Colorado officials have said ski industry employees living in congregate settings would be part of the early vaccine rounds.
Vaccine distribution has now entered the political phase. This Post attempts to describe some of these asymmetrical discombobulations!
“Members of the U.S. Congress will be able to get vaccinated for COVID-19 with the distribution of the first tranche of vaccine doses, the congressional physician said on Thursday.
In a letter to members of Congress and their staff, Dr. Brian Monahan said he had been notified by the White House’s National Security Council that Congress “will be provided with a specific number of COVID-19 vaccine doses to meet long-standing requirements for continuity of government operations.”…
“My recommendation to you is absolutely unequivocal: there is no reason why you should defer receiving this vaccine. The benefit far exceeds any small risk,” Monahan said in the letter.
He said once members of Congress are vaccinated, Capitol Hill staff members who are considered essential will be given the vaccine, and then it will be made available to other staff members until the doses run out.” (A)
“Dr Anthony Fauci has said that President Trump ultimately ‘might want to get vaccinated,’ as he praised Mike Pence and the surgeon general, Jerome Adams, for opting to be injected live on television.
Fauci, speaking on CNN on Friday night, said he thought it would be a good idea for Trump to get the vaccination.
Being infected does not mean that you are guaranteed immunity.
But Fauci said that, given Trump was recently infected – his diagnosis was confirmed on October 1 – he may still have a high level of antibodies.
‘That’s a personal choice between the president and his physicians,’ said Fauci…
On Wednesday a White House official told CNN that Trump would not be vaccinated until his doctors told him to.
The official said the president continues to be open to getting vaccinated, but that he also wants to make sure frontline medical workers receive the vaccine first.” (B)
“Former New Jersey Gov. Chris Christie revealed Thursday he spent seven days in an intensive care unit before recovering from Covid-19, and implored Americans to wear masks and take the pandemic “very seriously.”
“The ramifications are wildly random and potentially deadly,” Christie said in a statement. “No one should be happy to get the virus and no one should be cavalier about being infected or infecting others.”
Christie tested positive for Covid-19 earlier this month and checked himself into Morristown Medical Center as a precautionary measure.
“Within 24 hours, I went from feeling absolutely fine to being in the intensive care unit,” Christie said Friday on ABC’s “Good Morning America.” He said he was treated with the antiviral drug remdesivir and Eli Lilly’s monoclonal antibody combination therapy.
News of his positive diagnosis — which came a day after President Donald Trump announced that he and first lady Melania Trump had both contracted the virus — followed his assistance to Trump in preparing for the first presidential debate in a series of sessions where no one wore masks.
Christie, who is overweight and asthmatic, had also attended a Supreme Court nomination ceremony for Judge Amy Coney Barrett on September 26, now believed to have been a superspreader event.” (C)
“Rudy Giuliani, the public leader of a quixotic effort by Donald Trump to overturn the 2020 presidential election, was released from hospital on Wednesday evening after being treated for Covid-19.
Giuliani received “exactly the same” treatment that Trump received during his own hospitalization in October, the former New York mayor said, apparently including a drug cocktail of monoclonal antibodies that few patients have access to.
“His doctor sent me here; he talked me into it,” Giuliani said of the president in an interview with a local New York radio station. “The minute I took the cocktail yesterday, I felt 100% better. It works very quickly, wow.”
Giuliani, 76, was admitted to Georgetown University hospital in Washington DC on Monday.
“My treatment by the nurses and staff at Georgetown Med Star hospital was miraculous,” the former New York mayor tweeted on Thursday. “I walked in with serious symptoms. I walked out better than ever.”
That account echoed the experiences of other members of Trump’s inner circle who have fallen grievously ill with coronavirus and been treated with monoclonal antibodies, synthetically manufactured proteins that mimic the immune system’s ability to fight off viruses.
But almost no one has access to the treatments in question: a cocktail manufactured by Regeneron and a similar treatment made by Eli Lilly.
The health secretary, Alex Azar, said on Wednesday that a total of 278,000 doses of the two therapies had been distributed in past months. Some states use a lottery system to allocate the drugs, while others rank patients by eligibility, the New York Times reported.
The United States has confirmed 15.5m cases of coronavirus over time, and more than 106,000 people are currently hospitalized in the United States with Covid-19, according to the Covid tracking project.
Giuliani, who has mocked contact tracing on Fox News and said people “overdo the mask”, is not the first member of Trump’s inner circle to credit the hard-to-get treatment with a fast return to health.
After the housing secretary, Ben Carson, 69, emerged from the hospital last month, he wrote on Facebook that he had been “desperately ill” but “President Trump was following my condition and cleared me for the monoclonal antibody therapy that he had previously received, which I am convinced saved my life.”
After being hospitalized in early October at Walter Reed medical center, Trump, 74, told the radio host Rush Limbaugh, “I might not have recovered at all” without the drug cocktail…
Giuliani credited his celebrity status with his successful course of treatment.
“If it wasn’t me, I wouldn’t have been put in a hospital, frankly,” Giuliani told WABC New York. “Sometimes when you’re a celebrity, they’re worried if something happens to you they’re going to examine it more carefully, and do everything right.” (D)
“Red tape, staff shortages, testing delays and strong skepticism are keeping many patients and doctors from these drugs, which supply antibodies to help the immune system fight the coronavirus. Only 5% to 20% of doses the federal government allocated have been used.
