“What seemed impossible months ago is now a reality: the first doses of a Covid-19 vaccine have been given to the American public, less than a year after the disease was first spotted in the US.
It’s an astonishing feat, since most vaccines take years to develop.
But it will be several months before most Americans can get a Covid-19 vaccine.
In the meantime, thousands of Americans are dying from the virus every day.
And the rates of new infections and deaths are accelerating at unprecedented rates, meaning Americans must hunker down this winter before rolling up their sleeves.
A critical care nurse was the first person in New York and among the first people in the country to get a first dose of the Pfizer/BioNTech vaccine…
The US Food and Drug Administration recently authorized the vaccine for emergency use, and the US Centers for Disease Control and Prevention has allowed it to be given to people 16 and older.
“We expect 145 sites across all the states to receive vaccine on Monday, another 425 sites on Tuesday, and the final 66 sites on Wednesday, which will complete the initial delivery of the Pfizer orders for vaccine,” said Gustave Perna, chief operating officer of Operation Warp Speed.
But the CDC has recommended that health care workers and residents of long-term care facilities get the vaccine first.”(A)
“In the US, the Pfizer/BioNTech vaccine is being distributed to hundreds of hospitals. Healthcare workers at high risk of being infected should get vaccinated first, the US Centers for Disease Control and Prevention’s vaccine advisory panel has recommended. Nursing home residents are next in line, and are due to start getting vaccinated from next week.
Mass vaccination could be a particular challenge in the US because it lacks a centralised healthcare system. Different states and hospitals can make different decisions on who gets the vaccine.
There is also concern about the rate of uptake, even though the vaccine will be free. Only half of US adults say they will get vaccinated, according to a recent survey. Another quarter are unsure and the remaining quarter say they won’t take it.” (B)
“Complicating the matter in Pennsylvania is the fact that the state has not disclosed how many doses are anticipated or how the vaccine will be allocated once it gets here.
The state released an interim vaccine plan Friday, but it doesn’t detail which regions or facilities will get the initial doses, making Pennsylvania and Puerto Rico the only places that haven’t released that information, according to a New York Times survey…
The Pennsylvania Department of Health will determine how much each region will receive, but those numbers have not been disclosed. After postponing release of the information twice last week, a department spokeswoman did not respond Friday, and a spokesman declined to comment on Saturday.
In next-door Ohio, Gov. Mike DeWine has released not only how many doses his state anticipates, but also how many will go to specific facilities statewide.” (F)
“President Donald Trump has asked White House staffers to receive the coronavirus vaccine “somewhat later in the program, unless specifically necessary,” he tweeted Sunday night after it surfaced that high-ranking administration officials were set to receive some of the first doses in the US.
The vaccinations, which were set to begin as soon as this week, would have come while the vaccine is in extremely limited supply and only generally available to high-risk health care workers. Other parts of the Trump administration were intended to be vaccinated in the coming days…
An administration official said health care providers at the National Institutes of Health will begin receiving the vaccine in the near future. Doctors and nurses in the intensive care unit at the NIH Clinical Center will be prioritized to receive the vaccine first. Other top officials, like Dr. Anthony Fauci, are on the list to receive the vaccine following those staffers who rank higher on the priority list, the official said.
“Senior officials across all three branches of government will receive vaccinations pursuant to continuity of government protocols established in executive policy,” National Security Council spokesman John Ullyot said in a statement. “The American people should have confidence that they are receiving the same safe and effective vaccine as senior officials of the United States government on the advice of public health professionals and national security leadership.”..
The President and other White House staff have regularly flouted US Centers for Disease Control and Prevention guidelines for safety during the pandemic such as the wearing of face masks and social distancing.
There have been several Christmas parties held at the White House recently where those guidelines weren’t followed, and Trump held many events during the campaign where large crowds gathered, maskless.” (E)
“With the Food and Drug Administration’s authorization of a coronavirus vaccine on Friday, the United States became the third highly developed Western country — after Britain and Canada — to approve such a shot, and is expected to start inoculating people within days.
But the three countries have very different health care systems. And they face different challenges in the race to get the vaccine to millions of people.
Here are some similarities and contrasts…
How centralized is the rollout?
In Britain, very. In the United States, not. In Canada, somewhere in between.
With a strong central government and a National Health Service that covers all of its people, Britain, which began giving the vaccine this past week, is directing the process from London. The national government chose the 50 hospitals that would initially get the vaccine and made sure they were prepared; decided how much each one would receive; and drafted the rules determining in what order people would be eligible to get it.
The Trump administration has deferred much of the decision-making to the states. The federal government will have the vaccine distributed to each state based on population, not need, but some states have complained that they do not know enough about the arrangements.
