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

to read PARTS 1-10 in chronological order click on

CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-10 (and prequels). March 1, 2020

“A man in Miami went to the hospital to receive a test for the coronavirus after developing flu-like symptoms, only to receive the news that he didn’t have it — and a $3,270 medical bill, the Miami Herald reports.

Why it matters: The man had just returned from a work trip to China, so took his symptoms more seriously than normal, which is exactly what public health experts want people to do.

Our thought bubble: The episode would be a great parody of the health care system, if it wasn’t real.

The man has a short-term health insurance plan, which usually have skimpy benefits in exchange for lower premiums, and don’t have to cover pre-existing conditions. The Trump administration has expanded them.

The hospital told the Herald that the patient is only on the hook for $1,400 based on his insurance, but his insurer told him that first, he must provide three years of medical records to prove that his flu didn’t relate to pre-existing conditions.

And more bills are probably coming.”  (A)

“Frank Wucinski and his 3-year-old daughter, Annabel, are among the dozens of Americans the government has flown back to the country from Wuhan, China, and put under quarantine to check for signs of coronavirus.

Now they are among what could become a growing number of families hit with surprise medical bills related to government-mandated actions.

Mr. Wucinski, a Pennsylvania native who has lived in China for years, accepted the U.S. government’s offer to evacuate from Wuhan with Annabel in early February as the new coronavirus spread. His wife, who is not an American citizen and remains in China, developed pneumonia that doctors think resulted from Covid-19, the disease caused by the respiratory virus. Her father, whom she helped care for, was infected and recently died.

The first stop for Mr. Wucinski and Annabel was a two-week quarantine at Marine Corps Station Miramar near San Diego. During that time, they had two mandatory stays in an isolation unit at a nearby children’s hospital. The first started upon arrival in the United States, and the second was a few days later, after an official heard Annabel coughing…

After their release from quarantine, Mr. Wucinski and his daughter went to stay with his mother in Harrisburg, Pa. That’s where they found a pile of medical bills waiting: $3,918 in charges from hospital doctors, radiologists and an ambulance company.

“I assumed it was all being paid for,” Mr. Wucinski said. “We didn’t have a choice. When the bills showed up, it was just a pit in my stomach, like, ‘How do I pay for this?’”

The federal government has the authority to quarantine and isolate patients if officials believe them to be a public health threat. These powers, which date back to cholera outbreaks among ship passengers in the late 19th century, are rarely used. They don’t say anything about who pays when the isolation happens in a nongovernmental medical facility — or when they’re brought there by a private ambulance company…

A Centers for Disease Control and Prevention spokesman declined to comment on whether it would pay the bills of patients kept in mandatory isolation…

“My question is why are we being charged for these stays, if they were mandatory and we had no choice in the matter?” Mr. Wucinski wrote in his message.

…. hen contacted by The New York Times, a Rady Children’s Hospital spokesman said the physicians’ bill had been sent in error and that the family would not be held responsible for the charges.

“We’re in the process of assessing how the error occurred,” the spokesman, Benjamin Metcalf, said. “We are working with government agencies regarding billing for these cases.”

The ambulance company that transported the Wucinskis, American Medical Response, charged the family $2,598 for taking them to the hospital. A company representative declined to comment on the bill “due to patient privacy concerns,” but said the company would look into the case.

An additional $90 in charges came from radiologists who read the patients’ X-ray scans and do not work for the hospital. Having such doctors, who may be outside a patient’s insurance networks, provide services to hospital patients is one of the major causes of surprise medical bills.” (W)

“Health officials in Washington state said on Saturday a coronavirus patient has died, marking the first death in the U.S. from COVID-19, the illness associated with the virus.

The person who died was a man in his 50s who had underlying health conditions, and there was no evidence he contracted the virus through travel, health officials said.

Shortly after announcement of the death, President Donald Trump at a White House press conference said the United States is issuing more travel restrictions and warnings to help prevent spread of the virus. He also said he is meeting with pharmaceutical executives to discuss work toward a coronavirus vaccine.