Ironically, government advisers met Wednesday and Thursday to plan for the opposite problem: potential future shortages of the drug as COVID-19 cases continue to rise. Many hospitals have set up lottery systems to ration what is expected to be a limited supply, even after taking into account the unused medicines still on hand.
Only 337,000 treatment courses are available and there are 200,000 new COVID-19 cases a day, “so the supply certainly cannot meet the demand,” said Dr. Victor Dzau, president of the National Academy of Medicine, whose experts panel met to discuss the drugs.
Antibodies are made by the body’s immune system to fight the virus but it can take several weeks after infection for the best ones to form. The drugs aim to help right away, by supplying concentrated doses of one or two antibodies that worked best in lab tests. The government is providing them for free, but there’s sometimes a fee for the IV required to administer the drugs.
Eli Lilly and Regeneron Pharmaceuticals have emergency authorization to supply their antibody drugs while studies continue. But the medicines must be used within 10 days of the onset of symptoms to do any good. Confusion over where to find the drugs and delays in coronavirus test results have conspired to keep many away.
“It can take anywhere between two and four days for results to come back and that’s absolutely precious time” for the drugs to have a chance to help, Dr. Keith Boell of Geisinger Health System in Pennsylvania told the experts panel.
“Our clinics have everything from a bus stop to a buggy stop,” serving big cities and horse-driven Amish communities, he said. “We really want to get these into anybody they can help” but it’s hard, he said.
Many states and health centers were not ready for the sudden availability of the drugs, said Dr. Ryan Bariola of the University of Pittsburgh’s 30-hospital system. It can be a nightmare for doctors or urgent care centers to figure out if a patient qualifies.
“How do you get it done? Do you call your local hospital? They may not have an infusion center set up. For a lot of independent physicians, this is very hard,” he said.
The crunch comes as vaccine efforts begin across the United States, monopolizing attention and staff.
States “didn’t see this coming … and have limited bandwidth” to deal with this on top of allocating vaccines, said Connie Sullivan, president of the National Home Infusion Association.
Many hospitals such as the University of Michigan’s quickly set up outpatient infusion centers but a shortage of nurses and other staff has been “the biggest problem we’ve had,” said a pharmacy resident, Megan Klatt.
Skepticism also is hurting use. The evidence that the drugs help is thin, several leading medical groups have not endorsed them, and many patients who feel only mildly ill see them as a risk: Half who have been offered them in the Michigan system have declined, Klatt said.
“It doesn’t help when physicians themselves are not totally convinced,” said Mohammad Kharbat, a pharmacy chief at a hospital system in Madison, Wisconsin, where half of patients also have declined.
At Wake Forest Baptist Health System in North Carolina, “we’ve had very little activity, very few referrals,” and not much interest from patients or doctors, said Dr. John Sanders.
The University of Utah has seen interest from patients and developed a formula to figure out who most needs the drugs, but getting the infusion “requires going to a website, being notified of your test result … doing some of the legwork yourself” and many people can’t manage that, said Dr. Emily Sydnor Spivak.
“We’re going to have to go out and find people” who qualify and offer them the drugs, she said.” (E)
“New Jersey plans to open six vaccination “mega-sites” in early January, including at the Meadowlands racetrack in East Rutherford, as the campaign to inoculate residents expands beyond hospital employees to other health care and essential workers.
The six sites are expected to provide 2,400 vaccinations per day for health care workers through mid-February, state Health Commissioner Judy Persichilli said Friday…
New Jersey’s vaccine rollout is taking place in phases and began this week with health care workers. Six hospitals that received the first doses of a Pfizer-BioNTech vaccine authorized for emergency use gave first doses to more than 2,100 of their front-line staff. The second of two doses is to be given in three weeks.
Starting December 28, staff and residents of long-term-care facilities will begin to receive vaccines, Gov. Phil Murphy said. Two retail pharmacy chains — CVS and Walgreens — will conduct the vaccinations in nursing homes.
“With each successive wave, we will be closer to offering to general public,” Murphy said. The monthslong campaign is intended to enable any resident who lives, works or studies in New Jersey to receive a vaccine.
The timing of the progression among the groups will depend on the supply of vaccine, Perischilli said.
This week, the state learned that it would be receiving 34% fewer doses of the Pfizer vaccine than it expected next week. And while supplies of a new vaccine by Moderna, which was authorized Friday night, are to arrive next week, the projected amount was also lower than state health officials expected.
That “1a” group will be followed by “1b” — essential front-line workers. This group is expected to include police, firefighters, corrections officers, transportation workers, educators, and food and agriculture workers, according to the federal Centers for Disease Control. Details have not yet been spelled out by the national Advisory Committee on Immunization Practices or the New Jersey Health Department.
Group 1c will include people 65 years old and older and people with medical conditions that make them particularly vulnerable to severe illness with COVID-19.
While the mega-sites continue to operate, the state is also establishing a broad network of local sites to provide vaccines. Among the 215 sites already registered are local and county health departments, health clinics, primary care practices, urgent care centers and some retail pharmacies. That network will expand over time, Persichilli said.
The state plans to open a website in the coming weeks for the public to register, locate a vaccination site and schedule an appointment, the health department has said. Details are not yet available.
New Jersey’s goal is to vaccinate 70% of eligible adults — 4.7 million people — by June.
“Yes, that is aggressive. Yes, it is aspirational,” Persichilli said Friday. “But it’s what we need to do so this virus has no place to go.” (F)
“New York will be setting up regional hubs through local hospital systems to distribute COVID-19 vaccines as early as next month to essential workers and high-risk residents.
