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“Dr. Camilla Rothe was about to leave for dinner when the government laboratory called with the surprising test result. Positive. It was Jan. 27. She had just discovered Germany’s first case of the new coronavirus.
But the diagnosis made no sense. Her patient, a businessman from a nearby auto parts company, could have been infected by only one person: a colleague visiting from China. And that colleague should not have been contagious.
The visitor had seemed perfectly healthy during her stay in Germany. No coughing or sneezing, no signs of fatigue or fever during two days of long meetings. She told colleagues that she had started feeling ill after the flight back to China. Days later, she tested positive for the coronavirus.
Scientists at the time believed that only people with symptoms could spread the coronavirus. They assumed it acted like its genetic cousin, SARS.
“People who know much more about coronaviruses than I do were absolutely sure,” recalled Dr. Rothe, an infectious disease specialist at Munich University Hospital…
Interviews with doctors and public health officials in more than a dozen countries show that for two crucial months — and in the face of mounting genetic evidence — Western health officials and political leaders played down or denied the risk of symptomless spreading. Leading health agencies including the World Health Organization and the European Center for Disease Prevention and Control provided contradictory and sometimes misleading advice. A crucial public health discussion devolved into a semantic debate over what to call infected people without clear symptoms.
The two-month delay was a product of faulty scientific assumptions, academic rivalries and, perhaps most important, a reluctance to accept that containing the virus would take drastic measures. The resistance to emerging evidence was one part of the world’s sluggish response to the virus.
It is impossible to calculate the human toll of that delay, but models suggest that earlier, aggressive action might have saved tens of thousands of lives. Countries like Singapore and Australia, which used testing and contact-tracing and moved swiftly to quarantine seemingly healthy travelers, fared far better than those that did not….
It is also painfully clear that time was a critical commodity in curbing the virus — and that too much of it was wasted.” (A)
“Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.
The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.
But as the deadly virus spread from China with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.
The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.
The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”…
Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.
The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.” (G)
“By using ventilators more sparingly on Covid-19 patients, physicians could reduce the more-than-50% death rate for those put on the machines, according to an analysis published Tuesday in the American Journal of Tropical Medicine and Hygiene.
The authors argue that physicians need a new playbook for when to use ventilators for Covid-19 patients — a message consistent with new treatment guidelines issued Tuesday by the National Institutes of Health, which advocates a phased approach to breathing support that would defer the use of ventilators if possible.
As the pandemic has flooded hospitals with a disease that physicians had never before seen, health care workers have had to figure out treatment protocols on the fly. Starting this month, a few physicians have voiced concern that some hospitals have been too quick to put Covid-19 patients on mechanical ventilators, that elderly patients in particular may have been harmed more than helped, and that less invasive breathing support, including simple oxygen-delivering nose prongs, might be safer and more effective.
The new analysis, from an international team of physician-researchers, supports what had until now been mainly two hunches: that some of the Covid-19 patients put on ventilators didn’t need to be, and that unusual features of the disease can make mechanical ventilation harmful to the lungs.
“This is one of the first coherent, comprehensive, and reasonably clear discussions of the pathophysiology of Covid-19 in the lungs that I’ve seen,” said palliative care physician Muriel Gillick of Harvard Medical School, who was one of the first to ask if ventilators were harming some Covid-19 patients, especially elderly ones. “There is mounting evidence that lots of patients are tolerating fairly extreme” low levels of oxygen in the blood, suggesting that such hypoxemia should not be equated with the need for a ventilator.
But using low levels of blood oxygen (hypoxemia) as a sign that a patient needs mechanical ventilation can lead physicians astray, they argue, because low blood oxygen in a Covid-19 patient is not like low blood oxygen in other patients with, for instance, other forms of pneumonia or sepsis.
The latter typically gasp for breath and can barely speak, but many Covid-19 patients with oxygen levels in the 80s (the high 90s are normal) and even lower are able to speak full sentences without getting winded and in general show no other signs of respiratory distress, as their hypoxemia would predict.
Related: With ventilators running out, doctors say the machines are overused for Covid-19
“In our personal experience, hypoxemia … is often remarkably well tolerated by Covid-19 patients,” the researchers wrote, in particular by those under 60. “The trigger for intubation should, within certain limits, probably not be based on hypoxemia but more on respiratory distress and fatigue.”…
There is a growing recognition that some Covid-19 patients, even those with severe disease as shown by the extent of lung infection, can be safely treated with simple nose prongs or face masks that deliver oxygen.The latter include CPAP (continuous positive airway pressure) masks used for sleep apnea, or BiPAP (bi-phasic positive airway pressure) masks used for congestive heart failure and other serious conditions. CPAP can also be delivered via hoods or helmets, reducing the risk that patients will expel large quantities of virus into the air and endanger health care workers. (B)
Targeting the kidneys. “Despite attempts to move away from ventilators, some COVID-19 patients still need them. As the pandemic has progressed, it’s become apparent that coronavirus patients on ventilators need special care.
When patients are put on a ventilator, they’re often given diuretics to get rid of extra fluid in the body. Lungs that need help need to be “dry” to function properly. When they’re wet, “they can’t move oxygen as well,” Denson said.
But the coronavirus has since proved it’s not a simple respiratory illness. It can affect the lungs, the brain, the blood and, critically for patients on ventilators, the kidneys.
Unlike lungs, kidneys prefer to be hydrated. The longer patients are kept dehydrated, their chances of kidney failure increase. Denson said he’s changed his treatments for COVID-19 patients to give additional hydration if they’re showing damage to the kidneys.
“I’m targeting the kidneys a little bit more,” he said. “I’m less aggressive up front getting people dry, and I’m more willing to use fluids if needed.”
It’s a balancing act that requires extreme attention on the part of ICU doctors and their staff. Too much hydration hurts the lungs. Too little hurts the kidneys. “It’s a constant battle,” Denson said.
Medications. When doctors faced the first surge of severely ill COVID-19 patients, no drugs had been shown to work against the virus, making treatment more challenging. As a result, doctors were willing to try certain medications based on limited evidence.
Early on in the pandemic, the drug hydroxychloroquine emerged as a potential treatment, following two studies that suggested it might be beneficial. As a result, many patients were given the drug, which is already approved for malaria and rheumatoid arthritis. But doctors soon found the drug was not useful in treating COVID-19, and subsequent research has shown it does not appear to help.
Now, doctors in ICUs are turning to the drug remdesivir. It’s not a cure, but it’s the only treatment that’s been shown in a clinical trial to have an effect on the illness so far.” (C)
“The Strategic National Stockpile, a once little-known resource, has turned into a political tug-of-war as states scramble for gowns, masks, ventilators and other equipment during the coronavirus pandemic.
But it was never intended to be able to meet massive, simultaneous demand from 50 states, its former director said.
“The Strategic National Stockpile is great as a fallback” that can be tapped after private sector supplies and state and local government supplies are exhausted, said Greg Burel, who is now president and principal consultant at Hamilton Grace, a consulting firm focused on preparedness and response.
“From what I’ve been seeing, and you’ve probably seen the same thing, it seems like almost from day one, everybody’s turned and looked at the SNS,” Burel said in an interview with POLITICO.
President Donald Trump has blamed the Obama administration for not refilling the reserve. “The previous administration, the shelves were empty. The shelves were empty,” Trump said last week.
However, the stockpile has also been underfunded for years, including during the Trump administration. The latest congressional appropriations enacted in November allotted about $700 million.
“What we had told Congress at the time though is that to get everything on the shelf that we wanted on the shelf at the time, that we needed a little over $1 billion in one appropriation and then we could smooth that out over the years,” Burel said.
The Trump administration’s official budget request for the SNS in fiscal 2020 was $705 million, or $95 million more than Congress approved for the prior year.
During the Obama administration, annual funding levels ranged around $500 million to $600 million. The Trump administration initially followed that pattern, requesting $575 million for the stockpile for both fiscal 2018 and 2019.
With the stockpile now quickly burning through badly needed supplies, Congress included $16 billion for the SNS in H.R. 748 (116), the $2 trillion coronavirus virus relief package that passed last month.
Burel noted that the added money won’t go that far because of the many ventilators that the SNS has sent to states that will need to be replaced or repaired at great expense when the current crisis is over. In addition, the stockpile’s pre-crisis supplies of masks, gloves and other personal protective equipment are nearly, if not completely, gone.
“There are a large number of materials that we have invested in for a number of years that by the end of this event will be completely gone,” Burel said. “A bunch of that $16 billion is just going to be eaten up with replacing what’s going out, recovering what’s gone out, cleaning it and putting back on the shelves — and then to manage a future vaccine campaign.”…
All of the SNS supplies that are “clearly useful in this particular event” have probably been distributed through allocations based on each state’s population, Burel said. But Burel said there is no reason to doubt the stockpile still has supplies for its original mission, responding to the chemical, biological and nuclear events….
The coronavirus pandemic has exposed the need for all elements of the emergency response network to keep more supplies on hand, Burel said.
That potentially means both manufacturers and hospitals keeping 60 to 90 days’ worth of personal protective equipment on hand, as well as state and local governments beefing up their own supplies.
Congress should also “fully fund” the SNS to ensure it has the supplies it needs to respond to pandemics and other threats, although it will never be able to respond to all eventualities, Burel said.
The emergency response veteran also said he favors producing more of the material in the United States and supplementing that with imported supplies.
“There has to be that swell of safety stock. We can’t fight this kind of pandemic event that has disrupted the supply chain beyond what the normal usage is unless there is some stock somewhere,” Burel said.”” (D)
“How many people are likely to die in the United States of Covid-19? How many hospital beds is the country going to need? When will case numbers peak?
To answer those questions, many hospital planners, media outlets, and government bodies — including the White House — relied heavily on one particular model out of the many that have been published in the past two months: the University of Washington’s Institute for Health Metrics and Evaluation (IHME).
The model first estimated in late March that there’d be fewer than 161,000 deaths total in the US; in early April, it revised its projections to say the total death toll through August was “projected to be 60,415” (though it acknowledged the range could be between 31,221 and 126,703).
The model has been cited often by the White House and has informed its policymaking. But it may have led the administration astray: The IHME has consistently forecast many fewer deaths than most other models, largely because the IHME model projects that deaths will decline rapidly after the peak — an assumption that has not been borne out.
On Wednesday, the US death count passed the 60,000 mark that the IHME model had said was the likely total cumulative death toll. The IHME on April 29 released a new update raising its estimates for total deaths to 72,433, but that, too, looks likely to be proved an underestimate as soon as next week. Even its upper bound on deaths — now listed as 114,228 by August — is questionable, as some other models expect the US will hit that milestone by the end of May, and most project it will in June.
One analysis of the IHME model found that its next-day death predictions for each state were outside its 95 percent confidence interval 70 percent of the time — meaning the actual death numbers fell outside the range it projected 70 percent of the time. That’s not great! (A recent revision by IHME fixed that issue; more on this below.)
This track record has led some experts to criticize the model. “It’s not a model that most of us in the infectious disease epidemiology field think is well suited” to making projections about Covid-19, Harvard epidemiologist Marc Lipsitch told reporters.
But if that’s the case, how has it risen to such prominence among policymakers? Other models have done better than IHME’s at predicting the course of the epidemic, and many of them use approaches epidemiologists believe are more promising. Yet it’s the IHME model that has generally guided policymakers, for the most part, in the direction of focusing on a return to normal.
One potential explanation for its outsize influence: Some of the factors that make the IHME model unreliable at predicting the virus may have gotten people to pay attention to it. For one thing, it’s more simplistic compared to other models. That means it can be applied in ways more complicated models could not, such as providing state-level projections (something state officials really wanted), which other modelers acknowledged that they didn’t have enough data to offer.
Meanwhile, its narrow confidence intervals for state-by-state estimates meant it had quotable (and optimistic) topline numbers. A confidence interval represents a range of numbers wherein the model is very confident the true value will lie. A narrow range that gives “an appearance of certainty is seductive when the world is desperate to know what lies ahead,” a criticism of the IHME model published in the Annals of Internal Medicine argued. But the numbers and precise curves the IHME is publishing “suggests greater precision than the model is able to offer.”
