PART 1. 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. 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. “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. 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. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. 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. 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. 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. 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. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. 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. CORONAVIRUS. March 14, 2020. “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. CORONAVIRUS. March 17, 2020. “ “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. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
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.”
“President Donald Trump said Monday (March 23rd) that he wants to reopen the country for business in weeks, not months, and he claimed, without evidence, that continued closures could result in more deaths than the coronavirus pandemic.
“We can’t have the cure be worse than the problem,” Trump told reporters at a press briefing.
The statement echoed a midnight Sunday tweet from the president in which he said, “We have to open our country because that causes problems that, in my opinion, could be far bigger problems.”
Trump acknowledged there were trade-offs, “there’s no question about that,” but claimed that, if closures stretch on for months, there would be “probably more death from that than anything that we’re talking about with respect to the virus.”” (A)
“But what is the exit strategy? “We’ve managed to get to the life raft,” says epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health (HSPH). “But I’m really unclear how we will get to the shore.”…
The number to watch in the next phase may no longer be the actual number of cases per day, but what epidemiologists call the effective reproduction number, or R, which denotes how many people the average infected person infects in turn. If R is above 1, the outbreak grows; below 1 it shrinks. The goal of the current lockdowns is to push R well below 1. Once the pandemic is tamed, countries can try to loosen restrictions while keeping R hovering around 1, when each infected person on average infects one other person, keeping the number of new cases steady.
To regulate R, “Governments will have to realize that there are basically three control knobs on the dashboard,” says Gabriel Leung, a modeler at the University of Hong Kong: isolating patients and tracing their contacts, border restrictions, and social distancing.
Singapore, Hong Kong, and South Korea have all managed to keep their epidemics in check through aggressive use of the first control. They identify and isolate cases early and trace and quarantine their contacts, while often imposing only light restrictions on the rest of society. But this strategy depends on massively scaling up testing, which has been hampered by a scarcity of reagents and other materials everywhere. The United States will be able to do millions of tests per week, says Caitlin Rivers of the Johns Hopkins Center for Health Security. “Although our testing capacity has grown a lot in the last couple of weeks, we are not where we need to be yet,” she says.
Contact tracing is another hurdle, and it is labor intensive. Massachusetts is hiring 500 contact tracers, but a recent report by Rivers and others estimates that the United States as a whole needs to train about 100,000 people…
As to the second control knob, border restrictions, most countries have already banned entry to almost all noncitizens. Quarantining returning citizens, as New Zealand and Australia began to do in the past few weeks, further minimizes the risk of new introductions of the virus. Such measures are likely to remain in place for a while; the more a country reduces transmission domestically, the greater the risk that any new outbreaks will originate with travelers. And foreign visitors are generally harder to trace than citizens and more likely to stay at hotels and visit potential transmission hot spots, says Alessandro Vespignani, a disease modeler at Northeastern University. “As soon as you reopen to travelers, that could be something that the contact tracing system is not able to cope with,” he says.
The third dashboard dial, social distancing, is the backbone of the current strategy, which has slowed the spread of the virus. But it also comes at the greatest economic and social cost, and many countries hope the constraints can be relaxed as case isolation and contact tracing help keep the virus in check…
Choosing a prudent path is difficult, Buckee says, in part because no controlled experiments have compared the effectiveness of different social distancing measures. “Because we don’t have really strong evidence,” she says, “it’s quite hard to make evidence-based policy decisions about how to go back.” But Lipsitch says that as authorities around the world choose different paths forward, comparisons could be revealing. “I think there’s going to be a lot of experimentation, not on purpose, but because of politics and local situations,” he says. “Hopefully the world will learn from that.” (B)
“Still, society can’t stay shut down forever. Public health and state leaders are starting to talk about how and when to relax social distancing guidelines, and President Trump is expected to soon announce finalized guidelines to help states make those decisions. Even then, it’s clear that life won’t go back to normal all at once. The decisions will be staggered, and a lot of it will come down to local and regional circumstances.
“We have to do it strategically and safely,” said Dr. Monica Bharel, commissioner of the Massachusetts Department of Public Health, at a briefing by the Association of State and Territorial Health Officials Wednesday. “The worst possible outcome of reopening public life would be a second wave of this pandemic.”
Public health leaders agree that in order to safely lift social distancing restrictions we must create and sustain systems that can rapidly stamp out any new coronavirus flare-ups so they don’t spiral out of control. Here are five key things health experts say must be addressed as we begin to start businesses and community life up again.
1. Improve rapid testing
2. Massively upgrade contact tracing capacity
3. Create systems to isolate the sick and protect the vulnerable
4. Build up hospital capacity and the PPE supply chain
5. Zero in on effective treatments…
Gottlieb says the combination of effective treatments as well as expanded testing and surveillance would put us in a situation where we can live with the virus, instead of being paralyzed by it.
“I think that [would be] a robust enough set of tools that this could become a livable threat, that we can get back to a fairly normal way of life and be able to mitigate the risk from coronavirus even before we have a vaccine in place,” he says. “Now, life will never be perfectly the same until we have a vaccine that can fully vanquish it.”
There are dozens of compounds being evaluated for the development of a vaccine, but that’s at least a year off.” (C)
“Everyone wants to know when we are going to be able to leave our homes and reopen the United States. That’s the wrong way to frame it.
The better question is: “How will we know when to reopen the country?”…
Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care…
A state needs to be able to at least test everyone who has symptoms…
The state is able to conduct monitoring of confirmed cases and contacts…
A robust system of contact tracing and isolation is the only thing that can prevent an outbreak and a resulting lockdown from recurring…
This will be a big challenge for most areas. Other countries have relied on cellphone tracking technology to determine whom people have been near. We don’t have anything like that ready, nor is it even clear we’d allow it. The United States also doesn’t have enough people working in public health in many areas to carry out this task…
In suppression, cases will dwindle at an exponential fashion, just as they rose. It’s not possible to set a benchmark number for every state because the number of infections that will be manageable in any area depends on the local population and the public health system’s ability to handle sporadic cases…
Until we get a vaccine or effective drug treatments, focusing on these major criteria, and directing efforts toward them, should help us determine how we are progressing locally, and how we might achieve each goal.
It would also prevent us from offering false hope about when America can start reopening. Instead of guesses, people could have clear answers about when they might be able to go back to a closer-to-normal way of life.” (D)
“CDC PLAN
The Framework for Reopening America provides guidance to state, local, tribal, and territorial governments to adjust restrictive community mitigation measures in a controlled way that supports the
safe reopening of communities when appropriate, supporting Americans reentering civic life.
Why Is the Plan Important to the American People
The strict community mitigation measures the majority of the United States is currently experiencing have succeeded in slowing the spread of COVI-19. This level of mitigation however cannot be adhered to forever, and has negative consequences on economic and long term health outcomes. Lifting stay-at-home orders carefully, on a community by community basis, only when ready, will help extend the gains made from this time of collective social distancing. Coming out of mitigation in a controlled way, with robust monitoring systems in place to contain new cases and outbreaks will be critical to navigating the next phase of this pandemic. Leaders at all levels will need to prepare communities for occasionally returning to stricter mitigation measures for brief periods as needed to continue containing the disease. This plan describes the conditions in which it is appropriate to lift community mitigation measures, the phased steps to reduce community mitigation measures, and indicators to rigorously monitor to inform decisions about adjusting mitigation measures.” (E)
“President Donald Trump announced federal guidelines to reopen the U.S. on Thursday that put the onus on governors of making decisions about their states’ economies…
Under the first phase of the three-phase plan, restaurants, movie theaters and large sporting venues would be appropriate to reopen under certain conditions, while schools, day care centers and bars would not.
The plan, released Thursday afternoon, is designed to “mitigate the risk of resurgence” of the pandemic and to “protect the most vulnerable,” according to the guidelines.
It is “implementable on a statewide or county-by-county basis” at the discretion of each state’s governor — a stark contradiction from the president’s earlier assertion that he had “total authority” to direct governors how and when to reopen.
The guidelines do not suggest any reopening dates, and Trump acknowledged that it would be “a gradual process.”
To begin implementing the guidelines, states must first meet a “gating” criterion that includes a “downward trajectory of documented cases within a 14-day period” or a “downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests),” as well as hospital preparedness.
If that criterion is met, states, could then enter Phase One, according to the guidelines.
Under Phase One protocols, large venues like restaurants, movie theaters, sporting venues and places of worship would be allowed to reopen if they “operate under strict physical distancing protocols,” according to the guidelines…
Under Phase One, “all vulnerable individuals should continue to shelter in place” and members of households with vulnerable residents “should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home.”
It also calls for the employers to allow employees to telework.
The plan also emphasizes that all people should continue to practice social distancing when in public and that they should continue to minimize nonessential travel.
Phase Two, the guidelines state, applies to states and regions “with no evidence of a rebound” that “satisfy the gating criteria a second time.”…
Phase Three would then kick in for states and regions with “no evidence of a rebound” that “satisfy the gating criteria a third time.”
At that point, “vulnerable individuals” could resume public interactions but should practice social distancing, according to the guidelines. Low-risk populations should still “consider minimizing time spent in crowded environments.”
Only in Phase Three could work sites resume normal staffing protocols without restrictions and visits to senior care facilities and hospitals could resume. People who interacted with residents and patients would still have to remain “diligent regarding hygiene.” Under Phase Three guidelines, large venues could operate under “limited” social distancing protocols, gyms could remain open with “standard” sanitation protocols and bars could operate with “increased standing room occupancy.”
The White House views Trump’s announcement as guidance under which “governors will have to make decisions what’s right for their individual states,” a White House official told NBC News.” (F)
GUIDELINES FOR OPENING UP AMERICA AGAIN (G)
“Anthony Fauci, director of the National Institute of Allergy and Infectious Disease (NIAID) and head of the White House Coronavirus Task Force, spoke on CBS Wednesday night about the developments needed in public health before Americans can safely return to work.
Fauci explained that in order to have a successful rolling re-entry program, where the economy would slowly open back up, we’d need to “test, identify, isolate, get someone who is infected out of circulation, and do a degree of contact tracing” to better monitor the virus’s status.
“The absolute thing that you would need is to be able to respond and contain whatever rebound you get so that you don’t wind up in a situation where you have another escalation,” he told CBS’s Norah O’Donnell…
Schaffner notes that while the emphasis is now on mitigation efforts, reopening the economy will be a question of health departments’ ability to switch back to containment strategies, meaning investigating every case and ensuring the individuals who had contact with infected patients are quarantined. He is not sure that local health departments in all jurisdictions have the resources or energy for a more intensive case-by-base public health follow up, but notes that it would be ideal to avoid future outbreaks.
In terms of reopening public spaces, Schaffner supports the idea of opening the least affected parts of the country in a “rolling fashion,” but to take a gradual approach.” (H)
“Let’s start with the good. Mr. Trump offered a three-phase approach recognizing that reopening is going to be a gradual process. The phases are tied not to strict dates — remember “open by Easter”? — but to achieving metrics.