It will be up to the states to decide how to divide the doses among hospitals, clinics and, ultimately, drugstores and doctors’ offices, but at first, at least, the vaccine will go to hospitals with ultracold storage…
Like Britain, Canada has a universal health care system, but like the United States, it has a federal government. The Canadian health care system is decentralized, administered by the provinces and territories.
For vaccine distribution, the central government plans to work through those regional governments. Ottawa will play a large role in directing the process.
Canada had ordered enough of the Pfizer-BioNTech vaccine for all of its people, Britain enough for 30 percent and the United States enough for 15 percent…
In Canada, where the military is playing a central role in vaccine distribution, the government is sending shipments to all 10 provinces. The three northern territories will have to wait.
In the United States, FedEx and UPS will ship vaccines from distribution centers to every part of the country. But the holiday season is the busiest time of the year for delivery services, which could slow things down.
How fast will most people get vaccines?
That is even murkier.
Britain, Canada, the United States and the European Union have all followed similar strategies, pre-ordering huge numbers of doses — more than enough to inoculate everyone — from multiple makers, hedging their bets in case some of the vaccines are not approved or some manufacturers have production breakdowns.
Relative to their populations, the United States has ordered far fewer doses than Canada or Britain, and last summer it passed up an offer to increase its advance order from Pfizer. Administration officials say the numbers are misleading, because the government has signed options to buy far more of the vaccine if it sees the need.
But in the face of intense global demand, it is not clear how fast pharmaceutical companies will be able to fulfill the orders they have, much less any additional orders.
And again, the speed of development, approval and production will affect how quickly supplies reach people. A country that places a bigger bet on one vaccine could be much better off than one that relies more heavily on another.” (G)
MEANWHILE –
“Heading into another holiday season, Texas has the fewest number of available intensive care beds to care for its sickest patients since the pandemic began, leaving health care experts worried hospitals could be pushed to the brink as coronavirus cases continue to climb.
As of Thursday, there were 672 staffed ICU beds available statewide. That’s compared with 2,100 open ICU beds available at the end of April, according to the Texas Department of State Health Services.
Intensive care units were full in at least 28 hospitals spread across Texas for the week ending Nov. 27, according to a Texas Tribune analysis of data released by the U.S. Department of Health and Human Services. More than 160 hospitals reported having less than 15% of their ICU beds available during the same period…
The Texas Tribune analyzed data for 200 of the largest hospitals that reported four or more ICU beds or ICU patients across the state. The numbers represent seven-day averages that were self-reported to the federal government.
There were 9,045 people in hospitals with COVID-19 as of Thursday, according to state data, near the record level last seen in late July.
The crush of demand for ICU beds is, in part, because many people put off treatment for non-coronavirus illnesses in the early months of the pandemic, Cummins said. Now, people are returning to emergency rooms with more severe complications for conditions like heart attacks and strokes…
Staff at Texas Health Frisco converted beds used for postpartum recovery to medical overflow, faced with an increasing number of patients with COVID-19, said Barclay Berdan, CEO of Texas Health Resources, one of the largest hospital systems in North Texas…
Texas Medical Center hospitals in Houston exceeded base ICU capacity Thursday for the first time since cases of COVID-19 surged this summer, the Houston Chronicle reported. That prompted hospitals to return to Phase 2 surge planning, in which regular beds are converted to ICU beds…
“The specter of the Christmas holiday is very nerve-wracking for hospitals,” … (D)
“A number of New York City hospitals are nearing capacity in their intensive care units as coronavirus cases rise across the city and state, new data shows.
A total of eight hospitals across the five boroughs have reached more than 90 percent fullness in their ICUs, according to the data, which was recently-released by the United States Department of Health and Human Services and compiled by Gothamist. The hospitals include three in Brooklyn, two in Manhattan, two in Queens and one in Staten Island.
The data comes as coronavirus hospitalizations increase across New York City. As of Friday, an average of 904 people have been admitted into the hospital each week over the last month.
Hospitals and public health officials have assured New Yorkers that, despite the surge, the state and medical response to the virus has improved since it first took hold of the city earlier this year.
“…NewYork-Presbyterian has been preparing for this possibility since the first wave,” NewYork-Presbyterian, which runs Brooklyn Methodist, told Patch in a statement. “We have expanded ICU capacity and are redeploying resources as needed within the hospital and across the NewYork-Presbyterian system, and every patient is receiving the care they need.”
One of the eight hospitals, Flushing Hospital in Queens, surpassed 100 percent capacity, with 123 percent of its ICU beds used by COVID-19 patients. Kingsbrook Jewish Medical Center in Brooklyn, with 100 percent fullness, was the second highest.
Gov. Andrew Cuomo said Friday that the average length of stay in the hospital for coronavirus patients has decreased in New York from 11 days earlier this year to just five days given new treatment methods and better preparation.