Washington Gov. Jay Inslee meanwhile declared a state of emergency in response to new cases of COVID-19, directing state agencies to use all resources necessary to prepare for and respond to the outbreak.

“This will allow us to get the resources we need,” Inslee said. “This is a time to take commonsense, proactive measures to ensure the health and safety of those who live in Washington state.”” (B)

“A patient infected with the novel coronavirus in Washington state has died, a state health official said Saturday, marking the first death due to the virus in the United States…

Three new presumptive positive cases were announced in Washington state on Saturday, meaning a test given by a state or local lab came back positive, but has yet to be confirmed by the CDC’s lab in Atlanta.

Among those three cases was the patient who died, health officials said.

The person-to-person cases include several of unknown origin, including:

• A woman in Washington County, Oregon, who is presumptive positive. She is in isolation.

• A high school boy in Snohomish County, Washington, who is presumptive positive. He’s doing well, according to Dr. Chris Spitters, interim health officer for the Snohomish Health District.

• An older woman in Santa Clara County, California, who tested positive.

• A Solano County, California, woman who is in serious condition at UC Davis Medical Center.” (C)

“The U.S. Centers for Disease Control and Prevention and Washington state health officials have launched an investigation into two cases of coronavirus at a nursing home in a suburb of Seattle, the same town where the nation’s first coronavirus fatality occurred.

An outbreak in such a facility is particularly troubling because of the close quarters and the vulnerability of the elderly residents to disease.

A health care worker at the Life Care Center in Kirkland and a female resident in her 70s have tested positive for the disease, state and federal officials revealed in a media call Saturday.

Around 27 of 108 residents and 25 of 180 staff members also have some symptoms of COVID-19, and are being tested, officials said.

Authorities are “very concerned about an outbreak in this setting, where there are many older people,” said county health official Jeff Duchin.” (D)

“Researchers who have examined the genomes of two coronavirus infections in Washington State say the similarities between the cases suggest that the virus may have been spreading in the state for weeks.

Washington had the United States’ first confirmed case of coronavirus, announced by the Centers for Disease Control and Prevention on Jan. 20. Based on an analysis of the virus’s genetic sequence, another case that surfaced in the state and was announced on Friday probably was descended from that first case.

The two people live in the same county, but are not known to have had contact with one another, and the second case occurred well after the first would no longer be expected to be contagious. So the genetic findings suggest that the virus has been spreading through other people in the community for close to six weeks, according to one of the scientists who compared the sequences, Trevor Bedford, an associate professor at the Fred Hutchinson Cancer Research Center and the University of Washington.

Dr. Bedford said it was possible that the two cases could be unrelated, and had been introduced separately into the United States. But he said that was unlikely, however, because in both cases the virus contained a genetic variation that appears to be rare — it was found in only two of the 59 samples whose sequences have been shared from China, where the virus originated.” (E)

“The first suspected U.S. case of a patient getting the new coronavirus through “community spread” — with no history of travel to affected areas or exposure to someone known to have the COVID-19 illness — was left undiagnosed for days because a request for testing wasn’t initially granted, according to officials at UC Davis Medical Center in Sacramento, Calif.

The patient in Northern California is now the 60th confirmed case of the coronavirus in the United States. The Centers for Disease Control and Prevention disclosed the latest case Wednesday evening, as President Trump assigned Vice President Pence to lead the administration’s response to the disease.

“This case was detected through the U.S. public health system — picked up by astute clinicians,” the CDC said in a brief statement about the new patient.

UC Davis included more details about the case in its own statement, drawing on an email sent to staff at its medical center. It said the officials initially ruled out a test for the coronavirus because the patient’s case didn’t match the CDC’s criteria.

The new patient, who lives in Solano County and has not been identified, was transferred to UC Davis Medical in Sacramento County from another hospital this month. Staff at UC Davis then suspected the patient might be infected with the coronavirus that has caused more than 2,800 deaths.

“Upon admission, our team asked public health officials if this case could be COVID-19,” the hospital said. “We requested COVID-19 testing by the CDC, since neither Sacramento County nor CDPH [California Department of Public Health] is doing testing for coronavirus at this time. Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered. UC Davis Health does not control the testing process.”

