PART 15. CORONAVIRUS. March 22, 2020. “…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.

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Link to – CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-15 (and prequels). March 22, 2020

CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-15 (and prequels). March 22, 2020
CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-15 (and prequels). March 22, 2020

(Hoboken, New Jersey; September 2001)

“Military helicopters and jets were overhead, as President Bush was getting ready to leave. The plumes of smoke from the World Trade Center were still billowing skyward.

Suddenly a huge white military hospital ship with four Red Crosses steamed by and docked right across river. I thought how this hospital ship brought the war even closer to home but mostly about how the hospitals in Hudson County had responded and performed so magnificently.”

“A U.S. Navy hospital ship is expected to head to the Seattle region next week, with the intention of helping to alleviate the strain on the city’s hospital system due to the influx of patients infected by the novel coronavirus.

The USNS Mercy — one of the Navy’s two 1,000-bed hospital ships — will likely leave its homeport of San Diego sometime next week. Meanwhile, the Mercy’s sister ship, the USNS Comfort, will not head to New York harbor from its homeport of Norfolk until early April,due to scheduled maintenance, officials said.” (A)

 “State and healthcare officials in Washington state have begun drafting plans for their worst-case scenario: denying patients complete medical care if the coronavirus overwhelms the health system in coming weeks.

Approximately 280 people were on a three-hour conference call Wednesday, including CMOs and nursing leaders for most of the state’s hospitals and health systems and representatives from the Washington State Hospital Association and state chapter of the American College of Emergency Physicians, the New York TImes reported.

The triage plan, still in progress, will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.

Other considerations leaders shared with the New York Times:

The goal in developing criteria for prioritizing care is to provide fair and evenly applied practices across the region, reducing the likelihood of variation in care depending on which hospital a patient goes to.

Another goal of drafting the plan is to avoid putting responsibility on individual physicians and nurses to make such decisions and reduce the anguish they would experience in denying care.

One leader noted the crisis strategies are not something anyone wants to anticipate, but it would be worse to be unprepared in the event they are needed.” (B)

“We are doing everything we can at the City level to prevent the spread of COVID-19 in all ways possible, including any people unnecessarily coming into Hoboken for a trip that we can’t track and to locations we can’t determine. As of last night, there were surprisingly several dozens of rentals available on Airbnb. All short-term rentals, including Airbnb are now prohibited until further notice in Hoboken, with a new order issued by the Office of Emergency Management. We have informed Airbnb and ask all hosts to remove their listings without delay.”

“Only one retailer, CVS, has opened a drive-through coronavirus testing site so far, but it is limited to only first responders who are referred by government and public health officials.

Walmart and Walgreens said they plan to open test sites in the Chicago area in the next few days.” (C)

“Patients can see a pharmacist at a Kroger Health pharmacy for rapid strep throat and flu testing – effective immediately – according to the company.

A pharmacist will evaluate symptoms of flu-like illness or sore throat, medical history, and conduct an examination. As part of the service, the pharmacist may perform a nasal swab or throat swab collection for a diagnostic test screening for influenza or Streptococcus bacteria (strep throat).

If indicated, pharmacists can also prescribe and supply the appropriate treatment during that same visit, helping decrease the length, severity and spread of illness…

104 Michigan Kroger Health pharmacies will be joining providers at The Little Clinic with the ability to provide this service.

In preparation of this service, about 250 Kroger Health pharmacists received specialized training that allows them to provide strep throat and flu testing at their pharmacies and prescribe medication, if needed.” (D)

“While the novel coronavirus continues to spread in the U.S. — and in Florida — the Florida Legislature voted Wednesday to expand the roles of pharmacists and some nurses to test and treat certain conditions and perform certain acts without the supervision of a physician…

After debate that weighed access with quality of care, the Senate passed two expanded practice bills that have been a top priority of House Speaker José Oliva.

HB 389 allows pharmacists to test and treat patients for the flu and strep throat and also give them authority to treat chronic medical conditions. HB 607, a scaled-back version of Oliva’s wish, allows highly trained advanced practice registered nurses to provide primary care and practice independently of doctors.” (E)

“A temporary field hospital for use by people unable to isolate and recover from COVID-19 in their own homes will be located at a soccer field in Shoreline, a city spokesman said.