Gov. Andrew Cuomo detailed Wednesday that each region will develop its own distribution plan by the first week of January as New York anticipates at least 170,000 doses of the Pfizer/BioNTech vaccine in the near term and the potential for 346,000 doses from Moderna starting Dec. 22.
“It is a medical procedure. It will be handled by medical professionals,” Cuomo said. “There will be no political favoritism.”
The state has received 87,750 doses so far, and those are largely designated for medical staff. Another 80,000 Pfizer doses are scheduled to arrive in the coming days, with those slated for nursing home residents and staff.
Cuomo said all vaccines will be free to New Yorkers, and each region will determine how the doses will be prioritized as part of the Phase II distribution plan.
But he warned it will be a slow process: It could be six to nine months before everyone who wants a vaccine could get one…
The regional vaccine hub coordinators are:
Finger Lakes: University of Rochester Medical Center – Western New York: Catholic Health System – Southern Tier: United Health Services – Central New York: SUNY Upstate Medical Center – Mid-Hudson: Westchester Medical Center – North Country: Champlain Valley Physicians Hospital – Mohawk Valley: Mohawk Valley Medical Center – Capital Region: Albany Medical Center – New York City: Greater New York Hospital Association – Long Island: Northwell Health Systems” (G)
“Tens of thousands of prison inmates in Massachusetts will be among the first to be offered coronavirus vaccines, before home health aides, seniors and medically vulnerable residents of the state.
The inmates, along with people who live in homeless shelters and other congregate settings, will be vaccinated by the end of February, after health care workers, emergency medical workers and residents of long-term care facilities receive the shots.
The state’s high prioritization of inmates is unusual. A dozen states have listed prisoners among those set to receive vaccines in the first round of inoculations, but none ranks inmates so highly. Federal health officials have recommended that corrections officers and staff at state facilities receive high priority but have said nothing about inmates. The federal prison system has said it will vaccinate officers and staff first.” (I)
“Stanford Medicine residents who work in close contact with COVID-19 patients were left out of the first wave of staff members for the new Pfizer vaccine. In their place were higher-ranking doctors who carry a lower risk of patient transmission, according to interviews with six residents and two other staff members and e-mail communications obtained by ProPublica.
“Residents are patient-facing, we’re the ones who have been asked to intubate, yet some attendings who have been face-timing us from home are being vaccinated before us,” said Dr. Sarah Johnson, a third-year OB-GYN resident who has delivered babies from COVID-positive patients during the pandemic. “This is the final straw to say, ‘We don’t actually care about you.’”
Another resident, who asked not to be named, said a nurse who works in an operating room for elective surgeries has been notified she’ll get the vaccine in the first wave. “We test people for COVID before elective surgeries, so by definition, we will know if those patients have COVID,” he said, so to him, it didn’t make sense that that nurse would be prioritized.
“We take complete responsibility for the errors in the execution of our vaccine distribution plan,” said Lisa Kim, a Stanford Medicine spokesperson. “Our intent was to develop an ethical and equitable process for distribution of the vaccine. We apologize to our entire community, including our residents, fellows and other frontline care providers, who have performed heroically during our pandemic response. We are immediately revising our plan to better sequence the distribution of the vaccine.”
An algorithm chose who would be the first 5,000 in line. The residents said they were told they were at a disadvantage because they did not have an assigned “location” to plug into the calculation and because they are young, according to an email sent by a chief resident to his peers. Residents are the lowest-ranking doctors in a hospital. Stanford Medicine has about 1,300 across all disciplines.
Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases.
Stanford Medicine didn’t respond to a request for comment on how the vaccines were allocated and whether there was a flaw in the algorithm. The tumult reflects the difficulties of ethically parceling out a limited supply of vaccine and weighing competing factors, such as age, risk of contracting the disease and comorbidities. Adding to the challenge is the angst that comes when such decisions are made without all stakeholders involved.” (H)
“Employers can require workers to get a Covid-19 vaccine and bar them from the workplace if they refuse, the federal government said in guidelines issued this week.
Public health experts see employers as playing an important role in vaccinating enough people to reach herd immunity and get a handle on a pandemic that has killed more than 300,000 Americans. Widespread coronavirus vaccinations would keep people from dying, restart the economy and usher a return to some form of normalcy, experts say.
Employers had been waiting for guidance from the U.S. Equal Employment Opportunity Commission, the agency that enforces laws against workplace discrimination, because requiring employees be tested for the coronavirus touches on thorny medical and privacy issues covered by the Americans With Disabilities Act of 1990.
The guidance, issued on Wednesday, confirmed what employment lawyers had expected.
Businesses and employers are uniquely positioned to require large numbers of Americans who otherwise would not receive a vaccination to do so because their employment depends on it.” (J)
“The chief executive of Uber, the ride-hailing company whose six New York lobbying firms include Albany’s best connected, wrote last week to Gov. Andrew M. Cuomo with an ask: priority for its drivers in the next round of coronavirus vaccinations.
Days later, the president of New York’s largest transit union spoke about the same topic with the chairman of the state transit authority, a Cuomo appointee. Not to be outdone, the Hotel Trades Council, a hospitality labor group with an aggressive political arm, urged the state’s health commissioner in a letter on Tuesday to give priority to its members.
Even a presidential elector had hoped to chat with the governor about who was getting vaccine priority — after they both took part in New York’s Electoral College vote.