The criticism of the IHME model, and an emerging debate over epidemiology models more broadly, has brought to light important challenges in the fight against the coronavirus. Good planning requires good projections. Models are needed to help predict resurgences and spot a potential second wave. Dissecting what the IHME model got wrong, what other models got right, and how the public and policymakers read these models is essential work in order to create the best pandemic plans possible.
What’s wrong with the IHME model of the coronavirus?” (E)
“When it became clear coronavirus had made its way to the United States in late January and was likely to spread around the country, many Americans purchased masks as a way to protect themselves from the disease. After all, they were told the virus is a respiratory illness that enters the body through the nose and mouth. They took proactive measures to protect themselves from getting sick.
But on Feb. 29, U.S. Surgeon General Jerome Adams took to Twitter to shame individuals doing their best to keep themselves out of clinics and the hospital. Keep in mind, this was more than two weeks before the federal government announced official social distancing and stay-at-home guidelines on March 16.
“Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!” he screamed through his keyboard.
We were told then that masks don’t work and that Americans shouldn’t be wearing them. At the same time, government officials were telling us they needed personal protective equipment (PPE) for doctors, nurses and others working in hospitals with cases of the disease. This PPE included masks. The illogical argument being made at the time was that masks protect doctors, but not the general public.
This argument appears to have been made in order to prevent a run on medical grade masks used by those on the front lines treating the disease, but the logic then, and now, made no sense. Masks only protect doctors? Really?
“The masks are important for someone who’s infected to prevent them from infecting someone else. Now, when you see people and look at the films in China, South Korea or whatever everybody is wearing a mask. Right now in the United States, people should not be walking around with masks,” Anthony Fauci told “60 Minutes” on March 8. “There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people ‘feel a little better’ and it might even block a droplet but it’s not providing the perfect protection the people think that it is. And often, there are unintended consequences. People keep fiddling with the mask and they keep touching their face.”
“When you think masks you should think of health care providers needing them, and people who are ill,” Fauci continued. “I’m not against it, if you want to do it. It can lead to a shortage for people who really need it.”
Again, masks work as protection for health care providers, but not regular people exposed to the disease at the grocery store?
Then on April 6, “in the middle of an outbreak” and the height of stay-at-home orders, federal government officials stressed a mask was not a replacement for social distancing, but could help protect people from getting sick or spreading the disease to others.
“CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission,” the Centers for Disease Control and Prevention published. “The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.” “(F)
“Lines for coronavirus tests have stretched around city blocks and tests ran out altogether in at least one site on Monday, new evidence that the country is still struggling to create a sufficient testing system months into its battle with Covid-19.
At a testing site in New Orleans, a line formed at dawn. But city officials ran out of tests five minutes after the doors opened at 8 a.m., and many people had to be turned away.
In Phoenix, where temperatures have topped 100 degrees, residents have waited in cars for as long as eight hours to get tested.
And in San Antonio and other large cities with mounting caseloads of the virus, officials have reluctantly announced new limits to testing: The demand has grown too great, they say, so only people showing symptoms may now be tested — a return to restrictions that were in place in many parts of the country during earlier days of the virus.
“It’s terrifying, and clearly an evidence of a failure of the system,” said Dr. Morgan Katz, an infectious disease expert at Johns Hopkins Hospital.
In the early months of the nation’s outbreak, testing posed a significant problem, as supplies fell far short and officials raced to understand how to best handle the virus. Since then, the United States has vastly ramped up its testing capability, conducting nearly 15 million tests in June, about three times as many as it had in April. But in recent weeks, as cases have surged in many states, the demand for testing has soared, surpassing capacity and creating a new testing crisis.
In many cities, officials said a combination of factors was now fueling the problem: a shortage of certain supplies, backlogs at laboratories that process the tests, and skyrocketing growth of the virus as cases climb in almost 40 states and the nation approaches a grim new milestone of three million total cases.
Fast, widely available testing is crucial to controlling the virus over the long term in the United States, experts say, particularly as the country reopens. With a virus that can spread through asymptomatic people, screening large numbers of people is seen as essential to identifying those who are carrying the virus and helping stop them from spreading it to others.
All along, the United States has struggled with issues tied to testing. In February, the federal government shipped a tainted testing kit to states, delaying a broader testing strategy and leaving states blind to a virus that was already beginning to circulate. Later, testing supplies became a choke point, and states called on the federal government to use the Defense Production Act to force additional production.” “(L)
“All 50 states have moved to reopen their economies, at least partially, after shutting down businesses and gatherings in response to the coronavirus pandemic.
But a Vox analysis suggests that most states haven’t made the preparations needed to contain future waves of the pandemic — putting themselves at risk for a rise in Covid-19 cases and deaths should they continue to reopen, which some states have already seen.
Experts told me states need three things to be ready to reopen. State leaders, from the governor to the legislature to health departments, need to ensure the SARS-CoV-2 virus is no longer spreading unabated. They need the testing capacity to track and isolate the sick and their contacts. And they need the hospital capacity to handle a potential surge in Covid-19 cases.
More specifically, states should meet at least five basic criteria. They should see a two-week drop in coronavirus cases, indicating that the virus is actually abating. They should have fewer than four daily new cases per 100,000 people per day — to show that cases aren’t just dropping, but also below dangerous levels. They need at least 150 new tests per 100,000 people per day, letting them quickly track and contain outbreaks. They need an overall positive rate for tests below 5 percent — another critical indicator for testing capacity. And states should have at least 40 percent of their ICU beds free to actually treat an influx of people stricken with Covid-19 should it be necessary.
These metrics line up with a range of expert recommendations, as well as the various policy plans put out by both independent groups and government officials to deal with the coronavirus.
Meeting these metrics doesn’t mean that a state is ready to reopen its economy — a process that describes a wide range of local and state actions. And failing them doesn’t mean a state is in immediate danger of a coronavirus outbreak if it starts to reopen; with Covid-19, there’s always an element of luck and other factors.
But with these metrics, states can gauge if they have repressed the coronavirus while building the capacity to contain future outbreaks should they come. In other words, the benchmarks show how ready states are for the next phase of the fight.
So far, most states are not there. As of July 8, just four states — Connecticut, New Hampshire, New Jersey, and New York — met four or five of the goals, which demonstrates strong progress. Fifteen states and Washington, DC, hit two or three of the benchmarks. The other 31 achieved zero or one.” (H)
“Official figures show the US has had the largest and most deadly outbreak, exacerbated by a slow initial response, mismanagement of testing and poor coordination between states and the federal government.
“As this outbreak has demonstrated, you can have the best labs in the world, the best notification systems and software, but if you don’t have the appropriate governance of when to use these powers … they don’t function,” Phelan says….
Its successful execution requires extraordinary public trust in their governments, says Lars Trägårdh, a Swedish historian who studies trust in institutions over time. “If you trust the government is working for your good, and you trust other citizens to follow the rules, you have huge advantages for collective action,” he says….
Over the next months, governments are going to allow people to resume their lives amid the worst economic conditions since the Great Depression. Should new waves of the virus be detected, states may again ask their citizens to return home.
Managing this is going to require significant stores of public trust, that in some places are quickly eroding. “If people agree to do something in the long term, without a threat hanging over their heads, they are more likely to keep doing it,” Trägårdh says. “The alternative is fear, distrust, and chaos, and that isn’t good, no matter what the policy might be.”…
“Leaders such as Trump deploy simple messages: insider versus outsider, us versus them,” says Sanjoy Chakravorty, a professor at Temple University in the US, who studies the politics of information. “And they are having an ideological crisis in how to manage the message here. This is a very complicated information sphere, which you can’t put into ‘us and them’ boxes … because in this case everybody is the ‘us’.”
Rather than rewarding bravado, the moment appears to favour leaders who can be honest about the uncertainty inherent in fighting a virus, says Kathleen Bachynski, an assistant professor of public health at Muhlenberg College. “If leaders are not willing or able to be honest about these limitations, there will be this loss of credibility – and it won’t be because they are wrong, it’s because information is changing.”
Those overseeing some of the more successful responses, such as Germany’s Angela Merkel or Jacinda Ardern of New Zealand, have been praised for their ability to project empathy and communicate complex ideas.” (I)
2. Twelve key lessons
2.1. Transparency is vital
2.2. Successful responses hinge on decisive leadership
2.3. We need unified responses to pandemics rather than diverse disconnected strategies
2.4. Effective communication must occur at the highest political levels
2.5. The European Union, and other regional blocs, must assume a greater health role
2.6. Global solidarity is the only way to win the war against COVID-19
2.7. The WHO has done a lot given the resources it has, but there is much room for improvement. It must now focus its activities, expand its remit and enhance its operational capacity
2.8. Existing global insurance institutions and policies are inadequate, and these require significant changes and improvements
2.9. Efforts to develop COVID-19 vaccines and treatments are commendable, but there is still much more to do
2.10. We need to test the responsiveness and resilience of health systems and make changes and improvements based on the results
2.11. Accountability is critical for building trust and for sound, inclusive decision making
2.12. There are opportunities to introduce novel approaches, such as using robots and artificial intelligence (AI), in this – and in future – pandemic response
3. Conclusion
Now that SARS-CoV-2 has become a pandemic with close to five million cases and over 300,000 deaths as a result of the virus, the case for investing in health systems, human resources, and health technologies is clear. It is also easy to see that in the past decade, austerity policies have cut investments in health and these systems have too often been reduced or ignored. While it is essential to cut waste within health systems, this pandemic highlights the need to have adequate capacity to address and tackle a crisis. It is also a reminder of the strategic importance of publicly accountable health systems, underpinned by investment in people and technologies. We must continue to build upon the lessons learned so far from the management of COVID-19 and adjust our approaches to this pandemic, and to other future health and environmental crises, accordingly. (J)
“……..there are several different scenarios for the future of the COVID-19 pandemic, and some of these are consistent with what occurred during past influenza pandemics. These can be summarized as follows and are illustrated in the figure below.
¤ Scenario 1: The first wave of COVID-19 in spring 2020 is followed by a series of repetitive smaller wavesthat occur through the summer and then consistently over a 1- to 2-year period, gradually diminishingsometime in 2021. The occurrence of these waves may vary geographically and may depend on whatmitigation measures are in place and how they are eased. Depending on the height of the wave peaks, this cenario could require periodic reinstitution and subsequent relaxation of mitigation measures over the next 1 to 2 years.
¤ Scenario 2: The first wave of COVID-19 in spring 2020 is followed by a larger wave in the fall or winter of 2020 and one or more smaller subsequent waves in 2021. This pattern will require the reinstitution of mitigation measures in the fall in an attempt to drive down spread of infection and prevent healthcare systems from being overwhelmed. This pattern is similar to what was seen with the 1918-19 pandemic (CDC 2018). During that pandemic, a small wave began in March 1918 and subsided during the summer months. A much larger peak then occurred in the fall of 1918. A third peak occurred during the winter and spring of 1919; that wave subsided in the summer of 1919, signaling the end of the pandemic. The 1957-58 pandemic followed a similar pattern, with a smaller spring wave followed by a much larger fall wave (Saunders-Hastings 2016). Successive smaller waves continued to occur for several years (Miller 2009). The 2009-10 pandemic also followed a pattern of a spring wave followed by a larger fall wave (Saunders-Hastings 2016).
¤ Scenario 3: The first wave of COVID-19 in spring 2020 is followed by a “slow burn” of ongoing transmission and case occurrence, but without a clear wave pattern. Again, this pattern may vary somewhat geographically and may be influenced by the degree of mitigation measures in place in various areas. While this third pattern was not seen with past influenza pandemics, it remains a possibility for COVID-19. This third scenario likely would not require the reinstitution of mitigation measures, although cases and deaths will continue to occur.
Whichever scenario the pandemic follows (assuming at least some level of ongoing mitigation measures), we must be prepared for at least another 18 to 24 months of significant COVID-19 activity, with hot spots popping up periodically in diverse geographic areas. As the pandemic wanes, it is likely that SARS-CoV-2 will continue to circulate in the human population and will synchronize to a seasonal pattern with diminished severity over time, as with other less pathogenic coronaviruses, such as the betacoronaviruses OC43 and HKU1, (Kissler 2020) and past pandemic influenza viruses have done. “ (K)
“….. the very big lesson we should all take on board here is that modern science protects and serves us. Though everyone understood that the catastrophic influenza pandemic of 1918/19 was caused by a virus, diagnosis back then was all symptomatic, no human influenza virus was isolated until 1933 and it was only during World War 2 (1939-45) that the first, primitive influenza vaccines were rolled out to protect the troops against the possibility of a repeat pandemic that, thankfully, did not occur. When it comes to SARS-CoV-2 and COVID-19 we had a specific diagnostic test within days and, I will personally be very surprised if large-scale human vaccination is not in full swing by the second half of 2021.