The death rate has decreased from 20 recent to 8 percent, Cuomo said.
The governor has also pointed to state-mandated “load balancing” among hospital systems — or distributing patients among hospitals so no one facility is overwhelmed — as a major difference between the handling of the current surge and the first crisis earlier this year.” (C)
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
“There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.” Donald Rumsfeld
“A US Centers for Disease Control and Prevention advisory committee voted Saturday to recommend the Pfizer and BioNTech Covid-19 vaccine in patients 16 and older as the US continues to be ravaged by the coronavirus
The vote by the CDC’s Advisory Committee on Immunization Practices came the day after the US Food and Drug Administration authorized the Pfizer vaccine for emergency use — a day in which the US once again saw a record number of new cases, deaths and Covid-19 patients in hospitals.
Vaccines cannot be administered until CDC Director Dr. Robert Redfield accepts the committee’s recommendation, which is expected to take place within hours…
The first shipments of Pfizer and BioNTech’s Covid-19 vaccine will leave Kalamazoo, Michigan, on Sunday after the FDA authorized the vaccine for emergency use, a landmark in the pandemic.
The Food and Drug Administration’s authorization came amid one of the worst days of the pandemic for the US, with record numbers of new cases, deaths and Covid-19 patients in US hospitals.
The emergency use authorization (EUA) is a “significant milestone,” FDA Commissioner Dr. Stephen Hahn said in a statement Friday. He said it comes after an “open and transparent review process that included input from independent scientific and public health experts and a thorough evaluation by the agency’s career scientists.”
An EUA stops short of a full approval. Pfizer would have to file a separate application for its vaccine to be fully licensed by the FDA.
But the EUA “holds the promise to alter the course of this pandemic in the United States,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research.
Once the vaccines leave Pfizer’s Kalamazoo facility, they’ll be bound for 636 locations across the country, Gen. Gustave Perna, chief operating officer of the federal government’s vaccine initiative Operation Warp Speed, said in a news conference Saturday.
“We expect 145 sites across all the states to receive the vaccine on Monday, another 425 sites on Tuesday, and the final 66 sites on Wednesday, which will complete the initial delivery of the Pfizer orders for the vaccine,” Perna added.
But two key steps remain before vaccinations can start. The US Centers for Disease Control and Prevention vaccine advisory committee met Saturday morning and must vote to recommend the vaccine. The agency next must accept that recommendation.
Then vaccinations can begin. But it will be months before most Americans will get one. Advisers to the CDC have recommended healthcare workers and long-term care facility residents be first in line.” (A)
“The FDA has determined that Pfizer-BioNTech COVID-19 Vaccine has met the statutory criteria for issuance of an EUA. The totality of the available data provides clear evidence that Pfizer-BioNTech COVID-19 Vaccine may be effective in preventing COVID-19. The data also support that the known and potential benefits outweigh the known and potential risks, supporting the vaccine’s use in millions of people 16 years of age and older, including healthy individuals. In making this determination, the FDA can assure the public and medical community that it has conducted a thorough evaluation of the available safety, effectiveness and manufacturing quality information.
The Pfizer-BioNTech COVID-19 Vaccine contains messenger RNA (mRNA), which is genetic material. The vaccine contains a small piece of the SARS-CoV-2 virus’s mRNA that instructs cells in the body to make the virus’s distinctive “spike” protein. When a person receives this vaccine, their body produces copies of the spike protein, which does not cause disease, but triggers the immune system to learn to react defensively, producing an immune response against SARS-CoV-2.” (B)
“A lot of things are different when you’re in the midst of a global pandemic. A case in point: How federal regulators scrutinize and authorize new vaccines.
The U.S. Food and Drug Administration ushered in a new phase of the fight against COVID-19 on Friday by giving its blessing to a vaccine made by Pfizer Inc. and BioNTech. It’s the first such vaccine to get a green light from the FDA, and immunizations will begin in a matter of days.
There are plenty of reasons why it passed muster. Clinical trial data indicate that:
• It was 95% effective at preventing cases of COVID-19 in both Latinos and non-Latinos.
• It was 100% effective in Black people.
• It was 94% effective in people who were at least 56 years old. (The older you get, the greater the risk of a serious case of COVID-19.)
• It was 95% effective in those who had at least one medical condition that made them more likely to develop a serious case of COVID-19.
• It was 96% effective for people who were obese, another condition that makes people more vulnerable to COVID-19.
Yet none of this was enough for the vaccine to win official FDA approval. What it got instead was a more limited emergency use authorization.
Why?
Blame it on the pandemic.
During a public health emergency, it’s imperative to develop new medicines and vaccines as quickly as possible. But even when speed is of the essence, the FDA still takes the time to be sure patients aren’t subjected to untested therapies that do more harm than good.