Among state capitals, New York’s has long stood apart as a venue for favor trading and behind-the-scenes deals. Now, as the coronavirus rages and vaccines remain in short supply, the pandemic has been thrust squarely into the maw of Albany politics.
“Everyone is chasing the same thing now, and it really is remarkable,” said James E. McMahon, a veteran Albany lobbyist who represents a school bus company and other firms interested in early vaccination. “The need was there and then there’s the vaccine and all of a sudden, people are saying, ‘Oh Jesus, we’ve got to get in line now.’”
Apparently attuned to the atmosphere, Mr. Cuomo made several pronouncements this past week that his administration would not be swayed by interest groups.
“There will be no political favoritism,” the governor said in a news conference on Wednesday, a message he repeated on Friday.
The question of where groups of workers stand in the line for vaccines has yet to be resolved in New York or in a majority of other states, according to a review by the nonprofit Kaiser Family Foundation. The federal government is expected to issue final recommendations on who should be deemed essential soon. But it is largely up to states to prioritize vaccine distribution among those workers.
Some states, like Illinois, are awaiting further federal guidance for allocation beyond the initial vaccine supplies.
Others have provided some details. Colorado officials have said ski industry employees living in congregate settings would be part of the early vaccine rounds. Health officials in Georgia and Arkansas are including workers in meatpacking or food processing plants.
In New York, emergency responders like police officers, transit workers and those who maintain power grids and other critical infrastructure will almost certainly be part of the next wave, according to a state plan.
But the remaining uncertainty has led to clamoring for consideration in state capitols and in Washington from a wide array of businesses and workers. Tens of millions of Americans, designated as essential, continue to toil amid the pandemic’s dangers while others work from home.
The list of those who qualified as essential in New York, in order to continue working through virus-related shutdowns, stretched from chiropractors to landscapers to bicycle mechanics. That long list has allowed all sorts of industries to claim they should also be among the first for the vaccine.” (K)
POSTSCRIPT
“Striking a compromise between two high-risk population groups, a panel advising the Centers for Disease Control and Prevention voted Sunday to recommend that people 75 and older be next in line to receive the coronavirus vaccine in the United States, along with about 30 million “frontline essential workers,” including emergency responders, teachers and grocery store employees…
The panel of doctors and public health experts had previously indicated it would recommend a much broader group of Americans defined as essential workers — about 87 million people with jobs designated by a division of the Department of Homeland Security as critical to keeping society functioning — as the next priority population and that elderly people who live independently should come later.
But in hours of discussion on Sunday, the committee members concluded that given the limited initial supply of vaccine and the higher Covid-19 death rate among elderly Americans, it made more sense to allow the oldest among them to go next along with workers at the highest risk of exposure to the virus.
Groups of essential workers, such as construction and food service workers, the committee said, would be eligible for the next wave. Members did clarify that local organizations had great flexibility to make those determinations.” (L)
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PREQUELS
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
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)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
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)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
“In the scramble to vaccinate millions of health workers, difficult choices about who comes first — and who must wait — have started to surface. So far, the effort is concentrated in hospitals. Workers treating Covid-19 patients in intensive care units and in emergency departments have in recent days been beaming symbols of the virus’s demise.
But there are roughly 21 million health care workers in the United States, making up one of the country’s largest industries, and vaccinating everybody in the first wave would be impossible. That has left entire categories of workers — people who are also at risk for infection — wondering about their place in line…
There are broad gray areas, he said: primary care doctors in areas with high infection rates, workers who handle bodies, firefighters who respond to 911 calls, dentists, pathologists who handle coronavirus samples in labs, hospice workers, chaplains…
These are hard choices and will become even harder as the vaccine becomes more widely available for the general public and states begin wrestling with the question of who is an essential worker…
The Centers for Disease Control and Prevention has laid out categories but they are broad, so each state — and each hospital system — has come up with its own plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers like Dr. Baker — as well as professional societies of groups such as pathologists, dentists and medical examiners — wondering where they stand.” (A)
“As frontline healthcare workers around the country receive the first doses of a Covid-19 vaccine, mental health providers worry they may not be included, even though they are often working in hospitals and clinics and may be exposed to Covid-19. The crux of the matter rests with how individual states end up interpreting broad federal guidelines for vaccine distribution. These states will be the ultimate arbiters of who are “essential workers” that qualifies for early inoculations. A CDC committee approved guidance to states in early December that vaccines should go to health care workers “who have the potential for direct or indirect exposure to patients or infectious materials” and to “residents of long-term care facilities.”
Mental health groups worry that wording leaves too much room for interpretation. Without more specific directions, “we would be at the mercy of each state to recognize the importance of mental health and substance use providers,” Reyna Taylor, the head of policy at the National Council for Behavioral Health, said in an email…
Mental health providers should be part of the first group of recipients of these vaccines because they face unique risks treating patients in person, Taylor said. Many take walk-in appointments and provide primary care. In mental health emergencies, she said, providers may have to treat someone before they can learn whether the person has Covid-19 or not. “When you’re providing services to someone who’s in a mental health or substance use crisis, you’re not thinking about Covid-19, you’re thinking about saving someone’s life from that crisis,” she said. Even if they aren’t in crisis, “the nature of serious mental illness and substance use disorder [means] there is at times a lack of awareness of their symptoms, including the symptoms of Covid-19,” she added in an email, and as a result providers “have to treat everyone who walks in as if they are Covid-19 positive.”..