In addition, the relaxing of emergency precautions will be scaled according to the intensity of the problem within a given state or region. The uncertainty that has dominated the national psyche will be abated by tangible milestones like school reopenings (phase two) and allowing visits to senior living facilities (phase three).
The plan also recognizes that not all businesses and facilities pose equal risks of spreading the coronavirus. Distancing and sanitation at a gym is conceivably more difficult than in a bar, though we should be on the lookout for new research to expand our understanding of that nuance. Therefore, different businesses should be allowed to reopen at a pace appropriate to their risk.
Finally, the plan rightly emphasizes vulnerable populations and senior living facilities. These facilities will remain at a high risk of explosive growth in cases until we can achieve widespread testing, vaccination and immunity. So the plan prohibits visits to them until the final phases and requires strict hygiene protocols when visits do occur.
That’s the good. Now the bad. The plan is a failure when it comes to testing, which everyone recognizes as a linchpin in any effort to reopen the country. It certainly assumes that testing will occur: A key metric for each phase of reopening is the trend in coronavirus cases. Accordingly, within a 14-day period there needs to be a “downward trajectory” of either documented cases or the percent of positive tests.
But there is no requirement that states first show that they have tested enough people to establish that the trajectories they are seeing are truly reflective of population-level trends. Overall, testing has been far too low for these trajectories to be relied on. Even after six weeks, barely 1 percent of the country’s population has been tested for Covid-19 and new daily tests have plateaued around 150,000. This is also not enough testing for effective levels of contact tracing.
More important, the plan calls for measuring a relative decline, and not an absolute threshold for very limited spread. So there could be a 14-day decline and yet the number of new cases could still be too high. We need a firm threshold, such as 20 new cases per one million people, that ensures a low number of new coronavirus cases when we start to re-open.
Another big concern with the plan is that, like the current C.D.C. testing guidelines, it still focuses on testing symptomatic people. If we are to stop the spread, the focus has to broaden to asymptomatic coronavirus-infected people who can be unwitting super-spreaders and ignite a resurgence…
Finally, nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence. There is no guidance on defining a significant uptick in cases or how to respond. As Dr. Anthony Fauci mentioned in the press briefing announcing the plan, there may be instances where states must “pull back.” But what does pulling back entail? How will states know when to do this? There is no guidance.” (I)
“As some governors consider easing social distancing restrictions, new estimates by researchers at Harvard University suggest that the United States cannot safely reopen unless it conducts more than three times the number of coronavirus tests it is currently administering over the next month.
An average of 146,000 people per day have been tested for the coronavirus nationally so far this month, according to the COVID Tracking Project, which on Friday reported 3.6 million total tests across the country. To reopen the United States by mid-May, the number of daily tests performed between now and then should be 500,000 to 700,000, according to the Harvard estimates.
That level of testing is necessary to identify the majority of people who are infected and isolate them from people who are healthy, according to the researchers. About 20 percent of those tested so far were positive for the virus, a rate that the researchers say is too high.
“If you have a very high positive rate, it means that there are probably a good number of people out there who have the disease who you haven’t tested,” said Ashish Jha, the director of the Harvard Global Health Institute. “You want to drive the positive rate down, because the fundamental element of keeping our economy open is making sure you’re identifying as many infected people as possible and isolating them.”
The researchers said that expanded testing could reduce the rate to 10 percent, which is the maximum rate recommended by the World Health Organization. In Germany, that number is 7 percent, and in South Korea, it is closer to 3 percent…
A shortage of test kits and technical flaws in the United States significantly delayed more widespread testing of the virus, letting it spread undetected for weeks. With more than 695,000 cases as of Friday, the country has the highest number of known cases in the world…
“We need to switch from saying to people, ‘if you have mild symptoms, if you’re not feeling super sick, don’t come and stay at home,’ to ‘if you have any symptoms, you need to come in to get tested right away,’ ” he said.” (J)
Governor Andrew Cuomo: (08:44)
How are you building the bridge? It’s going to be a phased reopening, right? During the phased reopening, the priority is make sure you do no harm and keep your eye on the public health issue. That is what is key in all of this. It’s going to be a calibration of reopening based on public health safety and that infection rate. Because what we have done in the reducing of the infection rate is a pure function of what New Yorkers have done and what people across the country have done. When you relax that social distancing, you could very well see an increase in the infection rate. It’s all a calibration to the public health, but it’s going to be a gradual increasing of economic activity in calibration with the public health standards.
Governor Andrew Cuomo: (09:42)
The single best tool to doing this gauging is large scale testing. Test, trace and isolate, it’s what everybody’s talking about. What does this mean? It means you test, you find a positive, you trace back who they were with, where they were, test those people and you isolate the people who are positive. It’s inarguable. It’s just very, very hard to do. It opens this new world of testing. This new world of testing is a new world to all of us by the way. There’s diagnostic testing. Are you positive or negative? There’s then testing for antibodies. Were you exposed? If I find out that you were already exposed and you had the virus, now you can go back to work because you had the virus, you have antibodies.
Where do you do the testing? We’ve been doing testing in hospitals. Frankly, that’s not a great place to do testing. You don’t want people walking into a hospital emergency room who may be positive for COVID. Our drive-thru locations are better, but how do you bring that to scale? Then even if you have the equipment and the testing site and the personnel to do the testing, where do you get the labs to test all of these tests? This is a whole world of questions that nobody has ever seen before.
Governor Andrew Cuomo: (12:06)
The bottom line is, you need large scale testing. Let’s do it. We can’t do it yet. That is the unvarnished truth. I know because New York has been doing this since this started exploring this new world. We have done more tests than any other state. We’ve done over 500,000 tests, which is more than the other states that are near us combined. We’ve been very aggressive here, but in all this time we’ve only done 500,000 tests. Now, that’s a large number of tests, yes. But this is over a one-month period. Even 500,000 tests, you’re talking about a state with 19 million people. You get a sense of the scale of what we have to do here.
Governor Andrew Cuomo: (13:10)
We cannot do it without federal support. I’ve been saying this for days. If you have a state that has a lower need, yes, they may be able to do it. But when you have a state that has to do a large number of these tests, I’m telling you we can’t do it without federal support. I’ve said that from day one. We will coordinate and we have been coordinating all the tests in our state. That’s how we got to that 500,000 number, more aggressive than I think anyone else. We have 228 private laboratories in this state. We will coordinate with them. We’ll make sure that we’re not competing with ourselves because there are a lot of groups that are now testing. New York State Department of Health developed their own antibody test. That test is going to be very important. It’s in our control because we’ll actually do those tests. We don’t need a private lab. We don’t need anyone else.” (K)
““Our best scientists & health experts assess that states today have enough tests to implement the criteria of phase one, if they choose,” Vice President Mike Pence said at a press conference the night of April 17.
But according to the Covid Tracking Project, the US has averaged fewer than 150,000 tests each day so far in the week of April 13, including at both public and commercial labs. That’s an improvement from the early days of March, when the country reported new tests in the dozens and later the hundreds. But it’s not an increase from more recent weeks: In the week of April 6, the country also averaged fewer than 150,000 tests a day.
What the country needs to properly do testing, according to experts, is at least 500,000 tests a day. Some experts call for much more than that — millions or even tens of millions a day — but the general point is that the US needs to be doing multiple times the testing that it’s currently doing to be able to test everyone with symptoms and their close contacts…
The recent slowdown in new tests is driven by shortages in nasal swabs, personal protective equipment, reagents, test kits, and machines needed to run the specific tests required. According to David Lim at Politico, some labs also complain that the Centers for Disease Control and Prevention’s testing criteria — which prioritizes hospitalized patients, health care workers, and those vulnerable to the virus, such as older people — is holding back potential tests, leaving existing testing capacity unused.
To fix the gaps, experts argue, the federal government needs to relax criteria for testing, invest in new supplies and labs, and better coordinate supply chains to address, among other issues, chokepoints. States, with limited resources and little control of the national supply chain, simply can’t do this all on their own.
Such fixes, however, are easier said than done. Experts warn the next phase of testing will be much more difficult than the initial phase, which largely required getting existing labs to start doing coronavirus testing — the low-hanging fruit.
“We’ve made substantial progress ramping testing this month,” Scott Gottlieb, a former commissioner of the Food and Drug Administration, wrote in a tweet on April 10. “But many gains were made by getting players into fight (clinical labs, academic labs). Now we must expand lab capacity, platforms, throughput, test kits. Getting next million tests/week will be harder than getting first.”
This is one reason the plans to end social distancing are so grim: Not only do they suggest that some level of social distancing will be needed for the next year or so (until a vaccine or a similarly effective treatment is widely available) — which we don’t know if the country can sustain — but they call for a level of surveillance and testing the US simply hasn’t yet shown the ability and willingness to build and manage…
But unless something changes, America is simply not meeting the benchmark of aggressive testing that experts say is necessary to start to reopen the country. As eager as Trump is to get the economy going again, the US just isn’t ready to do it in a safe way yet.” (L)
“On Wednesday, Singapore reported 142 new cases of COVID-19 — the highest single-day record for the city-state. In the last week, Singapore had two record-breaking numbers of new infections — with 120 new confirmed cases on April 5 and 106 on April 7, according to data collected by Worldometer — after weeks of successfully controlling the outbreak within its borders.
The new cases have been connected to foreign workers living in compact dormitories, the Straits Times reported. The recent resurgence of infections has prompted the government to implement a lockdown, closing down schools and most workplaces for a month…
Singapore was one of several Asian countries whose coronavirus response efforts were hailed as a “gold standard” of how to bring an outbreak under control.
While many other countries have imposed city-wide lockdowns and ordered citizens to stay at home, Singapore relied on surveillance, quarantine, and social distancing to curb the spread of infection. The city-state boldly resisted aggressive lockdown measures to limit disruptions to companies and workers in hopes of softening the inevitable economic blow of the pandemic…
However, the recent spike of cases in Singapore underscored how easily the virus can spread even with social distancing measures in place — and it may give a glimpse at what the US may be in for if the government lifts the orders too early…
Vice President Mike Pence announced that the Centers for Disease Control and Prevention is considering loosening its guidelines for self-isolation.
Under the proposed guideline, people who are exposed to the novel virus could be allowed to return to work if they are asymptomatic, wear a face mask, and monitor their temperature twice a day, a person familiar with the proposal told the Associated Press.
However, as the Trump administration eyes loosening restrictions, some estimates show that the US has yet to hit the peak of its coronavirus outbreak. Some estimate that it could occur in late April or early May.
Experts, including those on the White House Coronavirus Task Force, warned that lifting restrictions too early could result in a “second wave” of COVID-19 cases in the country.
An epidemiologist told Business Insider that countries might need to impose new lockdowns every three months until a vaccine is available. Lifting lockdown measures could lead to a re-emergence of the virus. As residents emerge from their homes, go to work, take their children to school, and go shopping, people could be asymptomatic but still spread the novel virus to others.