The Shoreline Temporary Field Hospital, at 19030 First Ave. N.E., will provide up to 200 beds, according to the city website. It will house “people exposed to, at risk of exposure, or becoming ill with the novel coronavirus.”

“It’s basically to relieve pressure on the hospitals and to free up beds for critical patients,” said Eric Bratton, a city spokesman. The hospital will be on a turf soccer field that is on school district property but is leased by the city, Bratton said.

“My understanding is they’re setting it up now, but they’re not anticipating using it or occupying it for another week or so,” Bratton said.

King County is creating field hospitals at several locations for people who cannot remain in their own homes or do not have a home.” (F)

“The FDA on Feb. 29 loosened diagnostic test restrictions, opening the door for health systems to use their own COVID-19 tests, instead of relying on public health labs or the CDC for testing.

Developing a new diagnostic test usually takes about six months to a year, but microbiologists and other scientists at top health systems have been working around the clock to create new tests for COVID-19 in just about a month.

Here are six health systems that developed their own tests for COVID-19:

1. Rochester, Minn.-based Mayo Clinic developed and validated a COVID-19 test in under a month, Matthew Binnicker, PhD, a clinical microbiologist and director of the system’s Clinical Virology Laboratory, said March 12. The health system submitted its data to the FDA seeking emergency use authorization. Initially, Mayo’s lab will process up to 300 tests a day. The lab said it plans to double that number over the next few weeks after it obtains additional equipment.” (G)

“New Jersey Health Commissioner Judy Persichilli said Thursday the state had a two-part plan to reopen Inspira Medical Center Woodbury in the wake of the coronavirus pandemic, which could happen in 3-4 weeks.

“I told him his task is to empty out the facility and our task as a team is to bring it back up,” Persichilli said, referring to Inspira CEO John DiAngelo. “The first part is for Mr. DiAngelo and his team to move out the existing individuals who are inhabiting that location.”

The hospital closed in December after Inspira opened a newer facility in the Mullica Hill section of Harrison in Gloucester County. The facility currently houses only a satellite emergency department, behavioral health services, and outpatient services including imaging and lab work. It will be able to provide 300 new beds, the commissioner said…

Persichilli said the hospital would not be just for COVID-19 patients but would provide all types of medical services to “absorb the surge” as more patients need to be treated for the virus.” (H)

“Facing a dire shortage of protective face masks for health care workers, administrators at the University of Nebraska Medical Center decided they had no choice.

Masks are certified for one-time use only. But on Thursday, the center began an experimental procedure to decontaminate its masks with ultraviolet light and reuse them. Administrators plan to use each mask for a week or longer.

To the knowledge of the program’s administrators, the medical center is the first to disinfect and reuse masks.

“We have talked with a lot of others around the country who are going after a similar approach,” said John Lowe, the medical center’s assistant vice chancellor for health security training and education, who designed the program.

When administrators made the decision, they knew the procedure violated regulations promulgated by the Centers for Disease Control and Prevention, which said that if masks were decontaminated they could no longer be certified for use.

But late Thursday night, the agency issued new guidance, saying that “as a last resort, it may be necessary” for hospitals to use masks that were not approved by the National Institute for Occupational Safety and Health.

That change would seem to mean it is now acceptable for hospitals to decontaminate and reuse masks during the coronavirus pandemic, said Shawn Gibbs, a professor of environmental health at Indiana University.

If that were not the case, he added, then many hospitals would find themselves in a tightening bind as gear shortages spread: “What is preferred — not using respirator protection equipment, or using a decontaminated respirator whose certification is voided?”” (I)

“Here are 14 notes from hospitals, health systems and physicians on their responses to the coronavirus pandemic.” (J)

“CMS is urging all hospitals to comply with the American College of Surgeons’ recommendation to cancel non-urgent elective procedures amid the COVID-19 pandemic.

However, some hospitals and health systems nationwide have opted to continue some surgeries based on their patients’ needs.

Here’s their thinking:

UC Davis Medical Center (Sacramento)

The major academic medical center cares for a large volume of patients with complex health conditions and surgical needs. The hospital said it is continuing to offer scheduled surgeries for select patients, as the hospital is not yet seeing any surges related to COVID-19. About half of the hospital’s surgical cases for March 19 are oncology- or injury-related. A spokesperson for UC Davis said the hospital is evaluating surgical cases daily to determine which can be rescheduled.

