Trump administration changes definition of national stockpile after Kushner remarks

https://thehill.com/homenews/administration/491037-trump-administration-changes-definition-of-national-stockpile-after?fbclid=IwAR2lHXc3N0KElN6ArXDF6KNCj5wN8h6nnMywBferCCTm2EeVZ_qVHi0C65Y&fbclid=IwAR076Nbty2YJqqQD7RvJUTomb0X_2Y8qBDKg6fXyamKYKGHLES5-T2hNKCU

The Trump administration quietly changed an online description of the country’s Strategic National Stockpile following a press briefing with White House adviser Jared Kushner.

Previously, according to the federal public health emergency website, the Strategic National Stockpile was described as “the nation’s largest supply of life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.”

The description continued: “When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency.”

That definition disappeared from the site on Friday.

The new, one-paragraph description says the stockpile is meant as a “short-term stopgap.”

“The Strategic National Stockpile’s role is to supplement state and local supplies during public health emergencies. Many states have products stockpiled, as well. The supplies, medicines, and devices for life-saving care contained in the stockpile can be used as a short-term stopgap buffer when the immediate supply of adequate amounts of these materials may not be immediately available,” the website now says.

In a statement posted to the HHS Public Affairs Twitter account, the agency said it “first began working to update this text a week ago to more clearly explain the role of the Strategic National Stockpile. HHS has been using this same language in statements to the press for weeks now.”

The language more closely matches what Kushner said on Thursday when he made his coronavirus task force briefing debut.

Kushner, a senior adviser and the president’s son-in-law, was recently directed to work with the Federal Emergency Management Agency (FEMA) on supply chain issues related to the coronavirus outbreak. He is said to have assumed the role roughly two weeks ago.

Kushner said states should be more resourceful in procuring supplies for themselves, and not be relying on the federal government for assistance.

“The notion of the federal stockpile was it’s supposed to be our stockpile, it’s not supposed to be the state’s stockpile that they then use,” Kushner said.

Kushner accused some state officials of requesting supplies without knowing what they need.

“Some governors you speak to, or senators, and they don’t know what’s in their state,” Kushner said when asked by a reporter what it takes for a state to receive ventilators from the national stockpile.

“Don’t ask us for things when you don’t know what you have in your own state. Just because you’re scared, you ask your medical professionals and they don’t know. You have to take inventory of what you have in your own state and then you have to be able to show that there’s a real need,” Kushner said.

The COVID-19 pandemic has forced the federal government to deplete much of its reserves as states and hospitals nationwide struggle with a surge of critical patients. FEMA officials recently told a House panel that the government has fewer than 10,000 ventilators in stock.

Governors have been pleading with the Trump administration for help, and have continually said they are not receiving nearly enough supplies from the stockpile to address the surge in hospitalizations.

The Coronavirus’s Unique Threat to the South
More young people in the South seem to be dying from COVID-19. Why?

https://www.theatlantic.com/politics/archive/2020/04/coronavirus-unique-threat-south-young-people/609241/?fbclid=IwAR1coFYUSsDUD4MjqqI_maioBfb41N1l55xUWxHXbNcB-DJCpKTU6otC1QY

In a matter of weeks, the coronavirus has gone from a novel, distant threat to an enemy besieging cities and towns across the world. The burden of COVID-19 and the economic upheaval wrought by the measures to contain it feel epochal. Humanity now has a common foe, and we will grow increasingly familiar with its face.

Yet plenty of this virus’s aspects remain unknown. The developing wisdom—earned the hard way in Wuhan, Washington, and Italy—has been that older people and sicker people are substantially more likely to suffer severe illness or die from COVID-19 than their younger, healthier counterparts. Older people are much more likely than young people to have lung disease, kidney disease, hypertension, or heart disease, and those conditions are more likely to transform a coronavirus infection into something nastier. But what happens when these assumptions don’t hold up, and the young people battling the pandemic share the same risks?

The world is about to find out. So far, about one in 10 deaths in the United States from COVID-19 has occurred in the four-state arc of Louisiana, Mississippi, Alabama, and Georgia, according to data assembled by the COVID Tracking Project, a volunteer collaboration incubated at The Atlantic. New Orleans is on pace to become the next global epicenter of the pandemic. The virus has a foothold in southwestern Georgia, and threatens to overwhelm hospitals in the Atlanta metropolitan area. The coronavirus is advancing quickly across the American South. And in the American South, significant numbers of younger people are battling health conditions that make coronavirus outbreaks more perilous.

The numbers emerging seem to indicate that more young people in the South are dying from COVID-19. Although the majority of coronavirus-related deaths in Louisiana are still among victims over 70 years old, 43 percent of all reported deaths have been people under 70. In Georgia, people under 70 make up 49 percent of reported deaths. By comparison, people under 70 account for only 20 percent of deaths in Colorado. “Under 70” is a broad category, not really useful for understanding what’s going on. But digging deeper reveals more concerning numbers. In Louisiana, people from the ages of 40 to 59 account for 22 percent of all deaths. The same age range in Georgia accounts for 17 percent of all deaths. By comparison, the same age group accounts for only about 10 percent of all deaths in Colorado, and 6 percent of all deaths in Washington State. These statistics suggest that middle-aged and working-age adults in the two southern states are at much greater risk than their counterparts elsewhere; for some reason, they are more likely to die from COVID-19.

All data in this stage of the pandemic are provisional and incomplete, and all conclusions are subject to change. But a review of the international evidence shows that, as far as we know, the outbreaks currently expanding in the American South are unique—and mainly because of how many people in their working prime are dying. Spain’s official accounting of the pandemic last week showed that deaths among people under 70 years old make up only about 12 percent of total deaths in the country. Case-fatality rates around the world are notoriously tricky because they are based in part on the extent of testing, but a recent study of the outbreak in Wuhan, China, found a case-fatality rate of 0.5 percent among adults from the ages of 30 to 59. The current estimate of fatality rates in the same age range in Louisiana is about four times that.

A recent analysis from the Kaiser Family Foundation might shed some light on what’s going on here. The paper, drawing on the CDC guidelines, identifies people who may be at risk of serious complications from COVID-19. Kaiser’s at-risk group includes all people over 60 years old and all adults younger than 60 who also have heart disease, cancer, lung disease, or diabetes. In each state, older people are the majority of the people considered to be at risk of complications. But the Deep South and mid-South form a solid bloc of states where younger adults are much more at risk. In Arkansas, Alabama, Kentucky, Tennessee, Louisiana, and Mississippi, relatively young people make up over a quarter of the vulnerable population. Compare that with the coronavirus’s beachhead in Washington State, where younger adults make up only about 19 percent of the risk group.