On Wednesday, Dr. Deborah Birx, the White House coronavirus response coordinator, cautioned against reading “early signs of hope” and doubled down on maintaining social distancing measures.
“What’s really important is that people don’t turn these early signs of hope into releasing from the 30 days to stop the spread. It’s really critical,” Dr. Deborah Birx, the White House coronavirus response coordinator, said on Wednesday.
“So, if people start going out again and socially interacting, we could see a very acute second wave very early. We are really encouraging every American to continue to follow the guidelines for these 30 days,” she added.” (M)
“Sloppy laboratory practices at the Centers for Disease Control and Prevention caused contamination that rendered the nation’s first coronavirus tests ineffective, federal officials confirmed on Saturday.
Two of the three C.D.C. laboratories in Atlanta that created the coronavirus test kits violated their own manufacturing standards, resulting in the agency sending tests that did not work to nearly all of the 100 state and local public health labs, according to the Food and Drug Administration.
Early on, the F.D.A., which oversees laboratory tests, sent Dr. Timothy Stenzel, chief of in vitro diagnostics and radiological health, to the C.D.C. labs to assess the problem, several officials said. He found an astonishing lack of expertise in commercial manufacturing and learned that nobody was in charge of the entire process, they said.
Problems ranged from researchers entering and exiting the coronavirus laboratories without changing their coats, to test ingredients being assembled in the same room where researchers were working on positive coronavirus samples, officials said. Those practices made the tests sent to public health labs unusable because they were contaminated with the coronavirus, and produced some inconclusive results.
In a statement on Saturday, a spokeswoman for the F.D.A., Stephanie Caccomo, said, “C.D.C. did not manufacture its test consistent with its own protocol.”” (N)
“Despite the campaignlike and hopeful title of the briefing — “Opening up America Again” — there’s still a very long road ahead for the overwhelming majority of the country. Consider that the 20 states, including D.C., with the fewest coronavirus cases make up just 11% of the U.S. population.
States with the most cases and the largest populations will have to act like mini-countries. It’s going to produce a patchwork of plans that could wind up looking pretty similar to the red-blue electoral maps, and there are still lots of questions.
1. How do issues with testing impact governors’ ability to meet the benchmarks laid out in the guidelines?
2. Will the reopenings give a false sense of security to rural places?
3. How will employers screen and do contact tracing?
4. How will travel work between states in different phases?
States will likely get to different phases at varying rates. So, how much of a gap will this create between states in different phases? And what about travel between those places? Until there’s a vaccine or a treatment, there’s no way to be sure there won’t be flare-ups or outbreaks that could lead to places with few cases, which may have relaxed restrictions, seeing unnecessary deaths.” (O)
“Across the country, governors are finding themselves caught between increasingly competitive pressures, several said on Sunday, as they balance maintaining restrictions meant to curb the spread of the coronavirus against growing frustration with the restrictions and the economic anguish they cause.
In Maryland and Virginia, governors said stay-at-home orders would have to remain in effect until those states begin to see decreases in the number of Covid-19 cases. Elsewhere in the nation, state officials said they would need to conduct far more testing before easing restrictions, and continue to face shortages of supplies and testing kits.
“We are fighting a biological war,” Gov. Ralph Northam of Virginia said on the “State of the Union” program on CNN. He added that governors have been forced “to fight that war without the supplies we need.”..
Public health experts have said testing would need to at least double or even triple to begin considering even a partial reopening of the country’s economy, and business leaders reiterated the message in a conference call with Mr. Trump last week…
Dr. Deborah Birx, the coronavirus response coordinator for the White House, also pushed back against criticism that enough people were not being tested, saying that not every community required high levels of testing and that tens of thousands of test results were probably not being reported.
She said the government was trying “to predict community by community the testing that is needed,” Dr. Birx said on the CBS program “Face the Nation” on Sunday. “Each will have a different testing need, and that’s what we’re calculating now.”
On the ABC program “This Week,” Dr. Birx said she thought statistics on testing were incomplete: “When you look at the number of cases that have been diagnosed, you realize that there’s probably 30,000 to 50,000 additional tests being done that aren’t being reported right now.”
As some governors look to ease coronavirus restrictions, public health experts say the country needs at least half a million tests per day to safely reopen.
There are currently about 150,000 diagnostic tests conducted each day, according to the Covid Tracking Project. Researchers at Harvard estimated last week that in order to ease restrictions, the nation needed to at least triple that pace of testing.
When the host of “This Week,” George Stephanopoulos, asked Dr. Birx about that estimate, she said current testing levels were adequate.
“We believe it’s been enough in a whole series of the outbreak areas — when you see how Detroit has been able to test, Louisiana, Rhode Island, New York and New Jersey,” Dr. Birx said.
She said that a team at Walter Reed National Military Medical Center in Maryland was calling hundreds of labs around the country to determine exactly what supplies they need “to turn on full capacity, which we believe will double the number of tests that are available for Americans.” (P)
Inside America’s 2-Decade Failure to Prepare for Coronavirus
Top officials from three administrations describe how crucial lessons were learned and lost, programs launched and canceled, and budgets funded and defunded.
He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus
An examination reveals the president was warned about the potential for a pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response.
The ‘Red Dawn’ Emails: 8 Key Exchanges on the Faltering Response to the Coronavirus
Experts inside and outside the government identified the threat early on and sought to raise alarms even as President Trump was moving slowly. Read some of what they had to say among themselves at critical moments.
PART 1. 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. 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. “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. 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. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. 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. 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. 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. 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. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. 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. CORONAVIRUS. March 14, 2020. “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. CORONAVIRUS. March 17, 2020. “ “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. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
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.”
New York hospitals are beginning to operate as one system under a new plan by Gov. Andrew Cuomo as the state tries to increase its medical capacity to stop the coronavirus pandemic.
Right now, New York’s hospitals are no longer operating as independent facilities. Under the plan announced this week by New York Gov. Andrew Cuomo, there is effectively one big New York state hospital system fighting off the coronavirus…
Cuomo announced that he had met with New York hospital leaders and come up with a plan to, in effect, merge them into one operating system with many different locations. From Buffalo to NYC, hospitals will be sharing staff, patients, and supplies for the foreseeable future, with Albany overseeing the distribution of resources.
“It’s not unusual for a time of an emergency for regulatory authorities to basically say, ‘Hospitals, you must do this.’ Usually there are provisions in state law that enable that to happen,” Susan Dentzer, a senior policy fellow at Duke University’s Margolis Center for Health Policy, told me. Hurricane Katrina is one recent example she gave.
But the plan is still remarkable. There are about 200 hospitals in New York state, totaling 53,000 beds before Cuomo told them to double their capacity. About 20,000 of those beds are in New York City.
It is a matter of necessity, as New York has already seen more than 100,000 Covid-19 cases and 1,500 deaths — with the peak still projected to be a week away, according to the Institute for Health Metrics and Evaluation’s estimates, requiring as many as 100,000 beds.
“This is on a scale that has not happened in the United States ever, with the possible exception of 1918,” Dentzer said of the New York strategy. “Nothing on this scale has ever happened in at least 100 years.”
I asked Peter Viccellio, associate chief medical officer at the Stony Brook emergency department in Long Island, about the New York hospitals plan. I want to share his response in full:
We’re in an almost apocalyptic crisis, which requires cutting through the bullshit. If hospital A has resources and hospital B doesn’t, it’s in the best interest of the patient that hospital A and B work together. Protective equipment should be available to all health care providers, not just those who work at a place with a better procurement officer. We ALL need the proper equipment to treat the patient, and adequate space. Fighting against each other for resources — this isn’t the time. Resources need to be distributed in a rational way. The current rugby scrum is nonsense.
The top priority in Cuomo’s plan is moving staff from less affected hospitals to those buckling under a surge of Covid-19 cases. Doctors and nurses from upstate hospitals will be transferred to NYC facilities. Likewise, hospitals will try to send patients from overcrowded hospitals to those with available beds. Ventilators, which support critical patients’ breathing, could also be shuffled between hospitals based on need.
The New York state department of health will manage the movement of staff and resources, in conjunction with hospitals. It will set certain thresholds for the number of occupied ICU beds or ICU Covid-19 cases that would trigger some of these transfers. The state will also coordinate the distribution of the protective gear that helps keep doctors and nurses healthy and able to work from the various state and hospital stockpiles…
This kind of coordination is relatively commonplace within a single hospital system that has multiple facilities. What’s unique here is the scale: an entire state merging all of its hospital systems into one.
And that will present plenty of challenges both logistical (what happens when patients move from an in-network hospital to an out-of-network one?) and personal (are patients going to be moved far away from their families?). A few more questions, via the Kaiser Family Foundation’s Larry Levitt: What are the payment rates and who is paying? Do hospitals have to pay each other when one sends another resources?
“I do think it’s going to be incredibly messy and complicated to sort out reimbursement of all this on the back end,” he said.
Another one: Is Congress going to provide more funding to bail out hospitals in New York and elsewhere, which have taken a brutal financial hit as they cancel elective surgeries to free up more beds and staff to battle Covid-19?
We’ll need answers to those questions. But the time for radical action is here. As Joynt Maddox put it, “If not now, when?”
“This is the kind of organization we need in a pandemic, with very clear guardrails around the scenarios under which it’s put into place and under which it no longer applies,” she said. “I can see plenty of potential problems, but plenty of upside too.”
New York is the first state to take such a dramatic step as the coronavirus takes its toll there. But it may not be the last. (A)
The state’s largest private employer (the Mayo Clinic) is instituting across the board pay cuts and furloughs to shoulder a projected $3 billion loss this year.
Mayo Clinic’s cost-cutting measures follow its decision in mid-March to halt elective surgeries and procedures — a move that was quickly applied statewide as part of Gov. Tim Walz’s executive order to suspend non-critical medical procedures not deemed essential to save a life.
“The decision to eliminate elective surgeries and outpatient visits was the right decision in terms of protecting the safety of our patients and staff, and also preserving limited PPE (personal protective equipment),” said Chief Administrative Officer Jeff Bolton. “But it has led to significant reductions in revenues.”
Bolton said the hospital in Rochester is at about 35 percent of capacity, while capacity in Mayo’s surgery services is at about 25 percent.
“If you go back to the Great Depression, the institution went through a very similar financial crisis, and salaries were reduced during that period of time,” said Bolton. “There were a lot of actions that were very similar to the ones we are taking today.”
The pay and work reductions, which will apply to all employees at Mayo’s campuses in Minnesota, Florida and Arizona, will start in May, and last until the end of the year. Together, Mayo employs more than 63,000 people…
Mayo Clinic executives, including CEO Gianrico Farrugia, will take a 20 percent cut starting this month. Physicians and senior administrators will take a 10 percent salary cut, other salaried employees will take a seven percent reduction, while other workers will be asked to take extended furloughs.
