virus, officials have reluctantly announced new limits to testing: The demand has grown too great, they say, so only people showing symptoms may now be tested — a return to restrictions that were in place in many parts of the country during earlier days of the virus.
“It’s terrifying, and clearly an evidence of a failure of the system,” said Dr. Morgan Katz, an infectious disease expert at Johns Hopkins Hospital.
In the early months of the nation’s outbreak, testing posed a significant problem, as supplies fell far short and officials raced to understand how to best handle the virus. Since then, the United States has vastly ramped up its testing capability, conducting nearly 15 million tests in June, about three times as many as it had in April. But in recent weeks, as cases have surged in many states, the demand for testing has soared, surpassing capacity and creating a new testing crisis.
In many cities, officials said a combination of factors was now fueling the problem: a shortage of certain supplies, backlogs at laboratories that process the tests, and skyrocketing growth of the virus as cases climb in almost 40 states and the nation approaches a grim new milestone of three million total cases.
Fast, widely available testing is crucial to controlling the virus over the long term in the United States, experts say, particularly as the country reopens. With a virus that can spread through asymptomatic people, screening large numbers of people is seen as essential to identifying those who are carrying the virus and helping stop them from spreading it to others.
All along, the United States has struggled with issues tied to testing. In February, the federal government shipped a tainted testing kit to states, delaying a broader testing strategy and leaving states blind to a virus that was already beginning to circulate. Later, testing supplies became a choke point, and states called on the federal government to use the Defense Production Act to force additional production.” “(L)
“All 50 states have moved to reopen their economies, at least partially, after shutting down businesses and gatherings in response to the coronavirus pandemic.
But a Vox analysis suggests that most states haven’t made the preparations needed to contain future waves of the pandemic — putting themselves at risk for a rise in Covid-19 cases and deaths should they continue to reopen, which some states have already seen.
Experts told me states need three things to be ready to reopen. State leaders, from the governor to the legislature to health departments, need to ensure the SARS-CoV-2 virus is no longer spreading unabated. They need the testing capacity to track and isolate the sick and their contacts. And they need the hospital capacity to handle a potential surge in Covid-19 cases.
More specifically, states should meet at least five basic criteria. They should see a two-week drop in coronavirus cases, indicating that the virus is actually abating. They should have fewer than four daily new cases per 100,000 people per day — to show that cases aren’t just dropping, but also below dangerous levels. They need at least 150 new tests per 100,000 people per day, letting them quickly track and contain outbreaks. They need an overall positive rate for tests below 5 percent — another critical indicator for testing capacity. And states should have at least 40 percent of their ICU beds free to actually treat an influx of people stricken with Covid-19 should it be necessary.
These metrics line up with a range of expert recommendations, as well as the various policy plans put out by both independent groups and government officials to deal with the coronavirus.
Meeting these metrics doesn’t mean that a state is ready to reopen its economy — a process that describes a wide range of local and state actions. And failing them doesn’t mean a state is in immediate danger of a coronavirus outbreak if it starts to reopen; with Covid-19, there’s always an element of luck and other factors.
But with these metrics, states can gauge if they have repressed the coronavirus while building the capacity to contain future outbreaks should they come. In other words, the benchmarks show how ready states are for the next phase of the fight.
So far, most states are not there. As of July 8, just four states — Connecticut, New Hampshire, New Jersey, and New York — met four or five of the goals, which demonstrates strong progress. Fifteen states and Washington, DC, hit two or three of the benchmarks. The other 31 achieved zero or one.” (H)
“Official figures show the US has had the largest and most deadly outbreak, exacerbated by a slow initial response, mismanagement of testing and poor coordination between states and the federal government.
“As this outbreak has demonstrated, you can have the best labs in the world, the best notification systems and software, but if you don’t have the appropriate governance of when to use these powers … they don’t function,” Phelan says….
Its successful execution requires extraordinary public trust in their governments, says Lars Trägårdh, a Swedish historian who studies trust in institutions over time. “If you trust the government is working for your good, and you trust other citizens to follow the rules, you have huge advantages for collective action,” he says….
Over the next months, governments are going to allow people to resume their lives amid the worst economic conditions since the Great Depression. Should new waves of the virus be detected, states may again ask their citizens to return home.
Managing this is going to require significant stores of public trust, that in some places are quickly eroding. “If people agree to do something in the long term, without a threat hanging over their heads, they are more likely to keep doing it,” Trägårdh says. “The alternative is fear, distrust, and chaos, and that isn’t good, no matter what the policy might be.”…
“Leaders such as Trump deploy simple messages: insider versus outsider, us versus them,” says Sanjoy Chakravorty, a professor at Temple University in the US, who studies the politics of information. “And they are having an ideological crisis in how to manage the message here. This is a very complicated information sphere, which you can’t put into ‘us and them’ boxes … because in this case everybody is the ‘us’.”
Rather than rewarding bravado, the moment appears to favour leaders who can be honest about the uncertainty inherent in fighting a virus, says Kathleen Bachynski, an assistant professor of public health at Muhlenberg College. “If leaders are not willing or able to be honest about these limitations, there will be this loss of credibility – and it won’t be because they are wrong, it’s because information is changing.”
Those overseeing some of the more successful responses, such as Germany’s Angela Merkel or Jacinda Ardern of New Zealand, have been praised for their ability to project empathy and communicate complex ideas.” (I)
2. Twelve key lessons
2.1. Transparency is vital
2.2. Successful responses hinge on decisive leadership
2.3. We need unified responses to pandemics rather than diverse disconnected strategies
2.4. Effective communication must occur at the highest political levels
2.5. The European Union, and other regional blocs, must assume a greater health role
2.6. Global solidarity is the only way to win the war against COVID-19
2.7. The WHO has done a lot given the resources it has, but there is much room for improvement. It must now focus its activities, expand its remit and enhance its operational capacity
2.8. Existing global insurance institutions and policies are inadequate, and these require significant changes and improvements
2.9. Efforts to develop COVID-19 vaccines and treatments are commendable, but there is still much more to do
2.10. We need to test the responsiveness and resilience of health systems and make changes and improvements based on the results
2.11. Accountability is critical for building trust and for sound, inclusive decision making
2.12. There are opportunities to introduce novel approaches, such as using robots and artificial intelligence (AI), in this – and in future – pandemic response
3. Conclusion
Now that SARS-CoV-2 has become a pandemic with close to five million cases and over 300,000 deaths as a result of the virus, the case for investing in health systems, human resources, and health technologies is clear. It is also easy to see that in the past decade, austerity policies have cut investments in health and these systems have too often been reduced or ignored. While it is essential to cut waste within health systems, this pandemic highlights the need to have adequate capacity to address and tackle a crisis. It is also a reminder of the strategic importance of publicly accountable health systems, underpinned by investment in people and technologies. We must continue to build upon the lessons learned so far from the management of COVID-19 and adjust our approaches to this pandemic, and to other future health and environmental crises, accordingly. (J)
“……..there are several different scenarios for the future of the COVID-19 pandemic, and some of these are consistent with what occurred during past influenza pandemics. These can be summarized as follows and are illustrated in the figure below.
¤ Scenario 1: The first wave of COVID-19 in spring 2020 is followed by a series of repetitive smaller wavesthat occur through the summer and then consistently over a 1- to 2-year period, gradually diminishingsometime in 2021. The occurrence of these waves may vary geographically and may depend on whatmitigation measures are in place and how they are eased. Depending on the height of the wave peaks, this cenario could require periodic reinstitution and subsequent relaxation of mitigation measures over the next 1 to 2 years.