There are not enough vaccine doses to give all the eligible healthcare workers and long-term care residents of the first group recommended by the CDC. That will force states to decide who in the priority group should be vaccinated and who should wait until more vaccine doses are manufactured…
Whether mental healthcare is part of the first subgroup getting the vaccine will be up to each state’s interpretation of the guidelines, Bahta said. Some may decide that mental health and substance use providers belong in the first phase, “Phase 1a,” while others might group them in the “1b” category, which the committee has not yet voted on but may include essential workers like bus drivers, teachers and police officers. “There will be a multitude of variations on how this plays out,” she said in an email…” (B)
“Here’s a look at what to expect from the coming coronavirus vaccination campaign.
Who can get a vaccine and when?
December
Who might get vaccinated: Health care workers and nursing home residents
December is a month for some big decisions. The US Centers for Disease Control and Prevention’s Advisory Committee for Immunization Practices has voted to recommend that 21 million frontline health care workers and support staff and 3 million residents of long-term care facilities who have been hardest hit by the pandemic be in the first group.
Health care workers and long-term care facility residents should get Covid-19 vaccine first, CDC vaccine advisers say
It will be easiest to vaccinate these groups — they’re already in institutional settings and the nursing home residents can get vaccinated at the same time their caregivers are being immunized….
January
Who might get vaccinated: More health care workers, other essential workers like emergency medical technicians, firefighters and police
If two or more vaccines get approved by the FDA, January might be when discussion really starts on who can get vaccinated and when….
Several groups of independent experts have weighed in on how to allocate vaccines, including the National Academies of Science, Engineering and Medicine and Johns Hopkins University.
They’ve all laid out basic principles that include protecting the country’s health care system, protecting the most vulnerable people, controlling the spread of the virus and being equitable across society.
ACIP will need to meet to decide on the details off all these phases.
January might include some of the rest of Phase 1 of a four-phase vaccine rollout.
Phase 1b is roughed out to include essential workers, including emergency medical technicians, as well as frontline workers at very high risk of infection, such as food workers. This phase may also include older adults living in congregate settings or crowded conditions.
There’s a also a proposed Phase 1c, which might include people of all ages with underlying conditions such as diabetes and kidney disease who are at significantly higher risk of dying or getting severely ill from Covid-19.
February
Who might get vaccinated: More essential workers and high-risk adults
By February, states may have hit their stride on vaccinating residents. Vaccination campaigns may move beyond hospitals and nursing homes, rehabilitation centers and other such facilities to pharmacies and medical practices…
March
It’s possible that the US will still be in Phase 1 of vaccination in March, simply because of the sheer numbers involved. Anyone healthy and under 65 who is not an essential or high-risk worker would not be thinking about vaccination yet.
April
If more vaccines have been approved and brought online, it’s possible Phase 2 of vaccination could begin by now.
This group has not been decided yet, but Phase 2 might include K-12 teachers and staff and other child care workers, as well as other critical workers such as retail workers and transportation workers. This group could also include people in homeless shelters and all people over 65 who were not already included in phase 1…
May
Young adults and children would have to wait until Phase 3 and under other scenarios that’s likely to be May at the soonest — perhaps June or later, depending on what ACIP decides, what the vaccine supply looks like and how smoothly distribution is going…
Which vaccine should I get?
At first there will be little choice — both Pfizer and Moderna are providing a new type of immunization called an mRNA vaccine. It’s considered especially safe because it does not use a whole virus — just a piece of genetic material — and both seem especially effective, providing 95% protection against symptomatic disease.
What’s not known is how long that protection might last, whether either vaccine protects against asymptomatic disease and whether either stops people from spreading the virus to others.
Vaccines coming later might offer harder choices. AstraZeneca’s vaccine uses what’s called a replication deficient virus to deliver a piece of genetic material from the coronavirus. So does Johnson & Johnson’s vaccine. There’s not a lot of safety data about these vaccines yet, and no evidence the viral vectors could be harmful. Nonetheless, some doctors may be reluctant to offer them to patients with compromised immune systems, including those with rheumatoid arthritis or multiple sclerosis who are taking immune-suppressing drugs; pregnant women; people taking certain cancer treatments and others..” (C)
“In coming days, squads of CVS and Walgreens employees, clad in protective gear and carrying small coolers, will begin to arrive at tens of thousands of nursing homes and assisted-living facilities to vaccinate staff and residents against the coronavirus.
It promises to be a crucial milestone in America’s battle against a pandemic that has inflicted especially severe carnage on nursing homes. At least 106,000 residents and staff of long-term care facilities have died from the virus, accounting for 38 percent of the country’s Covid-related fatalities.
But even before it begins, the mass-vaccination campaign is facing serious obstacles that are worrying nursing home executives, industry watchdogs, elder-care lawyers and medical experts. They expect nursing homes to be the most challenging front in the mission to vaccinate Americans.
Some residents and staff are balking at taking the vaccine. Short-staffed facilities are concerned about workers calling in sick with side effects, straining resources just as some frail residents are likely to experience fever and fatigue from the shot. Most nursing home employees work in shifts; will it be possible to vaccinate everyone over the course of just a few visits from CVS and Walgreens?
The virus has devastated residents and staff members in more than 28,000 long-term care facilities across the country.
While some states began vaccinations in nursing homes this week, the broader nationwide effort will start over the next few days. And there remains widespread confusion about a key element: how nursing homes will get consent to vaccinate residents who aren’t able to make their own medical decisions. A CVS executive said such residents’ legal representatives will be able to provide consent to nursing homes electronically or over the phone, but officials at multiple large nursing home chains said they weren’t aware of that.