So the agency uses an alternative evaluation process that’s designed to vet things more quickly than the usual FDA approval regimen. If a drug or vaccine passes muster, it’s granted an emergency use authorization, or EUA.
An EUA can be used on a brand-new medical product or on an existing one that has already been approved for another purpose. They’re not limited to vaccines — under the right circumstances, an EUA can be granted to anything used to “diagnose, treat, or prevent serious or life-threatening diseases or conditions,” the FDA explains….
Once sufficient data are in hand, the FDA can decide whether emergency use authorization is warranted. Doctors and scientists on the agency’s staff pore over the study results. So do the independent scientists and health experts on the agency’s Vaccines and Related Biological Products Advisory Committee.
In the case of a vaccine, authorization can be granted if “the known and potential benefits outweigh the known and potential risks,” the FDA says.
The agency also assesses the company’s ability to consistently produce high-quality doses of its vaccine.
Granting emergency use authorization isn’t the end of the story. Once an authorized vaccine goes out to the public, its manufacturer must keep track of any serious side effects that befall those who take it, especially adverse events that result in hospitalization or even death.
The FDA, the Centers for Disease Control and Prevention and other government agencies will do their own safety monitoring as well. If the FDA ever determines that the benefits of the vaccine no longer outweigh the harms, the emergency use authorization can be revoked.
An EUA can last only as long as a public health emergency is in effect. But scientists anticipate that the coronavirus will continue to circulate in humans even after the COVID-19 pandemic ends. In that case, vaccine makers that want to keep their products on the market will need to have regular FDA approval — and to get it, they’ll need to keep their Phase 3 clinical trials going.
And that’s probably what they’ll do. The FDA said it expects vaccine makers who receive emergency use authorizations to “continue to collect placebo-controlled data in any ongoing trials for as long as feasible” so they can apply for regular approval.” (C)
“Pfizer has a deal with the U.S. government to supply 100 million doses of the vaccine by next March. Under that agreement, the shots will be free to the public.
Every state, along with six major cities, has submitted to the federal government a list of locations — mostly hospitals — where the Pfizer vaccine is to ship initially. In populous Florida, the first recipients will be five hospitals, in Jacksonville, Miami, Orlando, Tampa and Hollywood. In tiny, rural Vermont, only the University of Vermont Medical Center and a state warehouse will get supplies.
McKesson Corporation, a giant medical supplier, is sending kits of syringes, alcohol pads, face shields and other supplies to the same sites, where they will meet up with the vaccines that Pfizer is shipping in special boxes, packed with dry ice, designed to keep them at minus 94 degrees Fahrenheit.
The Pfizer packaging will include a device that tracks the location of the box, plus a thermal probe that will make sure the deep freeze is maintained throughout the journey from the company’s distribution sites in Michigan and Wisconsin.” (D)
CDC requested each state outline its capacities for distributing COVID-19 vaccines across a broad set of 15 critical areas: public health preparedness planning; organizational structure; plans for a phased approach; identifying and reaching critical populations to be prioritized for vaccine access; identifying and recruiting providers to administer the vaccine; vaccine administration capacity; allocating, distributing, and managing its inventory of vaccines; storage and handling; collecting, tracking, and reporting key measures of progress; second dose reminders; immunization information system requirements; developing a comprehensive communications plan around vaccination; regulatory considerations; safety monitoring; and program monitoring.
CDC guidance and federal oversight could evolve over the next several months as vaccines become available and distribution begins. The Biden campaign and transition team have planned for a more prominent role for the federal government in the U.S. COVID-19 response, which would likely include more detailed federal guidance and a stronger federal hand in vaccine distribution, planning and implementation, even as state and local jurisdictions will remain responsible for much of this effort. A critical challenge facing vaccine distribution efforts will be funding. To date, only $200 million has been distributed to state, territorial, and local jurisdictions for vaccine preparedness, though it is estimated that at least $6-8 billion is needed. President-elect Biden has said his administration would seek to invest $25 billion in manufacturing and distribution, which would require Congressional action.
While the CDC has made executive summaries of these plans available, there is no central repository for the full plans. We therefore sought to collect plans available from all 50 states and DC, as of November 13, identifying 47 full state plans in total (linked in the “State Plans” tab). We then reviewed each plan to gauge how states described their vaccine distribution planning progress to date. Rather than assess every single component of these plans in detail we identified common themes and concerns across the state plans, in particular focusing on what states reported regarding their progress in the following key areas:
identifying priority populations for vaccination in their state;
identifying the network of providers in their state that will be responsible for administering vaccines;
developing the data collection and reporting systems needed to track vaccine distribution progress; and
laying out a communications strategy for the period before and during vaccination.
Where are States in their Planning?
