The U.S. now has the most infections, and 1,300 have died. New hot spots in the north- Detroit, greater Chicago, joining New Orleans and Louisiana in general as areas of concern. For now, New York remains the hub for infections. [below]
The overarching problem is a laid-back federal government run by Trump who’s only focused on making himself look good. It results in a rudderless campaign, featuring states competing against other states and against FEMA for the necessary equipment. They wind up bidding against each other, driving up the price, delaying the delivery. How dysfunctional, how enriching for the private sector !
Oft-cited was the exchange Trump had with Washington’s Jay Inslee. Trump’s repetitious ‘we’ll be back-up for the states’ lead Inslee to say, “… We don’t need a backup; we need a Tom Brady.”
President Trump suggested to Gov. Jay Inslee of Washington State on a conference call Thursday that the federal government had already done a great deal for Mr. Inslee’s state and rebuffed his plea for a more forceful response to the coronavirus outbreak, according to two officials familiar with the conversation.
On a call with other governors, Mr. Inslee urged Mr. Trump to take more aggressive steps to mobilize private-sector manufacturers to produce critically-needed supplies to respond to the virus, the two officials said. But the president has largely resisted using the Defense Production Act, which gives the government the authority to force companies to produce equipment in national demand — and suggested on the call that the federal government had already offered significant aid to the state of Washington, which was initially the center of the outbreak in the U.S.
A third person familiar with what was said on the call said that Mr. Inslee didn’t specifically invoke the Defense Production Act, but asked why the federal government could not do more to move companies, noting that states were reaching out to them themselves. https://www.nytimes.com/2020/03/26/world/coronavirus-news.html?action=click&module=Spotlight&pgtype=Homepage#link-204aed62
On the front lines: Endless waits, desperate supply shortages– enough for the day, but what about tomorrow; not changing gowns or gloves often enough, scrounging for a ventilator, etc.
Clifford Marks, NYC Emergency Medicine resident:
…our hospital is already nearing its breaking point, with the peak of this outbreak still weeks away.
The first thing you should appreciate is the speed with which our hospital went from no covid-19 cases to being inundated with them. I saw my first covid-19 positive case a little over a week ago. Forty-eight hours later, I had seen dozens. Two weeks ago, we had zero confirmed positive covid-19 patients in the entire hospital. Today, three-quarters of our Emergency Department space is reserved for people with confirmed or suspected covid-19. Over the past 10 days, the number of patients on ventilators has nearly quadrupled
In light of this impending shortage, we were recently sent a protocol to help guide us in determining which patients will get access to the dwindling number of ventilators in our hospital should we indeed run out. Following it would mean disconnecting some people from ventilators because they have not improved over their first few days. In some circumstances, it could mean allocating lifesaving ventilators by drawing lots.
Our supply of personal protective equipment is running dangerously low. We wear N95 masks intended for use with a single patient for our entire shift, when we see dozens of them. I was told to clean and take my eye protection home because there might not be more when I returned.
…The crush of covid-19 patients has dangerous consequences even for those with other health conditions. The area of the hospital where we usually run traumas or cardiac arrests is necessarily devoted to the care of covid-19 patients in extremis. So we care for critically ill, presumably non-covid patients in an area of the emergency department not designed for that purpose. Last week, we had a patient who came in altered, with signs of significant head trauma — we were concerned they might have a brain bleed and need to be intubated. But when the patient arrived, no ventilators were available in that area of the department.
But we aren’t just running low on ventilators; we’re also running low on more banal therapies. This week, I tried to get one of my asthma patients an albuterol inhaler only to be told by multiple pharmacies that this common medication was on back order and might not be available for another week. https://www.washingtonpost.com/outlook/2020/03/25/wait-is-endless-supplies-are-gone-my-new-york-hospital-is-melting-down/
Trump seeks to open part of the country, to have all the governors identify and label all counties for their ‘level of risk.’ Public official pros and sound people in general attacked this as unworkable and destructive, but Trump keeps working this angle, easing restrictions in discrete sections of the country where infections currently seem to be low. Of course in view of how many of the infected are barely or not-at-all symptomatic and considering how skeletal our testing program remains, such a strategy makes no sense.