Health and Human Services Secretary Alex Azar said Thursday morning that the CDC is streamlining the process it uses to test for the coronavirus across the country, saying it will spread the new process to all of its labs.

Azar said all of the CDC’s network of nearly 100 public labs will soon be using the modified process. The next step, he said, is to develop a “bedside diagnostic” that doctors and hospitals could use. He did not give details about when that might occur.” (F)

“About 124 health care workers — including at least 36 nurses — are under self-quarantine after possible exposure to the coronavirus patient admitted to UC Davis Medical Center last week, a nurse union said.

“Despite University of California medical facilities being generally better prepared and equipped to treat challenging medical cases, the recent UC Davis Medical Center COVID-19 case highlights the vulnerability of the nation’s hospitals to this virus and the insufficiency of current Centers for Disease Control guidelines,” the National Nurses United said in a news release Friday.

“We know that we can be successful in getting all our hospitals prepared to control the spread of this virus. We are committed to working with hospitals and state and federal agencies to be ready,” Bonnie Castillo, the union’s executive director, said in a statement. “But nurses and health care workers need optimal staffing, equipment, and supplies to do so.”

The patient was transferred to UC Davis on February 19 from a Northern California hospital. Officials from both hospitals said the patient wasn’t initially tested for the virus because she didn’t meet the existing CDC criteria.

The patient didn’t have any relevant travel history or exposure to another known patient, said Dr. Sara Cody, director of the county’s public health department.

Confirmation that the Solano County woman had contracted the virus came Sunday, after UC Davis doctors insisted on testing.

Since then, CDC officials say they’ve updated their testing guidelines.

“As soon as that case was recognized, we met and we revised our case definition for persons under investigation,” CDC Director Dr. Robert Redfield said earlier this week. “Today, that has been posted (to the CDC website) along with a new health advisory that the recommendation should be when a clinician or individual suspects coronavirus, then we should be able to get a test for coronavirus.”” (G)

“Sacramento County’s top health official says he expects a few of the UC Medical Center employees exposed to the coronavirus last week to test positive themselves in the coming days.

That’s not as alarming as it may sound, Peter Beilenson, county health services director, said on Friday. Those employees, if infected, stand a good likelihood that they will not become sick or will only be mildly ill, and may not need to be treated.

“I expect there will be a few positives, probably asymptomatic,” Beilenson said. He said he bases that prediction on early data indicating 80 percent of people infected by the new virus have mild symptoms or none at all…

“I think there will be more cases. That is not a horrible thing,” he said. “Once the disease gets into the population, with so many mild symptoms, common cold-like symptoms, people will be spreading it unbeknownst to them. It gets it to be more a common variety.”

In total, more than 100 employees of three Northern California hospitals are believed to have been exposed. In addition to those at the Vacaville hospital and UC Davis Medical Center, another three employees recently were sent home from Kaiser Permanente-South in Sacramento after potential exposure to the virus, according to Rep. John Garamendi…

“The best guess is that there are people who are not showing symptoms, but, are, nevertheless, infected. That’s a very normal way for diseases to spread,” Matyas said. “To public health officials, this is what disease does. The issue is that it’s not alarming, but we have to move to the next phase.”

That not only means testing and screening, but also being more rigorous at the hospital level, as Matyas said, to “universally assume the possibility” that a patient seeking care and has flu- or cold-like symptoms may carry the virus.

The mystery patient at UC Davis Medical Center has been the center of national attention and politicized debate since officials at the center announced on Wednesday that they had what was believed to be the first coronavirus patient in the U.S. with no known provenance for the illness.” (H)

California Gov. Gavin Newsom said Thursday that 33 people have tested positive for COVID-19 and the state is currently monitoring at least 8,400 others —a day after U.S. health officials confirmed the first possible community transmission of the coronavirus in a Solano County resident.

“This is a fluid situation right now and I want to emphaize the risk to the American public remains low,” said Dr. Sonia Y. Angell, California Department of Public Health Director and State Health Officer during a press conference. “There have been a limited number of confirmed cases to date.”..