Based on the information in their plans, states are in varying stages of preparation for distributing a COVID-19 vaccine. While all have established a task force or planning committee to steer these efforts, which include representatives from different sectors, some have been planning for several months while other states’ planning efforts have started more recently. Some states have already begun the process of signing up providers to administer COVID-19 vaccines and building out existing immunization registries, while others are still just developing plans to do the same. All reported, however, that these initial plans are to be considered drafts only, to be updated as more information from the federal government and about a vaccine itself was available. Specifically, almost all cited the need to know which vaccine(s) would be authorized or approved, and that they will look to further federal guidance and recommendations before some key decisions are made, such as finalizing which individuals will be targeted as priority populations. Several raised concerns about the lack of visibility regarding vaccine distributions that will be made directly from the federal government to certain providers in their states, such as large pharmacy chains. These concerns were raised before the November 12 announcement by the federal government that it will be distributing future COVID-19 vaccines directly to some independent pharmacies and multi-state pharmacy chains across the U.S., in parallel to state efforts to recruit vaccination providers. States also discussed lessons learned from previous vaccine distribution efforts such as H1N1 pandemic influenza, including the need to build flexibility into distribution plans when supply is unpredictable and tailoring messages and outreach to diverse populations, which are certain to be challenges for a COVID-19 vaccine as well. Finally, even recognizing the that states are in different states of readiness in terms of their distribution planning efforts, it is clear all state health departments are taking this responsibility seriously and are overseeing significant efforts to make progress in their preparations. (E)
Training for Healthcare Providers
When COVID-19 vaccines become available, health departments will be key partners in ensuring the success of the COVID-19 Vaccination Program, including by offering training to healthcare providers in vaccine management, administration, and reporting. Onboarding opportunities will focus on:
ACIP COVID-19 vaccine recommendations, when available
How to order and receive COVID-19 vaccine
COVID-19 vaccine storage and handling (including transport requirements)
How to administer vaccine, including reconstitution, use of adjuvants, appropriate needle size, anatomic sites for vaccine administration, avoiding shoulder injury with vaccine administration, etc.
How to document and report vaccine administration via the jurisdiction’s Immunization Information System (IIS) or other external system
How to manage vaccine inventory, including accessing and managing product expiration dates
How to report vaccine inventory
How to manage temperature excursions
How to document and report vaccine wastage/spoilage
Procedures for reporting adverse events to the Vaccine Adverse Event Reporting System (VAERS)
How to help patients enroll in v-safe, a smartphone-based tool that checks in with patients to ask about side-effects after receiving COVID-19 vaccine
Providing Emergency Use Authorization (EUA) fact sheets or Vaccine Information Sheets (VISs) to vaccine recipients
How to submit facility information for COVID-19 vaccination clinics to CDC’s Vaccine(F)
“Hours before the Food and Drug Administration authorized the first COVD-19 vaccine late Friday, a high-ranking White House official told the agency’s chief he could face firing if the vaccine was not cleared by day’s end, two administration officials said.
The FDA granted emergency use for the vaccine produced by Pfizer Inc. and its German partner BioNTech. The decision kicks off a massive vaccination effort to help defeat the pandemic. President Donald Trump said late Friday that Pfizer had “passed the gold standard of safety” and hailed the vaccine as “one of the greatest scientific accomplishments in history.”
But the move followed tense discussions between White House chief of staff Mark Meadows and FDA Commissioner Stephen Hahn, according to a senior administration official who was familiar with the call but was not authorized to discuss private conversations.
The chief of staff told Hahn his job was in jeopardy if the emergency use authorization was not issued before Saturday, said a second administration official familiar with the conversation.” (G)
“The ACA requires most employer and individual market health plans to cover and waive cost-sharing (such as a deductible, co-payment, or coinsurance) for certain recommended preventive services. These include immunizations for “routine use” in children and adults that have been recommended by ACIP; vaccines are only considered to be for routine use if they are listed on the Immunization Schedules of the Centers for Disease Control & Prevention (CDC).
The ACA gave plans and insurers up to two years to cover a vaccine, following the ACIP recommendation. It was for this reason that the Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted in March 2020, accelerated the timetable with a provision requiring insurers and employer plans to cover COVID-19 vaccines within 15 days after a recommendation from ACIP.
Other limitations in current law could leave consumers without full coverage of the vaccine:
The ACA requirement applies only to ACA-compliant health plans. Grandfathered plans, short-term plans, health care sharing ministries, Farm Bureau plans, and certain other forms of health insurance are not required to cover the vaccine at all, let alone waive enrollee cost-sharing. Although comprehensive data is not available, these alternative forms of coverage appear to be quite prevalent. For example, 14 percent of workers with job-based coverage are in a grandfathered plan, while at least 4-5 million individuals are enrolled in a short-term plan or sharing ministry arrangement.[1]
Health plans are not required to cover preventive services, including immunizations, delivered by an out-of-network provider, if an in-network provider is available to deliver the same service. If a consumer receives the vaccine from a clinic, urgent care center, or other provider who does not participate in their health plan’s network, they could find themselves responsible for the cost, in whole or in part.