Even so, the big lesson for the public is that, no matter how wonderful the laboratory science, actually getting products out there to protect people is a much more cumbersome process. Ensuring that a novel drug or vaccine is safe and efficacious takes time. Even though regulatory authorities have been comfortable with the idea that preliminary trials in animals and small numbers of human volunteers (Phase 1) can be conducted simultaneously, all that information must be evaluated before any product can be given to substantial numbers of people. Every possible effort is being made to ensure that all participants in large, closely monitored Phase 2 then Phase 3 trials will be protected, or at least safe, following community exposure to SARS-CoV-2.
Much of what had to be done over this first six months of the COVID-19 challenge was just plain hard work. An enormous effort was, for example, made within VIDRL to build testing capacity by helping other private and public laboratories get up to speed. And the Institute is still in the process of evaluating rapid person-side antibody tests that can be used for large-scale serological surveys. The obvious lesson here is that we are protected by having well-funded, high quality public laboratories and Institutions that can rapidly build capacity in the face of any pandemic threat.” (N)
“Four former directors of the Centers for Disease Control and Prevention sharply criticized the Trump administrationon Tuesday for undermining the federal health agency and casting doubt on its scientific guidelines in the midst of the coronavirus pandemic.
“As America begins the formidable task of getting our kids back to school and all of us back to work safely amid a pandemic that is only getting worse, public health experts face two opponents: covid-19, but also political leaders and others attempting to undermine the Centers for Disease Control and Prevention,” wrote former CDC Directors Tom Frieden, Jeffrey Koplan, David Satcher and Richard Besser in an op-ed published Tuesday by The Washington Post.
“As the debate last week around reopening schools more safely showed, these repeated efforts to subvert sound public health guidelines introduce chaos and uncertainty while unnecessarily putting lives at risk.”” (O)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
“In late March, as the number of COVID-19 cases was growing exponentially in the state, Cuomo said New York hospitals might need twice as many beds as they normally have. Otherwise there could be no space to treat patients seriously ill with the new coronavirus.
“We have 53,000 hospital beds available,” Cuomo, a Democrat, said at a briefing on March 22. “Right now, the curve suggests we could need 110,000 hospital beds, and that is an obvious problem and that’s what we’re dealing with.”
The governor required all hospitals to submit plans to increase their capacity by at least 50%, with a goal of doubling their bed count. Hospitals converted operating rooms into intensive care units, and at least one replaced the seats in a large auditorium with beds. The state worked with the federal government to open field hospitals around New York City, including a large one at the Jacob K. Javits Convention Center.
But when New York hit its peak in early April, fewer than 19,000 people were hospitalized with COVID-19. Some hospitals ran out of beds and were forced to transfer patients elsewhere. Other hospitals had to care for patients in rooms that had never been used for that purpose before. Supplies, medications and staff ran low…
All told, more than 30,000 New York state residents have died of COVID-19. It’s a toll worse than any scourge in recent memory and way worse than the flu, but, overall, the health care system didn’t run out of beds.
Gov. Andrew Cuomo, at a March 22 briefing, displayed a projection that New York could need 110,000 hospital beds. At the peak, fewer than 19,000 were hospitalized with COVID-19.
“All of those models were based on assumptions, then we were smacked in the face with reality,” said Robyn Gershon, a clinical professor of epidemiology at the NYU School of Global Public Health, who was not involved in the models New York used. “We were working without situational awareness, which is a tenet in disaster preparedness and response. We simply did not have that.”
Cuomo’s office did not return emails seeking comment, but at a press briefing on April 10, the governor defended the models and those who created them. “In fairness to the experts, nobody has been here before. Nobody. So everyone is trying to figure it out the best they can,” he said. “Second, the big variable was, what policies do you put in place? And the bigger variable was, does anybody listen to the policies you put in place?”” (A)
“The government’s top infectious disease expert said on Tuesday that the rate of new coronavirus infections could more than double to 100,000 a day if current outbreaks were not contained, warning that the virus’s march across the South and the West “puts the entire country at risk.”
Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, offered the grim prediction while testifying on Capitol Hill, telling senators that no region of the country is safe from the virus’s resurgence. The number of new cases in the United States has shot up by 80 percent in the past two weeks, according to a New York Times database, with new hot spots flaring far from the Sun Belt epicenters.
I can’t make an accurate prediction, but it is going to be very disturbing, I will guarantee you that,” Dr. Fauci said, “because when you have an outbreak in one part of the country, even though in other parts of the country they are doing well, they are vulnerable.”” (B)
“At (Houston’s) Lyndon B. Johnson Hospital on Sunday, the medical staff ran out of both space for new coronavirus patients and a key drug needed to treat them. With no open beds at the public hospital, a dozen COVID-19 patients who were in need of intensive care were stuck in the emergency room, awaiting transfers to other Houston area hospitals, according to a note sent to the staff and shared with reporters.
A day later, the top physician executive at the Houston Methodist hospital system wrote to staff members warning that its coronavirus caseload was surging: “It has become necessary to consider delaying more surgical services to create further capacity for COVID-19 patients,” Dr. Robert Phillips said in the note, an abrupt turn from three days earlier, when the hospital system sent a note to thousands of patients, inviting them to keep their surgical appointments.
And at The University of Texas MD Anderson Cancer Center, staff members were alerted recently that the hospital would soon begin taking in cancer patients with COVID-19 from the city’s overburdened public hospital system, a highly unusual move for the specialty hospital.
These internal messages highlight the growing strain that the coronavirus crisis is putting on hospital systems in the Houston region, where the number of patients hospitalized with COVID-19 has nearly quadrupled since Memorial Day. As of Tuesday, more than 3,000 people were hospitalized for the coronavirus in the region, including nearly 800 in intensive care…
Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance — a bottleneck that’s tying up emergency medical service resources and slowing emergency response times across the region.
Part of the problem, Peña said, is that when his crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it. That’s a problem that’s likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for “crisis response jobs.”…
The crisis in Houston has accelerated rapidly in recent weeks, at times resulting in muddled messaging from both hospital leaders and public officials.
On June 24, several hospital executives affiliated with the Texas Medical Center — a sprawling medical campus that’s home to most of Houston’s major hospital systems — issued a statement warning that COVID-19 hospitalizations were growing at an “alarming rate” and could soon put an unsustainable strain on hospital resources.
But the following day, after Abbott issued an executive order directing hospitals to limit elective surgeries — a measure intended to preserve hospital capacity but one that also hurts hospital revenues — the CEOs of four hospitals in the medical center abruptly dialed back their earlier warnings at a hastily organized news conference. They said they hadn’t meant to alarm the public. The hospitals still had room to add ICU beds, they said, both to treat COVID-19 and to continue caring for other patients.
“I think the Texas Medical Center’s purpose was to really urge people to do the right things in the community, and do so by talking about capacity, but really ended up unintentionally sounding an alarm bell too loudly,” Dr. Marc Boom, president and CEO of Houston Methodist, which is part of the Texas Medical Center, said at the news conference. “We clearly do have capacity.”…
Not all hospitals are equally equipped to respond to a surge in COVID-19 demand, accompanied by a loss of more profitable business, Ho said. Hospital systems like Houston Methodist have “the financial resources to sort of convert anything into an ICU just because they have more money, more cash on hand,” she said.
Houston’s public hospitals, Ben Taub and Lyndon B. Johnson, don’t have those same resources.
“The problem is that, of course, there are going to be more patients who are going to be going to Ben Taub” because the virus is disproportionately affecting Black and Latino people in low-income communities, and Ben Taub is traditionally the safety net for those without health insurance, Ho said. “I don’t know to what extent they are able to send patients to the other hospitals.”” (C)
“The trend is worrying: A sharp increase in patients can once again overwhelm hospitals, putting critical resources including staffing, beds and ventilators in short supply.
Already, some hospitals are so swamped they’ve transferred patients elsewhere. Doctors in parts of Texas report waiting lists for their ICU beds, while others have had to decide which patients to admit, incapable of treating all those seeking help. In other parts of the US, health care professionals are seeing younger and sicker patients and making a simple plea: Wear a mask and stay at home.
The increasing infections come weeks after many states began reopening their economies after extended closures intended to stem the spread of coronavirus…
In Harris County, which encompasses Houston and is the most populous county in Texas, at least two hospitals are “pretty much at maximum capacity,” Houston Mayor Sylvester Turner said Wednesday.
“The threat … Covid-19 poses to our community right now is higher than it has been. There is a severe and uncontrolled spread between our families, friends, and communities,” Turner said. “And we need to slow it down, so that it doesn’t overwhelm our health care delivery system.”
“’We are having an explosion of Covid’
Some local officials and public health administrators are already reporting strained hospital capacity with the latest influx of patients.
In Bexar County, home to San Antonio, officials reported this week the number of hospitalizations continues to rise while hospital capacity has shrunk to a little more than 20%, CNN affiliate KSAT reported.
“We are having an explosion of Covid,” says Adam Sahyouni, a Covid ICU nurse manager at San Antonio’s Methodist Hospital. “We aren’t overrun yet, but it’s overwhelming.”
According to data published by the city of San Antonio, at the beginning of June there were 39 coronavirus patients in the ICU and 20 on ventilators. By June 30, 288 coronavirus patients were in ICUs and 158 on ventilators…
At Methodist Hospital in San Antonio, ICU rooms are packed — and some patients are on a waiting list.
“Yesterday was probably one of my worst days that I’ve ever had,” Dellavolpe said. “I got 10 calls, all of whom (were) young people who otherwise would be excellent candidates to be able to put on ECMO (life support). They’re so sick that if they don’t get put on, they don’t get that support, they’re probably going to die. I had three beds.”
“It’s a level of decision-making that I don’t think a lot of us are prepared for.”” (D)
“As Texas sets records for new COVID-19 cases and hospitalizations day after day, the state’s hospital capacity — one of the key metrics that Gov. Greg Abbott cited as he allowed businesses to reopen — has become the focus of increased attention and concern.
But the state isn’t releasing the information it collects about how many beds individual hospitals have available. And only a fraction of the state’s hospitals, cities and counties are providing that information to the public on their own…
According to data from DSHS, the state had 1,322 available intensive care unit beds and close to 13,000 available hospital beds Wednesday. But there are important regional disparities. The Northeast Texas Regional Advisory Council reported Wednesday that 43% of its hospital beds are in use with 92 ICU beds available, while the East Texas Gulf Coast Regional Advisory Council, which includes nine counties and more than 1.3 million people, is 83% full with only 10 open ICU beds.
Some of the regional advisory councils provide county-level breakdowns of available hospital beds within their boundaries, including the Southeast Texas Regional Advisory Council, which includes Houston.
Many local government and health authorities have opted not to make hospital capacity information public.
“Publicly, we do not share which hospitals are at capacity, because there is constant shifting and we want the hospitals to have the freedom to move resources as needed,” Mark Escott, Austin’s interim public health authority, said in an email.
Dallas County provides daily briefs that include hospitalizations, ICU admissions and emergency room visits — but doesn’t include available hospital capacity — saying local health experts use these key indicators to determine the COVID-19 risk level and the appropriate response.
The Texas Medical Center in Houston, which includes 21 hospitals, used to update daily a set of “early warnings,” including its base intensive care capacity. On June 24, TMC leaders issued a statement warning that patients with COVID-19 were being admitted at an “alarming rate.” The next day, the medical center reported it had reached 100% of ICU base capacity — and then stopped updating that information for almost three days.
During a joint news conference June 25, Houston Methodist CEO Dr. Marc Boom said officials were concerned that the level of alarm was “unwarranted.”
The Houston Chronicle reported that Abbott had expressed displeasure to hospital executives about headlines related to ICU capacity, but Abbott spokesman John Wittman said any insinuation that the governor suggested the executives publish less data is false.