¤ Scenario 2: The first wave of COVID-19 in spring 2020 is followed by a larger wave in the fall or winter of 2020 and one or more smaller subsequent waves in 2021. This pattern will require the reinstitution of mitigation measures in the fall in an attempt to drive down spread of infection and prevent healthcare systems from being overwhelmed. This pattern is similar to what was seen with the 1918-19 pandemic (CDC 2018). During that pandemic, a small wave began in March 1918 and subsided during the summer months. A much larger peak then occurred in the fall of 1918. A third peak occurred during the winter and spring of 1919; that wave subsided in the summer of 1919, signaling the end of the pandemic. The 1957-58 pandemic followed a similar pattern, with a smaller spring wave followed by a much larger fall wave (Saunders-Hastings 2016). Successive smaller waves continued to occur for several years (Miller 2009). The 2009-10 pandemic also followed a pattern of a spring wave followed by a larger fall wave (Saunders-Hastings 2016).
¤ Scenario 3: The first wave of COVID-19 in spring 2020 is followed by a “slow burn” of ongoing transmission and case occurrence, but without a clear wave pattern. Again, this pattern may vary somewhat geographically and may be influenced by the degree of mitigation measures in place in various areas. While this third pattern was not seen with past influenza pandemics, it remains a possibility for COVID-19. This third scenario likely would not require the reinstitution of mitigation measures, although cases and deaths will continue to occur.
Whichever scenario the pandemic follows (assuming at least some level of ongoing mitigation measures), we must be prepared for at least another 18 to 24 months of significant COVID-19 activity, with hot spots popping up periodically in diverse geographic areas. As the pandemic wanes, it is likely that SARS-CoV-2 will continue to circulate in the human population and will synchronize to a seasonal pattern with diminished severity over time, as with other less pathogenic coronaviruses, such as the betacoronaviruses OC43 and HKU1, (Kissler 2020) and past pandemic influenza viruses have done. “ (K)
“….. the very big lesson we should all take on board here is that modern science protects and serves us. Though everyone understood that the catastrophic influenza pandemic of 1918/19 was caused by a virus, diagnosis back then was all symptomatic, no human influenza virus was isolated until 1933 and it was only during World War 2 (1939-45) that the first, primitive influenza vaccines were rolled out to protect the troops against the possibility of a repeat pandemic that, thankfully, did not occur. When it comes to SARS-CoV-2 and COVID-19 we had a specific diagnostic test within days and, I will personally be very surprised if large-scale human vaccination is not in full swing by the second half of 2021.
Even so, the big lesson for the public is that, no matter how wonderful the laboratory science, actually getting products out there to protect people is a much more cumbersome process. Ensuring that a novel drug or vaccine is safe and efficacious takes time. Even though regulatory authorities have been comfortable with the idea that preliminary trials in animals and small numbers of human volunteers (Phase 1) can be conducted simultaneously, all that information must be evaluated before any product can be given to substantial numbers of people. Every possible effort is being made to ensure that all participants in large, closely monitored Phase 2 then Phase 3 trials will be protected, or at least safe, following community exposure to SARS-CoV-2.
Much of what had to be done over this first six months of the COVID-19 challenge was just plain hard work. An enormous effort was, for example, made within VIDRL to build testing capacity by helping other private and public laboratories get up to speed. And the Institute is still in the process of evaluating rapid person-side antibody tests that can be used for large-scale serological surveys. The obvious lesson here is that we are protected by having well-funded, high quality public laboratories and Institutions that can rapidly build capacity in the face of any pandemic threat.” (N)
“Four former directors of the Centers for Disease Control and Prevention sharply criticized the Trump administrationon Tuesday for undermining the federal health agency and casting doubt on its scientific guidelines in the midst of the coronavirus pandemic.
“As America begins the formidable task of getting our kids back to school and all of us back to work safely amid a pandemic that is only getting worse, public health experts face two opponents: covid-19, but also political leaders and others attempting to undermine the Centers for Disease Control and Prevention,” wrote former CDC Directors Tom Frieden, Jeffrey Koplan, David Satcher and Richard Besser in an op-ed published Tuesday by The Washington Post.
“As the debate last week around reopening schools more safely showed, these repeated efforts to subvert sound public health guidelines introduce chaos and uncertainty while unnecessarily putting lives at risk.”” (O)
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.”
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 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 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)
“In late March, as the number of COVID-19 cases was growing exponentially in the state, Cuomo said New York hospitals might need twice as many beds as they normally have. Otherwise there could be no space to treat patients seriously ill with the new coronavirus.
“We have 53,000 hospital beds available,” Cuomo, a Democrat, said at a briefing on March 22. “Right now, the curve suggests we could need 110,000 hospital beds, and that is an obvious problem and that’s what we’re dealing with.”
The governor required all hospitals to submit plans to increase their capacity by at least 50%, with a goal of doubling their bed count. Hospitals converted operating rooms into intensive care units, and at least one replaced the seats in a large auditorium with beds. The state worked with the federal government to open field hospitals around New York City, including a large one at the Jacob K. Javits Convention Center.
But when New York hit its peak in early April, fewer than 19,000 people were hospitalized with COVID-19. Some hospitals ran out of beds and were forced to transfer patients elsewhere. Other hospitals had to care for patients in rooms that had never been used for that purpose before. Supplies, medications and staff ran low…
All told, more than 30,000 New York state residents have died of COVID-19. It’s a toll worse than any scourge in recent memory and way worse than the flu, but, overall, the health care system didn’t run out of beds.
Gov. Andrew Cuomo, at a March 22 briefing, displayed a projection that New York could need 110,000 hospital beds. At the peak, fewer than 19,000 were hospitalized with COVID-19.
“All of those models were based on assumptions, then we were smacked in the face with reality,” said Robyn Gershon, a clinical professor of epidemiology at the NYU School of Global Public Health, who was not involved in the models New York used. “We were working without situational awareness, which is a tenet in disaster preparedness and response. We simply did not have that.”
Cuomo’s office did not return emails seeking comment, but at a press briefing on April 10, the governor defended the models and those who created them. “In fairness to the experts, nobody has been here before. Nobody. So everyone is trying to figure it out the best they can,” he said. “Second, the big variable was, what policies do you put in place? And the bigger variable was, does anybody listen to the policies you put in place?”” (A)
“The government’s top infectious disease expert said on Tuesday that the rate of new coronavirus infections could more than double to 100,000 a day if current outbreaks were not contained, warning that the virus’s march across the South and the West “puts the entire country at risk.”
Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, offered the grim prediction while testifying on Capitol Hill, telling senators that no region of the country is safe from the virus’s resurgence. The number of new cases in the United States has shot up by 80 percent in the past two weeks, according to a New York Times database, with new hot spots flaring far from the Sun Belt epicenters.
I can’t make an accurate prediction, but it is going to be very disturbing, I will guarantee you that,” Dr. Fauci said, “because when you have an outbreak in one part of the country, even though in other parts of the country they are doing well, they are vulnerable.”” (B)
“At (Houston’s) Lyndon B. Johnson Hospital on Sunday, the medical staff ran out of both space for new coronavirus patients and a key drug needed to treat them. With no open beds at the public hospital, a dozen COVID-19 patients who were in need of intensive care were stuck in the emergency room, awaiting transfers to other Houston area hospitals, according to a note sent to the staff and shared with reporters.
A day later, the top physician executive at the Houston Methodist hospital system wrote to staff members warning that its coronavirus caseload was surging: “It has become necessary to consider delaying more surgical services to create further capacity for COVID-19 patients,” Dr. Robert Phillips said in the note, an abrupt turn from three days earlier, when the hospital system sent a note to thousands of patients, inviting them to keep their surgical appointments.