Tricia Neuman, a senior vice president at the Kaiser Family Foundation, says this analysis points to the underlying issues that might complicate or worsen the pandemic in the South. “Due to high rates of conditions like lung disease and heart disease and obesity, the people living in these states are at risk if they get the virus,” Neuman told me. These aren’t “people who are sick, but these are people who have underlying comorbidities that put them at higher risk of serious illness if they get infected.”

The KFF analysis doesn’t include potential complications from hypertension—which is also suspected to be driving coronavirus-linked hospitalizations—but the data are predictable on that front. If you define Oklahoma as part of the South, southern states fill out the entirety of the top ten states in percentage of population diagnosed with hypertension by a doctor. Southerners are more likely to suffer from chronic diseases than other Americans—even as Americans are more likely to suffer from chronic disease than citizens of other countries with comparable wealth. According to Neuman, these estimates don’t include people with cancer or who are immunocompromised — groups that are also at high risk for serious illness from COVID-19. And cancer mortality rates are highest in southern states.

These differences are not innate to southerners; they are the result of policy. Health disparities tend to track both race and poverty, and the states in the old domain of Jim Crow have pursued policies that ensure those disparities endure. The South is the poorest region in the country. The poor, black, Latino, or rural residents who make up large shares of southern populations tend to lack access to high-quality doctors and care. According to the State Health Access Data Assistance Center, Mississippi, North Carolina, Texas, Florida, Georgia, and Louisiana all spend less than $25 per person on public health a year, compared to $84 per person in New York. Nine of the 14 states that have refused to expand Medicaid to poor residents under the Affordable Care Act are in the South. And many of those states are led by Republican leaders who have imitated President Donald Trump’s dallying and flip-flopping, and now find themselves flat-footed.

The slow response from those governors will be even more ruinous in a region with so many challenges. Chronic disease and the apparent increased risk for younger people from COVID-19 are only part of the story in the South. Other factors could complicate its pandemic response. Advocates have drawn attention to the extreme vulnerability of people in prison to the coronavirus—and the South incarcerates a larger proportion of its population than anywhere else in the United States. A federal prison in Louisiana has already seen a spike in COVID-19 cases this week. Also, a global fear in this pandemic is that it will sicken health professionals and doctors, and leave them unable to contend with waves of hospitalizations. Southern states have some of the lowest ratios of active physicians to patients in the country.

In all, the South seems likely to be a new kind of battleground, one in which distancing and isolation are going to be especially important in stopping the virus. Centuries of policy gave the pandemic a head start—and younger targets—in the South. Now there are mere days to change course.

Protective gear in national stockpile is nearly depleted, DHS officials say

https://www.msn.com/en-us/news/us/protective-gear-in-national-stockpile-is-nearly-depleted-dhs-officials-say/ar-BB122cFl

The government’s emergency stockpile of respirator masks, gloves and other medical supplies is running low and is nearly exhausted due to the coronavirus outbreak, leaving the Trump administration and the states to compete for personal protective equipment in a freewheeling global marketplace rife with profiteering and price-gouging, according to Department of Homeland Security officials involved in the frantic acquisition effort.

As coronavirus hotspots flare from coast to coast, the demand for safety equipment — also known as personal protective equipment (PPE) — is both immediate and widespread, with health officials, hospital executives and governors saying that their shortages are critical and that health-care workers are putting their lives at risk while trying to help the surging number of patients.

Two DHS officials said the stores kept in the Department of Health and Human Service’s Strategic National Stockpile are nearly gone, despite assurances from the White House that there is availability.

“The stockpile was designed to respond to handful of cities. It was never built or designed to fight a 50-state pandemic,” said a DHS official, who spoke on the condition of anonymity because the official was not authorized to speak publicly about the stockpile. “This is not only a U.S. government problem. The supply chain for PPE worldwide has broken down, and there is a lot of price-gouging happening.”

President Trump said during Tuesday’s White House briefing that the administration has nearly 10,000 ventilators on reserve and that authorities are ready to deploy the lifesaving equipment rapidly to coronavirus hotspots in coming weeks. He also said large amounts of PPE were being shipped directly from manufacturers to hospitals. But the DHS officials said the stockpile has not been able to handle the load.

Hospitals and states face a real risk of running out of supplies, one of the officials said. “If you can’t protect the people taking care of us, it gets ugly.”

Several reports in recent days have documented a Wild West-style online marketplace for bulk medical supplies dominated by intermediaries and hoarders who are selling N95 respirator masks and other gear at huge markups. Forbes reported that U.S. vendors have sold 280 million masks — mostly into the export market — and that U.S. states and local governments were outbid in the frenzy.

There are few signs the Trump administration is making efforts to stop the export shipments or seize the supplies for use in U.S. hospitals, despite statements from Attorney General William P. Barr last week that U.S. wholesalers hoarding masks and other supplies would get “a knock on your door.”

Governors have been pleading with federal authorities to ship more equipment and protective gear. Distribution of the supplies has happened unevenly, with some states saying they’ve received a fraction of the supplies they desperately need and some cities having received no assistance from their state governments.

The world is battling the COVID-19 outbreak that the World Health Organization declared a global pandemic, which has claimed more than 4,720 lives and infected more than 211,698 people in the U.S.

Officials at the Federal Emergency Management Agency said the government had anticipated the Strategic National Stockpile would be exhausted, and the administration is moving swiftly to procure and distribute medical supplies.

“FEMA planning assumptions for COVID-19 pandemic response acknowledged that the Strategic National Stockpile (SNS) alone could not fulfill all requirements at the State and tribal level,” Janet Montesi, a FEMA spokeswoman, said in a statement. “The federal government will exhaust all means to identify and attain medical and other supplies needed to combat the virus.”

a group of shoes on the floor: N95 particulate respirator masks and procedure face masks shown at a Dealmed-Park Surgical supply facility in Lakewood, N.J.© Victor J. Blue/Bloomberg N95 particulate respirator
masks and procedure face masks shown at a Dealmed-Park Surgical supply facility in Lakewood, N.J.
The government has more than $16 billion available to make the acquisitions, she said.

“We remain committed to helping ensure key medical supplies expeditiously arrive at the front lines for our health care workers,” Montesi said.

According to the White House, FEMA had shipped or delivered 11.6 million N95 respirator masks, 26 million surgical masks, 5.2 million face shields, 4.3 million surgical gowns, 22 million gloves and 8,100 ventilators as of March 28.

A stockpile of 1.5 million expired N95 masks that U.S. Customs and Border Protection has in storage will be distributed to the Transportation Security Administration and U.S. Immigration and Customs Enforcement, CBP said in a statement. The Centers for Disease Control and Prevention has issued guidelines for the safe use of masks with expiration dates that have passed, potentially leaving their elastic bands too loose to form a proper face seal.

Rep. Nanette Barragán (D-Calif.) said this week she and other lawmakers were told some of the expired CBP masks would be given to hospitals.