If the provider charges the insurer separately for both an office visit and administration of the vaccine, the insurer is prohibited from imposing cost-sharing for the vaccine administration, but can impose cost-sharing for the office visit. Similarly, if the primary reason of the patient’s visit is for something other than receiving the vaccine, the patient may be charged for the visit.
Consumers who receive the vaccine in hospital-owned facilities or practices could face “facility fees,” meaning charges that are added to the bill to cover the cost of maintaining the facility. Not all health plans will cover these fees, leaving the policyholder to pay any outstanding balance, which can sometimes be hundreds of dollars.” (I)
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,”…
…The information provides nationwide data on hospital capacity and bed use at a hospital-by-hospital level…
The dataset — which includes capacity reporting from hospitals in 2,200 counties in the U.S. — spotlights areas where hospitals are getting dangerously full. In 126 counties, the average hospital is at least 90% occupied, according to an analysis of the data by the COVID-19 Hospitalization Tracking Project. The states with the most counties above this threshold are Kentucky, Georgia, Minnesota, Oklahoma and Texas.
Hospitals both large and small are feeling the strain, the data show. In Texas, for example, both the Memorial Hermann Hospital System, with its 250 beds, and the Hereford Regional Medical Center, with its 31 beds, were above 90% capacity in the past week.
Previously, with only state-level data available, it was hard for health leaders and researchers to identify regional hot spots. The new data show where individual hospitals are being overwhelmed, even when a state overall isn’t at crisis levels…
The dataset, uploaded to Healthdata.gov, provides a weekly snapshot of how COVID-19 is impacting individual hospitals across the country, including the number of COVID-19 patients admitted to the hospital and the number of severely ill patients requiring intensive care. The information dates back to July 31. Going forward, the data is expected to be updated each week.” (A)
“It focuses on one important metric — how many beds are filled with COVID-19 patients — and shows this for each hospital and on average for each county.
The ratio of COVID-19 hospitalizations to total beds gives a picture of how much strain a hospital is under. Though there’s not a clear threshold, it’s concerning when that rate rises above 10%, hospital capacity experts told NPR.
Anything above 20% represents “extreme stress” for the hospital, according to a framework developed by the Institute for Health Metrics and Evaluation at the University of Washington.
If that figure gets to near 50% or above, the stress on staff is immense. “It means the hospital is overloaded. It means other services in that hospital are being delayed. The hospital becomes a nightmare,”….
The University of Minnesota’s analysis shows that there are 55 counties where the hospital average has reached that rate.” (B)
To find data on a hospital highlight and click on this link, then on the map roll the cursor over the state of interest until you locate the county – hospital specific data will appear below the map.
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.”
“Ben Carson, Chris Christie and Donald J. Trump are not the sturdiest candidates to conquer the coronavirus: older, in some cases overweight, male and not particularly fit. Yet all seem to have gotten through Covid-19, and all have gotten an antibody treatment in such short supply that some hospitals and states are doling it out by lottery….
Mr. Giuliani’s candid admission once again exposes that Covid-19 has become a disease of the haves and the have-nots. The treatment given to Mr. Trump’s allies is raising alarms among medical ethicists as state officials and health system administrators grapple with gut-wrenching decisions about which patients get antibodies in a system that can only be described as rationing.
“We should not have Chris Christie and Ben Carson — and in the case of Carson with intervention by the president — get access,” said Arthur Caplan, a medical ethicist who works with drug companies on how to ration scarce medicines, referring to the secretary of housing and urban development’s admission that the president “cleared” him for the therapy. “That is not the way to secure public support for difficult rationing systems.”..
In an interview on Wednesday, one prominent businessman, who spoke on condition of anonymity to avoid harming his reputation, described his aggressive efforts to track down the Regeneron treatment — including calling friends who were hospital executives and hospital donors — after he tested positive last week.
Eventually he was directed to an emergency room in his city, which was expecting him. He was given an infusion of the drug on Monday. He is feeling much better, he said….
Once state and local health agencies determine which hospitals or medical facilities should get the drugs, they are shipped out by a third-party distributor. Then it is up to health care providers to figure out what to do with them. Dr. Peter L. Slavin, the president of Massachusetts General Hospital, said in an interview Tuesday that access there would be by lottery.