And at The University of Texas MD Anderson Cancer Center, staff members were alerted recently that the hospital would soon begin taking in cancer patients with COVID-19 from the city’s overburdened public hospital system, a highly unusual move for the specialty hospital.
These internal messages highlight the growing strain that the coronavirus crisis is putting on hospital systems in the Houston region, where the number of patients hospitalized with COVID-19 has nearly quadrupled since Memorial Day. As of Tuesday, more than 3,000 people were hospitalized for the coronavirus in the region, including nearly 800 in intensive care…
Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance — a bottleneck that’s tying up emergency medical service resources and slowing emergency response times across the region.
Part of the problem, Peña said, is that when his 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. That’s a problem that’s likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for “crisis response jobs.”…
The crisis in Houston has accelerated rapidly in recent weeks, at times resulting in muddled messaging from both hospital leaders and public officials.
On June 24, several hospital executives affiliated with the Texas Medical Center — a sprawling medical campus that’s home to most of Houston’s major hospital systems — issued a statement warning that COVID-19 hospitalizations were growing at an “alarming rate” and could soon put an unsustainable strain on hospital resources.
But the following day, after Abbott issued an executive order directing hospitals to limit elective surgeries — a measure intended to preserve hospital capacity but one that also hurts hospital revenues — the CEOs of four hospitals in the medical center abruptly dialed back their earlier warnings at a hastily organized news conference. They said they hadn’t meant to alarm the public. The hospitals still had room to add ICU beds, they said, both to treat COVID-19 and to continue caring for other patients.
“I think the Texas Medical Center’s purpose was to really urge people to do the right things in the community, and do so by talking about capacity, but really ended up unintentionally sounding an alarm bell too loudly,” Dr. Marc Boom, president and CEO of Houston Methodist, which is part of the Texas Medical Center, said at the news conference. “We clearly do have capacity.”…
Not all hospitals are equally equipped to respond to a surge in COVID-19 demand, accompanied by a loss of more profitable business, Ho said. Hospital systems like Houston Methodist have “the financial resources to sort of convert anything into an ICU just because they have more money, more cash on hand,” she said.
Houston’s public hospitals, Ben Taub and Lyndon B. Johnson, don’t have those same resources.
“The problem is that, of course, there are going to be more patients who are going to be going to Ben Taub” because the virus is disproportionately affecting Black and Latino people in low-income communities, and Ben Taub is traditionally the safety net for those without health insurance, Ho said. “I don’t know to what extent they are able to send patients to the other hospitals.”” (C)
“The trend is worrying: A sharp increase in patients can once again overwhelm hospitals, putting critical resources including staffing, beds and ventilators in short supply.
Already, some hospitals are so swamped they’ve transferred patients elsewhere. Doctors in parts of Texas report waiting lists for their ICU beds, while others have had to decide which patients to admit, incapable of treating all those seeking help. In other parts of the US, health care professionals are seeing younger and sicker patients and making a simple plea: Wear a mask and stay at home.
The increasing infections come weeks after many states began reopening their economies after extended closures intended to stem the spread of coronavirus…
In Harris County, which encompasses Houston and is the most populous county in Texas, at least two hospitals are “pretty much at maximum capacity,” Houston Mayor Sylvester Turner said Wednesday.
“The threat … Covid-19 poses to our community right now is higher than it has been. There is a severe and uncontrolled spread between our families, friends, and communities,” Turner said. “And we need to slow it down, so that it doesn’t overwhelm our health care delivery system.”
“’We are having an explosion of Covid’
Some local officials and public health administrators are already reporting strained hospital capacity with the latest influx of patients.
In Bexar County, home to San Antonio, officials reported this week the number of hospitalizations continues to rise while hospital capacity has shrunk to a little more than 20%, CNN affiliate KSAT reported.
“We are having an explosion of Covid,” says Adam Sahyouni, a Covid ICU nurse manager at San Antonio’s Methodist Hospital. “We aren’t overrun yet, but it’s overwhelming.”
According to data published by the city of San Antonio, at the beginning of June there were 39 coronavirus patients in the ICU and 20 on ventilators. By June 30, 288 coronavirus patients were in ICUs and 158 on ventilators…
At Methodist Hospital in San Antonio, ICU rooms are packed — and some patients are on a waiting list.
“Yesterday was probably one of my worst days that I’ve ever had,” Dellavolpe said. “I got 10 calls, all of whom (were) young people who otherwise would be excellent candidates to be able to put on ECMO (life support). They’re so sick that if they don’t get put on, they don’t get that support, they’re probably going to die. I had three beds.”
“It’s a level of decision-making that I don’t think a lot of us are prepared for.”” (D)
“As Texas sets records for new COVID-19 cases and hospitalizations day after day, the state’s hospital capacity — one of the key metrics that Gov. Greg Abbott cited as he allowed businesses to reopen — has become the focus of increased attention and concern.
But the state isn’t releasing the information it collects about how many beds individual hospitals have available. And only a fraction of the state’s hospitals, cities and counties are providing that information to the public on their own…
According to data from DSHS, the state had 1,322 available intensive care unit beds and close to 13,000 available hospital beds Wednesday. But there are important regional disparities. The Northeast Texas Regional Advisory Council reported Wednesday that 43% of its hospital beds are in use with 92 ICU beds available, while the East Texas Gulf Coast Regional Advisory Council, which includes nine counties and more than 1.3 million people, is 83% full with only 10 open ICU beds.
Some of the regional advisory councils provide county-level breakdowns of available hospital beds within their boundaries, including the Southeast Texas Regional Advisory Council, which includes Houston.
Many local government and health authorities have opted not to make hospital capacity information public.
“Publicly, we do not share which hospitals are at capacity, because there is constant shifting and we want the hospitals to have the freedom to move resources as needed,” Mark Escott, Austin’s interim public health authority, said in an email.
Dallas County provides daily briefs that include hospitalizations, ICU admissions and emergency room visits — but doesn’t include available hospital capacity — saying local health experts use these key indicators to determine the COVID-19 risk level and the appropriate response.
The Texas Medical Center in Houston, which includes 21 hospitals, used to update daily a set of “early warnings,” including its base intensive care capacity. On June 24, TMC leaders issued a statement warning that patients with COVID-19 were being admitted at an “alarming rate.” The next day, the medical center reported it had reached 100% of ICU base capacity — and then stopped updating that information for almost three days.
During a joint news conference June 25, Houston Methodist CEO Dr. Marc Boom said officials were concerned that the level of alarm was “unwarranted.”
The Houston Chronicle reported that Abbott had expressed displeasure to hospital executives about headlines related to ICU capacity, but Abbott spokesman John Wittman said any insinuation that the governor suggested the executives publish less data is false.
“We were getting panicked calls from elected officials and members of the media saying, ‘You all are out of ICU beds, what are we going to do?’” David Callender, president and CEO of the Memorial Hermann Hospital, told KHOU-TV. “We were not doing a very good job with our slides and portraying how we manage our capacity.”..
Last week, Sarah Eckhardt, the former Travis County judge serving as an adviser to interim County Judge Sam Biscoe, said she was having trouble obtaining information about capacity at local private hospitals. On Tuesday, she said that the county has since received all the information it needs to plan its response to the recent surge in COVID-19 hospitalizations, which reached 369 in Travis County on Tuesday, including 132 people in ICU.