“Although we are the largest hospital in the area, we are not encouraging surgeries, but we are saying to surgeons and their patients that we can accommodate patients’ needs,” the spokesperson told Becker’s. “These surgeries, especially pain-relieving, trauma and cancer-related procedures, are not seen as ‘elective’ by patients. Moreover, we are able to make changes in less than 24 hours, should demands change.” (K)

“These hospitals and physicians aren’t stopping elective surgeries: Here’s their thinking” (L)

“A bipartisan effort is underway to include legislation in the Senate’s $1 trillion coronavirus package that would protect patients from surprise medical bills, The Hill confirmed Wednesday.

A last-minute push from Sen. Lamar Alexander (R-Tenn.) and Rep. Frank Pallone Jr. (D-N.J.) seeks to include language that is favored by insurers, rather than doctors and hospitals, according to sources familiar with the effort.

The provision, similar to what was included in separate bills from the House Energy and Commerce Committee and the Senate Health Committee, would let the government set provider rates based on the average price for in-network services offered in a geographical area, a practice known as “benchmarking.”

Protecting patients from receiving medical bills for thousands of dollars after receiving care from an out-of-network doctor had been seen as a rare area of possible bipartisan agreement this year.

But the effort has been slowed by an array of competing proposals and intense lobbying from doctors and hospitals, who worry it would lead to damaging cuts to their payments. Some conservative groups and lawmakers also argue the approach is akin to government price-setting.” (M)

“Last-minute fighting among lawmakers over the details of a more than $1 trillion economic stabilization package to aid families and businesses devastated by the coronavirus pandemic left the sweeping legislation teetering on the brink on Sunday, with the Republican-controlled Senate pushing ahead toward a vote on the package without a formal compromise with Democrats.

The top four congressional leaders met with Steven Mnuchin, the Treasury secretary, to hash out differences over the package, which remains unfinished after days of rapid closed-door negotiations with administration officials and bipartisan groups of senators.

They emerged without news of an agreement, but indicated that talks would continue even as Senator Mitch McConnell of Kentucky, the majority leader, planned to move forward with an initial procedural vote on the package during a rare Sunday session in the Senate…

But Mr. McConnell said that the leaders “were very close” and “were still talking” after the meeting in his office, which included Senator Chuck Schumer, Democrat of New York, and Representative Kevin McCarthy, Republican of California, the two minority leaders…

Democrats, for their part, continued to push for stronger protections for workers and raised alarms about the scope of some funding levels and programs. Among the concerns, according to Democratic aides, was the size of a Treasury Department fund and the discretion Mr. Mnuchin and his lieutenants would have to decide who would receive those funds, as well as how quickly the administration would have to disclose loans or loan guarantees made to companies and industries.

Democrats have also voiced concerns that the bill does not contain enough barriers to prevent industries from laying off their work forces after receiving federal funds, and are pushing for giving grants instead of loans to airlines.” (N)

“Speaker Nancy Pelosi is hitting pause on bipartisan negotiations on a $1.6 trillion-plus emergency package in the Senate, saying the House will forge ahead with its own bill to address coronavirus after congressional leaders failed to reach a deal earlier Sunday.

Pelosi’s comments come just hours before the Senate is scheduled to take a critical procedural vote on the package aimed at trying to stymie an economic collapse as the coronavirus continues to disrupt massive sectors of the U.S. economy.

“From my standpoint, we’re apart,” Pelosi told reporters as she entered Senate Majority Leader Mitch McConnell’s (R-Ky.) office Sunday morning…

Senior House Democrats have been working on dual tracks for days — simultaneously drafting language for their own bill while also conferring with Senate Democrats on what they’d like to see in the McConnell-Schumer proposal.

The various House panels involved, from Financial Services to Ways and Means, Energy and Commerce and Education and Labor, were told to wrap up their portions of the bill Saturday night. The House Appropriations Committee is now compiling all of the language and legislative text could be expected as soon as Monday, according to multiple sources.

Democratic leadership also huddled on a conference call on Friday night, where Pelosi reiterated her plans to release a legislative framework that lets Democrats lay a marker in the talks.