“We were getting panicked calls from elected officials and members of the media saying, ‘You all are out of ICU beds, what are we going to do?’” David Callender, president and CEO of the Memorial Hermann Hospital, told KHOU-TV. “We were not doing a very good job with our slides and portraying how we manage our capacity.”..
Last week, Sarah Eckhardt, the former Travis County judge serving as an adviser to interim County Judge Sam Biscoe, said she was having trouble obtaining information about capacity at local private hospitals. On Tuesday, she said that the county has since received all the information it needs to plan its response to the recent surge in COVID-19 hospitalizations, which reached 369 in Travis County on Tuesday, including 132 people in ICU.
Travis County has a 22.9% positivity rate, a figure “substantially higher than most of the country,” Escott said in a news conference Wednesday. The positivity rate is the ratio of positive cases to the number of tests conducted, and it can vary depending on who is being tested, health experts say. Public testing in the county is being rationed to only people with symptoms.
“I think that it’s pretty plain that if the chief executives of the county and the city are having a hard time getting information about the occupancy levels in the hospitals, then how would you expect the regular individual to know?” Eckhardt said.” (E)
“Over the past week, Dr. Aric Bakshy, an emergency physician at Houston Methodist, had to decide which coronavirus patients he should admit to the increasingly busy hospital and which he could safely send home.
To discuss questions like these, he has turned to doctors at hospitals where he trained in New York City that were overwhelmed by the coronavirus this spring. Now their situations are reversed.
Thumbing through a dog-eared notebook during a recent shift, Dr. Bakshy counted about a dozen people he had treated for coronavirus symptoms. His colleagues in Houston had attended to many more. Meanwhile, friends at Elmhurst Hospital in Queens told him that their emergency department was seeing only one or two virus patients a day.
As Houston’s hospitals face the worst outbreak of the virus in Texas, now one of the nation’s hot zones, Dr. Bakshy and others are experiencing some of the same challenges that their New York counterparts did just a few months ago and are trying to adapt some lessons from that crisis.
Like New York City in March, the Houston hospitals are experiencing a steep rise in caseloads that is filling their beds, stretching their staffing, creating a backlog in testing and limiting the availability of other medical services. Attempts to buy more supplies — including certain protective gear, vital-sign monitors and testing components — are frustrated by weeks of delays, according to hospital leaders.
Methodist is swiftly expanding capacity and hiring more staff, including local nurses who had left their jobs to work in New York when the city’s hospitals were pummeled. “A bed’s a bed until you have a staff,” said Avery Taylor, the nurse manager of a coronavirus unit created just outside Houston in March.
But with the virus raging across the region, medical workers are falling ill. Dr. Bakshy was one of the first at Methodist to have Covid-19, getting it in early March. As of this past week, the number of nurses being hired to help open new units would only replace those out sick.
Methodist, a top-ranked system of eight hospitals, had nearly 400 coronavirus inpatients last Sunday. A week later — even as physicians tried to be conservative in admitting patients and discharged others as soon as they safely could — the figure was 626. The flagship hospital added 130 inpatient beds in recent days and rapidly filled them. Now, administrators estimate that the number of Covid-19 patients across the system could reach 800 or 900 in coming weeks, and are planning to accommodate up to 1,000.
Other Houston hospitals are seeing similar streams of patients. Inundated public hospitals are sending some patients to private institutions like Methodist while reportedly transferring others to Galveston, 50 miles away.
“What’s been disheartening over the past week or two has been that it feels like we’re back at square one,” Dr. Mir M. Alikhan, a pulmonary and critical care specialist, said to his medical team before rounds. “It’s really a terrible kind of sinking feeling. But we’re not truly back at square one, right? Because we have the last three months of expertise that we’ve developed.”
Houston’s hospitals have some advantages compared with New York’s in the spring. Doctors know more now about how to manage the sickest patients and are more often able to avoid breathing tubes, ventilators and critical care. But one treatment shown to shorten hospital stays, the antiviral drug remdesivir, is being allocated by the state, and hospitals here have repeatedly run out of it.
Methodist’s leaders, who were planning for a surge and had been dealing with a stream of coronavirus patients since March, pointed to the most important difference between Houston now and New York then: the patient mix. The majority of new patients here are younger and healthier and are not as severely ill as many were in New York City, where officials report that over 22,000 are likely to have died from the disease.
But so far, the death toll has not climbed much in Texas and other parts of the South and West seeing a surge.
“We are having to pioneer the way of trying to understand a different curve with some very good characteristics versus the last curve,” said Dr. Marc Boom, Methodist’s president and chief executive.
But he cautioned, “What I’m watching really closely is whether we see a shift back in age — because if the young really get this way out there and then start infecting all of the older, then we may look more like the last wave.”
Dr. Sylvie de Souza, head of the emergency department at Brooklyn Hospital Center, which on Friday reported no new coronavirus admissions and no current inpatient cases, said that she was receiving distressing text messages from doctors elsewhere in the country asking for advice. “It’s disappointing,” she said. “It sort of brings me back to the end of March, and it’s like being there all over again.”..
But doctors in Houston are tightening criteria for admission. Dr. Bakshy, the Methodist emergency room doctor, who worked at Bellevue and Mount Sinai in New York, said that he was conferring with his former colleagues.
“We all have questions about who truly needs to be hospitalized versus not,” he said. “If we had unlimited resources, of course we’d bring people in just to make sure they’re OK.”
Now, he said, a patient has to have low oxygen levels or serious underlying conditions “to really justify coming into the hospital,” although exceptions can be made.
Another challenge in New York and Houston has been determining who is infected and needs to be isolated from others. Nearly 40 percent of all emergency room patients at Methodist are now testing positive; some of them lack symptoms.
Because test results are sometimes delayed by more than a day, Dr. Bakshy and his colleagues have had to make their best guesses as to whether someone should be admitted to a ward for coronavirus patients.
Hospitals in New York tended to move patients within their own systems to level loads. In Houston, the wealthier institutions have joined together to aid those least able to expand capacity.
This past week, Methodist sent a team to a nearby public hospital to accept transfer patients. Top officials from Methodist and the other flagship hospitals that make up the Texas Medical Center, normally competitors, consult regularly by phone. They have been coordinating for days with the county’s already overwhelmed safety-net system, Harris Health, taking in its patients. The private institutions have also agreed to take turns, with others in the state, accepting patients from rural hospitals.”..
But doctors, based on the experiences of physicians in New York and elsewhere, are avoiding ventilators when possible and are maintaining Ms. Hernandez on a high flow of oxygen through a nasal tube. She is on the maximum setting, but can talk to the clinical team and exchange text messages with her daughter, who is also a Methodist inpatient with the coronavirus…
Methodist was part of two remdesivir trials. But because the research has ended, it and other hospitals now depend on allotments of the drug from the state. As virus cases increased, the supplies ran short, said Katherine Perez, an infectious-disease specialist at the hospital. “In Houston, every hospital that’s gotten the drug, everyone’s just kind of used it up,” she said.
The hospital received 1,000 vials, its largest batch ever, a little over a week ago. Within four days, all the patients who could be treated with it had been selected, and pharmacists were awaiting another shipment.
A new chance to test remdesivir in a clinical trial in combination with another drug may provide some relief. As cases rise, Methodist researchers are being flooded with offers to participate in studies, with about 10 to 12 new opportunities a week being vetted centrally. Without solid research, “your option is to do a bunch of unproven, potentially harmful, potentially futile, interventions to very sick people who are depending on you,” said Dr. H. Dirk Sostman, president of Methodist’s academic medicine institute.
Dr. Boom, the Methodist chief executive, said if he could preserve one thing from the New York experience in March, it would be how the country came together as it had in previous disasters.” (F)
“Houston Health Department Health Authority Dr. David Persse said the city had reached a 25% positivity rate.
“The virus is very prevalent in the community,” Persse said, adding that there were more than 1,200 people in Houston hospitals with more than 500 of them in the ICU due to complications from the coronavirus. “The virus is very much out there,” Persse said, “It’s very much actively spreading.”
Texas is expected to see nearly 2,000 new hospitalizations per day by mid-July, according to forecasts published by the Centers for Disease Control and Prevention.
In Harris County, which encompasses Houston and is the most populous county in Texas, at least two hospitals are “pretty much at maximum capacity,” Turner said Wednesday.
“The threat … Covid-19 poses to our community right now is higher than it has been. There is a severe and uncontrolled spread between our families, friends, and communities,” Turner said. “And we need to slow it down, so that it doesn’t overwhelm our health care delivery system.”
On Friday, Texas reported a third day of new Covid-19 cases topping 7,000, according to state health department data.
It reported 7,555 cases Friday, continuing the trend of sharp growth of the disease in the state, with a record 8,076 new cases on Wednesday and 7,915 new cases Thursday, according to state data.
Texas also reported 50 new deaths from Covid-19 Friday. John Hopkins data puts the number of confirmed cases in the state at 185,591, with 2,592 deaths.
The virus has killed more than 129,000 people and infected over 2.7 million in the US since the pandemic started, according to Johns Hopkins University.” (G)
“For one brief, delusional moment in early April, I felt a smidgen of support for my governor, Greg Abbott. Sure, part of me thought his plan to reopen the state after just a few weeks of lockdown was cuckoo. Medical experts warned of a surge in coronavirus cases if Texas did just that…
But while New York and Washington were in crisis, the number of cases and deaths here remained remarkably low. Maybe Texas was being spared because of a lack of density in our cities or because people drove alone in their cars instead of cramming into subways. Maybe our already rising temperatures were killing off the virus.
Maybe, in contrast to the yahoo stereotype, most Texans were wearing masks, socially distancing and washing their hands and so had actually headed the virus off at the pass, or dodged the bullet, or whatever people think we like to say down here.
And maybe for those reasons, Mr. Abbott became infatuated with the idea that Texas would be among the first states to reopen. As he said, Texans needed to get back to work. That was indisputable. The food bank near my house was already overwhelmed with the unemployed and hungry.
Yes, Dr. Peter Hotez, Houston’s internationally known virus expert, warned of the dangers of opening early, but what did he know? The guy wears a bow tie…
On Memorial Day, the Galveston beaches were packed like Carnival in Rio. And out in rural Texas, folks who had no choice were working away in meat-processing plants. Businesses like Target and Wal-Mart welcomed shoppers without masks as if it were Black Friday.
As we now know, that was then. “Ten days away,” a friend who works for Judge Hidalgo told me the night before the June 2 march for George Floyd downtown, when police helicopters were circling over our socially distanced dinner party — 10 days before we would start to see the cases really spike.
That date coincided with the arrival of Mr. Abbott’s Phase 3, which allowed many businesses to reopen at 75 percent capacity on June 12. Shortly after that, the numbers exploded.
The governor knew better than to blame better testing for the increase, because we don’t have enough testing. Instead, he blamed those rowdy millennials: “There are certain counties where a majority of the people who are tested positive in that county are under the age of 30, and this typically results from people going to bars,” he said.
But, no worries, the governor added; Texas still has plenty of hospital beds. And today, we have more than 130,000 cases, up from over 60,000 at the end of May.
And so, here we are, with a jittery populace and the Texas Medical Center’s coronavirus website competing with TikTok. I.C.U.s in Houston are at 97 percent capacity, with “unsustainable surge capacity” predicted for hospital beds in late July. If “this trajectory persists,” Dr. Hotez tweeted, “Houston would become the worst-affected city in the U.S.” He added that it would “maybe rival what we’re seeing now in Brazil.”..
Now with the numbers climbing, Mr. Abbott has taken the bold step of hitting the pause button on future reopenings, allowing local officials to limit outdoor events to 100 people (down from 500), closing bars and suspending elective surgeries in some counties to save potentially needed bed space. But mainly his advice is just to stay put, which has become easier since New York, New Jersey and Connecticut are now requiring Texans to quarantine for 14 days upon arrival.
“We want to make sure that everyone reinforces the best safe practices of wearing a mask, hand sanitization, maintaining safe distance, but importantly, because the spread is so rampant right now, there’s never a reason for you to have to leave your home,” Mr. Abbott said in a recent interview. Unless you do need to go out, the safest place for you is at your home.”
In other words, we are all in this together. But we are also completely and totally on our own.” (H)
“In Queens, the borough with the most coronavirus cases and the fewest hospital beds per capita, hundreds of patients languished in understaffed wards, often unwatched by nurses or doctors. Some died after removing oxygen masks to go to the bathroom.