If residents or their representatives haven’t given consent before CVS or Walgreens employees show up, it is not clear whether or when they will have another chance to be inoculated.
“Given the pace of this rollout, I am very concerned that nursing facilities won’t have the time or capacity to really explain the vaccine to residents and their families,” said Nicole Howell, a state-funded ombudsman in California whose office works with 29,000 long-term care residents.
Because of the large number of facilities they must visit, CVS and Walgreens only have the capacity to go to each location two or three times. The Pfizer and Moderna vaccines both require two doses, separated by a few weeks, which means that at most nursing homes, all staff and residents will have to receive their shots on the same days…
But the more employees who get the vaccine, the more who are likely to experience side effects — and that could cause more problems.
“If even as little as 10 percent of your staff calls off the next day — while at the same time all of the residents are irritated, upset and having adverse effects — you’ve created a perfect storm,” said Chad Worz, chief executive of the American Society of Consultant Pharmacists, which represents pharmacies that serve long-term care providers.
There is no federal requirement for people to give consent before getting vaccinated, but it is standard practice and is often needed for billing purposes. States have different requirements about how medical consent can be given and what information needs to be provided to the person who is consenting. The Centers for Disease Control and Prevention’s guidance is that residents or their representatives should receive a fact sheet about the coronavirus vaccine and then consent to receiving it.
The task of getting consent is not always straightforward at nursing homes. Many residents, like those with dementia, aren’t capable of giving it on their own. Instead, nursing homes need to get the permission of their family members or other legal representatives.
CVS and Walgreens have created paper and digital consent forms that nursing homes can use. Consent must be given in advance; the pharmacies need to know how many doses of the vaccine, which must be kept very cold, to bring with them.” (D)
“A top Trump appointee repeatedly urged top health officials to adopt a “herd immunity” approach to Covid-19 and allow millions of Americans to be infected by the virus, according to internal emails obtained by a House watchdog and shared with POLITICO.
“There is no other way, we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,” then-science adviser Paul Alexander wrote on July 4 to his boss, Health and Human Services assistant secretary for public affairs Michael Caputo, and six other senior officials.
“Infants, kids, teens, young people, young adults, middle aged with no conditions etc. have zero to little risk….so we use them to develop herd…we want them infected…” Alexander added.
“[I]t may be that it will be best if we open up and flood the zone and let the kids and young folk get infected” in order to get “natural immunity…natural exposure,” Alexander wrote on July 24 to Food and Drug Administration Commissioner Stephen Hahn, Caputo and eight other senior officials. Caputo subsequently asked Alexander to research the idea, according to emails obtained by the House Oversight Committee’s select subcommittee on coronavirus.
Alexander also argued that colleges should stay open to allow Covid-19 infections to spread, lamenting in a July 27 email to Centers for Disease Control and Prevention Director Robert Redfield that “we essentially took off the battlefield the most potent weapon we had…younger healthy people, children, teens, young people who we needed to fastly [sic] infect themselves, spread it around, develop immunity, and help stop the spread.”..
“So the bottom line is if it is more infectiouness [sic] now, the issue is who cares?” Alexander wrote in a July 3 email to the health department’s top communications officials. “If it is causing more cases in young, my word is who cares…as long as we make sensible decisions, and protect the elderely [sic] and nursing homes, we must go on with life….who cares if we test more and get more positive tests.”” (E)
“The Food and Drug Administration authorized Pfizer Inc. and BioNTech SE’s Covid-19 vaccine for emergency use—the first to get such a green light—late Friday, setting in motion UPMC’s push to notify individual employees who will get the opportunity to receive the earliest shots. By Monday, the first UPMC health-care workers finally had an answer to who would be offered the vaccine.
UPMC didn’t have enough to go around. On Monday it received 975 doses at its Children’s Hospital of Pittsburgh and expected another 1,950 doses to arrive Tuesday for its flagship hospital, UPMC Presbyterian in Pittsburgh. A team including doctors, pharmacists and an ethicist had agreed only days earlier how they would pick those to go first.
“It is a very difficult thing for us to all feel confident that what we’ve done is fair and effective,” said Graham Snyder, UPMC’s medical director of infection prevention and hospital epidemiology.
Hospitals are among the first to confront the ethical, legal and practical challenges of coordinating a mass vaccination campaign among employees as shots become available. Federal advisers also identified workers in public transit, food supply and education as high priority, after health-care workers and vulnerable residents in nursing homes…
Divvying up the vaccine isn’t the first time hospitals have been forced to ration critical care and supplies in the pandemic. Surgeons have decided which procedures to put off and which can’t wait as hospitals become swamped with Covid-19 patients. Limited early supply of the antiviral drug remdesivir led to federal distribution of the drug to states, which then awarded scarce supplies to hospitals.
UPMC for six weeks used a weighted lottery to decide which Covid-19 patients would get the drug. “There were many days we did not have enough,” said Doug White, a doctor and ethicist at the University of Pittsburgh. “It’s incredibly sad to not have enough,” he said.
The UPMC weighted lottery for remdesivir slightly boosted chances for patients from economically distressed neighborhoods to help alleviate disparities and reach people hit harder by the pandemic.
UPMC Presbyterian in Pittsburgh is expected to receive 1,950 doses of the vaccine on Tuesday.