“We are currently in deep partnership with CDC on one overriding protocol that drives our principle focus right now and that’s testing, and the importance to increase our testing protocols and to have point of contact diagnostic testing as our top priority not just in the state of California but I imagine all across the United States,” Newsom said at a press conference.

Newsom said five of the 33 patients who tested positive for the virus have since left the state. It wasn’t immediately clear whether the 33 positive cases were part of the group of Diamond Princess passengers who were evacuated from the cruise ship that was quarantined off the coast of Japan. The U.S. had 60 cases as of Wednesday night, 42 of which are people who were on the ship, according to the CDC.

California health officials have 200 testing kits on hand and will be receiving more over the next few days, Newsom said.

“We have just a few hundred testing kits and that’s surveillance testing as well as diagnostic testing. That’s simply inadequate to do justice to the kind of testing that is required to address this issue head on,” he said.

Newsom said that the CDC has made “firm commitments” to improve the state’s testing capacity, but did not provide details, such as how many testing kits the agency has agreed to send to the state.” (I)

“It was the nation’s first infection that had unknown origins. The director of California’s Public Health Department last week called her case a “turning point” that could signal widespread infection is increasingly difficult to stop.

The woman’s case unleashed a deluge of questions and concerns about how local, state and federal officials responded to the mounting public health concern after the evacuees arrived at Travis Air Force Base — and what future responses might look like. A U.S. government whistleblower now says federal workers did not have the necessary protective gear or training when they were deployed to help quarantined people, including those at Travis.

Since the Solano County woman’s illness became known, teams of health care investigators have fanned out across Northern California trying to understand exactly how — and how widely — the virus has spread.

“We have deployed there,” Secretary of Health and Human Services Alex Azar told McClatchy this week. “We’ll send whatever we need to assist the state and local public health authorities with the contact tracing and getting to the bottom of her case.”” (J)

“For weeks, public health experts have been watching to see whether factory shutdowns and shipping problems in China caused by the coronavirus epidemic will cause drug shortages in the United States.

Late Thursday, the Food and Drug Administration issued a statement noting that one drug is now in short supply because of problems related to the coronavirus outbreak. But it refused to disclose the name of the drug and its manufacturer — as well as where the product or its ingredients were made — saying that it could not reveal “confidential commercial information.”

The agency’s vague announcement angered public health advocates and those who track drug shortages, who said the lack of information would only create more confusion as the virus has spread around the globe to at least 56 countries from the original epidemic in China.

The F.D.A. has long been criticized by public interest groups for refusing to reveal company information that could affect public safety. Federal law protects companies from having trade secrets and confidential proprietary information disclosed, which the agency has cited to withhold details, like naming countries where raw ingredients come from….”

The F.D.A. has said it is closely monitoring about 20 products where the manufacturers rely solely on China for their finished products or active pharmaceutical ingredients. Dr. Hahn said Thursday that the drugs being monitored are considered “noncritical drugs.”

Hospitals have struggled for years with shortages of hundreds of critical drugs, many of them staples of medical care that have been on the market for decades. In 2017, Hurricane Maria damaged many pharmaceutical factories in Puerto Rico, closing them for weeks and leading to supply problems, including a shortage of saline bags made by Baxter. Problems with manufacturing quality have caused other shortages, including a global shortfall of valsartan, a widely used blood pressure drug.

Erin Fox, a drug shortage expert at the University of Utah, said, “When the F.D.A. tells the American public that there is a shortage without disclosing the specific drug, this only creates fear and panic, which is unacceptable in the current situation.”

The F.D.A. frequently cites companies’ proprietary reasons for why it does not disclose certain information, including the names of specific drugs when companies are cited for manufacturing problems, or details about clinical trials, Dr. Carome said. “Those are examples where I think it’s an overuse,” he said.” (K)

“The surgeon general on Saturday urged the public to stop buying masks, warning that it won’t help against the spread of the coronavirus but will take away important resources from health care professionals.

“Seriously people — STOP BUYING MASKS!” the surgeon general, Jerome M. Adams, said in a tweet on Saturday morning. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!”