“Officials confirmed that the masks would indeed go to healthcare workers and be prioritized by highest need such as NY and NJ. I will follow up to make sure this happens!” the lawmaker tweeted Sunday.

A CBP official on Wednesday confirmed to The Washington Post that the masks would go to ICE agents and TSA officers instead, not to FEMA staff or medical personnel.

The government has long viewed the national stockpile supplies as a holdover during an emergency so the government could buy time for manufacturers to boost output and for new supply chains to solidify, according to a senior administration official, who spoke on the condition of anonymity because the official was not authorized to speak publicly. Having the medical supplies sitting in a warehouse doesn’t serve any purpose, the official said, even though the administration has been holding back thousands of ventilators.

Asked about concerns that the government will not be able to keep pace with the demand for PPE supplies, the official said the government has planes coming in from Asia every day for the next few weeks ferrying new materials, noting that a planeload with 80 tons of PPE arrived from China on Sunday.

The US now has more confirmed coronavirus cases than anywhere else in the world
Here’s how we got here — and what to do next.

https://www.vox.com/2020/3/26/21194153/us-confirmed-coronavirus-cases-world

March 26 marked an unhappy milestone for the United States: We’re now No. 1 in confirmed coronavirus cases.

China, where the novel coronavirus originated, was the previous leader. The country reported 81,782 cases as of Thursday near 6 pm on the coronavirus case counter by the Center for Systems Science and Engineering at Johns Hopkins University. Until now, second place was held by Italy, which has reported 80,589 cases.

Now the US leapfrogged them both with 82,404 cases. And it’s only going to get worse from here.

In late February, there were 80,000 cases in China and nascent outbreaks in Japan, South Korea, Iran, and Italy. But things in the US were still looking pretty good — at least, on the surface. The US on February 20 reported only 15 cases, all travel-related.

But once officials started testing in earnest for Covid-19, the cases started coming — and coming and coming. On March 1, there were 75. On March 7, 435. On March 14, 2,770. On March 21, 24,192. Now it’s at 82,404 — and those numbers are only going to go up in the coming weeks.

How did things go so wrong so fast? Much of the answer is that when we were reporting very few cases, things were already getting bad under the radar. A disastrously mismanaged February, during which government officials, much of the media, and even some experts assured Americans there was nothing to fear, let the virus spread until it was too big to ignore. By that time, it was also too big to stop without heavy-handed social distancing measures — and their attendant catastrophic economic costs.

Much of the blame lies with the president, who stripped public health agencies of the staffing, resources, and authority they needed to function, and then addressed the crisis in his usual fashion: with misinformation and bluster. It’s worked well for him against many of the scandals of his administration, but the virus was unimpressed.

But the failure wasn’t just the president’s. As Zeynep Tufekci, who has been urging us to do more for months, put it, “a soothing message got widespread traction, not just with Donald Trump and his audience, but among traditional media in the United States, which exhorted us to worry about the flu instead, and warned us against overreaction.” Even with the government sleeping on the job, there were signs from other countries that a catastrophe was arriving on our shores. But very few people said it out loud, and the ones who did were assured they were overreacting. Most people took public health experts’ reassurances at face value and assumed the low numbers of reported cases reflected reality.

Meanwhile, the virus spread.

Now, the world’s most powerful country has one of the world’s worst disasters on its hands. The question now is: Is it too late to turn things around?

The most confirmed cases in the world: What it means and what it doesn’t

The US has more confirmed cases than anywhere else in the world. It’s a sign that our coronavirus situation is very grave indeed. However, it doesn’t necessarily mean that we have the world’s worst coronavirus outbreak.

For one thing, while the US is still undertesting (people with milder cases are typically told to stay home and not be tested), other countries are probably undertesting by even more. Iran, by some estimates, may have millions of coronavirus cases, most of which the government has not reported.

Other hotspots that worry global development researchers include India and Indonesia — both populous countries with weak health systems and high poverty that are likely underreporting their coronavirus outbreaks by a significant margin. One study found that Indonesia is probably reporting around 10 percent of its symptomatic cases, and India between 10 percent and 30 percent.

Another important consideration is population. The US is the third-most populous country in the world. That means that, while our outbreaks are not yet worse per capita than many of the outbreaks in Europe, the top-line numbers look worse. Italy, for example, has reported one case for every 750 citizens. The US has reported one for every 4,000 (though 1 in every 400 New York City residents). Per capita numbers may better reflect how overwhelmed a country’s health system is and how badly it is impacted by the virus.

But overall numbers matter, too. Tens of thousands of people suffering and many of them dying isn’t less tragic if it happens in a large country where they’re a smaller share of the population.

So, while the US situation is very bad news, it’s the combination of a high population, a disastrous outbreak, and high testing capacity (in the last few days, we’ve finally — if belatedly — started testing on a large scale) that propelled America into the No. 1 slot. We should take our situation seriously.

But it’s a misinterpretation to claim that America has the worst outbreak in the world just because we have the most reported cases in the world. (To be clear, we could still end up with the worst outbreak in the world — but we’re not there yet.) When you test more, you’ll get more cases — but testing more is a good thing, and the United States, despite the desperate situation, is in a much better position to turn things around because of all the tests that we have run in the last week.

How coronavirus got a foothold in America

In late January, China locked down the country as hospitals and intensive care units (ICUs) in Wuhan were overwhelmed by coronavirus patients. In response, the United States banned foreign nationals who had recently traveled to China. That “resulted in a significant delay in the number of people coming in with infection,” Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), has said. “That bought time in the US to better prepare.”

Then, we squandered it. “Every other step of the government response was badly fumbled,” Frieden concluded.

Budget cuts and mismanagement by the Trump administration had gutted many of the agencies that were meant to address the crisis. The CDC started work on a test that would identify the novel coronavirus, but shipped the test out to labs with incorrect reagents, meaning that the test didn’t work. Guidance on when there’d be a new test was slow in coming.

Independent researchers at Seattle’s Flu Study, a research project studying flu in the Seattle region, sought permission to run their own test. They were denied it. “We felt like we were sitting, waiting for the pandemic to emerge,” said Dr. Helen Chu, who led the project. “We could help. We couldn’t do anything.” Labs around the country sought the Food and Drug Administration’s approval for their own test and met delays.

Strict rules about who could be tested for the virus were put into place. To be tested, someone had to have recently traveled from China or have been exposed to someone who tested positive. In hindsight, it’s easy to spot the Catch-22. If someone got coronavirus while traveling in South Korea, Iran, Italy, or any of the growing number of countries experiencing outbreaks, they could not be tested. If they infected anyone, those people couldn’t be tested either. Because we’d banned travel from China and would only test travelers from China (or those who had been exposed to a person who’d tested positive), we had rendered it impossible to notice whether the virus was spreading in America.

It was. Virologist Trevor Bradford estimates by comparing patient genomes that the coronavirus started spreading in Washington State in mid-January. By the end of February, it had been introduced to a nursing home, and patients started rapidly dying.