In hospitals in impoverished neighborhoods around the boroughs, some critically ill patients were put on ventilator machines lacking key settings, and others pleaded for experimental drugs, only to be told that there were none available.
It was another story at the private medical centers in Manhattan, which have billions of dollars in endowments and cater largely to wealthy people with insurance. Patients there got access to heart-lung bypass machines and specialized drugs like remdesivir, even as those in the city’s community hospitals were denied more basic treatments like continuous dialysis.
In its first four months in New York, the coronavirus tore through low-income neighborhoods, infected immigrants and essential workers unable to stay home and disproportionately killed Black and Latino people, especially those with underlying health conditions.
Now, evidence is emerging of another inequality affecting low-income city residents: disparities in hospital care.
While the pandemic continues, it is not possible to determine exactly how much the gaps in hospital care have hurt patients. Many factors affect who recovers from the coronavirus and who does not. Hospitals treat vastly different patient populations, and experts have hesitated to criticize any hospital while workers valiantly fight the outbreak.
Still, mortality data from three dozen hospitals obtained by The New York Times indicates that the likelihood of survival may depend in part on where a patient is treated. At the peak of the pandemic in April, the data suggests, patients at some community hospitals were three times more likely to die as patients at medical centers in the wealthiest parts of the city…
Inequality did not arrive with the virus; the divide between the haves and the have-nots has long been a part of the web of hospitals in the city.
Manhattan is home to several of the world’s most prestigious medical centers, a constellation of academic institutions that attract wealthy residents with private health insurance. The other boroughs are served by a patchwork of satellite campuses, city-run public hospitals and independent facilities, all of which treat more residents on Medicaid or Medicare, or without insurance.
The pandemic exposed and amplified the inequities, especially during the peak, according to doctors, nurses and other workers.” (I)
“Dr. Anthony S. Fauci, the nation’s top infectious disease expert, warned on Monday that the country was still “knee-deep in the first wave” of the pandemic, as U.S. deaths passed 130,000 and cases neared three million, while Texas and Idaho set daily records for new cases, according to a New York Times database.
Dr. Fauci said that the more than 50,000 new cases a day recorded several times in the past week were “a serious situation that we have to address immediately.”..
“I would say this would not be considered a wave,” Dr. Fauci said. “It was a surge, or a resurgence of infections superimposed upon a baseline that really never got down to where we wanted to go.”..
Dr. Fauci compared the United States unfavorably with Europe, which he said was now merely handling “blips” as countries move to reopen. “We went up, never came down to baseline, and now it’s surging back up,” Dr. Fauci said.” (J)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
“Contact tracing occurs when trained personnel contact infected people to investigate where they might have been infected and who they might have exposed to the virus. Along with widespread testing and ability to isolate potentially infectious people, tracing is an age-old public health intervention now being ramped up at an unprecedented scale.
“It’s not going well. I have to tell you, it’s not going well,” Fauci said in an interview with CNBC’s Meg Tirrell that was aired by the Milken Institute. “What we need to do is we need to rethink, and we are right now, the idea of many more tests getting into the community and even pooling tests.”
The White House advised states not to reopen until they had built the infrastructure to conduct widespread testing and contact tracing, though the federal government did not specify what a robust tracing infrastructure would look like. Rather than developing a coordinated national tracing plan, which some countries, such as Germany, have done, the Centers for Disease Control and Prevention has sought instead to support local efforts.
Earlier this week, CDC Director Dr. Robert Redfield testified that about 27,000 or 28,000 people are doing contact tracing work across the country. He later acknowledged that he estimates the necessary workforce to be about 100,000 tracers. Former CDC Director Dr. Tom Frieden thinks the country will need even more, up to 300,000.
“To just say you’re going to go out and identify, contact trace and isolate, that doesn’t mean anything until you do it,” Fauci said. “Not checking the box that you did it, but actually do it. Get people on the ground. Not on the phone. When you identify somebody, have a place to put them to get them out of social interaction.”
The CDC has allocated more than $10 billion for states to ramp up testing, tracing and isolation, but Fauci said he doesn’t see local officials making the kind of progress he’d like to see. He added that some states have done well in ramping up their programs. Getting more jurisdictions to do that work in preparation for the fall, when Fauci said he expects cases to surge again, will be key.
“When the fall comes, we better be ready that there will be surges in cases, and as I’ve said so many times now for months, we have a few months to prepare for that,” he said. “So when that happens, we have to be able to do the proper and effective way of identification, isolation and contact tracing.”” (A)
“Government virus expert Anthony Fauci told reporters in a press briefing on Friday that contact tracing efforts to contain the coronavirus are “not working.”
Why it matters: Without a vaccine, contact tracing of cases is the best tool available to stem the spread of an outbreak. But understaffed public health agencies, privacy concerns, disappointing technology, and the sheer size of the pandemic are limiting the technique’s effectiveness.
By the numbers: The public health standard is that a state should have at least 30 contract tracers — public health employees dedicated to investigating the contacts of positive cases — for every 100,000 people during a pandemic. According to a June 25 report by Nephron Research, however, just seven states have met that standard.
Another seven have near-term plans to sufficiently increase contact tracing capacity.
Even those states that have sufficiently beefed up their contact tracing systems are struggling to get people who have tested positive to report whom they were in contact with — or, in some cases, to even pick up the phone.
New York state currently has nearly 50 tracers per 100,000 people, the most in the U.S. But in New York City, long the epicenter of the pandemic, contact tracers were only able to successfully complete an interview with about half of all positive cases between June 1 and June 20.
That’s well below the 75% rate public health experts say is needed to keep an outbreak contained.
The situation is worse in other hard-hit cities like San Antonio, which has only received responses from about 300 of the 2,500 cases currently under review.
Context: The U.S. has had great success in the past controlling diseases like HIV and tuberculosis through contact tracing. But COVID-19 would present enormous challenges to even a well-funded and well-staffed national contact tracing effort — which the U.S. assuredly does not have.
Unlike tracing the spread of STDs, where contacts can be narrowed down to sexual partners, COVID-19 requires tracers to quiz a positive case for everyone they may have come into contact with, even for a relatively short period of time.
Early hopes that app-based smartphone contact tracing might help have largely gone unfulfilled….
The bottom line: More than four months after the first recorded U.S. COVID-19 cases, the virus is still outpacing our ability and willingness to track it.” (B)
“Dr. Anthony Fauci, the nation’s top infectious disease expert, said Friday that contact tracing simply isn’t working in the U.S.
Some who test positive don’t cooperate because they don’t feel sick. Others refuse testing even after being exposed. Some never call back contact tracers. And still others simply object to sharing any information.
Another new challenge: More young people are getting infected, and they’re less likely to feel sick or believe that they’re a danger to others.
While older adults were more likely to be diagnosed with the virus early in the pandemic, figures from the Centers for Disease Control and Prevention show that the picture flipped almost as soon as states began reopening. Now, people 18 to 49 years old are most likely to be diagnosed…
“Right now we have an insufficient capacity to do the job we need to,” Arkansas Gov. Asa Hutchinson said recently, announcing he wanted to use federal coronavirus relief funds to increase the number of contact tracers to 900.
Arkansas already has 200 doing the job, but infections have risen more than 230% and hospitalizations nearly 170% since Memorial Day. Businesses that had closed because of the virus were allowed to reopen in early May, and the state further eased its restrictions this month.
In addition to needing more staff to handle rising case numbers, contact-tracing teams also must build trust with people who might be uneasy or scared, said Dr. Umair Shah, executive director for Harris County Public Health in Houston, where an outbreak threatens to overwhelm hospitals.
That’s difficult to do if infected people don’t return calls…
Perry N. Halkitis, dean of the Rutgers School of Public Health, said COVID-19 spreads so fast that contact tracers need to get in touch with 75% of the potentially exposed people within 24 hours of their exposure to successfully combat the spread…
Contact tracing is key to avoiding worst-case outcomes, said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention and current president and CEO of Resolve to Save Lives, a nonprofit that works to prevent epidemics. But the explosion of U.S. cases has made it nearly impossible for even the most well-staffed health departments to keep up, he said.
Contact tracing is “a tried and true public health function,” Frieden said. “If the health department calls, pick up the phone.” (C)
“Dr. Anthony Fauci, the nation’s top infectious diseases expert, raised a question Friday as to whether contact tracing is even worth the endeavor. And in Texas, a health official in Austin revealed this week that information about hundreds of new cases is pouring in daily across the state via an archaic form of technology: the fax machine.
That has made the confirmation of positive cases extremely time-consuming, the official said, which in turn has hindered contact tracing, a labor-intensive commitment that involves calling people who are confirmed ill with COVID-19, asking for their recent contacts and reaching out to those people to determine if they need testing and if they should self-isolate, all in the hopes of breaking the chains of infection.
“The cases we receive come in by fax machine,” Dr. Mark Escott, the interim medical director and health authority for Austin Public Health, told Travis County commissioners. “And sometimes those faxes are positives and sometimes they’re negatives. Sometimes they have information like the person’s phone number that was tested and sometimes they don’t. So we have a whole team of people who have to sort through more than a thousand faxes a day to sort out the positives versus the negatives.”
The system remains a “very manual and archaic process,” he added, because nearly all of the labs and the hospitals in the state report coronavirus cases through fax, and those results must then be manually entered into a computer…
“Right now, what happens when you call somebody that’s a positive and ask where they’ve been over the past week, they’ve been everywhere. They’ve been at grocery stores and restaurants and bars and friends’ houses. They’ve had contact with hundreds of people,” he said at a news conference Wednesday. “Contact tracing in that circumstance is not going to be as effective. So that’s why we’re asking people not to depend on contact tracing at this stage of the outbreak.”
Since the beginning of the coronavirus pandemic, public health experts and Democratic lawmakers have been vocal about the need for local and state health agencies to perform contact tracing, in addition to ramping up of testing for COVID-19, the disease caused by the coronavirus.
But a lack of consistent messaging from the White House, the Trump administration’s apparent delay in distributing billions of dollars in funding appropriated by Congress in April for testing and tracing, and the woefully inadequate number of contact tracers needed nationwide to appropriately handle the growing caseload have derailed the efforts to create a robust tracing program, experts add…
Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, which released a report in April estimating the need to hire 100,000 contact tracers as part of a nationwide workforce, said there’s been a noticeable lack of a “top level embrace of contact tracing.”
While she said she’s “heartened” by states and local health agencies that moved to ramp up contact tracing efforts ahead of reopening their economies, including in Massachusetts and New York, she is “disheartened by the lack of support from our federal government on this.”” (D)
“Kimberly Jocelyn graduated from college last month as millions across the country sheltered in place to avoid the coronavirus pandemic. Looking for a pandemic-friendly way to connect with her community, she applied to be a New York City contact tracer.
After a FaceTime interview with New York City Health + Hospitals’ test and trace corps and a six-hour online course through Johns Hopkins University, Jocelyn joined the city’s team of roughly 3,500 in the effort to contact those who have tested positive for Covid-19 and identify who they might have exposed to the virus.
The work is crucial to cutting off chains of infection before they balloon into outbreaks. Along with social distancing and mask wearing, contact tracing is one of the only proven strategies in containing the coronavirus. It’s also difficult work, Jocelyn said, and it’s nonstop.
“My first call was with someone who was confused about how they contracted the virus,” she said, adding that it takes compassion and patience to do the job well. “We’re here to provide information about Covid, understand how they contracted Covid, and also to understand how they are, to see if they need any resources.”
Jocelyn, who’s now a supervisor of about 15 other tracers, said ideally, a tracer comes out of one of those conversations with contact information for family members, co-workers and anyone else who might have been exposed. Throughout a given day, a tracer on her team will contact between 30 and 50 people, tracking the virus around the city and trying to corner it off into identified chains of people…
“If you’re not doing mitigation, so closing things down, implementing social distancing, once you stop doing that, the only tool you have to keep people from transmitting to each other is contact tracing, isolation and quarantine,” said Dr. Karen Smith, former director of the California Department of Public Health. “It’s the only tool you’ve got and it’s a tool that works really well when adequately staffed.”” (E)
“New York City’s ambitious contact-tracing program, a crucial initiative in the effort to curb the coronavirus, has gotten off to a worrisome start just as the city’s reopening enters a new phase on Monday, with outdoor dining, in-store shopping and office work resuming.