The plea comes as panicked consumers rush to buy masks online, including so-called N95s, a surge that has led to price gouging and counterfeit products.

In another tweet, Mr. Adams said the best way to protect against the virus is to wash hands regularly, and for those who are feeling ill to stay home.

Health officials around the world have been imploring the public to stop buying masks if they are healthy or not caring for someone who is ill. Medical professionals need a large supply of the masks because they are in direct contact with infected patients and must change their masks repeatedly.

“There are severe strains on protective equipment around the world,” said Dr. Michael J. Ryan, executive director of the health emergency program at the World Health Organization, during a briefing on Friday. “Our primary concern is to ensure that our front line health workers are protected and that they have the equipment they need to do their jobs.”

Dr. Ryan said masks primarily prevent a person from giving the disease to someone else.

“There are limits to how a mask can protect you from being infected,” he said. “The most important thing everyone can do is wash your hands, keep your hands away from your face and observe very precise hygiene.”

The W.H.O.’s guidelines recommend that health workers use surgical masks to cover their mouths and noses but the Centers for Disease Control and Prevention has instructed them to wear masks known as N95s, which are thicker, fit more tightly around the mouth and nose, and block out much smaller particles than surgical masks do.

Both masks help prevent the spread of droplets from a person’s cough or sneeze, but medical specialists have said that for average members of the public, they are generally not effective.

A person is more likely to get infected by touching contaminated surfaces than from a droplet traveling through the air.

Air can also get in around the edges of the masks, particularly flat surgical masks. Health care workers who wear N95 masks as part of their jobs are required to undergo a fit test at least once a year to ensure that there are no gaps around their mouths.

Most people are unlikely to know how to wear these masks and could accidentally contaminate themselves if they touch the outside of the mask when they remove it and then touch their face.

“Not having a mask does not necessarily put you at any increased risk of contracting this disease,” Dr. Ryan said…

Robert Redfield, director of the Centers for Disease Control and Prevention, told the House Foreign Affairs Committee on Thursday that it was critical that masks remain available for doctors and nurses who were caring for those affected by the virus and for people tending to loved ones with the illness.

“There is no role for these masks in the community,” he said. “These masks need to be prioritized for health care professionals that as part of their job are taking care of individuals.”” (L)

It has been nearly three months since the first cases of a new coronavirus pneumonia appeared in Wuhan, China, and it is now a global outbreak. And yet, despite over 80,000 infections worldwide (most of them in China), the world still doesn’t have a clear picture of some of the most basic information about this outbreak…

In recent days the W.H.O. has complained that China has not been sharing data on infections in health care workers. Earlier this month, the editors of the journal Nature called on researchers to “ensure that their work on this outbreak is shared rapidly and openly.”..

Lest Americans feel that it could never happen here, Dr. Lipkin points out that it took many months for health officials in the United States to acknowledge and recognize H.I.V. as a new virus, despite the fact that gay men were turning up at alarming rates with unusual pneumonias and skin cancers.

Scientific competition has also slowed reaction and response, experts fear — leading to the extraordinary editors’ plea in Nature. For a young researcher, a paper in Nature or the New England Journal of Medicine is gold in career currency. Scientific prestige may encourage perfecting data for peer review, but preparedness requires rapid dissemination of information.

While federal officials in the United States warn Americans to be ready for the virus, there are some important aspects of its spread about which we have little information — even though they have likely already been studied by scientists and officials, in China, in Japan and elsewhere. Scientists in various countries are presumably gathering large amounts of data day by day and the world deserves to see more of it.

“Were there patterns around infections, places, procedures? Maybe that is being collected and readied for the medical literature. But it would be hugely important to know,” said Dr. Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, which studies epidemics.

For example: Of the more than 1,700 health workers who were infected in China, did those infections occur before they knew to wear protective equipment? Were they doing procedures that might lead to exposure? Those answers would quell fears about how the virus spreads and how to protect front line workers.