In the meantime, even people who should have known better took the CDC’s low case numbers at face value. There’s no community spread in the United States, public health officials around the country reassured us.

The risk of coronavirus in the US is “just minuscule,” National Institutes of Health official Anthony Fauci, now one of the most trusted authorities leading the response, said on February 17. “We have more kids dying of flu this year at this time than in the last decade or more,” he added.

We were told that risk in our communities “remains low.” Media outlets wrote articles about how we were at greater risk from the flu — a serious mistake in hindsight, to be sure, but an accurate representation of what they were hearing from America’s top public health authorities.

Bedford estimates that there were more than 7,000 cases in the US near the end of February (as opposed to 68 confirmed cases), when a lab in California first detected a community-acquired coronavirus case. If we’d known about them, we could have taken the extensive but not economy-shattering measures that countries like South Korea and Taiwan have taken to stop the virus — testing extensively, aggressively tracing contacts of everyone who tests positive, increasing production of masks and making them widely available.

Instead, we proceeded as if we were safe, while the least invasive ways to beat back the virus steadily slipped out of our reach.

Always a bit behind the curve

By March, it was obvious that there was community transmission in multiple cities across America. But our response was still slow. The FDA only slowly authorized more labs to conduct testing, and revisions to make their guidelines stricter forced some labs to destroy tests they’d already collected. US testing increased, but the prevalence of the virus was increasing, too.

States, counties, and cities had to decide one by one whether to shut their schools, declare a state of emergency, urge social distancing measures, or go into lockdowns. They did so haphazardly, with insufficient data because there was still limited testing in their communities. Italy closed all its schools on March 4 and locked down the country when they had fewer than 10,000 cases; the US surpassed the 10,000 case mark (March 19) and the 20,000 case mark (March 21) and the 50,000 case mark (March 24) without any national order to reduce nonessential activities.

Some local and state officials — like San Francisco Mayor London Breed and Ohio Gov. Mike DeWine — acquitted themselves well, taking strong early measures to reduce the spread of the virus. Some didn’t, like Texas Lt. Gov. Dan Patrick, who argued that we shouldn’t take economically damaging measures because if asked “are you willing to take a chance on your survival in exchange for keeping the America that all America loves for your children and grandchildren?” grandparents around the nation would agree to risk letting the virus spread.

Lockdowns are economically devastating, but the death of thousands of Americans in overwhelmed hospitals and the decimation of our health care workforce will not be any less economically devastating for the states that take that route.

In New York, which discovered as they ramped up testing that local cases were terrifyingly out of control, Mayor Bill de Blasio and Gov. Andrew Cuomo sparred over whether the city would have a shelter-in-place order like the one implemented earlier in the California Bay Area. Epidemiologists urged us to employ social distancing, but disorganization, unclear communication from political leaders, and ongoing lack of testing likely reduced compliance rates.

That said, it would be wrong to say that the US hasn’t taken strong measures to stop the virus. School closures were ordered. They were extended to restaurants and bars. California, home to 40 million people and one-fifth of the country’s GDP, ordered its population to stay at home. Nineteen other states have followed. When all the measures go into effect, more than half the country will have been ordered to stay at home (and similar measures may go into effect in more states as the situation worsens).

But we took these steps belatedly — again, in part because of lack of testing capacity. That meant each measure wasn’t sufficient on its own, and we had to keep escalating. It is still not clear we’ve done enough for desperate situations like New York, New Orleans, and Atlanta, which are already running out of ICU beds.

Our ugly start put us at an enormous disadvantage for the next phase of the coronavirus fight, and we spent most of March on the defensive while case numbers grew and grew.

So, how does this end?

When every day the news gets worse, it’s easy to start to despair — or to start thinking we should give up, write off 3 percent of our population, and try to, as Bill Gates condemned the idea, “ignore that pile of bodies over in the corner” as we go back to work.

We should not do that.

But we shouldn’t resign ourselves to another year and a half in lockdown, either — though it’s true that it will be a long time before the country or the world returns to normal. There are lots of promising options available, and pursuing some combination of them will likely allow us to ease up on some of the costliest current restrictions.

“Suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members,” an influential report from the Imperial College London argued, and then more than a year of maintaining “this type of intensive intervention package — or something equivalently effective at reducing transmission.” Other researchers have criticized specific assumptions underlying that model, but there’s wider agreement on the general premise that we need to find an “intervention package” that keeps transmission low.

But the details of that intensive intervention package are up to us, and some possibilities could be improvements over the current lockdowns. Countries are exploring a wide range of options for reducing transmission with minimal human costs.

One option, based on South Korea’s success at managing the virus, is called “test and trace.” The idea is to get much much better at testing so that we can identify sick people sooner, isolate them and all of their contacts, and let other people go about their daily lives.

That’s the approach favored by the WHO, based on what’s worked best so far in the countries that have controlled their outbreaks. “To suppress and control the epidemic, countries must isolate, test, treat, and trace,” WHO Director-General Tedros Adhanom Ghebreyesus argued last week.

“Everyone staying home is just a very blunt measure. That’s what you say when you’ve got really nothing else,” Emily Gurley of the Johns Hopkins Bloomberg School of Public Health told NPR. “Being able to test folks is really the linchpin in getting beyond what we’re doing now.”

Accomplishing this will require making testing much more widespread. Tactics like test pooling, which Nebraska has started using and which other states may copy, can be employed to let us test more patients with the same number of tests. Developing tests with faster turnaround time will mean that sick people get answers within an hour instead of waiting for weeks. We’re a long way away from this, but that doesn’t mean that it couldn’t happen fast with enough focused attention and funding.

Another option, serological tests, will let us check who has already recovered from the virus, so some people will know they’ve developed immunity and can return to normal. The UK is aggressively exploring this option and says they plan to make millions of serological tests available within “days rather than weeks or months,” says Sharon Peacock, the director of the national infection service at Public Health England.

Lockdowns affect lots of people who could be at work. Once we have better testing, we can lock down only people who’ve been exposed for the period of time that they’re at risk of spreading the virus (most countries require 14 days of self-quarantine).

Better treatments, too, might change the dynamic of our fight against the coronavirus. Several promising drugs are undergoing trials right now, including a multi-nation, thousands-of-patients, multi-drug randomized trial organized by the WHO called SOLIDARITY. The president has controversially highlighted chloroquine, an antimalarial drug, but others showing promising early results include Japanese flu drug favipiravir, HIV medication remdesivir, and others. If a successful treatment that makes the illness much less dangerous is discovered, we could return sooner to normal life.

To be clear, it’s a mistake to hype any one of these drugs as a cure-all (and please, don’t hoard them at home). And the president certainly hasn’t helped by touting them as miracle cures despite mixed early evidence.