The city has hired 3,000 disease detectives and case monitors, who are supposed to identify anyone who has come into contact with the hundreds of people who are still testing positive for the virus in the city every day. But the first statistics from the program, which began on June 1, indicate that tracers are often unable to locate infected people or gather information from them.
Only 35 percent of the 5,347 city residents who tested positive or were presumed positive for the coronavirus in the program’s first two weeks gave information about close contacts to tracers, the city said in releasing the first statistics. The number ticked up slightly, to 42 percent, during the third week, Avery Cohen, a spokeswoman to Mayor Bill de Blasio, said on Sunday.
Contact tracing is one of the few tools that public health officials have to fight Covid-19 in lieu of a vaccine, along with widespread testing and isolation of those exposed to the coronavirus. The early results of New York’s program raise fresh concerns about the difficulties in preventing a surge of new cases as states across the country reopen.
The city has successfully done contact tracing before, with diseases like tuberculosis and measles. But as with much involving the coronavirus outbreak, officials have never faced the challenge at this scale, with so many cases across the five boroughs.
The city’s program has so far been limited by a low response rate, scant use of technology, privacy concerns and a far less sweeping mandate than that in some other countries, where apartment buildings, stores, restaurants and other private businesses are often required to collect visitors’ personal information, which makes tracking the spread easier…
Perry N. Halkitis, dean of the School of Public Health at Rutgers University, which is guiding an effort to bring on thousands of tracers in New Jersey, called New York City’s 35 percent rate for eliciting contacts “very bad.”
He suggested that the poor showing stemmed in part from the inexperience of the contact tracers and insufficient hands-on training.
“This is a skill,” he said. “You need to practice.”” (F)
“For Lauri Jones, the trouble began in early May. The director of a small public health department in Washington state was working with a family under quarantine because of coronavirus exposure. When she heard one family member had been out in the community, Jones decided to check in.
The routine phone call launched a nightmare.
“Someone posted on social media that we had violated their civil liberties [and] named me by name,” Jones recalled. “They said, ‘Let’s post her address. . . . Let’s start shooting.’ ”
People from across the country began calling her personal phone with similar threats.
“We’ve been doing the same thing in public health on a daily basis forever. But we are now the villains,” said Jones, 64, who called the police and set up surveillance cameras at her home.
Public health workers, already underfunded and understaffed, are confronting waves of protest at their homes and offices in addition to pressure from politicians who favor a faster reopening. Lori Tremmel Freeman, chief executive of the National Association of County and City Health Officials, said more than 20 health officials have resigned, retired or been fired in recent weeks “due to conditions related to having to enforce and stand up for strong public health tactics during this pandemic.”
Although shutdown measures are broadly popular, a vocal minority opposes them vociferously. There have been attacks on officials’ race, gender, sexual orientation and appearance. Freeman said some of the criticisms “seem to be harsher for women.”
Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials, said attacks on health officials have been particularly awful in California, Colorado, Georgia, Ohio and Pennsylvania.
This month in California, Nichole Quick, Orange County’s chief health officer, stepped down after she faced threats and protests at her home for requiring face coverings in many businesses as cases rose. The mandate, issued May 23, was softened to a recommendation a week later.
Andrew Noymer, a professor of public health at the University of California at Irvine who is part of a county task force, said it was not the first time Quick had been undermined.
On March 17, Quick issued a strict lockdown order; a day later, it was amended to add exceptions.
“It was couched as a clarification, but it was a walk-back” because of pressure from business leaders, Noymer said.
Quick’s departure is part of an exodus of public health officials across the country who have been blamed by citizens and politicians for the disruptions caused by the coronavirus pandemic.” (G)
“Germany, a country of more than 83 million people, has flattened its coronavirus curve, dropping from a peak of more than 6,000 new cases a day to just around 600 now. Contact tracing by telephone is one tool the country has relied on.
“Public Health Authority, Pankow,” says an operator, answering her phone before the first ring is over and identifying the Berlin district where she works. “So,” she confirms with the caller, “you’ve had contact with someone who’s tested positive.”
She asks for the name of the infected person, types it into her computer, and the caller’s name appears on her screen as someone the contact tracers were about to call.
“Did you spend more than 15 minutes at close contact with this person?” the operator asks. The caller tells her they went for a walk.
Across Germany, there are about 400 call centers like this one, each filled with dozens of operators fielding calls from worried citizens, taking first steps at contact tracing and referring callers to medical personnel…
Merkel aims for the country to have one tracer per 4,000 people — nearly 21,000 tracers for Germany’s population of 83 million.
“We’ve recruited staff from other district authorities, including social services, but we also have traffic wardens and librarians working for us,” says Dr. Uwe Peters, director of the Pankow district health authority. “We’ve even recruited gardeners from parks and recreation. They all help man the hotline. We also have students helping out and we’re about to be allocated five soldiers as well.”..
“One teacher had contact with 400 students,” says Krummacher. “It could also be a midwife working at the hospital, having close contact to many, many women. There are all sorts of constellations.”” (H)
“John Welch, a nurse anesthetist with the nonprofit Partners in Health, was working at a clinic on the rural central plateau of Haiti when, in August of 2014, he got a call asking if he could fly to Liberia…
Liberia, a nation of five million people, eventually employed as many as ten thousand tracers. Welch recalled that, after he had been in the region for eight months, “if you told me there would be an outbreak in a particular region, I could tell you which village. If you told me the village, I could tell you which house.” … He told me, “I think we are at a similar point with covid-19 to where we were with Ebola when I first arrived in Monrovia.”..
Many states have also launched contact-tracing programs without what P.I.H. considers one of the most vital components—the care-resource coördinators who help solve the problems, like a need for food or medicine, that keep people from isolating. Mike Reid, an infectious-disease doctor at the University of California, San Francisco, who is helping design the city’s contact-tracing program, said that there was an active debate over whether to include care-resource coördinators. Reid believes that the role is “absolutely critical,” he told me, but because of funding concerns it was likely to be cut from the San Francisco program. “We’ve had plenty of states get on the phone with us, and you get to the care-resource-coördination part, and you can just see their eyes glaze over,” one P.I.H. staffer told me. “Like, ‘Wait, these aren’t contact tracers? Why do we have to pay for this again?’ ”
The answer, at least for the P.I.H. staffers, was that, without helping people to isolate, you would never persuade them to do so. The full contact-tracing process is “the bulwark of how we will reopen,” as George Rutherford, an epidemiologist at U.C.S.F., who is also working on California’s statewide program, put it. But contact tracing can’t easily solve the problems that are typical in the places where outbreaks tend to occur—prisons, nursing homes, and protests—or the policies that help determine who stays home and who doesn’t. What it has to offer, to try to insulate communities from the virus, is the attention of individual people: tracers, investigators, resource coördinators. The more of them you have, the better the odds…”” (I)
“But everywhere you look, tech has failed to deliver. In France, less than 3% of the population has downloaded StopCovid. The U.K. missed an initial rollout deadline and has chosen to start over using another platform. Tracing apps in the U.S. have been caught in a social media war about whether virus news is real or fake, while Australia’s COVIDSafe hasn’t detected a single case despite 6 million downloads. Singapore’s TraceTogether was an early entrant, but even its government began distributing portable tokens this week to complement the app. The one nation with a modicum of success has been China, but only because authorities made the technology mandatory and imposed privacy practices that would be unacceptable elsewhere.
The value of contact-tracing apps is “really questionable,” says Sean McDonald, a senior fellow at the Centre for International Governance Innovation, an independent think tank based in Canada. “The underlying science of proximity as a good indicator of infection relies on a whole bunch of other variables, like whether or not you’re wearing a mask, or whether or not you’re outside.”
Contact-tracing apps use smartphones to track a person’s whereabouts, alerting users if they’ve been in contact with someone who’s had the disease. They’re designed to help supplement the traditional, labor-intensive approach to contact tracing, which involves hundreds of people interviewing those who have been exposed and painstakingly piecing together information about what they did and who they may have come into contact with. In the absence of a vaccine, digital technology was seen as critical for getting people back to work faster and economies up and running…
One of the biggest issues is making sure there’s a critical mass of people signing up. The apps, most of which are voluntary, need a significant number of users if they’re ever going to be effective. A University of Oxford study published in April and based on a simulation of an urban population of 1 million found virus transmission could be suppressed if at least 80% of smartphone users—which amounts to about 56% of all people—participated. That’s a very high number. Even in Singapore, which has a largely compliant populace used to following government orders, only 35% of people have downloaded the app, among the highest take-up rates in the world….
Vivian Balakrishnan, the minister in charge of Singapore’s Smart Nation Initiative, said in a Facebook post that “we need to entrust human contact tracers with information during this crisis.” Contact tracing “remains a human endeavor requiring human judgment,” he said.” (J)
“As countries search for ways to exit lockdown and avoid or manage a second wave of covid-19 cases, many have turned to the promise held by contact-tracing apps. In a rare display of collaboration, Apple and Google recently joined forces to help the technology work effectively…
The principle behind contact-tracing apps is fairly simple. Once installed, they use Bluetooth low-energy (LE) technology to record when a phone has come into close proximity with anyone else using the app. If either person later reports coronavirus symptoms, the other party is notified, so they could self-isolate or seek health advice. An alert could also be sent if a medical authority certifies the other person tested positive for the virus – this would be one way to avoid users trolling the system by falsely claiming symptoms. In theory, the apps work anonymously and only store data temporarily, without collecting location…
There are a host of other questions. Key elements will be the level of trust between citizens and governments, how privacy is preserved, keeping the apps voluntary, and how to also protect people who might not have a smartphone or the ability to install an app – a group that is likely to include many vulnerable older people. The American Civil Liberties Union yesterday laid out a list of principles, including the need for an exit strategy for such apps, to avoid such systems being maintained for “surveillance creep” after an epidemic has passed.
Nevertheless, many countries are on the verge of deploying apps. Germany is expected to release one imminently, and Australia is working on one too. One of the most high profile existing apps has been Singapore’s TraceTogether app, built by the city state’s government. But even its creators admit that it is too early to tell how effective it is. Moreover, “every country will have to develop its own app” because of different situations and requirements, says a spokesperson at Pan-European Privacy-Preserving Proximity Tracing, a European technology initiative…
However effective the apps turn out to be, they cannot be a silver bullet for exiting social distancing measures, and must be part of a much broader effort of testing and contact tracing.” (K)
“As Texas becomes a national hot spot for the new coronavirus, the state is still falling short on the governor’s months-old goal to employ up to 4,000 contact tracers — and the number of virus detectives dropped recently when the state health agency reassigned hundreds of state workers.
Earlier this month, 400 Texas Department of State Health Services employees who had been temporarily assigned to contact tracing were directed to other roles, including other COVID-19 response jobs, because there were sufficient personnel to track all the cases they were covering, spokesperson Lara Anton said…
Now, about 2,800 contact tracers are at work in Texas, even as the state has routinely reported more than 5,000 new COVID-19 cases each day. In early June, the state’s contact tracing workforce numbered about 2,900, and it reached almost 3,200 later in the month before dropping again…
But experts say that a state with 29 million people where cases are climbing at an alarming rate needs as big a workforce as it can muster.
And health officials in some of Texas’ biggest cities — some of whom have already asked the state for assistance — said they are struggling to keep pace with contact tracing as cases skyrocket. Of the state’s 2,800 contact tracers, 1,250 are working in local health departments, Anton said…
And in a state where more than a third of residents speak a language other than English at home, just 112 of the state’s 2,800 contact tracers have indicated that they are Spanish speakers, according to the state heath agency. Tracers who speak only English have access to a translation service that helps reach more individuals, but that could mean each call takes twice as long, experts said.” (L)
“Imagine being given a list of 23 people and told that you need to track down and contact every person that each of those 23 people has come into contact with in the last two weeks. Time is of the essence because those contacts may have been exposed to COVID-19.
With nearly 50,000 newly confirmed cases of the coronavirus in Florida in the last seven days, that’s the one-week caseload for each of the state’s 2,200 contact tracers. And their caseload continues to grow.
According to the National Association of County and City Health Officials, during a pandemic, about 30 contact tracers are needed for every 100,000 people. The latest data show there are only eight states that meet the threshold.