Likewise, there were hundreds of people who tested positive aboard the Diamond Princess cruise ship and were transferred to the hospital. But there has been little public information released about what shape they were in. How many in the cohort were really sick, how many just had minor symptoms and how many just needed isolation? Does the pattern of infection suggest a role for transmission via plumbing on the ship?” (M)

“The federal government is “ramping up testing” in the United States for the coronavirus and is looking to vastly increase its screening efforts as global cases of the virus continue to rise, said Health and Human Services Secretary Alex Azar on Sunday.

Azar and Vice President Mike Pence made the rounds of the Sunday morning political talk shows looking to assure the public that risk to most Americans remains low despite the inevitability of more cases arising in the near future.

“I think it’s very important that we treat the American people like adults and explain to them that we don’t know where this will go, that we will see more cases, that we will see continued community spreading in the United States, as we’re seeing around the world,” Azar said during an appearance on ABC’s “This Week.” “How big that gets, we do not know. But we have the most advanced public health system and surveillance system in the world. We are actively working on a vaccine. We are actively working on therapeutics. The diagnostic is out in the field, and we’re going to work to protect the American people with every tool that we’ve got.”..

Pence, appearing on NBC’s “Meet the Press” said “there’s no question” there will be more cases of the virus formally known as COVID-19, but said the risk “remains low” to Americans.

“We’re going to bring the best scientific minds, experts together … we’re going to work every day … to contain this disease, to treat those that are contracted, and I’m very confident we’re ready, and I know … that we’ll get through this,” said Pence who was tapped by Trump to lead the federal government’s response to the disease.

Pence told “Meet the Press” host Chuck Todd that the administration would “respect any decisions that are made at the state and local level” to address the virus. Gov. Andrew M. Cuomo on Saturday announced that New York had received approval by federal health officials to begin its testing, the approval coming after the governor pressed Pence to fast track the decision.” (N)

“The Trump administration may use a 70-year-old law to speed up the manufacturing of medical supplies before a coronavirus outbreak, Alex M. Azar II, the health secretary, said on Friday, a seeming acknowledgment that the virus poses a threat beyond the reassurances of President Trump.

The Defense Production Act, passed by Congress in 1950 during the Korean War, allows the president to expand production of the materials for national security purposes. Mr. Azar said that the federal government could move to expedite certain contracts, including for supplies like face masks, gowns and gloves. Mr. Azar has said that 300 million of a type of mask known as N95 are needed for the emergency medical stockpile for health care workers.

“I don’t have any procurements I need it for now, but if I need it, we’ll use it,” Mr. Azar told reporters at a White House briefing on the administration’s request to Congress for emergency funds to respond to the virus…

Mr. Azar said that “the situation may worsen, and we may need to mitigate its spread in the United States.” If cases of the coronavirus began spreading widely, he said, those showing mild symptoms should stay home rather than seek help at hospitals, to avoid the risk of overcrowding health facilities.

“The advice is going to be: Stay home, manage your symptoms, and we’ll provide guidance of at what point would you seek high-level medical attention,” Mr. Azar said.

Mr. Azar’s remarks appeared to reflect a recognition that the outbreak may reach a newer and more dangerous phase. In addition to his comments about the government stockpiling protective equipment and about how people should seek medical care in the case of a wider outbreak, he also raised the possibility of school closures.

“It might make sense to close a school or certain schools or take other measures like that,” Mr. Azar said. “Every option needs to be on the table as we assess the situation, but it depends on the circumstances.”” (O)

“Hospitals and public health officials on the leading edge of the U.S. mitigation strategy have been getting ready for weeks…

At the sprawling NYU Langone Health system in New York, which has nearly 1,700 inpatient beds at six facilities, doctors are working to prevent patients from swamping hospitals with minor respiratory complaints and crowding out patients who may need more intensive care.

They are ramping up messaging that tells people how to arrange online appointments with providers and other alternatives, said Michael S. Phillips, chief hospital epidemiologist for the system…

NYU is already working to conserve “personal protective equipment” — full-body “moon suits,” masks, face shields and other gear — for a shortage that Phillips considers inevitable. Many masks used in U.S. hospitals come from Hubei province in China, where the outbreak began. And when production in China resumes, equipment surely will be reserved for use in that country, he said. About 65 percent of N95 respirators are manufactured outside the continental United States, in China and Mexico, according to HHS data.