But it’s not unlikely that our treatment options will improve dramatically as we learn more. “We need more data at every level,” UCSF biologist Nevan Krogan, who is researching drug treatments for the disease, said in March.

Finally, our manufacturing can scale up production of personal protective equipment and ventilators, and we can rapidly train more people to care for coronavirus patients, increasing our hospital capacity and our ability to cope with the virus.

“Let’s figure out testing, let’s get enough PPE [personal protective equipment] for first responders,” Tara Smith, who studies infectious disease at Kent State University, told my colleague Brian Resnick. “Let’s get enough swabs. Let’s buy more ventilators, build more ventilators — to have this second chance at not messing things up.”

While all that’s happening, researchers like Stephen Kissler of Harvard have proposed that we might alternate periods of social distancing, trying to keep society functioning and our mental health acceptable while not overloading our hospitals. “Intermittent social distancing — triggered by trends in disease surveillance — may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound,” the Imperial College London report concluded.

So while life as normal might be a long way off, we shouldn’t expect to be sitting in lockdown for the next year. This is a painful, temporary, weeks-long (maybe months-long) step while we progress as fast as possible on all of those fronts.

There are now two months of coronavirus response behind us. We spent one of them unaware that we were under attack, and the second trying to figure out how to respond. By the time we had a good picture of the problem in front of us, we had a problem on an unprecedented scale.

But it’s not all hopeless. If the world is at war with the coronavirus, it’s encouraging to remember that the US has historically been incompetent in the early stages of a global war — but unstoppable once we set ourselves to the task at hand. This isn’t over — it is, in fact, barely getting started — and it’s up to all of us to decide how it ends.

Look. I found an article on Venezuela, in English, that says something about it that doesn’t come from CIA talking points.

Venezuela’s Coronavirus Response Might Surprise You

https://venezuelanalysis.com/analysis/14824

Within a few hours of being launched, over 800 Venezuelans in the U.S. registered for an emergency flight from Miami to Caracas through a website run by the Venezuelan government. This flight, offered at no cost, was proposed by President Nicolás Maduro when he learned that 200 Venezuelans were stuck in the United States following his government’s decision to stop commercial flights as a preventative coronavirus measure. The promise of one flight expanded to two or more flights, as it became clear that many Venezuelans in the U.S. wanted to go back to Venezuela, yet the situation remains unresolved due to the U.S. ban on flights to and from the country.

Those who rely solely on the mainstream media might wonder who in their right mind would want to leave the United States for Venezuela. Time, The Washington Post, The Hill and the Miami Herald, among others, published opinions in the past week describing Venezuela as a chaotic nightmare. These media outlets painted a picture of a coronavirus disaster, of government incompetence and of a nation teetering on the brink of collapse. The reality of Venezuela’s coronavirus response is not covered by the mainstream media at all.

Furthermore, what each of these articles shortchanges is the damage caused by the Trump administration’s sanctions, which devastated the economy and healthcare system long before the coronavirus pandemic. These sanctions have impoverished millions of Venezuelans and negatively impact vital infrastructure, such as electricity generation. Venezuela is impeded from importing spare parts for its power plants and the resulting blackouts interrupt water services that rely on electric pumps. These, along with dozens of other implications from the hybrid war on Venezuela, have caused a decline in health indicators across the board, leading to 100,000 deaths as a consequence of the sanctions.

Regarding coronavirus specifically, the sanctions raise the costs of testing kits and medical supplies, and ban Venezuela’s government from purchasing medical equipment from the U.S. (and from many European countries). These obstacles would seemingly place Venezuela on the path to a worst-case scenario, similar to Iran (also battered by sanctions) or Italy (battered by austerity and neoliberalism). In contrast to those two countries, Venezuela took decisive steps early on to face the pandemic.

As a result of these steps and other factors, Venezuela is currently in its best-case scenario. As of this writing, 11 days after the first confirmed case of coronavirus, the country has 86 infected people, with 0 deaths. Its neighbors have not fared as well: Brazil has 1,924 cases with 34 deaths; Ecuador 981 and 18; Chile 746 and 2; Peru 395 and 5; Mexico 367 and 4; Colombia 306 and 3. (With the exception of Mexico, those governments have all actively participated and contributed to the U.S.-led regime change efforts in Venezuela.) Why is Venezuela doing so much better than others in the region?

Skeptics will claim that the Maduro government is hiding figures and deaths, that there’s not enough testing, not enough medicine, not enough talent to adequately deal with a pandemic. But here are the facts:

First, international solidarity has played a priceless role in enabling the government to rise to the challenge. China sent coronavirus diagnostic kits that will allow 320,000 Venezuelans to be tested, in addition to a team of experts and tons of supplies. Cuba sent 130 doctors and 10,000 doses of interferon alfa-2b, a drug with an established record of helping COVID-19 patients recover. Russia has sent the first of several shipments of medical equipment and kits. These three countries, routinely characterized by the U.S. foreign policy establishment as evil, offer solidarity and material support. The United States offers more sanctions and the IMF, widely known to be under U.S. control, denied a Venezuelan request for $5 billion in emergency funding that even the European Union supports.

Second, the government quickly carried out a plan to contain the spread of the disease. On March 12, a day before the first confirmed cases, President Maduro decreed a health emergency, prohibited crowds from gathering, and cancelled flights from Europe and Colombia. On March 13, Day 1, two Venezuelans tested positive; the government cancelled classes, began requiring facemasks on subways and on the border, closed theaters, bars and nightclubs, and limited restaurants to take-out or delivery. It bears repeating that this was on Day 1 of having a confirmed case; many U.S. states have yet to take these steps. By Day 4, a national quarantine was put into effect (equivalent to shelter-in-place orders) and an online portal called the Homeland System (Sistema Patria) was repurposed to survey potential COVID-19 cases. By Day 8, 42 people were infected and approximately 90% of the population was heeding the quarantine. By Day 11, over 12.2 million people had filled out the survey, over 20,000 people who reported being sick were visited in their homes by medical professionals and 145 people were referred for coronavirus testing. The government estimates that without these measures, Venezuela would have 3,000 infected people and a high number of deaths.

Third, the Venezuelan people were positioned to handle a crisis. Over the past 7 years, Venezuela has lived through the death of wildly popular leader, violent right-wing protests, an economic war characterized by shortages and hyperinflation, sanctions that have destroyed the economy, an ongoing coup, attempted military insurrections, attacks on public utilities, blackouts, mass migration and threats of U.S. military action. The coronavirus is a different sort of challenge, but previous crises have instilled a resiliency among the Venezuelan people and strengthened solidarity within communities. There is no panic on the streets; instead, people are calm and following health protocols.