That’s in addition to a hiring freeze, laying off contract employees and halting some construction projects, Bolton said.
Even after these changes, Mayo will face a $900 million shortfall at the end of the year, which will be covered by Mayo’s reserves established over the last decade, Bolton said.
Bolton said cost-cutting measures will not affect the pay rate of hourly workers.
The financial blow of halting elective services comes on the heels of what Mayo officials had described as a “year of remarkable growth.” In 2019, Mayo reported revenue of $13.8 billion, which was up nearly 10 percent from the previous year.
For the first time in Mayo’s history, net operating income topped out at $1 billion…
Bolton added that Mayo’s ability to rebound after the end of the year will also depend on how long the pandemic lasts, and if a global recession impacts how many patients travel to Mayo for treatment.” (B)
“HHS’ Office of Inspector General released a report April 6 that details the challenges hospitals are confronting due to COVID-19, how they are responding, and what they are asking of the government to better meet their needs during the coronavirus crisis.
The OIG conducted brief telephone interviews March 23-27 with administrators from 323 hospitals across 46 states, the District of Columbia and Puerto Rico, which were part of a random sample. Hospital administrators shared the following challenges their organizations face in response to COVID-19, as well as how they would like the government to respond:
1. Challenge: Severe shortages of testing supplies and extended waits for results. Hospitals reported frequently waiting seven days or longer for test results, which results in a number of “rule-out” cases that strain existing challenges with staffing, bed availability and shortages of personal protective equipment. According to one hospital, 24 hours is typically considered a long turnaround time for virus testing.
Hospitals’ ask: Hospitals expressed a need for greater coordination from the federal government around testing kits and supplies to provide “equitable distribution of supplies throughout the country,” according to the report. Hospitals also asked for the government to provide testing kits, take steps to ensure that supply chains can provide hospitals with a sufficient supply of tests, and expedite results by allowing more entities to produce and conduct tests.
2. Challenge: Widespread shortages of PPE. stockpile, or that the supplies they had received were insufficient in quantity or quality.
3. Challenge: Difficulty maintaining adequate staffing and supporting staff. Hospitals cited need for specialized staff, concerns that staff exposure to the virus will exacerbate shortages and overwork, and concerns about the emotional toll that staff face.
4. Challenge: Decreased revenue, increased costs and gaps in reimbursement. Hospitals have essentially stopped elective procedures and many other services, which accounts for a substantial portion of hospitals’ revenue.
5. Challenge: Changing and/or inconsistent guidance from authorities. (C)
“CMS announced April 9 that it has delivered more than $51 billion in payments to hospitals and other healthcare providers in the past week through the Accelerated and Advance Payment Program.
CMS expanded the payment program to a broader group of healthcare providers in late March to help offset the financial impact of COVID-19. On April 7, the agency said it had distributed $34 billion in funds to healthcare providers and suppliers through the program in the past week. Two days later, CMS said the amount had grown to $51 billion.
CMS has received roughly 32,000 requests from healthcare providers and suppliers for advance payments in the past week, and 21,000 of those requests have been approved. That’s compared to the 100 total requests CMS approved in the past five years.” (D)
“The $2 trillion federal coronavirus aid package signed into law that includes $100 billion for nonprofit hospitals won’t completely cover the revenue hospitals will lose as a result of the pandemic, Moody’s Investors Service wrote in an April 3 note.
While the aid package includes several provisions like compensation for lost revenue, increased Medicare reimbursement and advances on future Medicare reimbursement, cash flow at nonprofit hospitals will still likely be materially lower for the next several months. Postponed services alone are likely to reduce hospital revenue by 25 percent to 40 percent a month on average, Moody’s said, a reduction that is affecting even hospitals that aren’t treating large COVID-19 case loads.” (E)
“As the coronavirus crisis intensified, and many Americans started losing their employer-based health coverage, the Trump administration considered creating a special open-enrollment period for the Affordable Care Act. It seemed like a common-sense move, which had the backing of private insurers.
But the White House balked, to the surprise of nearly everyone involved in the process. As Politico reported the other day, the decision appeared to be largely political: Team Trump didn’t want to turn to “Obamacare” to help people in a crisis.
“You have a perfectly good answer in front of you, and instead you’re going to make another one up,” one Republican close to the administration said. “It’s purely ideological.”
It also left the White House in search of a policy alternative. Roll Call reported on the apparent solution: the administration plans to reimburse providers for uninsured COVID-19 patients.
Health and Human Services Secretary Alex Azar said at a White House press briefing that hospitals and health care providers would be reimbursed at Medicare rates for the treatment of uninsured patients. Providers would be banned from balance billing patients or sending them a surprise medical bill to make up the difference in costs not covered by the government.
Note, there was already a policy in place to cover the cost of virus testing, regardless of coverage status. This new policy goes considerably further: uninsured Americans who get the virus will be able to go to the hospital and receive care, and the federal government will reimburse the medical facilities for the cost…
There are, however, some lingering concerns. For one thing, many hospital administrators have said their facilities are facing a severe financial crunch now, and the new policy is based on after-the-fact reimbursements. That money will arrive, but not anytime soon…
A New York Times report added that there are other concerns about whether the funding will go to facilities in the states hardest hit by the crisis: “The administration’s plan … would tend to shift more money toward states with more uninsured patients. New York, California and Washington, which have experienced early surges in infections, entered the crisis with very low levels of uninsured residents. Republican-led states, like Florida and Texas, that have declined to expand Medicaid are likely to benefit more from funding targeted directly at uncompensated care.” (F)
“Hospital CEOs are blasting HHS’ decision to distribute the first $30 billion in emergency funding based on Medicare fee-for-service revenue, according to Kaiser Health News.
HHS said April 10 it would allocate money to hospitals and providers based on their historical share of revenue from the Medicare program, rather than the burden caused by the coronavirus or number of uninsured patients treated….
Kenneth Raske, CEO of the Greater New York Hospital Association, wrote in a memo to association members that the method is “woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in ‘hot spot’ areas such as the New York City region.”..
An HHS spokesperson told Kaiser Health News the agency decided to use Medicare revenue as the basis of distribution because it “allowed us to make initial payments to providers as quickly as possible.” (T)
“The CEO and executive leadership team at Mount Sinai Health System will take pay cuts to help offset the significant COVID-19 costs the New York City-based health system is facing.
Mount Sinai President and CEO Kenneth Davis, MD, and his executive team offered and agreed to take a 50 percent pay cut, according to information the health system shared with Becker’s Hospital Review April 9. The pay cuts will continue “as long as necessary so that these dollars can be directed to our front lines in this fight,” the health system said.” (G)
“California Gov. Gavin Newsom said April 8 that the state is working to gather more demographic information on COVID-19 patients. One major finding revealed that healthcare workers made up roughly 10 percent of the confirmed cases as of April 7, according to The New York Times.” (H)
________________________________
“All day, most days, for $10 an hour, Marley Brownlee comes and goes from the homes of the old and the weak.
She has almost none of the equipment that could protect her vulnerable clients — or herself — from the deadly virus that has transformed life across the United States. No masks, goggles or gown. She takes what precautions she can using gloves, hand sanitizer and disinfectant wipes. Her hands are raw from washing, and last week, she considered spraying herself down with Lysol between appointments.
It is a sprawling sector of the U.S. health-care delivery system — and one whose fortunes could be critical in efforts to contain covid-19, the deadly lung disease caused by the coronavirus. With nursing homes across the country locked down and hospitals preparing for an onslaught of covid-19 patients, many who require medical services or help with the basic tasks of daily living are likely to be confined to their homes in the weeks and months ahead. Yet the providers of those services say they are unprepared to step into the breach, hamstrung by regulations ill-suited to the current pandemic and unable to access protective gear that could shield workers and clients alike from infection.
“There’s no doubt that we’re being sort of forgotten in all this, and I fear that mentality is going to eventually come back and punish us,” said Joe Russell, executive director of the Ohio Council for Home Care and Hospice. “If we’re carrying this disease from household to household, these people are just as vulnerable as anybody in a hospital or a nursing home.”..
Such concerns are being pressed in states across the country and in Washington, where home-care industry leaders are pleading with Trump administration officials and members of Congress not to exclude their providers from the nation’s belated efforts to launch a coherent policy response to the pandemic.” …
They have two primary requests: An adequate supply of protective equipment — including the scarce N95 masks that are most effective in preventing transmission of the coronavirus — and increased flexibility in Medicare regulations that govern person-to-person contact at patients’ homes…
The home-care industry lacks the prominence and cachet of American hospitals, especially its most celebrated medical centers. No agency that sends workers into houses to help a stroke victim learn to mount the stairs again or assist a patient with a wheelchair in the bathroom vies for recognition with Johns Hopkins Hospital or the Cleveland Clinic. Yet home care has grown into a pillar of the medical and senior-care systems, serving both older clients who wish to avoid nursing homes — now more than ever — and people with disabilities, who in previous decades were often clustered in large institutions.” (S)
“Washington (CNN)A sailor who tested positive for Covid-19 on the USS Theodore Roosevelt has died of coronavirus, the US Navy said Monday.
The Navy did not disclose the name of the sailor, who was admitted to the intensive care unit of a US Navy hospital on Thursday. CNN previously reported a sailor from the USS Theodore Roosevelt who tested positive for the virus March 30 was found unresponsive and placed in the intensive care unit during a daily medical check.
The Navy said that the sailors who found him unresponsive attempted to administer CPR prior to his being transferred to the intensive care unit.
In addition, a US defense official told CNN that four sailors from the ship have been transferred to hospital.
Nearly 600 sailors on the Roosevelt have tested positive for Covid-19, the US Navy said in a statement, adding that 92% of the Roosevelt’s crew members have been tested for the virus.
The impact of the coronavirus pandemic on the Roosevelt was at the center of a controversy that led to the resignation last week of acting Navy Secretary Thomas Modly, who had dismissed the aircraft carrier’s captain Brett Crozier after the leak of a memo in which he implored Navy officials to urgently evacuate the ship to protect the health of its sailors. Crozier also flagged his concerns about challenges of trying to contain the virus aboard the ship and requested that sailors be allowed to quarantine on land.
“We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset: our Sailors,” he wrote in the memo that three US defense officials confirmed to CNN.
More than 4,000 sailors have since been evacuated and moved ashore in Guam. Sailors who have tested negative for the coronavirus are being housed in isolation in local area hotels.
The Navy says it is required to keep about 1,000 sailors aboard the vessel to perform key functions such as the operation of the ship’s nuclear reactors…
Vice Chairman of the Joint Chiefs of Staff Gen. John Hyten told reporters Thursday the US military needed to plan for similar outbreaks in the future as the Defense Department works to cope with the virus’ impacts.
“I think it’s not a good idea to think the Teddy Roosevelt is a one-of-a-kind issue. We have too many ships at sea, we have too many deployed capabilities. There’s 5,000 sailors on a nuclear-powered aircraft carrier. To think it will never happen again is not a good way to plan. What we have to do is figure out how to plan in these kind of Covid environments,” Hyten said.