“The notion that we are going to be able to treat a significant percentage of the people who qualify for the drug with the drug — it’s not going to happen,” he said.” (A)
(October, 2020)
“As the symptoms of Covid-19 took hold, President Trump got an infusion of an experimental antibody cocktail and was whisked by helicopter to Walter Reed National Military Medical Center. When his oxygen levels dipped, he was quickly put on a steroid normally given to patients with severe cases of the disease. At every step of the way, the president has had a team of expert physicians carefully monitoring his care.
That experience is a world away from the stressful waiting game most patients wade through after a positive test.
They are told to stay home and monitor their symptoms. If they do become severely ill, there is only a remote chance they will get access to the antibody cocktail, which was developed by Regeneron Pharmaceuticals and is being tested in clinical trials. The company said Monday that the president was among fewer than 10 people who have gotten access to the drug through a compassionate use program.
“Covid is all about privilege. The more privilege you have, the more you can ignore some of the rules of Covid. Where one person would need to be in the hospital, another person can have the hospital come to them. That’s privilege,” said Lakshman Swamy, an ICU physician at Cambridge Health Alliance in Massachusetts.
If the president’s privileged treatment is understandable given his prominence, the contrast is no less stark for millions of Americans who have faced down Covid-19 in their homes or local hospitals, where barriers to cutting-edge care do not simply melt at the mere mention of their names or job titles.
“That’s the most heartbreaking thing about this virus,” Josh Barocas, an infectious disease physician at Boston Medical Center, a safety-net hospital that treats a largely underserved population. “A portion of the people who are severely symptomatic don’t have access to health care … and they are the population that is just being decimated by this.”
In many ways, it’s not a disparity that’s exclusive to Trump. High-profile individuals — in particular, professional athletes — have had frequent access to testing with fast-turnaround results. For much of the rest of the population, however, confirming a case of Covid-19 has meant waiting in line for a test, and waiting even longer for results.
Many patients are worried about losing their jobs because of a positive test, or afraid to go into the hospital because no one else will be available to care for their children if they’re admitted. So they stay home and try to ride it out.
For ordinary patients, there is no such thing as a precautionary hospitalization. Unlike the president, they would not be admitted based on concerns about what could happen if they are not in close proximity to doctors and state-of-the art equipment. They are only hospitalized if signs of severe infection emerge…
But ordinary patients don’t necessarily get the everything-but the-kitchen sink care received by the president. In addition to remdesivir and the antibody cocktail, the president’s physicians have also said he was given the steroid dexamethasone after a temporary drop in his oxygen levels. It is unclear whether the president was actually sicker than his doctors had portrayed at that point. But for most patients, the steroid is only given if they are severely ill and already on a ventilator or otherwise receiving supplemental oxygen.” (B)
“The medical team in charge of Trump’s care have prescribed the President an experimental antibody cocktail, an antiviral drug, and a steroid usually administered to patients with severe cases of COVID-19. The comprehensive nature of Trump’s treatments and the conflicting reports about his health have led medical experts to raise concerns about a new risk: “VIP syndrome.”
“VIP syndrome,” coined in 1964 by Walter Weintraub, a doctor at the University of Maryland School of Medicine, describes a phenomenon in which the medical treatment of a famous, powerful, or influential patient—a very important person, or VIP—faces challenges caused by the person’s fame, power, or influence.
Doctors might make decisions they wouldn’t normally make because they are more willing to accede to the famous person’s demands or are more concerned than usual that the VIP avoids feeling pain or recovers quickly.
“[VIP syndrome] often pressures the health care team to bend the rules by which they usually practice medicine,” according to a 2011 paper in the Cleveland Clinic Journal of Medicine.
Complications can arise when doctors embark on medical treatments that diverge from the standard course of care that may turn out to be detrimental to the patient’s health.
“A VIP draws special attention based on his or her status in society and level of importance as perceived by the health care professional providing treatment,” according to a 2007 article in the peer-reviewed medical journal Intensive Care Medicine. “The special handling of the VIP patient…induces the potential for inappropriate and ineffective care.”
To be clear, there is no firm evidence that VIP syndrome is a factor in the President’s care, but experts have offered it as a possible explanation for the mixed messages from Trump’s medical team.” (C)
“So overall I think the care of President Trump raises many questions. One, it’s possible he’s a whole lot sicker than what we’re led to believe, or he’s had this virus for longer than we think he has. But the other possibility is that he is receiving VIP Medicine, which means more drugs sooner and new combinations. And it sounds like that ought to be better for patients, but so often it isn’t, and it can be detrimental.
So I’m concerned for the president, I’m concerned for his medical care. And I guess I’m concerned about the message that it sends to the broader public. That just because there are therapies that might work doesn’t mean that we know that they do work. And potentially there’s a reason why we’re not offering a bunch of therapies to someone who still has the odds in his favor. Because even though he’s 74, and even though he’s overweight, most people who fit those criteria with SARS-COV-2 do fully recover. And that’s not a situation where you want to try kitchen sink medicine, that’s a situation where you want to stick to well accepted evidence based practices.