Travis County has a 22.9% positivity rate, a figure “substantially higher than most of the country,” Escott said in a news conference Wednesday. The positivity rate is the ratio of positive cases to the number of tests conducted, and it can vary depending on who is being tested, health experts say. Public testing in the county is being rationed to only people with symptoms.
“I think that it’s pretty plain that if the chief executives of the county and the city are having a hard time getting information about the occupancy levels in the hospitals, then how would you expect the regular individual to know?” Eckhardt said.” (E)
“Over the past week, Dr. Aric Bakshy, an emergency physician at Houston Methodist, had to decide which coronavirus patients he should admit to the increasingly busy hospital and which he could safely send home.
To discuss questions like these, he has turned to doctors at hospitals where he trained in New York City that were overwhelmed by the coronavirus this spring. Now their situations are reversed.
Thumbing through a dog-eared notebook during a recent shift, Dr. Bakshy counted about a dozen people he had treated for coronavirus symptoms. His colleagues in Houston had attended to many more. Meanwhile, friends at Elmhurst Hospital in Queens told him that their emergency department was seeing only one or two virus patients a day.
As Houston’s hospitals face the worst outbreak of the virus in Texas, now one of the nation’s hot zones, Dr. Bakshy and others are experiencing some of the same challenges that their New York counterparts did just a few months ago and are trying to adapt some lessons from that crisis.
Like New York City in March, the Houston hospitals are experiencing a steep rise in caseloads that is filling their beds, stretching their staffing, creating a backlog in testing and limiting the availability of other medical services. Attempts to buy more supplies — including certain protective gear, vital-sign monitors and testing components — are frustrated by weeks of delays, according to hospital leaders.
Methodist is swiftly expanding capacity and hiring more staff, including local nurses who had left their jobs to work in New York when the city’s hospitals were pummeled. “A bed’s a bed until you have a staff,” said Avery Taylor, the nurse manager of a coronavirus unit created just outside Houston in March.
But with the virus raging across the region, medical workers are falling ill. Dr. Bakshy was one of the first at Methodist to have Covid-19, getting it in early March. As of this past week, the number of nurses being hired to help open new units would only replace those out sick.
Methodist, a top-ranked system of eight hospitals, had nearly 400 coronavirus inpatients last Sunday. A week later — even as physicians tried to be conservative in admitting patients and discharged others as soon as they safely could — the figure was 626. The flagship hospital added 130 inpatient beds in recent days and rapidly filled them. Now, administrators estimate that the number of Covid-19 patients across the system could reach 800 or 900 in coming weeks, and are planning to accommodate up to 1,000.
Other Houston hospitals are seeing similar streams of patients. Inundated public hospitals are sending some patients to private institutions like Methodist while reportedly transferring others to Galveston, 50 miles away.
“What’s been disheartening over the past week or two has been that it feels like we’re back at square one,” Dr. Mir M. Alikhan, a pulmonary and critical care specialist, said to his medical team before rounds. “It’s really a terrible kind of sinking feeling. But we’re not truly back at square one, right? Because we have the last three months of expertise that we’ve developed.”
Houston’s hospitals have some advantages compared with New York’s in the spring. Doctors know more now about how to manage the sickest patients and are more often able to avoid breathing tubes, ventilators and critical care. But one treatment shown to shorten hospital stays, the antiviral drug remdesivir, is being allocated by the state, and hospitals here have repeatedly run out of it.
Methodist’s leaders, who were planning for a surge and had been dealing with a stream of coronavirus patients since March, pointed to the most important difference between Houston now and New York then: the patient mix. The majority of new patients here are younger and healthier and are not as severely ill as many were in New York City, where officials report that over 22,000 are likely to have died from the disease.
But so far, the death toll has not climbed much in Texas and other parts of the South and West seeing a surge.
“We are having to pioneer the way of trying to understand a different curve with some very good characteristics versus the last curve,” said Dr. Marc Boom, Methodist’s president and chief executive.
But he cautioned, “What I’m watching really closely is whether we see a shift back in age — because if the young really get this way out there and then start infecting all of the older, then we may look more like the last wave.”
Dr. Sylvie de Souza, head of the emergency department at Brooklyn Hospital Center, which on Friday reported no new coronavirus admissions and no current inpatient cases, said that she was receiving distressing text messages from doctors elsewhere in the country asking for advice. “It’s disappointing,” she said. “It sort of brings me back to the end of March, and it’s like being there all over again.”..
But doctors in Houston are tightening criteria for admission. Dr. Bakshy, the Methodist emergency room doctor, who worked at Bellevue and Mount Sinai in New York, said that he was conferring with his former colleagues.
“We all have questions about who truly needs to be hospitalized versus not,” he said. “If we had unlimited resources, of course we’d bring people in just to make sure they’re OK.”
Now, he said, a patient has to have low oxygen levels or serious underlying conditions “to really justify coming into the hospital,” although exceptions can be made.
Another challenge in New York and Houston has been determining who is infected and needs to be isolated from others. Nearly 40 percent of all emergency room patients at Methodist are now testing positive; some of them lack symptoms.
Because test results are sometimes delayed by more than a day, Dr. Bakshy and his colleagues have had to make their best guesses as to whether someone should be admitted to a ward for coronavirus patients.
Hospitals in New York tended to move patients within their own systems to level loads. In Houston, the wealthier institutions have joined together to aid those least able to expand capacity.
This past week, Methodist sent a team to a nearby public hospital to accept transfer patients. Top officials from Methodist and the other flagship hospitals that make up the Texas Medical Center, normally competitors, consult regularly by phone. They have been coordinating for days with the county’s already overwhelmed safety-net system, Harris Health, taking in its patients. The private institutions have also agreed to take turns, with others in the state, accepting patients from rural hospitals.”..
But doctors, based on the experiences of physicians in New York and elsewhere, are avoiding ventilators when possible and are maintaining Ms. Hernandez on a high flow of oxygen through a nasal tube. She is on the maximum setting, but can talk to the clinical team and exchange text messages with her daughter, who is also a Methodist inpatient with the coronavirus…
Methodist was part of two remdesivir trials. But because the research has ended, it and other hospitals now depend on allotments of the drug from the state. As virus cases increased, the supplies ran short, said Katherine Perez, an infectious-disease specialist at the hospital. “In Houston, every hospital that’s gotten the drug, everyone’s just kind of used it up,” she said.
The hospital received 1,000 vials, its largest batch ever, a little over a week ago. Within four days, all the patients who could be treated with it had been selected, and pharmacists were awaiting another shipment.
A new chance to test remdesivir in a clinical trial in combination with another drug may provide some relief. As cases rise, Methodist researchers are being flooded with offers to participate in studies, with about 10 to 12 new opportunities a week being vetted centrally. Without solid research, “your option is to do a bunch of unproven, potentially harmful, potentially futile, interventions to very sick people who are depending on you,” said Dr. H. Dirk Sostman, president of Methodist’s academic medicine institute.
Dr. Boom, the Methodist chief executive, said if he could preserve one thing from the New York experience in March, it would be how the country came together as it had in previous disasters.” (F)
“Houston Health Department Health Authority Dr. David Persse said the city had reached a 25% positivity rate.
“The virus is very prevalent in the community,” Persse said, adding that there were more than 1,200 people in Houston hospitals with more than 500 of them in the ICU due to complications from the coronavirus. “The virus is very much out there,” Persse said, “It’s very much actively spreading.”
Texas is expected to see nearly 2,000 new hospitalizations per day by mid-July, according to forecasts published by the Centers for Disease Control and Prevention.