For the vaccine, UPMC is expected to receive nearly 30,000 doses by the end of December. UPMC employs about 90,000 people, of which about 60,000 are health-care workers.
Covid-19 has disproportionately hit health-care workers who are people of color, who account for about 40% of the workforce but 53% of Covid-19 cases, an analysis by the Kaiser Family Foundation shows. Black and Hispanic people accounted for a larger share of health-care employees in housekeeping, cafeterias, security, clergy and other support jobs, the analysis found.
That disproportionate impact shouldn’t be overlooked with distribution of the vaccine, which would further exacerbate disparities, said Dayna Bowen Matthew, dean of the George Washington University Law School, whose work focuses on racial disparities in health care. “The way we distribute this vaccine could either decrease or increase existing inequalities,” she said.
To pare the list down further, UPMC will give priority to employees who have the highest risk of severe disease, but this requires information about workers’ health, which employers generally can’t request.
UPMC will ask workers to confirm they have a high-risk condition, such as heart disease, but the system won’t ask for specifics. UPMC also won’t verify it is true.
“It’s an honor system,” said Dr. Snyder. “Could somebody lie and say they do, just to get ahead of the line? Yes. But I have a lot of faith in our health-care workers to answer that honestly.”
“Hospitals in general are advised to target the members of their workforces at highest risk, but the institutions are left on their own to decide exactly who that will be, Colin Milligan, a spokesperson for the American Hospital Association, said by email.
“It is clear that the hospitals will not receive enough in the first weeks to vaccinate everyone on their staff, so decisions had to be made,” Milligan wrote.
At Intermountain Healthcare in Salt Lake City, the first shots will go to staff members “with the highest risk of contact with Covid-positive patients or their waste,” said Dr. Kristin Dascomb, the medical director of infection prevention and employee health. Within that group, managers will determine which caregivers are first in line.
At UW Medicine in Seattle, which includes Harborview Medical Center, an early plan called for high-risk staff members to be selected randomly to receive first doses, said Dr. Shireesha Dhanireddy, medical director of the infectious disease clinic. But the University of Washington hospital system expects to receive enough doses to vaccinate everyone in the high-risk tier within two weeks, so randomization isn’t necessary — for now.
“We are allowing people to schedule themselves,” Dhanireddy said, and encouraging staffers to be vaccinated near the end of their workweeks in case they have reactions to the vaccine.
Trial results have shown that the shots frequently produce side effects that, while not debilitating, could cause symptoms that might keep someone home for a day or two, such as fever, muscle aches or fatigue.
Noting that guidelines call for no more than 25 percent of any unit to be vaccinated at once, Sifri, of UVA Health, said, “We want to make sure that not everybody has the vaccine on the same day so that if there are some side effects, we don’t end up being short-staffed.”
Once the initial 3,000 doses are distributed at UVA Health, the hospital plans to rely on what Sifri described as “a very strong honor code” to allow staff members to decide where they should be in line. They’ve been asked to consider professional factors, like the type of work they do, as well as personal risks, such as age or underlying conditions, like diabetes.
“We’re going to ask team members, using the honor code, to determine what their risk is for Covid and to determine whether they need to have an early vaccine sign-up time or a later vaccine sign-up time,” he said.
The plan was chosen after health care staff members soundly rejected other options. For example, few favored a proposal to allocate doses via a lottery, like the chaotic birthday-based system depicted in the 2011 pandemic horror film “Contagion.”
Hospital officials also stressed that they are trying to devise distribution plans that ensure that vaccines are allocated equitably among health care workers, including the social, racial and ethnic groups that have been disproportionately harmed by Covid-19 infections. That requires thinking beyond front-line doctors and nurses.
At UVA Health, for example, one of the first groups invited to get shots will be 17 workers whose job is to clean rooms in the special pathogens unit where severe Covid-19 cases are treated.
“We acknowledge that everybody is at risk for Covid, everybody is deserving of a vaccine,” Sifri said.
In many cases, it will be clear who should go first. For instance, although Dhanireddy is an infectious disease doctor who consults on Covid-19 cases, she is happy to wait.
“I wouldn’t put myself in the first group at all,” she said. “I think that we need to protect our staff that are really right there with them most of the day — and that’s not me.”
But hospitals must remain vigilant about relying on workers to prioritize their own access, Dhanireddy said. “Sometimes, self-selection works more for self-advocacy,” she said. “It’s great that some individuals say they would defer to others, but sometimes that’s not actually the case.”
For some health care workers, not being first in line is fine. Because the vaccine is initially authorized only for emergency use, hospitals won’t require employees to be inoculated as part of the first round. Between 70 percent and 75 percent of health care staff at UVA Health and Intermountain Health would accept a Covid-19 vaccine, internal surveys showed. The rest are unsure — or unwilling.” (B)
“…Initially, supply will be very limited, meaning states have to make difficult decisions about who should get the first allocations.
To help guide these decisions, the CDC’s Advisory Committee on Immunization Practices (ACIP) released an interim recommendation on December 1 for the highest priority group (“Phase 1a”) to include health care workers (HCWs) and long-term care (LTC) residents; we estimate that this populations together represents about 17.6 million people. ACIP also provided further guidance regarding sub-prioritization within these groups. While ACIP has yet to finalize recommendations on subsequent prioritization (expected soon), according to presentations and materials provided in recent ACIP meetings, the committee is likely to recommend that (non-health care) essential workers be the next priority group (“Phase 1b”), followed by persons age 65 and older and those with conditions that place them at high risk for severe illness from COVID-19 (“Phase 1c”). These groups are much larger, which will likely make the next stages of prioritization much more difficult given that supply will still be limited (according to ACIP, there are an estimated 87 million essential workers, 53+ million seniors and more than 100 million individuals with high-risk medical conditions).