NYU is urging health care personnel to re-use moon suits now to help preserve inventory for later. That is appropriate, for example, in treating patients with tuberculosis, he said. Face masks can be used again by the same person, especially after practice sessions, he said.

“We are really looking carefully at how we’re utilizing

[protective equipment]

, and I think every hospital in the United States is girding for these kind of shortages,” Phillips said.

While some hospitals have as many as 14 weeks worth of masks on hand, the overall situation is grim. India, Taiwan and Thailand also have halted or limited exports as they brace for spikes in demand in their own countries.

Anticipating a surge in need, California’s state officials have ordered 300,000 masks to distribute to hospitals and clinics on an emergency basis, hoping to add to the 20,000 currently in state stockpiles. Officials would not say where they hope to find that many masks.

Health care systems nationally have about two weeks of supply left on hand, said Soumi Saha, senior director of advocacy at Premier Inc., a large group purchasing organization that serves 4,000 hospitals.

Normally, an average of 2 million masks per month are used in the United States, Premier said. That rises to 4 million per month during a typical flu season.

Two domestic manufacturers that use raw material from the United States — 3M and Prestige Ameritech — are ramping up production but are not expected to be able to satisfy demand of 4­ million masks a month until April, Saha said.

“I don’t think hospitals can sort of buy their way out of this problem. It is not a bidding war for N95s,” said Amy Ray, director of infection prevention for the MetroHealth System in Cleveland. “The supply is the supply, and prudence is necessary to preserve the stock that we have.’’” (P)

“The World Health Organization on Friday raised its assessment of the global coronavirus risk from “high” to “very high,” the most serious assessment in its new four-stage alert system.

“This is a reality check for every government on the planet,” said Dr. Michael J. Ryan, deputy director of W.H.O.’s health emergency program. “Wake up. Get ready. This virus may be on its way.”

The assessment addresses the risks of both uncontrolled spread of the virus and the resulting impacts.

United States health officials have given similarly alarming assessments, though President Trump has played down the threat.

The W.H.O. does not officially use the word “pandemic,” often defined as the worldwide spread of a new disease, but many health experts say the coronavirus epidemic is one, or soon will be.” (Q)

“President Trump complained on Friday that Democrats and the news media were trying to scare Americans about the coronavirus to score political points against him but asserted that the outbreak had been relatively limited because of his action to stem infections…

Mr. Trump spoke hours after Mick Mulvaney, the acting White House chief of staff, likewise blamed the news media for exaggerating the seriousness of coronavirus because “they think this will bring down the president, that’s what this is all about.”..

Mr. Mulvaney said the administration took “extraordinary steps four or five weeks ago,” to prevent the spread of the virus when it declared a rare public health emergency and barred entry by most foreign citizens who had recently visited China.

“Why didn’t you hear about it?” Mr. Mulvaney said of travel restrictions that were widely covered in the news media. “What was still going on four or five weeks ago? Impeachment, that’s all the press wanted to talk about.”

The news media has been covering the global spread of coronavirus for months.

But Mr. Mulvaney claimed that the news media was too preoccupied covering impeachment, he said, “because they thought it would bring down the president.”

The media’s focus switched to the coronavirus for the same reason, he continued.

“The reason you’re seeing so much attention to it today is that they think this is going to be the thing that brings down the president,” he added. “That’s what this is all about it.”

Following the president’s lead, Mr. Mulvaney also brushed off concerns over the virus; there have been 60 cases identified in the United States.

“The flu kills people,” he said. “This is not Ebola. It’s not SARS, it’s not MERS. It’s not a death sentence, it’s not the same as the Ebola crisis.” (R)

“If the next few weeks or months bring calm — and scientists increasingly worry that they will not — the world would do well to remember this time what it seems to have forgotten again and again. Another pathogen will emerge soon enough, and another after that. Eventually, one of them will be far worse than all its predecessors. If we are very unlucky, it could be worse than anything in living memory. Imagine something as contagious as measles (which any given infected person passes to 90 percent of the people he or she encounters) only many times more deadly, and you’ll have a good sense of what keeps global health officials up at night.