Robert Costa, Laura Vozzella, Josh Dawsey, David Nakamura:
Tensions between President Trump and governors from states hit hardest by the coronavirus pandemic are rising at a time when the White House is pushing to loosen restrictions on social distancing in parts of the country due to concerns that they are hurting the economy.
Trump insisted Thursday that Americans are eager to “go back to work” and advised the governors in a letter that his administration is developing new guidelines that will categorize the risk level for each county in the nation — potentially laying the groundwork for less-affected areas to relax some of the strictest measures.
But the president’s upbeat assessment conflicts with warnings from public health experts that abandoning current restrictions too soon could be potentially catastrophic. And his posture has distressed the leaders in states where the virus is spreading exponentially — overwhelming hospitals, exhausting medical supply stockpiles and ravaging communities.
…At a White House news briefing, Trump called reports of tension on his call with the governors “fake news…” https://www.washingtonpost.com/politics/trump-pushes-to-open-up-the-country-as-governors-in-hard-hit-states-warn-more-needs-to-be-done-to-combat-pandemic/2020/03/26/6f426042-6fa5-11ea-b148-e4ce3fbd85b5_story.html
How long will it last? Probably for quite a while, and contrary to the liar-in-chief, normal functioning will not resume until there is a tangible, thorough upgrade to the testing.
David Leonhardt:
For one thing, serious symptoms trail new infections by several days or more. The number of deaths in New York and nationwide is likely to spike over the next week. At a single hospital in Queens yesterday, 13 people died — a scene that Ashley Bray, a doctor there, described as “apocalyptic.” The coming spike in hospitalizations could easily overwhelm hospitals, especially because of the shortage of medical equipment.
For another, not every part of the country has engaged in rigorous social distancing. Cases in Republican-leaning states, especially in the South, are now growing more quickly than in Democratic-leaning states, as Nate Silver noted yesterday. One likely reason is that many Republicans, taking their cues from President Trump and some other party leaders, still don’t view the virus as a threat, as polls show. My colleague Jennifer Senior argues that other states are different from New York more in timing than degree: “The idea that New York is an exception rather than a harbinger is madness,” she writes.
Whatever happens over the next week or two, the country still has no viable way to start functioning normally again without a huge increase in testing. Even if new cases slow, the return of typical activity will cause new outbreaks. “Testing will allow us to isolate the infected so they can’t infect others,” Aaron Carroll and Ashish Jha, both medical school professors, wrote in The Atlantic.
Or as Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said yesterday: “Asking people to stay at home and shutting down population movement is buying time and reducing the pressure on health systems. But on their own, these measures will not extinguish epidemics.” https://www.nytimes.com/2020/03/26/opinion/coronavirus-cases-testing.html?action=click&module=Opinion&pgtype=Homepage
Our reactive, uncoordinated testing program: It was late being developed, its employment remains limited.
Ed Yong:
The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.
With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper.
Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle.
Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.” https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/
Most basically, the Trump team simply ignored the NSC’s pandemic playbook, the step-by-step list of priorities that they should have followed. But, they ignored it. Case closed !
Dan Diamond, Nahal Toosi:
The Trump administration, state officials and even individual hospital workers are now racing against each other to get the necessary masks, gloves and other safety equipment to fight coronavirus — a scramble that hospitals and doctors say has come too late and left them at risk. But according to a previously unrevealed White House playbook, the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago.
“Is there sufficient personal protective equipment for healthcare workers who are providing medical care?” the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. “If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?”
The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics, which POLITICO is detailing for the first time. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.