It’s one thing to go with the expanded access route when someone’s on death’s door. It’s another thing entirely to do it early when somebody has the odds on his side of doing well. So VIP Medicine, it isn’t always what’s best for people. And I think the president’s case may be an example of that.” (D)
“You are a bioethics fellow at a major hospital. How are VIPs treated differently than the rest of us? Lecturer Joseph Dunne
Medical centers try and do the same things they always do when anyone comes in—which is to provide the best medically indicated care possible for the patient at hand.
I can assure you that hospitals don’t have super-secret machines hidden in the back or technology saved for just such people! The only difference in treatment, if there is any, comes instead with more practical measures like locking or restricting the patient’s chart access—to protect against snoopers and gossipers—and providing additional security personnel to protect the vulnerable patient.
What are the ethical pressures physicians face when treating VIPs?
It’s this scenario: “Doctors save lives. So when we bring you our VIP, you should save their life, right? Don’t you know how important they are!?”
I am not a physician, but there seems to be an intense pressure facing the physician treating the VIP to “do everything possible” and simply make them well again because of how necessary or integral they are to the function of whatever important institution(s) they are connected with.
Do these pressures change the medically indicated care plan?
Pressures typically apply to not-purely-medical things like requests for the most experienced medical personnel, access to window rooms (or requests against them so no one can see in) and heightened 24/7 monitoring. Pressures to treat VIPs don’t typically affect what is medically indicated—if at all.
If a prominent person comes in for a myocardial infarction (heart attack), then they will be treated, medically speaking, in the same way as other patients suffering from that issue. That’s because there’s not much that can be done outside of routine medically indicated care for the issue….
The only deviation from this general trend is when the medical care may involve novel treatments, meaning not yet approved by the FDA, for novel conditions—for example, new treatments for COVID-19. Where there is no clear routine or medically indicated care yet, physicians will typically exercise their best judgment under the developing umbrella of justifiable treatment options — some of which can be more or less risky, more or less efficacious, and more or less scarce. Physicians would most likely begin by utilizing the less risky, more efficacious and less scarce options and see if those work first.
In philosophy, people are considered morally equal. So why does a VIP get scarce COVID treatment when my grandma doesn’t?
The worry is that social inequality, in some sense, trumps—pun not intended—medical equality. Is this justified or is it a moral calamity?
Here’s one reason to think that it’s not unjustified: Suppose a hospital system gets a limited supply of COVID vaccines and has to figure out how to distribute them. Who should get them first? You might think that we should give them to people based purely on who is the most vulnerable (older, obese, etc.). But most hospitals won’t distribute the vaccine like this — in fact, they have been recommended not to by the NIH and CDC via the National Academies of Sciences, Engineering and Medicine.
Instead, hospitals will likely give those scarce vaccines to their own staff who work primarily with COVID patients, with their most vulnerable employees getting the vaccine first…” (E)
“In a video shot moments after his return, Trump addressed the American people as if he had already beat the disease. “Don’t let it dominate you,” he said, not wearing a mask, despite almost certainly still being infectious. “Don’t be afraid of it, you’re going to beat it, we have the best medical equipment, we have the best medicine.”
Trump has certainly had the most advanced medicine. He was treated with at least three drugs – an experimental monoclonal antibody from Regeneron, antiviral remdesivir and steroid dexamethasone – which are usually reserved for patients with “severe” Covid-19 or a “life-threatening” condition.
Average Americans will not have access to Regeneron’s antibody cocktail, and certainly not at the dose Trump took, which was three times greater than what is being studied. Regeneron’s chief scientific officer, George Yancopoulos, acknowledged this special treatment.
“If I had to treat one patient, I’d give the high dose,” Yancopoulos said, according to Science magazine. “From a societal point of view and the need to treat as many people as possible, I’d give the lower dose.”
Remdesivir has been in short supply for months. It only became available for hospitals to buy from the distributor, rather than the US government, the same day Trump is believed to have received his first positive Covid-19 test. Dexamethasone is normally reserved only for severely ill patients.
All of this special treatment underlines the inequality in America’s medical system – regular people have to jump through bureaucratic hoops and pay exorbitant prices for healthcare. But special treatment is not necessarily healthy for the patient it is bestowed on either.
Doctors at the Cleveland Clinic, where the institution’s academic esteem attracts royalty and political luminaries from around the world, set out principles to care for VIP’s. The first one is “don’t bend the rules” of clinical practice.
“In other words, suspending usual practice when caring for a VIP patient can imperil the patient,” wrote the group of physicians. Cleveland Clinic doctors continued: “Usually, the VIP is relieved if the physician states explicitly, ‘I am going to treat you as I would any other patient.’”” (F)