Fourth, mass organizing and prioritizing people above all else. Communes and organized communities have taken the lead, producing facemasks, keeping the CLAP food supply system running (this monthly food package reaches 7 million families), facilitating house-by-house visits of doctors and encouraging the use of facemasks in public. Over 12,000 medical school students in their last or second-to-last year of study applied to be trained for house visits. For its part, the Maduro administration suspended rent payments, instituted a nationwide firing freeze, gave bonuses to workers, prohibited telecoms from cutting off people’s phones or internet, reached an agreement with hotel chains to provide 4,000 beds in case the crisis escalates, and pledged to pay the salaries of employees of small and medium businesses. Amid a public health crisis – compounded by an economic crisis and sanctions – Venezuela’s response has been to guarantee food, provide free healthcare and widespread testing, and alleviate further economic pressure on the working class.

The U.S. government has not responded to the Maduro administration’s request to make an exception for Conviasa Airlines, the national airline under sanctions, to fly the Venezuelans stranded in the United States back to Caracas. Given everything happening in the United States, where COVID-19 treatment can cost nearly $35,000 and the government is weighing the option of prioritizing the economy over the lives of people, perhaps these Venezuelans waiting to go home understand that their chances of surviving the coronavirus – both physically and economically – are much better in a country that values health over profits.

Leonardo Flores is Latin American policy expert and campaigner with CODEPINK.

I’ve been interested in this question. Cause if you are immune once youve had it, the world is a lot different, than if you could still get it again. And again.

Looks like the answer is: we dunno?

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3. Can I catch COVID-19 a second time?

Catching a coronavirus generally means that person is immune, at least for a time, to repeat infection. But doubts arose regarding COVID-19 in late February when a woman in her late 40s who had been discharged from hospital in Osaka, Japan tested positive a second time. There also a similar case with one of the Diamond Princess passengers, and another in South Korea. These were isolated cases, but more worrying was research from Guangdong province, China reporting that 14% of recovering patients had also retested positive.

However, it is too early to jump to conclusions. These cases have not been fully confirmed, with many possible explanations, including faulty, over-sensitive or over-diligent testing; or that the virus had become dormant for a time and then re-emerged. The Centers for Disease Control and Prevention (CDC) stress that our immune response to this particular disease is not yet clearly understood: “Patients with MERS-CoV infection are unlikely to be reinfected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.”

In terms of other after-effects, scientists are also currently speculating that coronavirus patients may suffer from reduced lung capacity following a bout of the disease. The Hong Kong Hospital Authority observed that two out of three recovering patients had lost 20-30% of lung function – something that can be treated with physiotherapy.
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4. How long might immunity to COVID-19 last?

“If you get an infection, your immune system is revved up against that virus,” Dr. Keiji Fukuda, director of Hong Kong University’s School of Public Health, told The LA Times. “To get reinfected again when you’re in that situation would be quite unusual unless your immune system was not functioning right.” With many past viruses, immunity can last years – but the reinfection question shows the bigger picture surrounding COVID-19 remains cloudy.

One thing that might help clarify the immunity question is developing serological tests for antibodies to SARS-CoV2, the COVID-19 pathogen. This would not only provide more information about individual immune-system responses, but also able researchers to more accurately identify the total population affected – by detecting people who might have slipped through the net after recovery. No country currently has confirmed access to such a test, according to The Guardian. But numerous scientists around the world – including one in Singapore that has claimed a successful trial – are working on them.
link:https://www.weforum.org/agenda/2020/03/coronavirus-recovery-what-happens-after-covid19/

L.A. County gives up on containing coronavirus, tells doctors to skip testing of some patients

https://www.latimes.com/california/story/2020-03-20/coronavirus-county-doctors-containment-testing?fbclid=IwAR0WbZEFPXvi83iGptYup2FtDs-vI0LHzV32Vk7SEaIEfrNPpd3SzgvPSEc

The nation’s second-largest municipal health system has told its staff that it is essentially abandoning hope of containing the coronavirus outbreak and instructed doctors not to bother testing symptomatic patients if a positive result won’t change how they would be treated.

The guidance, sent by the Los Angeles County Department of Health Services to its doctors on Thursday, was prompted by a crush of patients and shortage of tests, and could make it difficult to ever know precisely how many people in L.A. County contracted the virus.

The department “is shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the letter. Doctors should test symptomatic patients only when “a diagnostic result will change clinical management or inform public health response.”

The guidance sets in writing what has been a reality all along. The shortage of tests nationwide has meant that many patients suspected of having COVID-19 have not had the diagnosis confirmed by a laboratory.

In addition to the lack of tests, public health agencies across the country lack the staff to trace the source of new cases, drastically reducing the chances of isolating people who have been exposed and thereby containing the outbreak.

For years, state and local health officials have been warning that steep cuts to federal grants meant to boost preparedness for a pandemic would mean there wouldn’t be enough equipment and staff on hand to respond in the crucial, early stage. Those fears have come to fruition now, officials said.

A front-line healthcare provider who was not authorized to speak to the media and requested anonymity said county doctors are interpreting Thursday’s letter and other advice coming from senior L.A. County public health officials to mean they should only test patients who are going to be hospitalized or have something unique about the way they contracted the virus.

They are not planning to test patients who have the symptoms but are otherwise healthy enough to be sent home to self-quarantine — meaning they may never show up in official tallies of people who tested positive.

The letter also says that, with the increasing availability of tests at private labs, the health department will focus on testing aimed at detecting and preventing outbreaks in hospitals and “congregate living settings,” such as nursing homes.

Department officials did not immediately respond to a request for comment.

BANKS PRESSURE HEALTH CARE FIRMS TO RAISE PRICES ON CRITICAL DRUGS, MEDICAL SUPPLIES FOR CORONAVIRUS

https://theintercept.com/2020/03/19/coronavirus-vaccine-medical-supplies-price-gouging/?fbclid=IwAR2sXHwwqFEThedPxQPxCkhXuscEreaziqoNES5DwB9xPDdMw9hwHDS6vIA

IN RECENT WEEKS, investment bankers have pressed health care companies on the front lines of fighting the novel coronavirus, including drug firms developing experimental treatments and medical supply firms, to consider ways that they can profit from the crisis.

The media has mostly focused on individuals who have taken advantage of the market for now-scarce medical and hygiene supplies to hoard masks and hand sanitizer and resell them at higher prices. But the largest voices in the health care industry stand to gain from billions of dollars in emergency spending on the pandemic, as do the bankers and investors who invest in health care companies.

Over the past few weeks, investment bankers have been candid on investor calls and during health care conferences about the opportunity to raise drug prices. In some cases, bankers received sharp rebukes from health care executives; in others, executives joked about using the attention on Covid-19 to dodge public pressure on the opioid crisis.

Gilead Sciences, the company producing remdesivir, the most promising drug to treat Covid-19 symptoms, is one such firm facing investor pressure.

Remdesivir is an antiviral that began development as a treatment for dengue, West Nile virus, and Zika, as well as MERS and SARS. The World Health Organization has said there is “only one drug right now that we think may have real efficacy in treating coronavirus symptoms” — namely, remdesivir.