It’s unclear what exactly will be in the final House Democratic package. The caucus held several hours of conference calls this week for members to promote their ideas, including a significant expansion of unemployment insurance, direct cash payments to Americans under a certain income threshold, funding for hospitals and medical supplies, and grants to keep small businesses from folding. Hundreds of proposals were submitted from all corners of the caucus.

“I’m anxious to see what Speaker Pelosi would put on the table. She needs to be part of this conversation,” said Senate Minority Whip Dick Durbin (D-Ill.) when asked about Pelosi’s plans. “We do have a bicameral Congress and the House of Representatives will ultimately consider whatever is sent to them. And I hope we can have a bipartisan agreement when that’s sent.”

Many of those same provisions are also being negotiated in the Senate bill but some House Democrats wanted to go even further, using the urgency of the herculean package to achieve broader, long term policy goals like a massive infrastructure deal.” (O)

“Restaurants say they need $325 billion in federal assistance. Boeing wants $60 billion. The travel industry has requested $250 billion and manufacturers are seeking $1.4 trillion in loans to deal with the economic devastation being wrought by the coronavirus.

And that’s to say nothing of the casinos, airlines and franchise owners, all of whom have signaled that they, too, will need relief from the federal government to survive.

Then there are the industries and companies that do not immediately come to mind as front-line casualties but are nonetheless lobbying for their causes to be addressed as Congress prepares to allocate $1 trillion or more in response to the crisis.

The prospect of a bailout of a scale without precedent has set off a rush to the fiscal trough, with businesses enduring undeniable dislocation jostling with more opportunistic interests to ensure they get a share.

The sportswear company Adidas is seeking support for a long-sought provision allowing people to use pretax money to pay for gym memberships and fitness equipment — despite the mandatory closure of fitness facilities in many jurisdictions during the outbreak.

Drone makers are urging the Trump administration to grant waivers they have been seeking that would allow them to be used more widely — including to deliver medical supplies or food without risking human contact that could spread the virus.

Movers are requesting $187 million in assistance to make up for revenue lost as a result of a Defense Department order halting moves, while Airbnb is asking Congress to give tax breaks and access to small business loans to people who lost income from a decline in home rentals.

Then there are the pig farmers. They are citing coronavirus in renewing their call for the federal government to expedite foreign worker visas, with an executive at the National Pork Producers Council noting in an email “many Americans have experienced empty meat cases in recent days, as we adapt to the surge in demand.”

While the halls of the Capitol are eerily quiet, lobbyists are burning up the phone lines and flooding email inboxes trying to capitalize on the stimulus bills moving quickly through Congress. President Trump has already signed into law a coronavirus relief package including funds to provide sick leave, unemployment benefits, free coronavirus testing and food and medical aid to people affected by the pandemic.” (P)

“Yet there are lessons to be learned from two places that saw the new coronavirus before we did and that have had success in controlling its spread. Hong Kong and Singapore—both the size of my state—detected their first cases in late January, and the number of cases escalated rapidly. Officials banned large gatherings, directed people to work from home, and encouraged social distancing. Testing was ramped up as quickly as possible. But even these measures were never going to be enough if the virus kept propagating among health-care workers and facilities. Primary-care clinics and hospitals in the two countries, like in the U.S., didn’t have enough gowns and N95 masks, and, at first, tests weren’t widely available. After six weeks, though, they had a handle on the outbreak. Hospitals weren’t overrun with patients. By now, businesses and government offices have even begun reopening, and focus has shifted to controlling the cases coming into the country…

The fact that these measures have succeeded in flattening the covid-19 curve carries some hopeful implications. One is that this coronavirus, even though it appears to be more contagious than the flu, can still be managed by the standard public-health playbook: social distancing, basic hand hygiene and cleaning, targeted isolation and quarantine of the ill and those with high-risk exposure, a surge in health-care capacity (supplies, testing, personnel, wards), and coördinated, unified public communications with clear, transparent, up-to-date guidelines and data. Our government officials have been unforgivably slow to get these in place. We’ve been playing from behind. But we now seem to be moving in the right direction, and the experience in Asia suggests that extraordinary precautions don’t seem to be required to stop it. Those of us who must go out into the world and have contact with people don’t have to panic if we find out that someone with the coronavirus has been in the same room or stood closer than we wanted for a moment. Transmission seems to occur primarily through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions.” (Q)

“President Trump on Thursday exaggerated the potential of drugs available to treat the new coronavirus, including an experimental antiviral treatment and decades-old malaria remedies that hint of promise but so far show limited evidence of healing the sick.