In Harris County, which encompasses Houston and is the most populous county in Texas, at least two hospitals are “pretty much at maximum capacity,” Turner said Wednesday.
“The threat … Covid-19 poses to our community right now is higher than it has been. There is a severe and uncontrolled spread between our families, friends, and communities,” Turner said. “And we need to slow it down, so that it doesn’t overwhelm our health care delivery system.”
On Friday, Texas reported a third day of new Covid-19 cases topping 7,000, according to state health department data.
It reported 7,555 cases Friday, continuing the trend of sharp growth of the disease in the state, with a record 8,076 new cases on Wednesday and 7,915 new cases Thursday, according to state data.
Texas also reported 50 new deaths from Covid-19 Friday. John Hopkins data puts the number of confirmed cases in the state at 185,591, with 2,592 deaths.
The virus has killed more than 129,000 people and infected over 2.7 million in the US since the pandemic started, according to Johns Hopkins University.” (G)
“For one brief, delusional moment in early April, I felt a smidgen of support for my governor, Greg Abbott. Sure, part of me thought his plan to reopen the state after just a few weeks of lockdown was cuckoo. Medical experts warned of a surge in coronavirus cases if Texas did just that…
But while New York and Washington were in crisis, the number of cases and deaths here remained remarkably low. Maybe Texas was being spared because of a lack of density in our cities or because people drove alone in their cars instead of cramming into subways. Maybe our already rising temperatures were killing off the virus.
Maybe, in contrast to the yahoo stereotype, most Texans were wearing masks, socially distancing and washing their hands and so had actually headed the virus off at the pass, or dodged the bullet, or whatever people think we like to say down here.
And maybe for those reasons, Mr. Abbott became infatuated with the idea that Texas would be among the first states to reopen. As he said, Texans needed to get back to work. That was indisputable. The food bank near my house was already overwhelmed with the unemployed and hungry.
Yes, Dr. Peter Hotez, Houston’s internationally known virus expert, warned of the dangers of opening early, but what did he know? The guy wears a bow tie…
On Memorial Day, the Galveston beaches were packed like Carnival in Rio. And out in rural Texas, folks who had no choice were working away in meat-processing plants. Businesses like Target and Wal-Mart welcomed shoppers without masks as if it were Black Friday.
As we now know, that was then. “Ten days away,” a friend who works for Judge Hidalgo told me the night before the June 2 march for George Floyd downtown, when police helicopters were circling over our socially distanced dinner party — 10 days before we would start to see the cases really spike.
That date coincided with the arrival of Mr. Abbott’s Phase 3, which allowed many businesses to reopen at 75 percent capacity on June 12. Shortly after that, the numbers exploded.
The governor knew better than to blame better testing for the increase, because we don’t have enough testing. Instead, he blamed those rowdy millennials: “There are certain counties where a majority of the people who are tested positive in that county are under the age of 30, and this typically results from people going to bars,” he said.
But, no worries, the governor added; Texas still has plenty of hospital beds. And today, we have more than 130,000 cases, up from over 60,000 at the end of May.
And so, here we are, with a jittery populace and the Texas Medical Center’s coronavirus website competing with TikTok. I.C.U.s in Houston are at 97 percent capacity, with “unsustainable surge capacity” predicted for hospital beds in late July. If “this trajectory persists,” Dr. Hotez tweeted, “Houston would become the worst-affected city in the U.S.” He added that it would “maybe rival what we’re seeing now in Brazil.”..
Now with the numbers climbing, Mr. Abbott has taken the bold step of hitting the pause button on future reopenings, allowing local officials to limit outdoor events to 100 people (down from 500), closing bars and suspending elective surgeries in some counties to save potentially needed bed space. But mainly his advice is just to stay put, which has become easier since New York, New Jersey and Connecticut are now requiring Texans to quarantine for 14 days upon arrival.
“We want to make sure that everyone reinforces the best safe practices of wearing a mask, hand sanitization, maintaining safe distance, but importantly, because the spread is so rampant right now, there’s never a reason for you to have to leave your home,” Mr. Abbott said in a recent interview. Unless you do need to go out, the safest place for you is at your home.”
In other words, we are all in this together. But we are also completely and totally on our own.” (H)
“In Queens, the borough with the most coronavirus cases and the fewest hospital beds per capita, hundreds of patients languished in understaffed wards, often unwatched by nurses or doctors. Some died after removing oxygen masks to go to the bathroom.
In hospitals in impoverished neighborhoods around the boroughs, some critically ill patients were put on ventilator machines lacking key settings, and others pleaded for experimental drugs, only to be told that there were none available.
It was another story at the private medical centers in Manhattan, which have billions of dollars in endowments and cater largely to wealthy people with insurance. Patients there got access to heart-lung bypass machines and specialized drugs like remdesivir, even as those in the city’s community hospitals were denied more basic treatments like continuous dialysis.
In its first four months in New York, the coronavirus tore through low-income neighborhoods, infected immigrants and essential workers unable to stay home and disproportionately killed Black and Latino people, especially those with underlying health conditions.
Now, evidence is emerging of another inequality affecting low-income city residents: disparities in hospital care.
While the pandemic continues, it is not possible to determine exactly how much the gaps in hospital care have hurt patients. Many factors affect who recovers from the coronavirus and who does not. Hospitals treat vastly different patient populations, and experts have hesitated to criticize any hospital while workers valiantly fight the outbreak.
Still, mortality data from three dozen hospitals obtained by The New York Times indicates that the likelihood of survival may depend in part on where a patient is treated. At the peak of the pandemic in April, the data suggests, patients at some community hospitals were three times more likely to die as patients at medical centers in the wealthiest parts of the city…
Inequality did not arrive with the virus; the divide between the haves and the have-nots has long been a part of the web of hospitals in the city.
Manhattan is home to several of the world’s most prestigious medical centers, a constellation of academic institutions that attract wealthy residents with private health insurance. The other boroughs are served by a patchwork of satellite campuses, city-run public hospitals and independent facilities, all of which treat more residents on Medicaid or Medicare, or without insurance.
The pandemic exposed and amplified the inequities, especially during the peak, according to doctors, nurses and other workers.” (I)
“Dr. Anthony S. Fauci, the nation’s top infectious disease expert, warned on Monday that the country was still “knee-deep in the first wave” of the pandemic, as U.S. deaths passed 130,000 and cases neared three million, while Texas and Idaho set daily records for new cases, according to a New York Times database.
Dr. Fauci said that the more than 50,000 new cases a day recorded several times in the past week were “a serious situation that we have to address immediately.”..
“I would say this would not be considered a wave,” Dr. Fauci said. “It was a surge, or a resurgence of infections superimposed upon a baseline that really never got down to where we wanted to go.”..
Dr. Fauci compared the United States unfavorably with Europe, which he said was now merely handling “blips” as countries move to reopen. “We went up, never came down to baseline, and now it’s surging back up,” Dr. Fauci said.” (J)
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.”
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 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 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.”
“Contact tracing occurs when trained personnel contact infected people to investigate where they might have been infected and who they might have exposed to the virus. Along with widespread testing and ability to isolate potentially infectious people, tracing is an age-old public health intervention now being ramped up at an unprecedented scale.
“It’s not going well. I have to tell you, it’s not going well,” Fauci said in an interview with CNBC’s Meg Tirrell that was aired by the Milken Institute. “What we need to do is we need to rethink, and we are right now, the idea of many more tests getting into the community and even pooling tests.”