Nearly 3,000 US service members have tested positive for coronavirus, two service members have died.” (I)
“There is much that the military can do to protect the American populace from the coronavirus’s ravages, and service members undoubtedly wish they could do more. They should have been well positioned to do just that: Internal 2017 documents obtained Wednesday by The Nation show that the military had planned for a coronavirus-type pandemic and predicted many of the same equipment shortages that the U.S. is now experiencing. But the data and murmurs emerging from the U.S. national security complex paint a picture of a hamstrung bureaucracy that’s as ill-prepared to protect its own people as most states are.
Numbers tell part of that story. As of last Friday, the Pentagon had reported 613 cases of Covid-19 in its combined military and civilian workforce, putting its total ahead of 28 states’. (The Department of Defense’s “population” of about 2.9 million people, by contrast, only makes it bigger than the population of 15 states.) But by Monday, military-linked infections had already topped 1,000, and Esper had ordered all U.S. commanders across the globe to stop reporting new infections on their installations to the public, calling such reports “information that is classified as a risk to operational security.” Subordinates of Esper at several U.S. military bases told Stars & Stripes that the order “could harm their ability to inform their own force and strain their ability to work with officials in their surrounding civilian communities amid the pandemic.”
Local military commands are already in disarray in many respects. The Navy is fast learning that ships and bases are breeding grounds for the coronavirus; in addition to the Roosevelt outbreak, cases have been reported on the USS Ronald Reagan and USS Boxer, as well as at the service’s boot camp and the Naval Academy. New York–based recruiters for the Marine Corps begged the service last week to shut down its boot-camp training base at Parris Island, South Carolina—always a close-quarters hotbed for germs. “Decision-makers are absolutely in denial if they believe high rates of infection and hospitalization will not happen on the depot under close proximity and enclosed spaces,” one Marine told Military.com. By Monday, Marine Corps officials were forced to relent, after at least 20 Parris Island recruits and trainers tested positive for the virus; the service’s West Coast boot camp in San Diego, however, remains open.” (J)
“At Crown Heights Center for Nursing and Rehabilitation in Brooklyn, workers said they had to convert a room into a makeshift morgue after more than 15 residents died of the coronavirus, and funeral homes could not handle all the bodies.
At Elizabeth Nursing and Rehabilitation Center in New Jersey, 19 deaths have been linked to the virus; of the 54 residents who remain, 44 are sick.
After 13 people died in an outbreak at the New Jersey Veterans Home in Paramus, the governor called in 40 combat medics from the National Guard…
The virus has perhaps been cruelest at nursing homes and other facilities for older people, where a combination of factors — an aging or frail population, chronic understaffing, shortages of protective gear and constant physical contact between workers and residents — has hastened its spread.
In all, nearly 2,000 residents of nursing homes have died in the outbreak in the region, and thousands of other residents are sick.
As of Friday, more than half of New York’s 613 licensed nursing homes had reported coronavirus infections, with 4,630 total positive cases and 1,439 deaths, officials said…
In New York, nursing home administrators said they had been overwhelmed by an outbreak that quickly spun beyond their control. They were unable, they said, to have residents tested to isolate the virus or to get protective equipment to keep workers from getting sick or transmitting the virus to residents.
“The story is not about whether there’s Covid-19 in the nursing homes,” said Scott LaRue, the chief executive of ArchCare, which operates five nursing homes in New York. “The story is, why aren’t they being treated with the same respect and the same resources that everyone else out there is? It’s ridiculous.”” (K)
“POLICE FORCES ACROSS the country are being increasingly hobbled by the coronavirus outbreak, with officers falling ill and operations being adjusted as the numbers of cases and deaths increase exponentially.
Approximately 17% of uniformed New York City Police Department employees – more than 6,000 total – are currently out sick, a department spokeswoman says. But 1,400 NYPD officers have now tested positive for the coronavirus, Commissioner Dermot Shea told CNN – a large increase over the number reported by the department as recently as Tuesday…
But police departments are being crunched in many other cities. Detroit Mayor Mike Duggan announced Monday that nearly 500 of the city’s police officers and more than 100 civilian employees were quarantined due to exposure to the coronavirus, according to WJBK-TV in Detroit. Sixty-nine Detroit Police Department officers and employees had tested positive as of Monday. Major metropolitan police departments in cities like Boston, Chicago, Los Angeles and New Orleans have positive cases as well, according to The Associated Press…
Police agencies across the country are responding to the crisis in a variety of ways, according to the Police Executive Research Forum, an independent research organization.
Some departments have begun suspending in-person briefings, while many others have postponed training and limited public access to police facilities, according to the organization. Garcia says the San Jose Police Department started conducting its daily briefings outside so that people could spread out more.
Policing itself is also being adjusted – many agencies are directing officers to avoid handling calls in person when possible and discouraging arrests for low-level offenses, the forum finds.
Garcia says that while his department started making preparations six weeks ago – long before California Gov. Gavin Newsom issued a stay-at-home order for the state’s 40 million residents – the outbreak has since affected operations, including shift changes and the daily briefings tweaks. But he is proud of how his staff has “risen to this challenge.”..
But Garcia notes that, in San Jose at least, “things pop up every day,” including calls regarding gatherings that might be violating the shelter-in-place order.
“There’s no playbook for this,” Garcia says. “Every day there’s something different that we’re trying to come up with.” (L)
“Much attention in this terrible pandemic is being focused on the country’s hospitals, and rightly so. But the battle is also being fought by the nation’s front-line emergency medical workers, paramedics and E.M.T.s. These skilled professionals are responding to a deluge of calls, risking their lives to aid millions of sick Americans.
In New York City, where the Fire Department’s roughly 4,400 emergency medical workers are already underpaid and overworked, the pandemic is taking an enormous toll.
They are responding to 6,000 to 7,000 calls a day; in normal times, the average is about 4,000. Nearly a quarter of these workers are on sick leave, according to Fire Department officials. At least three are in critical condition with coronavirus symptoms.
One question amid the shortage is how many face masks in the city’s stockpile are actually making it to the E.M.T.s, paramedics and other city workers who are most at risk. City officials declined to respond to repeated inquiries about how the masks and other critical medical supplies were being distributed across city agencies.
Mayor Bill de Blasio said at a news conference Tuesday that the F.D.N.Y. commissioner, Daniel Nigro, had assured him the department had the supplies it needed. The mayor said the department was meeting a “crisis standard” of personal protective equipment held as acceptable by the Centers for Disease Control and Prevention. “Anything more they need, they will get,” Mr. de Blasio said.
In interviews, they said some stations started running out of N95 masks weeks ago. They said they have been forced to reuse masks, gowns and other protective gear. To request additional N95 masks, they said they must explain in writing how they used their previous supply. And they said there is little or no coronavirus testing available to them or their colleagues…
How did this happen in New York, a city with a world-class department justly celebrated for its heroic service during the Sept. 11 attacks?
Emergency medical services have been an afterthought in New York for years. In much of the country, firefighters also serve as paramedics or E.M.T.s. But in New York, E.M.S. is a separate division within the Fire Department. Firefighters receive a base pay of about $85,000 after five years on the job, compared to about $65,000 for paramedics and $50,000 for E.M.T.s. The firefighting force is three-quarters white and about 99 percent male; more than half of E.M.S. workers are minorities, and more than a quarter are women, according to city data.” (M)
“As the coronavirus preys on the most vulnerable, it is taking root in New York’s sprawling network of group homes for people with special needs.
As of Monday, 1,100 of the 140,000 developmentally disabled people monitored by the state had tested positive for the virus, state officials said. One hundred five had died — a rate, far higher than in the general population, that echoes the toll in some nursing homes.
Separately, a study by a large consortium of private service providers found that residents of group homes and similar facilities in New York City and surrounding areas were 5.34 times more likely than the general population to develop Covid-19 and 4.86 times more likely to die from it. What’s more, nearly 10 percent of the homes’ residents were displaying Covid-like symptoms but had not yet been tested, according to the consortium, New York Disability Advocates.
Trouble throughout the New York City region — and, to a lesser extent, the state — was revealed in interviews with caregivers, parents, advocates and senior officials.
In Brooklyn, two parents of adult children in a group home said they were unnerved after another resident died in a suspected coronavirus case. “If it is the virus, what the hell are we going to do?” one of them said, while adding that the staff “deserve a lot of credit” for showing up.
On Staten Island, three state employees who are direct caregivers said 50 of their roughly 600 colleagues in the borough had tested positive. They described the challenges they faced on the job.
“One of the individuals here is positive, and his behavior is to get up, to pace, and he wants to give me a hug, shake my hand,” said one of the caregivers, asking that his name not be used because he was not authorized to speak.” (N)
“Seventy people at San Francisco’s largest homeless shelter have tested positive for the coronavirus, Mayor London Breed said on Friday.
The outbreak, which included two staff members, is the largest reported at a single shelter in the United States. It reinforces a major fear that homeless people, many whom have pre-existing respiratory illnesses, are especially vulnerable to the pandemic.
Advocates in San Francisco, where there are more than 8,000 homeless people, had expressed concern in recent weeks that the city had not moved quickly enough to use empty hotel rooms to thin out the shelter system.
California has procured more than 8,000 hotel rooms for homeless people and those who need to quarantine themselves, far short of the more than 100,000 people in the state who sleep on the streets.
The shelter where the outbreak occurred, Multi-Service Center South, normally houses around 400 people. In recent weeks, the city had reduced that number of occupants to 144, all of whom were tested on Friday.
The outbreak underlined the breathtaking speed at which the virus can spread in a congregate setting…
Experts say cities face a dilemma in addressing the homelessness crisis during the pandemic. Bringing people indoors offers access to showers and bathrooms but might also make the virus more transmissible.
“The shelters present a greater risk of transmission because you have people interacting and sleeping in close quarters,” said Linsey Marr, an expert in airborne disease transmission at Virginia Tech. “You have much greater density of people.”
Mr. Kositsky said that in addition to homeless people, hundreds of city employees charged with looking after them were also vulnerable to the virus.
“I’m out with the outreach workers and none of us have protective gear,” he said.” (O)
________________________________
“The Coronavirus crisis has exposed the ways in which big investors of hospitals are squeezing the sick and injured for as much money as possible after they leave the hospital.
The New Yorker reported Thursday about the way private equity firms have been throwing “surprise medical billing” on patients that accepted their health insurance. In some cases the hospital may be in-network for a patient, but the emergency surgeon isn’t or the radiologist, or anesthesiologist isn’t in-network…
Eileen Appelbaum at the Center for Economic and Policy Research has kept a watchful eye on the effort. She discovered that private equity firms “investment funds that purchase companies and try to increase their profitability,” are the ones responsible for changing the face of a hospital.
“In many cases, companies were sending work to other countries where labor costs were lower. In others, they were practicing ‘domestic outsourcing’: subcontracting out parts of their businesses to other U.S.-based companies, to run their accounting departments, corporate cafeterias, or janitorial services, among others, rather than employing those workers directly,” the report explained.