The drug, though developed in partnership with the University of Alabama through a grant from the federal government’s National Institutes of Health, is patented by Gilead Sciences, a major pharmaceutical company based in California. The firm has faced sharp criticism in the past for its pricing practices. It previously charged $84,000 for a yearlong supply of its hepatitis C treatment, which was also developed with government research support. Remdesivir is estimated to produce a one-time revenue of $2.5 billion.

During an investor conference earlier this month, Phil Nadeau, managing director at investment bank Cowen & Co., quizzed Gilead Science executives over whether the firm had planned for a “commercial strategy for remdesivir” or could “create a business out of remdesivir.”

Johanna Mercier, executive vice president of Gilead, noted that the company is currently donating products and “manufacturing at risk and increasing our capacity” to do its best to find a solution to the pandemic. The company at the moment is focused, she said, primarily on “patient access” and “government access” for remdesivir.

“Commercial opportunity,” Mercier added, “might come if this becomes a seasonal disease or stockpiling comes into play, but that’s much later down the line.”

Steven Valiquette, a managing director at Barclays Investment Bank, last week peppered executives from Cardinal Health, a major health care distributor of N95 masks, ventilators, and pharmaceuticals, on whether the company would raise prices on a range of supplies.

Valiquette asked repeatedly about potential price increases on a variety of products. Could the company, he asked, “offset some of the risk of volume shortages” on the “pricing side”?

Michael Kaufmann, a vice president at Cardinal Health, said that “so far, we’ve not seen any material price increases that I would say are related to the coronavirus yet.” Cardinal Health, Kaufman said, would weigh a variety of factors when making these decisions.

“Are you able to raise the price on some of this to offset what could be some volume shortages such that it all kind of nets out to be fairly consistent as far as your overall profit matrix?” asked Valiquette.

Kaufman responded that price decisions would depend on contracts with providers, though the firm has greater flexibility over some drug sales. “As you have changes on the cost side, you’re able to make some adjustments,” he noted.

The discussion, over conference call, occurred during the Barclays Global Healthcare Conference on March 10. At one point, Valiquette joked that “one positive” about the coronavirus would be a “silver lining” that Cardinal Health may receive “less questions” about opioid-related lawsuits.

Cardinal Health is one of several firms accused of ignoring warnings and flooding pharmacies known as so-called pill mills with shipments of millions of highly addictive painkillers. Kaufmann noted that negotiations for a settlement are ongoing, and noted that the company has told local officials that discharging the litigation would allow his company “to distribute free goods.”

Owens & Minor, a health care logistics company that sources and manufactures surgical gowns, N95 masks, and other medical equipment, presented at the Barclays Global Healthcare Conference the following day.

Valiquette, citing the Covid-19 crisis, asked the company whether it could “increase prices on some of the products where there’s greater demand.” Valiquette then chuckled, adding that doing so “is probably not politically all that great in the sort of dynamic,” but said he was “curious to get some thoughts” on whether the firm would consider hiking prices.

The inquiry was sharply rebuked by Owens & Minor chief executive Edward Pesicka. “I think in a crisis like this, our mission is really around serving the customer. And from an integrity standpoint, we have pricing agreements,” Pesicka said. “So we are not going to go out and leverage this and try to ‘jam up’ customers and raise prices to have short-term benefit.”

AmerisourceBergen, another health care distributor that supplies similar products to Cardinal Health, which is also a defendant in the multistate opioid litigation, faced similar questions from Valiquette at the Barclays event.

Steve Collis, president and chief executive of AmerisourceBergen, noted that his company has been actively involved in efforts to push back against political demands to limit the price of pharmaceutical products.

Collis said that he was recently at a dinner with other pharmaceutical firms involved with developing “vaccines for the coronavirus” and was reminded that the U.S. firms, operating under limited drug price intervention, were among the industry leaders — a claim that has been disputed by experts who note that lack of regulation in the drug industry has led to few investments in viral treatments, which are seen as less lucrative. Leading firms developing a vaccine for Covid-19 are based in Germany, China, and Japan, countries with high levels of government influence in the pharmaceutical industry.

AmerisourceBergen, Collis continued, has been “very active with key stakeholders in D.C., and our priority is to educate policymakers about the impact of policy changes,” with a focus on “rational and responsible discussion about drug pricing.”

Later in the conversation, Valiquette asked AmerisourceBergen about the opioid litigation. The lawsuits could cost as much as $150 billion among the various pharmaceutical and drug distributor defendants. Purdue Pharma, one of the firms targeted with the opioid litigation, has already pursued bankruptcy protection in response to the lawsuit threat.

“We can’t say too much,” Collis responded. But the executive hinted that his company is using its crucial role in responding to the pandemic crisis as leverage in the settlement negotiations. “I would say that this crisis, the coronavirus crisis, actually highlights a lot of what we’ve been saying, how important it is for us to be very strong financial companies and to have strong cash flow ability to invest in our business and to continue to grow our business and our relationship with our customers,” Collis said.

The hope that the coronavirus will benefit firms involved in the opioid crisis has already materialized in some ways. New York Attorney General Letitia James announced last week that her lawsuit against opioid firms and distributors, including Cardinal Health and AmerisourceBergen, set to begin on March 20, would be delayed over coronavirus concerns.

MARKET PRESSURE has encouraged large health care firms to spend billions of dollars on stock buybacks and lobbying, rather than research and development. Barclays declined to comment, and Cowen & Co. did not respond to a request for comment.

The fallout over the coronavirus could pose potential risks for for-profit health care operators. In Spain, the government seized control of private health care providers, including privately run hospitals, to manage the demand for treatment for patients with Covid-19.

But pharmaceutical interests in the U.S. have a large degree of political power. Health and Human Services Secretary Alex Azar previously served as president of the U.S. division of drug giant Eli Lilly and on the board of the Biotechnology Innovation Organization, a drug lobby group.

During a congressional hearing last month, Azar rejected the notion that any vaccine or treatment for Covid-19 should be set at an affordable price. “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest,” said Azar. “The priority is to get vaccines and therapeutics. Price controls won’t get us there.”

The initial $8.3 billion coronavirus spending bill passed in early March to provide financial support for research into vaccines and other drug treatments contained a provision that prevents the government from delaying the introduction of any new pharmaceutical to address the crisis over affordability concerns. The legislative text was shaped, according to reports, by industry lobbyists.