The White House advised states not to reopen until they had built the infrastructure to conduct widespread testing and contact tracing, though the federal government did not specify what a robust tracing infrastructure would look like. Rather than developing a coordinated national tracing plan, which some countries, such as Germany, have done, the Centers for Disease Control and Prevention has sought instead to support local efforts.
Earlier this week, CDC Director Dr. Robert Redfield testified that about 27,000 or 28,000 people are doing contact tracing work across the country. He later acknowledged that he estimates the necessary workforce to be about 100,000 tracers. Former CDC Director Dr. Tom Frieden thinks the country will need even more, up to 300,000.
“To just say you’re going to go out and identify, contact trace and isolate, that doesn’t mean anything until you do it,” Fauci said. “Not checking the box that you did it, but actually do it. Get people on the ground. Not on the phone. When you identify somebody, have a place to put them to get them out of social interaction.”
The CDC has allocated more than $10 billion for states to ramp up testing, tracing and isolation, but Fauci said he doesn’t see local officials making the kind of progress he’d like to see. He added that some states have done well in ramping up their programs. Getting more jurisdictions to do that work in preparation for the fall, when Fauci said he expects cases to surge again, will be key.
“When the fall comes, we better be ready that there will be surges in cases, and as I’ve said so many times now for months, we have a few months to prepare for that,” he said. “So when that happens, we have to be able to do the proper and effective way of identification, isolation and contact tracing.”” (A)
“Government virus expert Anthony Fauci told reporters in a press briefing on Friday that contact tracing efforts to contain the coronavirus are “not working.”
Why it matters: Without a vaccine, contact tracing of cases is the best tool available to stem the spread of an outbreak. But understaffed public health agencies, privacy concerns, disappointing technology, and the sheer size of the pandemic are limiting the technique’s effectiveness.
By the numbers: The public health standard is that a state should have at least 30 contract tracers — public health employees dedicated to investigating the contacts of positive cases — for every 100,000 people during a pandemic. According to a June 25 report by Nephron Research, however, just seven states have met that standard.
Another seven have near-term plans to sufficiently increase contact tracing capacity.
Even those states that have sufficiently beefed up their contact tracing systems are struggling to get people who have tested positive to report whom they were in contact with — or, in some cases, to even pick up the phone.
New York state currently has nearly 50 tracers per 100,000 people, the most in the U.S. But in New York City, long the epicenter of the pandemic, contact tracers were only able to successfully complete an interview with about half of all positive cases between June 1 and June 20.
That’s well below the 75% rate public health experts say is needed to keep an outbreak contained.
The situation is worse in other hard-hit cities like San Antonio, which has only received responses from about 300 of the 2,500 cases currently under review.
Context: The U.S. has had great success in the past controlling diseases like HIV and tuberculosis through contact tracing. But COVID-19 would present enormous challenges to even a well-funded and well-staffed national contact tracing effort — which the U.S. assuredly does not have.
Unlike tracing the spread of STDs, where contacts can be narrowed down to sexual partners, COVID-19 requires tracers to quiz a positive case for everyone they may have come into contact with, even for a relatively short period of time.
Early hopes that app-based smartphone contact tracing might help have largely gone unfulfilled….
The bottom line: More than four months after the first recorded U.S. COVID-19 cases, the virus is still outpacing our ability and willingness to track it.” (B)
“Dr. Anthony Fauci, the nation’s top infectious disease expert, said Friday that contact tracing simply isn’t working in the U.S.
Some who test positive don’t cooperate because they don’t feel sick. Others refuse testing even after being exposed. Some never call back contact tracers. And still others simply object to sharing any information.
Another new challenge: More young people are getting infected, and they’re less likely to feel sick or believe that they’re a danger to others.
While older adults were more likely to be diagnosed with the virus early in the pandemic, figures from the Centers for Disease Control and Prevention show that the picture flipped almost as soon as states began reopening. Now, people 18 to 49 years old are most likely to be diagnosed…
“Right now we have an insufficient capacity to do the job we need to,” Arkansas Gov. Asa Hutchinson said recently, announcing he wanted to use federal coronavirus relief funds to increase the number of contact tracers to 900.
Arkansas already has 200 doing the job, but infections have risen more than 230% and hospitalizations nearly 170% since Memorial Day. Businesses that had closed because of the virus were allowed to reopen in early May, and the state further eased its restrictions this month.
In addition to needing more staff to handle rising case numbers, contact-tracing teams also must build trust with people who might be uneasy or scared, said Dr. Umair Shah, executive director for Harris County Public Health in Houston, where an outbreak threatens to overwhelm hospitals.
That’s difficult to do if infected people don’t return calls…
Perry N. Halkitis, dean of the Rutgers School of Public Health, said COVID-19 spreads so fast that contact tracers need to get in touch with 75% of the potentially exposed people within 24 hours of their exposure to successfully combat the spread…
Contact tracing is key to avoiding worst-case outcomes, said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention and current president and CEO of Resolve to Save Lives, a nonprofit that works to prevent epidemics. But the explosion of U.S. cases has made it nearly impossible for even the most well-staffed health departments to keep up, he said.
Contact tracing is “a tried and true public health function,” Frieden said. “If the health department calls, pick up the phone.” (C)
“Dr. Anthony Fauci, the nation’s top infectious diseases expert, raised a question Friday as to whether contact tracing is even worth the endeavor. And in Texas, a health official in Austin revealed this week that information about hundreds of new cases is pouring in daily across the state via an archaic form of technology: the fax machine.
That has made the confirmation of positive cases extremely time-consuming, the official said, which in turn has hindered contact tracing, a labor-intensive commitment that involves calling people who are confirmed ill with COVID-19, asking for their recent contacts and reaching out to those people to determine if they need testing and if they should self-isolate, all in the hopes of breaking the chains of infection.
“The cases we receive come in by fax machine,” Dr. Mark Escott, the interim medical director and health authority for Austin Public Health, told Travis County commissioners. “And sometimes those faxes are positives and sometimes they’re negatives. Sometimes they have information like the person’s phone number that was tested and sometimes they don’t. So we have a whole team of people who have to sort through more than a thousand faxes a day to sort out the positives versus the negatives.”
The system remains a “very manual and archaic process,” he added, because nearly all of the labs and the hospitals in the state report coronavirus cases through fax, and those results must then be manually entered into a computer…
“Right now, what happens when you call somebody that’s a positive and ask where they’ve been over the past week, they’ve been everywhere. They’ve been at grocery stores and restaurants and bars and friends’ houses. They’ve had contact with hundreds of people,” he said at a news conference Wednesday. “Contact tracing in that circumstance is not going to be as effective. So that’s why we’re asking people not to depend on contact tracing at this stage of the outbreak.”
Since the beginning of the coronavirus pandemic, public health experts and Democratic lawmakers have been vocal about the need for local and state health agencies to perform contact tracing, in addition to ramping up of testing for COVID-19, the disease caused by the coronavirus.
But a lack of consistent messaging from the White House, the Trump administration’s apparent delay in distributing billions of dollars in funding appropriated by Congress in April for testing and tracing, and the woefully inadequate number of contact tracers needed nationwide to appropriately handle the growing caseload have derailed the efforts to create a robust tracing program, experts add…
Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, which released a report in April estimating the need to hire 100,000 contact tracers as part of a nationwide workforce, said there’s been a noticeable lack of a “top level embrace of contact tracing.”
While she said she’s “heartened” by states and local health agencies that moved to ramp up contact tracing efforts ahead of reopening their economies, including in Massachusetts and New York, she is “disheartened by the lack of support from our federal government on this.”” (D)
“Kimberly Jocelyn graduated from college last month as millions across the country sheltered in place to avoid the coronavirus pandemic. Looking for a pandemic-friendly way to connect with her community, she applied to be a New York City contact tracer.