“They moved away from the idea of, How do we make our current workforce more productive? to, How do we move workers off our payroll and onto a contract company? And then they can do whatever they want with the workers,” Appelbaum said. “And, if you’re a contract company, how do you get the contract? By being the lowest bidder. You’re at rock bottom, offering just barely enough to attract any workers at all.”
She explained that given the coronavirus, the issue of “surprise billing” is even more important. COVID-19 has a tendency to go from bad to dangerous in some who come down with the virus. That can be the moment that people are forced to go to the hospital or call an ambulance. It’s exactly the conditions where surprise billing can surface and bankrupt people, even if they are fully insured.” (P)
“Doctor Ming Lin is the first emergency room doctor to be fired for going public with his concerns about poor hospital emergency room safety practices and shortages of medical supplies and protective gear for health workers. He won’t be the last.
Like many hospitals in the US, PeaceHealth St. Joseph Medical Center in Bellingham Washington, where Ming Lin worked for the past 17 years as an emergency room doctor, has outsourced the management and staffing of its emergency room. So, Lin works on-site at the hospital’s ER, but he is employed by a physician staffing firm that runs the ER. These staffing firms are often behind the surprise medical bills for ER services that patients receive after their insurance company has paid the hospital and doctors, but not the excessive out-of-network charges billed by these outside staffing firms.
About a third of hospital emergency rooms are staffed by doctors on the payrolls of two physician staffing companies — TeamHealth and Envision Health — owned by Wall Street investment firms. Envision Healthcare employs 69,000 healthcare workers nationwide while TeamHealth employs 20,000. Private equity firm Blackstone Group owns TeamHealth, Kravis Kohlberg Roberts (KKR) owns Envision.
Care of the sick is not the mission of these companies; their mission is to make outsized profits for the private equity firms and its investors. Overcharging patients and insurance companies for providing urgent and desperately needed emergency medical care is bad enough. But it is unconscionable to muzzle doctors who speak out to advocate for the health of their patients and co-workers during the global pandemic that is rapidly spreading across the US…
The American Academy of Emergency Medicine protested Dr. Lin’s ouster and questioned how TeamHealth is allowed to provide hospital services when the law requires that physician practices must be owned by a licensed medical practitioner. TeamHealth skirts the law by owning all the assets of the physician practices it acquires — the real estate, offices, equipment, supplies, inventory, and even accounts receivable.
On paper, the physician practices are owned by a doctor-led organization that TeamHealth has set up to comply with the law. But what does it mean to own a physician practice if the practice has no assets and no possibility to exist on its own?
The furor over patients hit by surprise medical bills revealed that TeamHealth controls the billing for the doctors it supplies to hospital emergency rooms. The firing of Doctor Ming Lin pulls back the curtain and reveals that TeamHealth controls the doctors as well.” (Q)
“Hospitals taking money from the $2.2 trillion stimulus bill will have to agree not to send “surprise” medical bills to patients treated for COVID-19, the White House said Thursday…
“The Trump administration is committed to ensuring all Americans are not surprised by the cost related to testing and treatment they need for COVID-19,” White House spokesman Judd Deere said in a statement.
The stimulus bill includes $100 billion for the health care system, to ease the cash crunch created by the mass cancellation of elective procedures in preparation to receive coronavirus patients. Release of the first $30 billion, aimed at hospitals, is expected soon.
The prohibition on surprise billing will protect patients covered by government programs, employer plans or self-purchased insurance.
Hospitals that accept the grants will have to certify that they won’t try to collect more money than the patient would have otherwise owed if the medical attention had been provided in network.
“In a time when nothing is certain, patients can take solace in knowing that they will not receive outrageous, unavoidable bills weeks and months after they have survived the virus,” Annette Guarisco Fildes, head of the ERISA Industry Committee, said in a statement. ERISA is the name for a federal law that sets terms and conditions for multistate employer plans.
A spokeswoman for the organization said it’s their understanding that the ban on surprise billing will apply to doctors as well as hospitals.” (R)
Hope, and New Life, in a Brooklyn Maternity Ward Fighting Covid-19,
In a hospital at the center of the crisis, nearly 200 babies have arrived since March. Some pregnant women have fallen extremely ill, but doctors are winning battles for their lives and their children’s.
PART 1. 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. 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. “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. 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. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. 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. 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. 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. 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. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. 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. CORONAVIRUS. March 14, 2020. “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. CORONAVIRUS. March 17, 2020. “ “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. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
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.”
Staff from the Department of Health and Human Services (HHS) told the House Oversight and Reform Committee that the Trump administration has made its final shipments of personal protective equipment to states from the Strategic National Stockpile.
According to the staff, 90 percent of the stockpile’s inventory of N95 respirators, surgical and face masks, face shields, gowns and gloves have already been distributed to every state.
The remaining 10 percent is reserved for federal workers and will not be distributed to states.
Governors have said that a shortage of medical supplies has led to states navigating the private marketplace in an escalating bidding war against each other and the federal government. The depletion of the federal stockpile means those practices will continue.
“Now that the national stockpile has been depleted of critical equipment, it appears that the administration is leaving states to fend for themselves, to scour the open market for these scarce supplies, and to compete with each other and federal agencies in a chaotic, free-for-all bidding war,” committee Chairwoman Carolyn Maloney (D-N.Y.) said in a statement.
States that have turned to the federal government’s stockpile for emergency equipment have not received all they need.
An internal administration document released by the committee on Wednesday showed that only 11.7 million N95 respirator masks have been distributed nationwide, which is less than 1 percent of the 3.5 billion masks that the administration estimated would be necessary in the event of a severe pandemic.
The committee also found that only 7,920 ventilators have been distributed from the stockpile.” (A)
For weeks, the Trump administration pushed states to procure their own ventilators and protective gear, like masks, gloves and face shields. But a new effort by the administration to create a hybrid system of distribution — divided between the federal government, local officials and private health care companies — has led to new confusion, bordering on disarray, and charges of confiscation.
“Either be in or out, folks,” Governor Polis said on CNN. “Either you’re buying them and you’re providing them to the states and you’re letting us know what we’re going to get and when we’re going to get them, or stay out and let us buy them.”..
Federal officials say they are trying to expedite the shipment to the United States of large quantities of medical supplies procured by private health care providers such as McKesson Corporation, Cardinal Health, Owens & Minor, Medline and Henry Schein. FEMA allows those distributors to sell about half of the equipment to companies and counties that had previously placed orders. The other half of the shipments must be sold to counties that the federal government prioritizes by the severity of the outbreak, based on data compiled by the Centers for Disease Control and Prevention.
The federal government will also soon save 10 percent of the supplies on each flight for the national stockpile, according to officials. A Korean War-era production act also allows the federal government to force companies to prioritize its order over another client’s, whether it be a private hospital or another nation.
In the past week, 14 flights carrying more than 83 million gloves, four million masks, one million gowns and 300,000 respirators have landed in New York, Chicago, Miami, Los Angeles, Columbus, Ohio, and Louisville, Ky. Mr. Pence said more than 50 flights had been scheduled.
The administration pivoted to the system of distribution after President Trump tapped FEMA to replace the Department of Health and Human Services as the agency leading the response to the coronavirus pandemic. States had previously submitted formal requests to the government to obtain materials from the stockpile.
Because the federal government determines which states are in greater need, governors and hospitals executives preparing in advance for the worst have complained that FEMA was effectively commandeering their personal protective equipment, or P.P.E…
The intervention has confused some local officials and company executives who have watched as the administration has repeatedly called on states to find medical supples on their own without relying on the federal government. But hundreds of hospitals continue to struggle with widespread shortages of test kits, protective gear for staff members and ventilators, according to a new report by the inspector general for the Department of Health and Human Services….
Adding to the disarray is the White House’s ad hoc system of disaster response in which the right call to Mr. Trump can result in one county getting priority over another. Advisers to Jared Kushner, the president’s son-in-law, have surprised FEMA officials in recent weeks to deploy supplies to communities after the area’s representatives got through to Mr. Trump, even if the state had not yet gone through the formal process to secure supplies.” (V)
“Top White House trade adviser Peter Navarro warned in stark terms about how deadly and economically devastating the coronavirus outbreak could be, weeks before it became a full-blown pandemic.
Navarro delivered the warnings to others at the White House in internal memos in January and February, saying that the United States could see up to 2 million deaths and trillions of dollars in economic damage.
The first Navarro memo was dated Jan. 29 and was addressed to the White House National Security Council, according to The New York Times, which first reported on the document. In it, Navarro made his case for an “immediate travel ban on China.”
In that memo, Navarro also reportedly warned that “the lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil.”
“This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans,” Navarro wrote in the memo, according to the Times.
Navarro’s first memo came as the president was downplaying the prospect of the virus coming to the U.S., while, at the same time, just days later on Jan. 31 restricting travel from China, after it was reported that COVID-19 was first discovered in China in December 2019 in Wuhan, Hubei province.
The memo reportedly warned of up to $5.7 trillion in economic costs and up to a half-million American deaths in a worst-case scenario.
In late February Navarro penned another memo, this time addressed to the president himself and escalating the warnings.
The Feb. 23 memo, first reported by Axios and confirmed by Fox News, warned that “there is an increasing probability of a full-blown COVID-19 pandemic that could infect as many as 100 million Americans, with a loss of life as many as 1-2 million souls.”…
The inspector general for the Department of Health and Human Services released a report on Monday, which revealed severe shortages of testing supplies and extended waits for results at hospitals across the nation; widespread shortages of PPE which put staff and patients at risk; difficulty maintaining adequate staffing; and shortages of critical supplies, like hand sanitizer, facemasks, toilet paper, linen, disinfectant cleaning supplies and more, as well as materials and logistics support.” (B)
“Jared Kushner, President Trump’s son-in-law and senior adviser, criticized governors Thursday, saying they don’t have a handle on their own supplies of masks and ventilators needed to combat the coronavirus outbreak.
In a rare appearance in the White House briefing room, Kushner urged governors and some senators to be more resourceful in their own states instead of looking first to the federal government for help.
“What a lot of the voters are seeing now is that when you elect somebody to be a mayor or governor or president, you’re trying to think about who will be a competent manager during the time of crisis,” he said. “This is a time of crisis, and you’re seeing certain people are better managers than others.”..
On Thursday, he explained that Trump and Vice President Pence came to him looking for new ideas and “outside of the box” thinking.
But his lack of experience has drawn scrutiny, especially when he referred to the national stockpile of medical supplies as “our stockpile.”
“The notion of the federal stockpile was it’s supposed to be our stockpile,” he said. “It’s not supposed to be states’ stockpiles that they then use.”..