In order for Florida to meet the same threshold, it would need to nearly triple its workforce to around 6,500 contact tracers.” (M)
“The Ingham County Health Department is asking patrons who visited Harper’s Restaurant & Brew Pub between June 12 and June 20 to self-quarantine and report cases of Covid-19, the department said in a statement…
Of the more than 100 positive cases, 12 are from secondary transmission, Ingham County Health Officer Linda S. Vail said Monday night…
“Our oversight of the line on our stairs has been successful, but trying to get customers to follow our recommendations on the public sidewalk has been challenging,” the statement read. “Because we have no authority to control lines on public property, we are left with the dilemma of staying open and letting this situation continue, or closing until we can devise a strategy that eliminates the lines altogether.”
The bar opted to close down temporarily to install air purifiers and to eliminate lines, according to the statement.” (N)
H.How Germany Staffed Up Contact Tracing Teams To Contain Its Coronavirus Outbreak, by ROB SCHMITZ,https://www.npr.org/sections/health-shots/2020/06/22/880803278/how-germany-staffed-up-contact-tracing-teams-to-contain-its-coronavirus-outbreak
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
“The number of new U.S. cases this last week surged dangerously high, to levels not ever seen in the course of the pandemic, especially in states that had rushed to reopen their economies. The result has been a realization for many Americans that however much they have yearned for a return to normalcy, their leaders have failed to control the coronavirus pandemic. And there is little clarity on what comes next.”
“At least five states Friday reported single-day records of Covid-19 cases, adding to the growing concern over case tally spikes that has sent many states backpedaling on their reopening plans.”
“In the White House coronavirus task force’s first press conference in two months on Friday, Vice President Mike Pence stuck to happy talk and falsely claimed that the United States had “flattened the curve” as new cases rise.
Pence, who once said the US’s coronavirus outbreak would be “behind us” by Memorial Day, described the nation’s testing and prevention efforts as “a national accomplishment” and expressed optimism while acknowledging a “precipitous” increase in cases in the South.
Less than 24 hours before Pence’s appearance on Friday, the US reported more than 39,000 new COVID-19 cases, a record single-day increase.
Pence attributed the rise in reported cases to increased testing. “We want the American people to understand that it’s almost inarguable that more testing is generating more cases,” Pence said.
But medical experts and high-profile figures like Bill Gates have pushed back on that claim, citing a rise in the percentage of positive tests as evidence that increased testing alone is not inflating the number of new cases.
Even the director of the Centers for Disease Control and Prevention, Robert Redfield, acknowledged on Thursday that the actual number of COVID-19 infections was likely 10 times what the test results indicated.
Pence claimed that the US had flattened the curve, though new daily cases have increased in recent weeks.
Pence was flanked by Dr. Anthony Fauci and Dr. Deborah Birx, who have recently been less visible at White House events — they were appearing in their official capacity on the task force on Friday for the first time in two months.
Fauci and Birx wore masks, while Pence did not. (A)
“At least five states Friday reported single-day records of Covid-19 cases, adding to the growing concern over case tally spikes that has sent many states backpedaling on their reopening plans.
Florida, Georgia, Idaho, Tennessee and Utah all reported their highest-ever daily caseloads, according to their state’s health departments. And Florida, seen possibly as the next US epicenter, beat that record again Saturday with 9,585 cases.
And it is not just those states seeing rising numbers. The national number of daily coronavirus case reports reached a new high Friday as well, at almost 40,000, according to data from Johns Hopkins University, and 32 states are seeing the number of new cases grow from the prior week.
But the governor of Texas, the nation’s second most populous state, “paused” his state’s phased reopening plan and ordered further restrictions on businesses including bars.
And at least nine other states have announced they are not moving ahead to their next reopening phases: Arizona, Arkansas, Delaware, Idaho, Louisiana, Maine, Nevada, New Mexico and North Carolina.
Metropolitan areas across the US seeing exponential growth in cases means the nation will likely see a “dramatic increase” in the virus’ trajectory, Dr. Peter Hotez, a professor and dean of tropical medicine at Houston’s Baylor College of Medicine told CNN.
“At least in the metro areas, we’ve got people wearing masks now, the bars are closed and we’ve got some advocacy coming out of the county judge and the mayor,” he said of Texas. “I don’t know how much this will really slow this incredibly aggressive rise. It’s like trying to stop a train coming down the tracks.” (B)
“Pence boasted that “we flattened the curve” — though the curve for the number of new confirmed cases has headed sharply upward again in June after a decline and then plateau in April and May.
Pence said that “what we’re observing today” in Sun Belt states is that many young people who “have no symptoms” are testing positive — though Texas, Arizona, and Florida communities willing to report data keep hitting new highs for people with symptoms serious enough that they need to be hospitalized.
Pence described the Sun Belt situation as particular “outbreaks” occurring in “specific counties” and “specific communities” — declining to emphasize that, as expert Dr. Peter Hotez noted on CNN after the briefing, the places experiencing a “massive resurgence” include some of the most populous counties in the country.
“This is a tragedy, and what’s more, it’s not presented as a tragedy — it’s presented as, ‘We’re doing a pretty good job and now there are a couple of hotspots.’ These are not ‘hotspots’ — these are the largest metropolitan areas in the United States,” said Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas.
Pence also claimed that “all 50 states” are “opening up safely and responsibly” — even though about 30 states were experiencing increases in the rate of new cases, and though states reopened without having met the administration’s recommended safety milestones.
And Pence claimed that “to one extent or another, the volume of new cases coming in is a reflection of a great success in expanding testing across the country” — yet many states are seeing rising percentages of positive tests, which are indicative of genuinely rising levels of infection in the community.” (C)
“…..Dr. Anthony S. Fauci, the country’s top infectious diseases expert, also warned that outbreaks in the South and West could engulf the country…
European Union officials said the bloc was ready to bar most travelers from the U.S. and other countries considered too risky because they have not controlled the outbreak.
And for the first time, some U.S. governors were backtracking on reopening their states, issuing new restrictions for parts of the economy that had resumed.” (D)
“The shifting assessments of the nation’s handling of the virus stretched to the highest levels of the federal government, where Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, made clear that the standard approach to controlling infectious diseases — testing sick people, isolating them and tracing their contacts — was not working. The failure, he said, was in part because some infected Americans are asymptomatic and unknowingly spreading the virus but also because some people exposed to the virus are reluctant to self-quarantine or have no place to do so.
In a brief interview on Friday, he said officials were having “intense discussions” about a possible shift to “pool testing,” in which samples from many people are tested at once in an effort to quickly find and isolate the infected.
Dr. Fauci also issued an urgent warning that while coronavirus infections were spiking mostly in the South, those outbreaks could spread to other regions…
From Miami to Los Angeles, mayors were contemplating slowing or reversing their plans to return cities to public life. On Friday, San Francisco announced it was delaying plans to reopen zoos, museums, hair salons, tattoo parlors and other businesses on Monday, citing a spike in new cases. “Our numbers are still low but rising rapidly,” Mayor London Breed wrote on Twitter, adding, “I know people are anxious to reopen — I am too. But we can’t jeopardize the progress we’ve made.”
Mayor Carlos Gimenez of Miami-Dade County said late Friday that he would sign an emergency order closing beaches from July 3 to July 7, citing the surge of cases and fears about mass gatherings during the holiday weekend. Parks and beaches will be closed to fireworks displays, and gatherings of more than 50 people, including parades, will be banned.
“The closure may be extended if conditions do not improve,” he said in a statement, adding, “I have decided that the only prudent thing to do to tamp down this recent uptick is to crack down on recreational activities that put our overall community at higher risk.”
The decisions in Texas and Florida to revert to stronger restrictions represented the strongest acknowledgment yet that reopening had not gone as planned in two of the nation’s most populous states, where only days ago their Republican governors were adamantly resisting calls to close back down.
On Thursday, Gov. Greg Abbott of Texas placed the state’s reopening on pause, while remaining firm that going “backward” and closing down businesses was “the last thing we want to do.”
But by Friday, he did just that, ordering bars closed and telling restaurants to limit themselves to 50 percent capacity rather than 75 percent.
“If I could go back and redo anything, it probably would have been to slow down the opening of bars,” Mr. Abbott said in an interview with KVIA-TV in El Paso on Friday evening…
In Arizona, Gov. Doug Ducey has held out on setting new limits in his state, even as cases there surged past 66,000, with an average of 2,750 new cases per day. He warned this week that hospitals were likely to hit surge capacity soon but he has remained opposed to backtracking on reopening.
“This is not another executive order to enforce, and it’s not about closing businesses,” he said this week. “This is about public education and personal responsibility.”
Still, shutting down businesses again in Arizona is not out of the question, Daniel Ruiz, the state’s chief operating officer, said in an interview on Friday.
“We want to treat that like a last resort,” Mr. Ruiz said. “It’s a tool in the toolbox, but it’s something that we’re going to use very judiciously.”
California, which had the first stay-at-home order in the nation this spring, has surpassed 200,000 cases, and on Friday, Mr. Newsom announced new restrictions on Imperial County, which has the state’s highest rate of infection. The county has exceeded its hospital capacity so severely that some 500 patients have had to be moved to beds elsewhere, and hospitals as far away as the Bay Area have been seeing Imperial County patients.
“This disease does not take a summer vacation,” said Mr. Newsom, noting that at least 15 of California’s 58 counties were being monitored closely as the virus surges.
In Los Angeles County, health officials estimate that every 400th person may currently be infected. Mayor Eric Garcetti of Los Angeles said he planned to wait three to five days before deciding whether to pull back on the city’s reopening.
“We’re not in the red zone but we’re in the yellow zone,” the mayor said in an interview on Friday.
From case counts to hospitalizations, he said, the city’s metrics are moving in the wrong direction, in part because of a patchwork of responses in neighboring areas.
Mr. Garcetti said he would like health officials in the state, the county and the surrounding region to come to a consensus strategy.
“If you don’t move together, there’s no point in being the lone holdout,” he said. “If you don’t have an entire region working together, who cares if you keep your gyms closed?” (E)
“At a time when his poll numbers now call into question whether he can win a second term in November, Mr. Trump faces the prospect that his efforts to boost the economy by shrugging off the virus have backfired. Rather than head into the summer with a country on the mend, the president will be forced to explain how his response to the coronavirus contributed to a resurgence of it that may force some Americans back into a painful shutdown…
All spring, Mr. Trump expressed his impatience and annoyance with the social distancing measures that various states, and his own aides, were taking…
He has been enabled by a handful of advisers, some of whom share his desire to focus on the economy and some of whom are afraid of the president’s reaction if they press him too hard about the public health crisis unfolding once again in large chunks of the country.
The White House chief of staff, Mark Meadows, has been among the chief proponents of keeping the administration’s public health experts largely out of sight, according to several senior administration officials.
But he is not alone. Even though they are aware that Mr. Trump’s mishandling of the virus presents a threat to his re-election, his campaign advisers agreed to his demand for the rally last Saturday at an arena in Tulsa, Okla., hoping the adulation he would receive there would snap the president out of a funk he has been in for months.
But at least eight staff members — including two Secret Service agents — tested positive for the virus before the rally, which was lightly attended and attracted none of the overflow crowd that Mr. Trump’s advisers had promised. Since then, dozens of campaign aides who were in Oklahoma for the event have been told to quarantine.
His advisers are now trying to figure out how to give Mr. Trump the traveling road show he wants while acknowledging the widespread fears about the coronavirus and allowing for proper health measures. At the same time, the White House has stopped employing the health checks it had been using for several weeks, like temperature checks for people entering the complex.
One of the states where the cases are rising drastically is Florida, where Mr. Trump insisted the Republican National Convention at the end of August be relocated to meet his desire for a large-scale event free of social distancing measures. As of now, Republicans hope to put on a show celebrating Mr. Trump, the first lady and Mr. Pence with three nights of crowds as large as 12,000 people in Jacksonville.
Some of the president’s political allies have signaled in recent days that they intend to take the threat of the virus more seriously.
Speaking to a group of health care workers in Morehead, Ky., Senator Mitch McConnell, Republican of Kentucky and the majority leader, held up a simple face mask.
“Until we find a vaccine, these are really important,” the senator said. “This is not as complicated as a ventilator. This is a way to indicate that you want to protect others. We all need during this period until we find a vaccine to think of us as protecting not only ourselves but others.”