No drug has been approved to treat the new coronavirus, and doctors around the world have been desperately administering an array of medicines in search of something to help patients, especially those who are severely ill.

The malaria drugs, chloroquine and hydroxychloroquine, are among the remedies that have been tried in several countries as the virus has spread around the world, killing at least 9,800.

Both drugs have gone into short supply in the United States this month, as word has spread of their potential benefit to coronavirus patients. Manufacturers of the generic products have said they are ramping up production. One company, Teva, said it would donate millions of pills of hydroxychloroquine to hospitals, and another company, Mylan, said it would restart production of the drug.

In a White House briefing Thursday, Mr. Trump said the anti-malaria drugs had shown “tremendous promise.”

“I think it’s going to be very exciting,” he said. “I think it could be a game changer, and maybe not.”” (R)

“The outbreak of the respiratory virus began in China and was quickly spread around the world by air travelers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later, the World Health Organization declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalized and 586,000 dead.

That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.

The simulation’s sobering results — contained in a draft report dated October 2019 that has not previously been reported — drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.

The draft report, marked “not to be disclosed,” laid out in stark detail repeated cases of “confusion” in the exercise. Federal agencies jockeyed over who was in charge. State officials and hospitals struggled to figure out what kind of equipment was stockpiled or available. Cities and states went their own ways on school closings.

Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation’s leaders. Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.

In 2016, the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017, outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.

The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement on Monday that he had known all along that a pandemic was on the way.” (S)

“Senator Richard M. Burr sold hundreds of thousands of dollars’ worth of stock in major companies last month, as President Trump and others in his party were still playing down the threat presented by the coronavirus outbreak and before the stock market’s precipitous plunge.

The stocks were sold in mid-February, days after Mr. Burr, Republican of North Carolina and the chairman of the Intelligence Committee, wrote an opinion article for Fox News suggesting that the United States was “better prepared than ever before” to confront the virus. At least three other senators sold major stock holdings around the same time, disclosure records show.” (T)

“President Trump said “The FDA Commissioner — Stephen Hahn, who is with us — he’s fantastic.  And he has been working 24 hours a day.  He’s been — he’s worked like, probably as hard or harder than anybody in this — in the group, other than maybe Mike Pence or me.” (U)

ITALY “Our small city has been on lockdown for nearly two weeks. The streets are silent. Many factories are closed. The only people allowed outside are those walking their dogs, heading to the grocery store or those who have permission from the government. A few of our friends are hospitalized from the coronavirus, with many more in quarantine at home. Hundreds of people have died here.

In mid March, we heard that doctors from a nearby hospital didn’t have enough valves for their lifesaving ventilator machines. And the company that produced the valves couldn’t meet the growing demand.

Our company is five years old. We make earthquake sensors, silicone bandages, bicycles — practical stuff. We had never made valves before, but we wanted to help.

We visited the hospital to see the valve, which connects the patient to the breathing machine, mixing pure oxygen with air that enters through a rectangular window. It looks like a chess piece waving one arm and it needs to be replaced for each patient.

We came back to our office and started working, fueled by adrenaline. Our first few attempts didn’t succeed, but eventually we made four copies of the prototype on a small 3-D printing machine that we have in our office.

While the valve might look like a simple piece of plastic, it’s pretty complex; the hole that diffuses the oxygen is less than a millimeter in diameter.

The day after, we returned to the hospital and gave our valves to a doctor who tested them. They worked and he asked for 100 more. So we went back to the office, and returned to the hospital with 100 more. We hoped that this would last them for a few days. Still, the coronavirus rages on. A few hospitals in northern Italy asked us to make copies of the same piece. We are printing them now…

This sparked a second idea: to modify a snorkeling mask already on the market to create a ventilation-assisted mask for hospitals in need of additional equipment, which was successful when the hospital tested it on a patient in need.” (V)