A day after Kushner made his remarks, language on a government website about the national stockpile was changed to more closely reflect his description. But a spokesperson for the Department of Health and Human Services said the department had been using the new language for weeks. The assistant secretary for preparedness and response “first began working to update the website text a week ago to more clearly explain to state and local agencies and members of the public the role of the” Strategic National Stockpile, the spokesperson said.” (C)
“President Donald Trump has upended the panel of federal watchdogs overseeing implementation of the $2 trillion coronavirus law, tapping a replacement for the Pentagon official who was supposed to lead the effort.
A panel of inspectors general had named Glenn Fine — the acting Pentagon watchdog — to lead the group charged with monitoring the coronavirus relief effort. But Trump on Monday removed Fine from his post, instead naming the EPA inspector general to serve as the temporary Pentagon watchdog in addition to his other responsibilities.
That decision, which began circulating on Capitol Hill Tuesday morning, effectively removed Fine from his role overseeing the coronavirus relief effort, since the new law permits only current inspectors general to fill the position…
Trump has also begun sharply attacking Health and Human Services Inspector General Christi Grimm, following a report from her office that described widespread testing delays and supply issues at the nation’s hospitals.” (D)
“Over the weekend, First Lady Melania Trump urged Americans to continue to follow the recommendations of the Centers for Disease Control and Prevention in order to slow the spread of the novel coronavirus.
“As the weekend approaches I ask that everyone take social distancing & wearing a mask/face covering seriously,” the First Lady wrote in a tweet. “#COVID19 is a virus that can spread to anyone — we can stop this together.”…
“I don’t think I’m going to be doing it,” the president said during a Friday press conference. “Wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens — I just don’t see it.” Trump touted that he was glad his wife was taking action in the wake of the pandemic, but he himself would not be following those same guidelines.” (E)
“President Donald Trump and his administration are promoting an anti-malaria drug not officially approved for fighting the new coronavirus, even though scientists say more testing is needed before it’s proven safe and effective against COVID-19.
Trump trade adviser Peter Navarro championed hydroxychloroquine in television interviews Monday, a day after the president publicly put his faith in the medication to lessen the toll of the coronavirus pandemic.
“What do I know, I’m not a doctor,” Trump said Sunday. “But I have common sense.” In promoting the drug’s possibilities, the president has often stated, ”What have you got to lose?”
Trump held out promise for the drug as he grasps for ways to sound hopeful in the face of a mounting death toll and with the worst weeks yet to come for the U.S. The virus has killed more than 10,000 in the U.S., and measures meant to contain its spread have taken a painful economic toll and all but frozen life in large swaths of the country.
But medical officials warn that it’s dangerous to be hawking unproven remedies, and even Trump’s own experts have cautioned against it.
The American Medical Association’s president, Dr. Patrice Harris, said she personally would not prescribe the drug for a coronavirus patient, saying the risks of severe side effects were “great and too significant to downplay” without large studies showing the drug is safe and effective for such use.
Harris pointed to the drug’s high risk of causing heart rhythm problems.
“People have their health to lose,” she said. “Your heart could stop.”..
Doctors are already prescribing the malaria drug to patients with COVID-19, a practice known as off-label prescribing. Research studies are now beginning to test if the drugs truly help COVID-19 patients, and the Food and Drug Administration has allowed the medication into the national stockpile as an option for doctors to consider for patients who cannot get into one of the studies.” (F)
“After receding from the limelight once the Russia investigation and impeachment wrapped up, former New York City Mayor Rudy Giuliani is making headlines again, lobbying President Donald Trump on untested coronavirus treatments, according to a new report from The Washington Post.
Giuliani, 75, has served as Trump’s personal attorney on a pro bono basis throughout the first term thus far, most often dispatched to defend the president on television amid the Russia and Ukraine scandals.
Now, Giuliani is pushing for the malaria drug hydroxychloroquine and what he describes as removing “placenta killer cells” in a stem cell treatment for COVID-19. As the Post put it, the former mayor is attempting to position himself as “personal science adviser” to the president.
Both hydroxychloroquine and the stem cell treatment are unproven and have yet to receive FDA approval to treat the coronavirus.
Last week, Giuliani had a tweet removed for violating Twitter’s misinformation policy when he promoted the anti-malaria drug…
Trump said he would take hydroxychloroquine to keep himself immune from COVID-19 during a White House press briefing last week.
Giuliani is joining a growing number of Trump confidants backing the drug, which The Post reports is “worrying health experts who fear such comments undermine efforts to slow the virus’s spread and downplay the risks of the unproven treatments.”
The former mayor told The Post he has spoken to Trump about the potential treatment “three or four times,” and has sought medical advice from a controversial Long Island doctor with a conservative following and a pharmacist who previously pleaded guilty for conspiring to extort Steven Seagal.” (G)
“A nationwide shortage of two drugs touted as possible treatments for the coronavirus is being driven in part by doctors inappropriately prescribing the medicines for family, friends and themselves, according to pharmacists and state regulators.
“It’s disgraceful, is what it is,” said Garth Reynolds, executive director of the Illinois Pharmacists Association, which started getting calls and emails Saturday from members saying they were receiving questionable prescriptions. “And completely selfish.”..
A pharmacist in Houston, who asked to remain anonymous for fear of retaliation and violating patient privacy, said he was recently asked by a surgeon for an unusually large quantity with unlimited refills. “He said it was because his wife had lupus,” the pharmacist said, “but when I asked him for her name and diagnosis, he told me just to put it in his.”
Lupus patients are reporting difficulty in refilling their prescriptions for the drug. On Monday, the Lupus Foundation of America issued a joint statement asking the White House Coronavirus Task Force to “take action to ensure current supplies are allocated for patients taking them for indicated uses.” Several states in the past few days have already moved to limit prescriptions of the drugs, neither of which is approved to treat the coronavirus. Trump, in press conferences and tweets over the past week, has promoted the use of the drugs as potentially blunting the impact of the COVID-19 outbreak.
“It’s unfortunate that a news conference, I think prematurely, made it sound like this was the answer, and that’s led to this panic,” Michelle Petri, director of Johns Hopkins University School of Medicine’s Lupus Center, said Friday. “I have spent the last two days trying to help lupus patients who actually need their refills.” She said some patients have refills on back order while others are being provided smaller amounts than usual.
The West Virginia Board of Pharmacy, in an alert Saturday, ordered pharmacists to limit new prescriptions to no more than 30 tablets and only to cases where the drugs were being used for approved indications…
On Twitter, pharmacy workers traded stories about dentists and opthamologists requesting hydroxychloroquine under dubious pretenses. “A dentist just tried to call in scripts for hydroxychloroquine + azithromycin for himself, his wife, & another couple (friends),” tweeted a pharmacist in Eugene, Oregon. “I have patients with lupus that have been on HCQ [Hydroxychloroquine] for YEARS and now can’t get it because it’s on backorder.”
Steve Moore, president of the Pharmacists Society of the State of New York, said medical providers hoarding the drugs is occuring in the state, which has the highest number of coronavirus cases in the country.
“That’s a double whammy,” he said. “We’re potentially taking that medication away from patients with autoimmune conditions and patients with the actual virus that may need treatment.”” (H)
“In audio of the call published by CBS News, Montana Gov. Steve Bullock (D) details two problems with testing. First, that his state doesn’t have enough tests, saying “we’re one day away if we don’t get test kits from the CDC that we wouldn’t be able to do testing.” And second, that the federal government has depleted the tests available on the private market…
Trump’s response to questions of testing typically mirrors the answer he gave Bullock — that the US is doing more testing than anyone else. And this, to a point, appears to be true. As of Saturday, Adm. Brett Giroir, coronavirus task force member and assistant secretary for health at the Department of Health and Human Services, said the US had done 894,000 tests.
But while that is a large number, the number of tests done per capita is much smaller: According to the Washington Post, the US had conducted 2,250 tests per million people by March 28, a figure roughly two-thirds of the per capita testing rate South Korea achieved three weeks earlier.
The reason this distinction is important is that if we are to end social distancing in the next few months, rather than ending it only when a vaccine becomes available, it is imperative enough tests exist to test on a massive scale, as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has explained” (I)
“Dr. Deborah Birx said that the White House coronavirus task force is missing 50% of the data for coronavirus tests that have been conducted.
Birx, one of the top officials on the White House’s coronavirus task force, said Thursday that part of the $2 trillion economic stimulus measure that was signed into law by President Donald Trump requires that all tests conducted get reported to the Centers for Disease Control and Prevention. But Birx says she has not received that data yet.
“Well, I’m telling you, I’m still missing 50% of the data from reporting,” she said. “I have 660 (thousand) tests reported in. We’ve done 1.3 million. … So, we do need to see — the bill said you need to report. We are still not receiving 100% of the tests.”” (J)
“President Donald Trump had a hard time deciding Tuesday whether impeachment distracted him from fighting the coronavirus – but he eventually claimed it “probably” did.
“Well, I don’t like to think I did,” Trump said at a news conference with the White House coronavirus task force. “I think I handled it very well, but I guess it probably did. I mean, I got impeached.”
He added that, “I certainly devoted a little time to thinking about it.”
The president later expanded on his answer.
“But certainly I guess I thought of it. And I think I probably acted – I don’t think I would have done better had I not been impeached, OK? And I think that’s a great tribute to something. Maybe it’s a tribute to me. But I don’t think I would’ve acted any differently or I don’t think I would’ve acted any faster.””(K)
“New White House press secretary Kayleigh McEnany repeatedly downplayed the threat of the coronavirus in comments made in February and March, a CNN KFile review has found.
In radio and television appearances, McEnany, in her role as spokeswoman for President Donald Trump’s 2020 campaign, said the administration had the rapidly spreading coronavirus “under control” and said that because of travel restrictions enacted by the President, “we will not see diseases like the coronavirus come here.”
She also said Democrats were “actively rooting against what’s in the best interest of America,” including rooting for coronavirus to take hold. She said coronavirus, like the Russia and Ukraine scandals, was being used to take down Trump…
“We will not see diseases like the coronavirus come here”
Speaking on Fox Business on February 25, McEnany said because of travel policies enacted by the President, coronavirus would not continue to come to the United States…
In March, McEnany continued to defend the president as the outbreak spread. On local Michigan radio on March 10, she said it was incumbent on the public to take adequate political health measures but the situation was under control.
“This is something that is under control,” she said on the Frank Beckmann Show. “We have a President who has taken unprecedented action and mandatory quarantines and travel restrictions, and he’s taken every measure that he possibly could to protect the American people. I’m confident we have a great leader at the top, but it’s incumbent upon all of us just to take those precautions.”
“This President’s taken unprecedented action to protect this country from the coronavirus,” she continued. “He stopped it from being so much worse than it could have been, but leave it to the media and the left to score those cheap political points.”” (L)
“Since Chinese officials disclosed the outbreak of a mysterious pneumonialike illness to international health officials on New Year’s Eve, at least 430,000 people have arrived in the United States on direct flights from China, including nearly 40,000 in the two months after President Trump imposed restrictions on such travel, according to an analysis of data collected in both countries.