Here’s what is certain: Despite many warnings over many years, we are still not ready. Not in China, where nearly two decades after that SARS outbreak food markets that sell live animals still thrive and authoritarianism still undermines honest and accurate communication about infectious diseases. Not in Africa, where basic public health capacity remains hobbled by a lack of investment and, in some cases, by political unrest and violence. Not in the United States, where shortsighted budget cuts and growing nationalism have shrunk commitments to pandemic preparedness, both at home and abroad.

To be sure, some broad progress has been made in the past few years. Vaccine development and deployment now proceed faster than at any point in history. The World Health Organization has corrected many of the institutional shortcomings that thwarted its responses to previous outbreaks. Other countries, in both Europe and Africa, have stepped up to fill the global health leadership position that America appears to have vacated.”

But, as Covid-19 makes clear, much more is still needed.” (S)

“Today, as the country faces the possibility of a widespread outbreak of a new respiratory infection caused by the coronavirus, there are nowhere near that many ventilators, and most are already in use. Only about 62,000 full-featured ventilators were in hospitals across the country, a 2010 study found. More than 10,000 others are stored in the Strategic National Stockpile, a federal cache of supplies and medicines held in case of emergencies, according to Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention.

Tens of thousands of other respiratory devices could be repurposed in an emergency, experts say, but the shortfall could be stark, potentially forcing doctors to make excruciating life-or-death decisions about who would get such help should hospitals become flooded with the desperately sick…

Across the country, educators, businesses and local officials are beginning to confront the logistics of enduring a possible pandemic: school closings that could force millions of children to remain at home, emergency plans that would require employees to work remotely, communities scrambling to build up supplies.

In plausible worst-case-scenarios given the pattern of the outbreak thus far, the country could experience acute shortages not just in ventilators but also health workers to operate them and care for patients; hospital beds; and masks and other protective equipment.

“Even during mild flu pandemics, most of our I.C.U.s are filled to the brim with severely ill patients on mechanical ventilation,” said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security and an expert on health care preparedness. “I hope and pray Covid-19 turns out to be a moderate pandemic, but if not, we’re in serious trouble,” he said, referring to the name given the disease caused by the virus.

Resources are concentrated in the most populous and wealthiest cities, leaving rural areas and other neglected communities exposed to greater risk. And public health experts worry that efforts to contain an outbreak could be hamstrung by budget cuts that have weakened state health departments.

In an extreme situation, some hospitals’ plans include provisions for rationing, even removing some patients from ventilators without requiring their consent to make way for others presumed to have a better chance of survival. Some plans would also limit the access of certain categories of patients from critical care or even hospitalization during a peak pandemic based on criteria such as their age or an underlying chronic disease.

The concept of imposing such measures makes physicians dedicated to saving every life uncomfortable, and there is evidence that many people who could be removed from life support or refused care under such protocols would otherwise survive.” (T)

“Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks…

The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including:

the natural history of the virus, its transmission and diagnosis;

animal and environmental research on the origin of the virus, including management measures at the human-animal interface;

epidemiological studies;

clinical characterization and management of disease caused by the virus;

infection prevention and control, including best ways to protect health care workers;

research and development for candidate therapeutics and vaccines;

ethical considerations for research;

and integration of social sciences into the outbreak response. (U)

“The first confirmed case of novel coronavirus in New York State — a woman in her 30s who recently traveled to Iran — was announced Sunday night by Governor Cuomo.

“There is no reason for undue anxiety — the general risk remains low in New York,” Cuomo said in a statement. “We are diligently managing this situation and will continue to provide information as it becomes available.”

Cuomo said the woman who contracted the virus is currently isolated in her home.

“The patient has respiratory symptoms, but is not in serious condition and has been in a controlled situation since arriving to New York,” Cuomo said. “This was expected. As I said from the beginning, it was a matter of when, not if there would be a positive case of novel coronavirus in New York.” (V)