And Representative Liz Cheney, Republican of Wyoming, had a not-so-subtle message for Mr. Pence in a tweet she posted not long after the vice president refused to wear a mask during the task force briefing on Friday. Her tweet included a picture of her father, former Vice President Dick Cheney.
“Dick Cheney says WEAR A MASK,” she wrote, adding the hashtag: #realmenwearmasks.
But if anything, Mr. Trump, Mr. Pence and the rest of the senior members of the administration have seemed determined in the past 24 hours to embrace a previrus political reality — even if the medical facts contradict it.” (F)
“The Trump administration is ending funding and support for local COVID-19 testing sites around the country this month, as cases and hospitalizations are skyrocketing in many states.
The federal government will stop providing money and support for 13 sites across five states which were originally set up in the first months of the pandemic to speed up testing at the local level.
Local officials and public health experts expressed a mixture of frustration, resignation, and horror at the decision to let federal support lapse.
Texas will be particularly hard hit by the decision. The federal government gives much-needed testing kits and laboratory access to seven testing sites around Texas. But in the state, which is seeing new peaks in cases, people still face long lines for testing that continues to fail to meet overwhelming demand…
As the pandemic began to batter the United States in March, the Department of Health and Human Services and the Federal Emergency Management Agency began to deploy Community-Based Testing Sites around the country.
The sites provide testing kits and contract with laboratories and a call center to notify patients of their results. The federal government covers the costs of the contracts, while providing staff.
The Trump administration previously attempted to end support for the testing sites running under the same program in early April. The government reversed the move after a public outcry, extending the sites. The extension is now coming to an end.
Out of a starting number of 41 sites, 13 remain in operation across five states. In addition to Texas’ seven, Illinois and New Jersey each have two, while Colorado and Pennsylvania each have one.
The aid for testing takes a financial burden off of cities and states already buckling under a budget crunch from the pandemic, while boosting testing capacity.
An HHS spokeswoman told TPM that the program aimed to “develop and bring initial testing capabilities to socially vulnerable locations across the country” and said that states were expected to “transition” to control testing by June 30…
Testing is an area “where the federal government has the greatest capacity to be helpful,” Gary Slutkin, a former WHO epidemiologist and the CEO Of CURE Violence, told TPM.
“Testing is absolutely essential to everything from diagnosis and treatment to management of the epidemic itself,” Slutkin added. “The withholding of this essential tool for controlling this problem is cruel — it inhibits the ability of a country or a city or a community or a person or healthcare provider to know what to do.” (G)
“In a filing with the U.S. Supreme Court, the Trump administration has reaffirmed its position that the Affordable Care Act in its entirety is illegal because Congress eliminated the individual tax penalty for failing to purchase medical insurance.
Solicitor General Noel Francisco, the government’s chief advocate before the Supreme Court, said in a brief that the other provisions of Obamacare are impossible to separate from the individual mandate and that “it necessarily follows that the rest of the ACA must also fall.”…
The case before the high court began with a lawsuit brought by 20 states, led by Texas, calling for the elimination of the ACA. It has been consolidated for argument with another case brought by 17 states, led by California, seeking to preserve the law. The court is likely to hear the case in the fall…
Eliminating the ACA would end medical insurance for more than 20 million Americans. It would also end widely popular provisions of the law, such as extending parents’ coverage to children up to the age of 26 and prohibiting insurance companies from denying coverage based on preexisting conditions.
Trump and congressional Republicans have long said they want to “repeal and replace” Obamacare but have yet to offer legislation addressing what would take its place.” (H)
“When he travels to locations where the virus is surging, every venue the President enters is inspected for potential areas of contagion by advance security and medical teams, according to people familiar with the arrangements. Bathrooms designated for the President’s use are scrubbed and sanitized before he arrives. Staff maintain a close accounting of who will come into contact with the President to ensure they receive tests.
While the White House phases out steps such as temperature checks and required mask-wearing in the West Wing — changes meant to signal the country is moving on — those around the President still undergo regular testing…
Even as Trump attempts to move on, the protective bubble around him has grown thicker. Aides say the steps are necessary to allow the President — by all definitions an essential worker — to continue leading the country amid the pandemic.
But people familiar with the matter say the precautions also stem from Trump’s own insistence that he not contract the disease and his heightened awareness of how a sick President would affect both the country’s view of him and his ability to command a response to the pandemic.
After Trump told aides at the beginning of the outbreak he must avoid getting sick at all costs, efforts to prevent him from contracting the virus have progressively become more intensive and wide-ranging. Early steps such as keeping more hand sanitizer nearby eventually evolved into an intensive safety apparatus, including the testing regimen requiring dozens of staffers.
So far the efforts appear to have been effective, at least at preventing the President from contracting the virus. But events of the past week have also underscored the primacy of Trump himself to the safety measures, with the safety of staffers who compose his massive footprint coming second…
This week, the CDC updated its list of who is at increased risk for getting severely ill from Covid-19, removing a specific age threshold and instead warning Americans that the risk steadily increases with age. The CDC also added to its list of underlying conditions that increase the risk of severe illness, to include obesity and serious heart conditions.
Trump, who turned 74 on June 14, is considered obese, according to the results of his last physical, which showed he weighed 244 pounds and stands 6 feet 3 inches tall. The results from his first physical while in office indicated he also had a common form of heart disease….
The President has told officials repeatedly that he cannot get sick, and he grew upset when he learned last month that one of the military valets who handles his food and drink had come down with the disease. Trump asked how it was possible that someone with such intimate access to his person could have contracted the virus, and in the days following the revelation appeared cautious around people he did not know well, people familiar with his reaction said.
Trump appeared genuinely alarmed when people close to him contracted the disease, seeing in their experiences a fate he was adamantly working to avoid for himself. He raised repeatedly his friend Stanley Chera, a New York real estate developer who Trump had been friends with for decades. Trump described his surprise at Chera’s descent from contracting the virus to entering a coma to eventually succumbing to the disease.
Later, Trump was surprised again to learn that one of his closest foreign allies, British Prime Minister Boris Johnson, had fallen seriously ill from the virus, at one point being admitted to an intensive care unit in London. Trump asked for frequent updates on Johnson’s deteriorating condition and later asked to speak with him as soon as he was on his way to recovery.
Trump, who has long defined himself as a germaphobe, openly chastised aides who coughed or sneezed in his presence even before the virus. But amid the pandemic, any signs of respiratory sickness have been met with glares from the President. When Dr. Deborah Birx, the White House coronavirus response coordinator, told a briefing she’d had a fever and self-quarantined, Trump jokingly backed away.
When Polish President Andrzej Duda, Trump’s first foreign visitor in months, came to the White House this week, he and his entire delegation were administered coronavirus tests, as were the US officials who participated in the meeting.
For months, anyone who comes into close proximity with the President has been administrated a coronavirus test, though the Abbott Laboratories product used by the White House has raised concerns for high rates of false negatives.
Trump, who in the 1980s and ’90s openly discussed his success in avoiding a sexually transmitted disease — “It’s Vietnam,” he told Howard Stern, “It is very dangerous. So I’m very, very careful” — also took the controversial step of taking a round of hydroxychloroquine in a bid to prevent coronavirus.
Though the drug has not been proven to prevent infection with coronavirus, Trump had publicly touted its benefits and he announced midway through his round that he was taking it. Later, his doctor said Trump’s medical team used an electrocardiogram to closely monitor the President’s heart while he was taking the drug since some studies have suggested it could cause severe heart problems.” (I)
“There are far too few trained staff assigned to infection control. IPs do not even have time to document and report infections let alone evaluate patients and conduct training.
Judging when we have won the war against the coronavirus is not as simple as setting a benchmark of having no positive tests for SARS-CoV-2 (the virus which causes COVID-19) in the United States for two or four consecutive weeks. Because SARS-CoV-2 is an RNA virus, genetic drift may well occur which changes its viral capsule. Similar to the coronavirus which causes the common cold, vaccine production will be challenging at best. The virus has already jumped to the Southern Hemisphere. In all probability, it will be back in the Fall. The 1918 Spanish flu epidemic, a devastating second wave of infections wreaked havoc on the United States. And if these dire predictions do not occur and I hope they do not, we will certainly be hit with another novel virus in the future which creates similar risks.
The good news is that we have the technology and know-how to confront and substantially mitigate these epidemics. What we have lacked is the willpower to implement this knowledge. We will have won when the following takes place:
1. When we no longer neglect stockpiling needed equipment and supplies…
2. When we have a national public reporting laboratory infrastructure for all dangerous pathogens. Currently, we have a patchwork of laboratory systems in place with lack of a comprehensive public reporting…
3. When we have enough trained and supported infection preventionists (IPs).There are far too few trained staff assigned to infection control…
4. When we have developed more respect for infectious disease. The most important intervention to prevent transmission of almost any pathogen is handwashing…
5. When we have improved and larger physical plants to service patients… We also need support for environmental services, negative airflow rooms and centralized sterilizing systems for the ventilated air.
6. When we have redundancy in our healthcare facilities. In between epidemics we need to have employed staff with little to do and empty hospital beds…
7. When our leaders stop politicizing public health and rely on scientists to make public policy. Throughout a history of epidemics there has been a desire for governments to avoid accountability…
8. When we have healthcare, that is centered on patients and not on profits. We have to stop running a lean system and build a healthcare infrastructure so we can adapt and effectively confront future waves of this epidemic…
When the healthcare system meets all of these goals then I would consider it has won. If we are unable to rapidly transform our system and correct these flagrant deficiencies, then the worse projections from the Imperial College projections of 2.2 million United States citizen fatalities may come to pass.” (J)
“The number of new U.S. cases this last week surged dangerously high, to levels not ever seen in the course of the pandemic, especially in states that had rushed to reopen their economies. The result has been a realization for many Americans that however much they have yearned for a return to normalcy, their leaders have failed to control the coronavirus pandemic. And there is little clarity on what comes next.
“There has to be a clear coherent sustained communication, and that has absolutely not happened,” said Dr. William Schaffner, an infectious diseases specialist at Vanderbilt University in Nashville. “We’ve had just the opposite and now it’s hard to unring a whole series of bells.”
There was “real hubris” on the part of public health officials at the very start, Dr. Schaffner said, that the United States could lock down and contain the virus as China had. That futile hope helped create an unrealistic expectation that the shutdown, while intense, would not be for long, and that when it was lifted life would return to normal.
That expectation was reinforced by President Trump, who has downplayed the severity of the crisis, refused to wear a mask and began calling for states to open even as the virus was surging. A lack of federal leadership also meant that states lacked a unified approach.
With no clear message from the top, states went their own ways. A number of them failed to use the shutdown to fully prepare to reopen in a careful manner. As Americans bought precious time trying to keep the virus at bay, experts advised that states urgently needed to establish a robust system for tracking and containing any new cases — through testing, monitoring and contact tracing. Without this, the pandemic would simply come roaring back.
Testing and contact tracing efforts were ramped up, but not enough in some places. Even states that did embark on ambitious plans to do contact tracing struggled. Health officials in Massachusetts, which has one of the country’s most established tracing programs, said in May that only about 60 percent of infected patients were picking up the phone.
Just as the country needed to stay shut down longer, many states — mostly with Republican governors — took their foot off the brake, and Mr. Trump cheered them on.
In early May, when more than half of U.S. states had begun reopening parts of their economies, most failed to meet the nonbinding criteria recommended by the Trump administration itself to resume business and social activities.
The White House’s nonbinding guidelines suggested that states should have a “downward trajectory” of either documented coronavirus cases or of the percentage of positive tests.
Yet most states that were reopening failed to adhere to even these ill-defined recommendations. They had case counts that were trending upward, positive test results that were rising, or both, raising concerns among public health experts…
Dr. Schaffner offered a bleak prognosis for the country’s next chapter with the virus. He said he did not expect the country to return to a full lockdown, so in order to contain the infection people would have to begin to change behaviors in ways that were uncomfortable, unfamiliar — wearing masks, not gathering in large groups indoors, staying six feet apart.
“The only alternative until we have a vaccine is all of these behavioral interventions that we know work,” he said. But, he added, “The governors are all on different pages. It is no wonder that the average person is confused.” (K)