The bulk of the passengers, who were of multiple nationalities, arrived in January, at airports in Los Angeles, San Francisco, New York, Chicago, Seattle, Newark and Detroit. Thousands of them flew directly from Wuhan, the center of the coronavirus outbreak, as American public health officials were only beginning to assess the risks to the United States…
Mr. Trump has repeatedly suggested that his travel measures impeded the virus’s spread in the United States. “I do think we were very early, but I also think that we were very smart, because we stopped China,” he said at a briefing on Tuesday, adding, “That was probably the biggest decision we made so far.” Last month, he said, “We’re the ones that kept China out of here.”” (M)
“A US Navy hospital ship currently docked in New York City harbor is treating only 22 patients as of Friday afternoon, despite having a 1,000 bed capacity to treat non-coronavirus patients, according to a US Navy official.
Navy officials told CNN that they expect the number of patients being treated to increase significantly in the coming days as the process of referring patients to the ship is refined.
The USNS Comfort was deployed to New York City, the epicenter of the virus outbreak in the United States, to free up capacity in the city’s civilian hospitals so that they can focus on treating coronavirus patients.
New York City’s hospitals have been overwhelmed with coronavirus cases and are struggling to respond to patients constantly streaming in. A shortage of personal protective equipment has also placed medical workers at risk of contracting the virus. On Thursday, New York Gov. Andrew Cuomo announced that the temporary hospital facility at the Javits Convention Center, which holds 2,500 beds, will now treat Covid-19 patients….
Ambulances are not taking people directly to the ship, which docked in New York City on Monday. Patients are referred to the ship by shore-based hospitals and must be screened and tested for the virus before being admitted on board.
The Department of Defense said Friday that it would begin streamlining the process to admit patients onto the ship.
“Screening for care on the USNS Comfort will be modified and will now occur pier-side in an effort to reduce the backlog at some of the nearby New York hospitals,” the Pentagon said in a statement. “The screening effort for the USNS Comfort will no longer require a negative test (for coronavirus), but each patient will still be screened by temperature and a short questionnaire.”
There are some patients that the Comfort can’t bring on board, mainly those who are immunosuppressed due to the fact the ship is open bay and does not have the ability to isolate patients, according to a Navy official familiar with operations on the ship.
“We are conducting data analysis to see how we need to change our configuration — bottom line we’ve been here 48 hours, and this is a scenario no one has ever seen before,” the official told CNN. “No one wants to get this wrong. We hear the feedback from medical professionals, and are fine tuning,” but the Comfort will still only treat non-coronavirus patients.” (N)
“AS MUCH OF the New York City’s media focused on the brewing coronavirus disaster in the city’s jails on Rikers Island, a parallel crisis is looming at the federal jails located in the city: the Metropolitan Correctional Center in Lower Manhattan and the Metropolitan Detention Center in Brooklyn.
Nationwide, according to Bureau of Prison statistics, the number of positive cases of coronavirus in federal jails and prisons exploded by 8,600 percent in the two weeks since March 20 — an increase that’s especially concerning given the vulnerability of the people locked in conditions they can’t control. By Bureau of Prison estimates, roughly a third of the people incarcerated in MDC and MCC are at elevated risk of severe illness by the Centers for Disease Control and Prevention’s standards.
Jail officials are not holding off on testing for want of incarcerated people showing alarming symptoms: Clients have told lawyers that their housing units are full of coughing people.
It is hardly reassuring that, so far, few incarcerated people at either facility have tested positive. Jail officials admitted last week — only because of a judge’s order — that they’re doing almost no testing. As of Friday, only seven people out of a population of roughly 1,700 had been tested at MDC, of whom two tested positive. Of the roughly 760 people held at MCC, only five had been tested, of whom four tested positive.” (O)
“The Covid-19 pandemic is stretching our public health system to its limits and challenging our ability to meet the urgent and critical medical needs of the country as never before. As executives responsible for the legal affairs of major hospitals and lawyers working in Covid-19 hot spots, we know how crucial it is to have every available front-line medical worker fighting this pandemic.
But 29,000 of those workers are being threatened with deportation by the Trump administration. They have been protected by the Deferred Action for Childhood Arrivals program, under which undocumented immigrants who came to the United States as children can obtain protection against deportation and authorization to work in the United States. The Trump administration terminated that program, the Supreme Court is currently considering the lawfulness of that determination, and the court’s decision could come at any time.
New data from the Center for American Progress reveals that the DACA-recipient health care work force includes more than 6,000 diagnosing and treating practitioners, including respiratory therapists, physicians assistants and nurses; some 8,000 health aides, including nursing assistants and orderlies; more than 7,000 other health care support workers; and some 5,500 health technologists and technicians.
The Association of American Medical Colleges told the Supreme Court that nearly 200 physicians, medical students and residents depend on DACA for their ability to practice medicine and serve their communities. Those 200 trainees and physicians alone would care for hundreds of thousands of patients per year in normal times — the association estimates as many as 4,600 patients per year, per person. Under the demands of the Covid-19 pandemic, those numbers will be much higher.
The Center for Migration Studies found that 43,500 DACA recipients work in the health care and social-assistance industries, including more than 10,000 in hospitals…
If the Supreme Court allows the termination of DACA during this pandemic, the work of our hospitals will suffer a critical blow at exactly the moment when we can least afford it. At a time when the importance — and scarcity — of our medical resources has never been clearer, neither our institutions nor the nation can afford a disruption to the health care work force. We desperately need all hands on deck for this fight.” (P)
“Why is Germany’s death rate so low?..A Robust Public Health Care System
Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.
“We have so much capacity now we are accepting patients from Italy, Spain and France,” said Susanne Herold, a specialist in lung infections at the hospital who has overseen the restructuring. “We are very strong in the intensive care area.”
All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people. By comparison, that rate is 12 in Italy and 7 in the Netherlands.
By now, there are 40,000 intensive care beds available in Germany.
Some experts are cautiously optimistic that social distancing measures might be flattening the curve enough for Germany’s health care system to weather the pandemic without producing a scarcity of lifesaving equipment like ventilators.
“It is important that we have guidelines for doctors on how to practice triage between patients if they have to,” Professor Streeck said. “But I hope we will never need to use them.”
The time it takes for the number of infections to double has slowed to about nine days. If it slows a little more, to between 12 and 14 days, Professor Herold said, the models suggest that triage could be avoided.
“The curve is beginning to flatten,” she said.
Beyond mass testing and the preparedness of the health care system, many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.
Ms. Merkel, a trained scientist, has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country. The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.
The chancellor’s approval ratings have soared.
“Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”” (Q)
Georgia Gov. Brian Kemp signed an executive order on Thursday that requires residents of the state to shelter in place.
But the order overrides all local efforts to combat the coronavirus, including beach closures.
As of Friday night, Georgia state beaches are open once again, though visitors are required to follow social-distancing guidelines.
The governor of Georgia has imposed a state-wide order to shelter in place, as of Friday night — and, at the same time, reopened the state’s beaches.
In an executive order signed on Thursday, Gov. Brian Kemp, a Republican, issued an executive order April 2 that requires Georgians to remain in their homes for the next 10 days, with exceptions for vital businesses and necessary travel. But it also suspends “any local ordinance or order” aimed at “combating the spread of coronavirus or COVID-19.”
As a result, popular tourist spots like Tybee Island, which receives hundreds of thousands of visitors every year, are now back in business, even as the rest of the state shuts down.” (R)
“President Donald Trump’s top health advisers are developing medical criteria for safely reopening the U.S. economy in coming weeks should trends showing a crest in the coronavirus outbreak hold steady.
Deborah Birx, the immunologist who coordinates the White House virus task force, met into the night Tuesday with health experts, including Anthony Fauci, the nation’s top infectious disease expert, Centers for Disease Control and Prevention Director Robert Redfield and Food and Drug Administration Commissioner Stephen Hahn.
Notably absent from the late-night discussion were economic and political advisers to the president, along with the leader of the coronavirus task force, Vice President Mike Pence, and his chief of staff, Marc Short.
Excluding the political and economic advisers was a deliberate signal that the White House would continue for now to prioritize health considerations over economic ones, according to three people familiar with the meeting who requested anonymity to discuss internal deliberations.” (S)
“President Trump said he’d like to open the economy with a “big bang” and suggested that may first happen in regions of the country where the coronavirus outbreak has begun to subside.
“I’d love to open with a big bang, one beautiful country, but it’s very possible,” the president said Tuesday on Sean Hannity’s Fox News show.
“So we are looking at two concepts, we are looking at the concept we open up sections and also looking at the concept where you open up everything,” the president explained. “I think New York is getting ready if not already, but getting ready to peak and once it peaks, it will start coming down and it’s going to come down fast.”
Unlike New York and New Jersey, Trump said some states haven’t had the same level of coronavirus spread.
He said parts of Michigan and Detroit have been “hit very hard” – “so there are some places hit very hard in other places that have not been hit very hard frankly by comparison, very little.”
The president has kept an eye on the economy and the stock market during the battle against the pandemic, watching the financial tailspin as lockdowns were expanded in states across the country and workers were laid off or furloughed…
“We have to get our country open again. This wasn’t designed to have this. You crack it – you crack it in half, it’s no good. And we’ll be open again much sooner rather than later,” he told Hannity. “And we are going to be coming up with some ideas in the very near future, probably putting them out to the public, putting them out, but, you know, we’re going through April – as you know, April 30 – and we are going to make a decision from there.”” (T)
“A Sunday update of a prominent COVID-19 forecasting model suggests that fewer lives will be lost during the first wave of the coronavirus outbreak than previously thought.
The University of Washington’s Institute for Health Metrics and Evaluation (IHME) now predicts that 81,766 people will die of COVID-19 in the U.S. through early August. When the model was last updated, on April 2, it predicted 11,765 deaths more deaths, for a total of 93,531…
…The model’s latest update includes several important changes related to that planning. Many fewer hospital beds will be needed at peak than previously anticipated, according to the new projections. The April 5 update predicts the need for 140,823 total hospital beds and 29,210 ICU beds at the peak of the outbreak. Those numbers are down 121,269 and 10,517, respectively.
The model also revised downward the prediction for the number of ventilators needed at the height of the outbreak. It now predicts the need for 18,992 ventilators, down from 31,782.
One thing that didn’t change between the April 2 and April 5 models is the projected date of the outbreak’s peak. The model still predicts an April 16 apex for the daily COVID-19 death rate. Hospital use is expected to peak on April 15.” (U)
J.Top doctor says White House coronavirus task force still missing 50% of testing data, by Jason Hoffman and Caroline Kelly, https://www.cnn.com/2020/04/02/politics/birx-task-force-coronavirus-testing/index.html
PART 1. 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. 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. “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. 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. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. 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. 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. 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. 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. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. 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. CORONAVIRUS. March 14, 2020. “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. CORONAVIRUS. March 17, 2020. “ “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. CORONAVIRUS. March 22, 2020. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
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.