States look to and often follow ACIP guidance, but the federal recommendations are not binding and some states may choose to depart from the prioritization sequence outlined by ACIP, which could mean that initial access will depend on where people live. To see where states stand on prioritization, we collected and reviewed all statements and releases from state officials that reference the criteria they will use to prioritize vaccines during Phase 1 (these prioritization criteria build on and add detail to states’ initial vaccine distribution plans, which we already examined here). We did not assess how individual facilities (such as hospitals) will allocate vaccines once they arrive at their doors….
Our review finds that almost all states hew to ACIP regarding initial allocations of a COVID-19 vaccine (Phase 1a) and have looked specifically at ACIP for decision-making. Beyond that, a good number of states are still developing criteria for Phases 1b-c. Given that ACIP has yet to issue recommendations for these phases, states may be waiting for further guidance. However, based on ACIP’s preliminary framework, there are some differences between state priorities and where ACIP is likely to land, primarily related to the prioritization of seniors and/or those with high risk medical conditions relative to non-health essential workers. Moreover, these later prioritization decisions are likely to be more difficult given the large numbers of people in these groups and continued limits on vaccine supply.” (C)
“These COVID vaccines are preventing clinical disease, we don’t know if they prevent transmission,” Dr. Beyrer said.
It’s important to know the difference between infection and disease. Dr. Moss said just because you are infected or have transmitted coronavirus doesn’t mean you get sick.
“So you know, everyone who gets disease has an infection, and the infection causes the disease,” Dr. Moss said. “But not everyone who is infected has the disease.”
That is where Moderna and Pfizer have aimed their vaccines: preventing people from getting sick.
“What’s being measured in the trials is whether or not they prevent disease, mild, moderate and severe disease,” Dr. Moss explained.
This isn’t rare for vaccines. Dr. Moss said most vaccines don’t actually stop a virus from entering your body.
“That requires a really strong kind of immune response to prevent infection,” he said.
Simply put, we don’t know if these vaccines prevent infection, but we do know their primary job is to stop the virus from becoming a disease or lessen the disease.” (D)
Dr. Jonathan M. Metsch is Clinical Professor of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai; Affiliated Faculty at the Zicklin School of Business, Baruch College, C.U.N.Y. and, until recently Adjunct Professor at Rutgers School of Public Affairs and Administration and Rutgers School of Public Health.
Jonathan is a member (and Acting Chairman) of the Institutional Review Board (IRB) at Stevens Institute of Technology, a Commissioner of the Hoboken Historical Preservation Commission, and a Board member of The Hoboken Shelter.
Jonathan served as a Board member of Jewish Family Service of MetroWest and as a Leadership Newark Coach. He was the Founder of Hudson Cradle and served on the Board of the Hudson County Child Abuse Prevention Center, and the Steering Committee of MetroWest CARES.
From September, 2009 to November, 2011 Jonathan was a Commissioner of the Hoboken Municipal Hospital Authority, and part of the team that “privatized” this City-owned hospital. He was also the organizer and co-chairman of the Hoboken H1N1 Swine Flu Task Force.
Metsch was a UJA-Federation of New York MAP consultant, previously serving: on the Board of Hillel at Baruch College; as a member of the Jewish Community Centers review team; on the Board of Associated Camps; and as a member of the Food Sustainability portfolio review group.
While serving as President and CEO of LibertyHealth/ Jersey City Medical Center (and Associate Dean for Jersey City Medical Center, Mount Sinai School of Medicine) from 1989-2006, Jersey City Medical Center: was designated as a Regional Perinatal Center, Level II Trauma Center, Teaching Hospital Cancer Program, a Children’s Hospital, and a Medical Coordination Center (for statewide disaster preparedness); started cardiac surgery/ interventional cardiology; and became a major teaching affiliate of Mount Sinai School of Medicine. A total replacement hospital was opened on a new site in 2004.
Metsch was Chairman of the Board of the New Jersey Hospital Association and served on the Boards of the Seton Hall University School of Graduate Medical Education, the Hudson County AIDS Consortium, the State Health Planning Board, the Hudson County Perinatal Consortium, and The Hospital Alliance of New Jersey. He served on the Governor’s Advisory Commission on Hospitals, the Task Force on Affordability and Accessibility of Health Care in New Jersey, the Governor’s Advisory Council on AIDS, and the Department of Human Services HMO-Hospital Workgroup.
From 1972-1989 Jonathan worked at The Mount Sinai Medical Center (NYC) as: a faculty member of the Baruch-Mount Sinai Graduate Program in Health Care Administration; Administrator of Mount Sinai Services, City Hospital Center at Elmhurst; Associate Dean for Administration of Mount Sinai School of Medicine; and Senior Vice President for Administration, MSMC.
From 1967-1970 Jonathan was on active duty in the U.S. Air Force leaving with the rank of Captain.
Dr. Metsch earned: a B.A. from Queens College of the City University of New York; an M.P.A. from the University at Albany, State University of New York; and a Dr.P.H. from the University of North Carolina at Chapel Hill (from which he received the School of Public Health’s 2005 Harriet Hylton Barr Distinguished Alumni Award).
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)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