“Each section of this playbook includes specific questions that should be asked and decisions that should be made at multiple levels” within the national security apparatus, the playbook urges, repeatedly advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity and check on the U.S. stockpile of emergency resources. https://www.politico.com/news/2020/03/25/trump-coronavirus-national-security-council-149285
Priorities USA Action Ad: Replaying Trump quotes from January-March are very effective, so much so that Trump wants it forbidden from being played. This and similar, successor ads should be funded so it can be played from Labor Day to November 3, Election Day.
President Trump’s reelection campaign is threatening legal action against television stations in key battleground states if they continue airing an ad cut by the liberal super PAC Priorities USA alleging that the president called the coronavirus a “hoax.”
Alex Cannon, the legal counsel for Trump’s reelection campaign, sent a letter to television stations in key battleground states where the ad is running demanding they “cease and desist” from airing the ad if they want to “avoid costly and time consuming litigation.”
“Given the foregoing, should you fail to immediately cease broadcasting PUSA’s ad ‘Exponential Threat’, Donald J. Trump for President, Inc. will have no choice but to pursue all legal remedies available to it in law and in equity” the letter states. “We will not stand idly by and allow you to broadcast false, deceptive, and misleading information concerning President’s Trump’s healthcare positions without consequence.”
Priorities USA is putting $6 million behind the ad, which is running on television stations in Florida, Michigan, Minnesota, Pennsylvania and Wisconsin.
The ad, which is titled “Exponential Threat,” splices together different audio clips of Trump downplaying the virus over a graphic showing the number of cases on the rise.
“The coronavirus, this is their new hoax,” Trump says in the ad. “We have it totally under control. It’s one person coming in from China. One day it’s like a miracle, it will disappear. When you have 15 people and within a couple of days is gonna be down to close to zero. We really think we’ve done a great job in keeping it down to a minimum. I like this stuff. I really get it. People are surprised that I understand. No, I don’t take responsibility. https://thehill.com/homenews/campaign/489555-trump-campaign-threatens-legal-action-over-liberal-super-pac-ad
The Coronavirus could be seen as a practice run, a training ground for Society to address the developing threats to Civilization. Are we capable of learning so that we can confront the challenges of global warming? One particular area of concern: our food supply.
George Monbiot:P
We have been living in a bubble, a bubble of false comfort and denial. In the rich nations, we have begun to believe we have transcended the material world. The wealth we’ve accumulated – often at the expense of others – has shielded us from reality. Living behind screens, passing between capsules – our houses, cars, offices and shopping malls – we persuaded ourselves that contingency had retreated, that we had reached the point all civilisations seek: insulation from natural hazards.
Now the membrane has ruptured, and we find ourselves naked and outraged, as the biology we appeared to have banished storms through our lives. The temptation, when this pandemic has passed, will be to find another bubble. We cannot afford to succumb to it. From now on, we should expose our minds to the painful realities we have denied for too long.
The planet has multiple morbidities, some of which will make this coronavirus look, by comparison, easy to treat. One above all others has come to obsess me in recent years: how will we feed ourselves? Fights over toilet paper are ugly enough: I hope we never have to witness fights over food. But it’s becoming difficult to see how we will avoid them.
A large body of evidence is beginning to accumulate showing how climate breakdown is likely to affect our food supply. Already farming in some parts of the world is being hammered by drought, floods, fire and locusts (whose resurgence in the past few weeks appears to be the result of anomalous tropical cyclones.) When we call such hazards “biblical”, we mean that they are the kind of things that happened long ago, to people whose lives we can scarcely imagine. Now, with increasing frequency, they are happening to us.
In his forthcoming book, Our Final Warning, Mark Lynas explains what is likely to happen to our food supply with every extra degree of global heating. He finds that extreme danger kicks in somewhere between 3C and 4C above pre-industrial levels. At this point, a series of interlocking impacts threatens to send food production into a death spiral. Outdoor temperatures become too high for humans to tolerate, making subsistence farming impossible across Africa and South Asia. https://www.theguardian.com/commentisfree/2020/mar/25/covid-19-is-natures-wake-up-call-to-complacent-civilisation
shermandigest 