After a FaceTime interview with New York City Health + Hospitals’ test and trace corps and a six-hour online course through Johns Hopkins University, Jocelyn joined the city’s team of roughly 3,500 in the effort to contact those who have tested positive for Covid-19 and identify who they might have exposed to the virus.
The work is crucial to cutting off chains of infection before they balloon into outbreaks. Along with social distancing and mask wearing, contact tracing is one of the only proven strategies in containing the coronavirus. It’s also difficult work, Jocelyn said, and it’s nonstop.
“My first call was with someone who was confused about how they contracted the virus,” she said, adding that it takes compassion and patience to do the job well. “We’re here to provide information about Covid, understand how they contracted Covid, and also to understand how they are, to see if they need any resources.”
Jocelyn, who’s now a supervisor of about 15 other tracers, said ideally, a tracer comes out of one of those conversations with contact information for family members, co-workers and anyone else who might have been exposed. Throughout a given day, a tracer on her team will contact between 30 and 50 people, tracking the virus around the city and trying to corner it off into identified chains of people…
“If you’re not doing mitigation, so closing things down, implementing social distancing, once you stop doing that, the only tool you have to keep people from transmitting to each other is contact tracing, isolation and quarantine,” said Dr. Karen Smith, former director of the California Department of Public Health. “It’s the only tool you’ve got and it’s a tool that works really well when adequately staffed.”” (E)
“New York City’s ambitious contact-tracing program, a crucial initiative in the effort to curb the coronavirus, has gotten off to a worrisome start just as the city’s reopening enters a new phase on Monday, with outdoor dining, in-store shopping and office work resuming.
The city has hired 3,000 disease detectives and case monitors, who are supposed to identify anyone who has come into contact with the hundreds of people who are still testing positive for the virus in the city every day. But the first statistics from the program, which began on June 1, indicate that tracers are often unable to locate infected people or gather information from them.
Only 35 percent of the 5,347 city residents who tested positive or were presumed positive for the coronavirus in the program’s first two weeks gave information about close contacts to tracers, the city said in releasing the first statistics. The number ticked up slightly, to 42 percent, during the third week, Avery Cohen, a spokeswoman to Mayor Bill de Blasio, said on Sunday.
Contact tracing is one of the few tools that public health officials have to fight Covid-19 in lieu of a vaccine, along with widespread testing and isolation of those exposed to the coronavirus. The early results of New York’s program raise fresh concerns about the difficulties in preventing a surge of new cases as states across the country reopen.
The city has successfully done contact tracing before, with diseases like tuberculosis and measles. But as with much involving the coronavirus outbreak, officials have never faced the challenge at this scale, with so many cases across the five boroughs.
The city’s program has so far been limited by a low response rate, scant use of technology, privacy concerns and a far less sweeping mandate than that in some other countries, where apartment buildings, stores, restaurants and other private businesses are often required to collect visitors’ personal information, which makes tracking the spread easier…
Perry N. Halkitis, dean of the School of Public Health at Rutgers University, which is guiding an effort to bring on thousands of tracers in New Jersey, called New York City’s 35 percent rate for eliciting contacts “very bad.”
He suggested that the poor showing stemmed in part from the inexperience of the contact tracers and insufficient hands-on training.
“This is a skill,” he said. “You need to practice.”” (F)
“For Lauri Jones, the trouble began in early May. The director of a small public health department in Washington state was working with a family under quarantine because of coronavirus exposure. When she heard one family member had been out in the community, Jones decided to check in.
The routine phone call launched a nightmare.
“Someone posted on social media that we had violated their civil liberties [and] named me by name,” Jones recalled. “They said, ‘Let’s post her address. . . . Let’s start shooting.’ ”
People from across the country began calling her personal phone with similar threats.
“We’ve been doing the same thing in public health on a daily basis forever. But we are now the villains,” said Jones, 64, who called the police and set up surveillance cameras at her home.
Public health workers, already underfunded and understaffed, are confronting waves of protest at their homes and offices in addition to pressure from politicians who favor a faster reopening. Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials, said more than 20 health officials have resigned, retired or been fired in recent weeks “due to conditions related to having to enforce and stand up for strong public health tactics during this pandemic.”
Although shutdown measures are broadly popular, a vocal minority opposes them vociferously. There have been attacks on officials’ race, gender, sexual orientation and appearance. Freeman said some of the criticisms “seem to be harsher for women.”
Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials, said attacks on health officials have been particularly awful in California, Colorado, Georgia, Ohio and Pennsylvania.
This month in California, Nichole Quick, Orange County’s chief health officer, stepped down after she faced threats and protests at her home for requiring face coverings in many businesses as cases rose. The mandate, issued May 23, was softened to a recommendation a week later.
Andrew Noymer, a professor of public health at the University of California at Irvine who is part of a county task force, said it was not the first time Quick had been undermined.
On March 17, Quick issued a strict lockdown order; a day later, it was amended to add exceptions.
“It was couched as a clarification, but it was a walk-back” because of pressure from business leaders, Noymer said.
Quick’s departure is part of an exodus of public health officials across the country who have been blamed by citizens and politicians for the disruptions caused by the coronavirus pandemic.” (G)
“Germany, a country of more than 83 million people, has flattened its coronavirus curve, dropping from a peak of more than 6,000 new cases a day to just around 600 now. Contact tracing by telephone is one tool the country has relied on.
“Public Health Authority, Pankow,” says an operator, answering her phone before the first ring is over and identifying the Berlin district where she works. “So,” she confirms with the caller, “you’ve had contact with someone who’s tested positive.”
She asks for the name of the infected person, types it into her computer, and the caller’s name appears on her screen as someone the contact tracers were about to call.
“Did you spend more than 15 minutes at close contact with this person?” the operator asks. The caller tells her they went for a walk.
Across Germany, there are about 400 call centers like this one, each filled with dozens of operators fielding calls from worried citizens, taking first steps at contact tracing and referring callers to medical personnel…
Merkel aims for the country to have one tracer per 4,000 people — nearly 21,000 tracers for Germany’s population of 83 million.
“We’ve recruited staff from other district authorities, including social services, but we also have traffic wardens and librarians working for us,” says Dr. Uwe Peters, director of the Pankow district health authority. “We’ve even recruited gardeners from parks and recreation. They all help man the hotline. We also have students helping out and we’re about to be allocated five soldiers as well.”..
“One teacher had contact with 400 students,” says Krummacher. “It could also be a midwife working at the hospital, having close contact to many, many women. There are all sorts of constellations.”” (H)
“John Welch, a nurse anesthetist with the nonprofit Partners in Health, was working at a clinic on the rural central plateau of Haiti when, in August of 2014, he got a call asking if he could fly to Liberia…
Liberia, a nation of five million people, eventually employed as many as ten thousand tracers. Welch recalled that, after he had been in the region for eight months, “if you told me there would be an outbreak in a particular region, I could tell you which village. If you told me the village, I could tell you which house.” … He told me, “I think we are at a similar point with covid-19 to where we were with Ebola when I first arrived in Monrovia.”..
Many states have also launched contact-tracing programs without what P.I.H. considers one of the most vital components—the care-resource coördinators who help solve the problems, like a need for food or medicine, that keep people from isolating. Mike Reid, an infectious-disease doctor at the University of California, San Francisco, who is helping design the city’s contact-tracing program, said that there was an active debate over whether to include care-resource coördinators. Reid believes that the role is “absolutely critical,” he told me, but because of funding concerns it was likely to be cut from the San Francisco program. “We’ve had plenty of states get on the phone with us, and you get to the care-resource-coördination part, and you can just see their eyes glaze over,” one P.I.H. staffer told me. “Like, ‘Wait, these aren’t contact tracers? Why do we have to pay for this again?’ ”
The answer, at least for the P.I.H. staffers, was that, without helping people to isolate, you would never persuade them to do so. The full contact-tracing process is “the bulwark of how we will reopen,” as George Rutherford, an epidemiologist at U.C.S.F., who is also working on California’s statewide program, put it. But contact tracing can’t easily solve the problems that are typical in the places where outbreaks tend to occur—prisons, nursing homes, and protests—or the policies that help determine who stays home and who doesn’t. What it has to offer, to try to insulate communities from the virus, is the attention of individual people: tracers, investigators, resource coördinators. The more of them you have, the better the odds…”” (I)
“But everywhere you look, tech has failed to deliver. In France, less than 3% of the population has downloaded StopCovid. The U.K. missed an initial rollout deadline and has chosen to start over using another platform. Tracing apps in the U.S. have been caught in a social media war about whether virus news is real or fake, while Australia’s COVIDSafe hasn’t detected a single case despite 6 million downloads. Singapore’s TraceTogether was an early entrant, but even its government began distributing portable tokens this week to complement the app. The one nation with a modicum of success has been China, but only because authorities made the technology mandatory and imposed privacy practices that would be unacceptable elsewhere.
The value of contact-tracing apps is “really questionable,” says Sean McDonald, a senior fellow at the Centre for International Governance Innovation, an independent think tank based in Canada. “The underlying science of proximity as a good indicator of infection relies on a whole bunch of other variables, like whether or not you’re wearing a mask, or whether or not you’re outside.”
Contact-tracing apps use smartphones to track a person’s whereabouts, alerting users if they’ve been in contact with someone who’s had the disease. They’re designed to help supplement the traditional, labor-intensive approach to contact tracing, which involves hundreds of people interviewing those who have been exposed and painstakingly piecing together information about what they did and who they may have come into contact with. In the absence of a vaccine, digital technology was seen as critical for getting people back to work faster and economies up and running…
One of the biggest issues is making sure there’s a critical mass of people signing up. The apps, most of which are voluntary, need a significant number of users if they’re ever going to be effective. A University of Oxford study published in April and based on a simulation of an urban population of 1 million found virus transmission could be suppressed if at least 80% of smartphone users—which amounts to about 56% of all people—participated. That’s a very high number. Even in Singapore, which has a largely compliant populace used to following government orders, only 35% of people have downloaded the app, among the highest take-up rates in the world….
Vivian Balakrishnan, the minister in charge of Singapore’s Smart Nation Initiative, said in a Facebook post that “we need to entrust human contact tracers with information during this crisis.” Contact tracing “remains a human endeavor requiring human judgment,” he said.” (J)
“As countries search for ways to exit lockdown and avoid or manage a second wave of covid-19 cases, many have turned to the promise held by contact-tracing apps. In a rare display of collaboration, Apple and Google recently joined forces to help the technology work effectively…
The principle behind contact-tracing apps is fairly simple. Once installed, they use Bluetooth low-energy (LE) technology to record when a phone has come into close proximity with anyone else using the app. If either person later reports coronavirus symptoms, the other party is notified, so they could self-isolate or seek health advice. An alert could also be sent if a medical authority certifies the other person tested positive for the virus – this would be one way to avoid users trolling the system by falsely claiming symptoms. In theory, the apps work anonymously and only store data temporarily, without collecting location…
There are a host of other questions. Key elements will be the level of trust between citizens and governments, how privacy is preserved, keeping the apps voluntary, and how to also protect people who might not have a smartphone or the ability to install an app – a group that is likely to include many vulnerable older people. The American Civil Liberties Union yesterday laid out a list of principles, including the need for an exit strategy for such apps, to avoid such systems being maintained for “surveillance creep” after an epidemic has passed.
Nevertheless, many countries are on the verge of deploying apps. Germany is expected to release one imminently, and Australia is working on one too. One of the most high profile existing apps has been Singapore’s TraceTogether app, built by the city state’s government. But even its creators admit that it is too early to tell how effective it is. Moreover, “every country will have to develop its own app” because of different situations and requirements, says a spokesperson at Pan-European Privacy-Preserving Proximity Tracing, a European technology initiative…
However effective the apps turn out to be, they cannot be a silver bullet for exiting social distancing measures, and must be part of a much broader effort of testing and contact tracing.” (K)
“As Texas becomes a national hot spot for the new coronavirus, the state is still falling short on the governor’s months-old goal to employ up to 4,000 contact tracers — and the number of virus detectives dropped recently when the state health agency reassigned hundreds of state workers.
Earlier this month, 400 Texas Department of State Health Services employees who had been temporarily assigned to contact tracing were directed to other roles, including other COVID-19 response jobs, because there were sufficient personnel to track all the cases they were covering, spokesperson Lara Anton said…
Now, about 2,800 contact tracers are at work in Texas, even as the state has routinely reported more than 5,000 new COVID-19 cases each day. In early June, the state’s contact tracing workforce numbered about 2,900, and it reached almost 3,200 later in the month before dropping again…
But experts say that a state with 29 million people where cases are climbing at an alarming rate needs as big a workforce as it can muster.
And health officials in some of Texas’ biggest cities — some of whom have already asked the state for assistance — said they are struggling to keep pace with contact tracing as cases skyrocket. Of the state’s 2,800 contact tracers, 1,250 are working in local health departments, Anton said…
And in a state where more than a third of residents speak a language other than English at home, just 112 of the state’s 2,800 contact tracers have indicated that they are Spanish speakers, according to the state heath agency. Tracers who speak only English have access to a translation service that helps reach more individuals, but that could mean each call takes twice as long, experts said.” (L)
“Imagine being given a list of 23 people and told that you need to track down and contact every person that each of those 23 people has come into contact with in the last two weeks. Time is of the essence because those contacts may have been exposed to COVID-19.
With nearly 50,000 newly confirmed cases of the coronavirus in Florida in the last seven days, that’s the one-week caseload for each of the state’s 2,200 contact tracers. And their caseload continues to grow.
According to the National Association of County and City Health Officials, during a pandemic, about 30 contact tracers are needed for every 100,000 people. The latest data show there are only eight states that meet the threshold.
In order for Florida to meet the same threshold, it would need to nearly triple its workforce to around 6,500 contact tracers.” (M)
“The Ingham County Health Department is asking patrons who visited Harper’s Restaurant & Brew Pub between June 12 and June 20 to self-quarantine and report cases of Covid-19, the department said in a statement…
Of the more than 100 positive cases, 12 are from secondary transmission, Ingham County Health Officer Linda S. Vail said Monday night…
“Our oversight of the line on our stairs has been successful, but trying to get customers to follow our recommendations on the public sidewalk has been challenging,” the statement read. “Because we have no authority to control lines on public property, we are left with the dilemma of staying open and letting this situation continue, or closing until we can devise a strategy that eliminates the lines altogether.”
The bar opted to close down temporarily to install air purifiers and to eliminate lines, according to the statement.” (N)
H.How Germany Staffed Up Contact Tracing Teams To Contain Its Coronavirus Outbreak, by ROB SCHMITZ,https://www.npr.org/sections/health-shots/2020/06/22/880803278/how-germany-staffed-up-contact-tracing-teams-to-contain-its-coronavirus-outbreak