Joe Grogan, director of the Domestic Policy Council, listens during a coronavirus briefing with health insurers in the Roosevelt Room of the White House in Washington, D.C., U.S., on Tuesday, March 10, 2020. The window for fully containing the coronavirus has passed in some parts of the U.S. and the White House will roll out plans later Tuesday to mitigate its impact. Photographer: Al Drago/Bloomberg via Getty ImagesJoe Grogan, director of the Domestic Policy Council, listens during a coronavirus briefing with health insurers in the Roosevelt Room of the White House in Washington, D.C., U.S., on Tuesday, March 10, 2020. Photo: Al Drago/Bloomberg via Getty Images

As The Intercept previously reported, Joe Grogan, a key White House domestic policy adviser now serving on Donald Trump’s Coronavirus Task Force, previously served as a lobbyist for Gilead Sciences.
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“Notwithstanding the pressure they may feel from the markets, corporate CEOs have large amounts of discretion and in this case, they should be very mindful of price gouging, they’re going to be facing a lot more than reputational hits,” said Robert Weissman, president of public interest watchdog Public Citizen, in an interview with The Intercept.

“There will be a backlash that will both prevent their profiteering, but also may push to more structural limitations on their monopolies and authority moving forward,” Weissman said.

Weissman’s group supports an effort led by Rep. Andy Levin, D-Mich., who has called on the government to invoke the Defense Production Act to scale up domestic manufacturing of health care supplies.

There are other steps the government can take, Weissman added, to prevent price gouging.

“The Gilead product is patent-protected and monopoly-protected, but the government has a big claim over that product because of the investment it’s made,” said Weissman.

“The government has special authority to have generic competition for products it helped fund and prevent nonexclusive licensing for products it helped fund,” Weissman continued. “Even for products that have no connection to government funding, the government has the ability to force licensing for generic competition for its own acquisition and purchases.”

Drug companies often eschew vaccine development because of the limited profit potential for a one-time treatment. Testing kit companies and other medical supply firms have few market incentives for domestic production, especially scaling up an entire factory for short-term use. Instead, Levin and Weissman have argued, the government should take direct control of producing the necessary medical supplies and generic drug production.

Last Friday, Levin circulated a letter signed by other House Democrats that called for the government to take charge in producing ventilators, N95 respirators, and other critical supplies facing shortages.

The once inconceivable policy was endorsed on Wednesday when Trump unveiled a plan to invoke the Defense Production Act to compel private firms to produce needed supplies during the crisis. The law, notably, allows the president to set a price ceiling for critical goods used in an emergency.

• This topic was modified 5 years, 11 months ago by zn.

Notes from UCSF Expert panel – March 10

University of California, San Francisco BioHub Panel on COVID-19

https://www.linkedin.com/content-guest/article/notes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d-/

March 10, 2020

Panelists
Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.
Emily Crawford: COVID task force director. Focused on diagnostics
Cristina Tato: Rapid Response Director. Immunologist.
Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.
Chaz Langelier: UCSF Infectious Disease doc

What’s below are essentially direct quotes from the panelists. I bracketed the few things that are not quotes.

Top takeaways
At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.
Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to “flatten the curve”, to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
How many in the community already have the virus? No one knows.
We are moving from containment to care.
We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.
40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
[We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that’s 1.6M Americans die over the next 12-18 months.]
The fatality rate is in the range of 10X flu.
This assumes no drug is found effective and made available.
The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.]
Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we’ll be dealing with this for the next year at least. Our lives are going to look different for the next year.
What should we do now? What are you doing for your family?
Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
How long does the virus last?
On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.
Avoid concerts, movies, crowded places.
We have cancelled business travel.
Do the basic hygiene, eg hand washing and avoiding touching face.
Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.
Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.
Three routes of infection
Hand to mouth / face
Aerosol transmission
Fecal oral route
What if someone is sick?
If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.
If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.
If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use” of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.]
Why is the fatality rate much higher for older adults?
Your immune system declines past age 50
Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults.
Risk of pneumonia is higher in older adults.
What about testing to know if someone has COVID-19?
Bottom line, there is not enough testing capacity to be broadly useful. Here’s why.
Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish “COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives.
The PCR test requires kits with reagents and requires clinical labs to process the kits.
While the kits are becoming available, the lab capacity is not growing.
The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.
Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon.
UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.
Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.
How well is society preparing for the impact?
Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.
If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected.
School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.
Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.
What will we do to handle behavior changes that can last for months?
Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.
Kids home due to school closures
[Dr. DeRisi had to leave the meeting for a call with the governor’s office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people.
Where do you find reliable news?
The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email.
The New York Times is good on scientific accuracy.

Observations on China
Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.
While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.
Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.
Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. Are we in the twilight of a century of medicine’s great triumph over infectious disease?
“We’ve been in a back and forth battle against viruses for a million years.”
But it would sure help if every country would shut down their wet markets.
As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia.

Column: Why sleepy Joe Biden is exactly what voters want
Joe Biden
Joe Biden campaigns in Philadelphia.(Mandel Ngan / AFP-Getty Images )
By VIRGINIA HEFFERNAN
MARCH 12, 20209 AM
One candidate inspired a stampede of voters on Tuesday. He also managed, for the time being, to take big money out of politics.

But it wasn’t Sen. Bernie Sanders. The Bellwether of Burlington promised to do these things, but in the end, he wasn’t the one who got the big turnout without the big bucks. It was former Vice President Joe Biden, a hoary has-been who reps what Sanders likes to call the “corporate wing of the Democratic Party.”

Once upon a time, Biden may have embraced that role. Decades ago, the first time he ran for president, he was an ace fundraiser — a sweetheart of the DNC, till that campaign fizzled and he was proclaimed the “once hot” Democrat in a news headline. This time he started with an exceedingly modest war chest and low expectations, only to build something more than momentum out of thin air.

It should be said that the Biden of 2020 didn’t try to run without big money. He probably wouldn’t have been averse to a lot of sweet corporate windfalls. And don’t expect him to turn them down now. They just didn’t come his way early on. Before his victories on Tuesday, he’d raised about $76 million to Sanders’s $134 million in grassroots donations.

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No wonder Biden’s touching but rattletrap campaign has had all the hallmarks of involuntary thrift. He didn’t just fail to appear in several primary states; in many, his campaign barely set up card tables. And the Biden comms efforts are still so threadbare that even his fundraising emails look like they come from cardboard boxes stamped “1987.” (We must have those bumper stickers blasting Reaganomics around here somewhere.)

Biden hasn’t even paid an agency to develop a snappy hashtag. #IAmTiredAndDontHaveAnyMoney, in fact, might have been the campaign’s default theme till about a week ago. At least it’s relatable.

But, money or no, and razzle-dazzle or no, Biden voters have showed up. Biden added four of the six Tuesday night states to his win column, including the big prize, Michigan, and as of Wednesday, he had pulled ahead in Washington, which is still counting votes. All those victories followed his Super Tuesday blowout: Virginia, North Carolina, Alabama, Tennessee, Oklahoma, Arkansas, Minnesota, Massachusetts, Texas and Maine.

There is a theoretical “path forward” for Sanders, but Biden seems to be the presumptive nominee now. It says something that President Trump, when he’s not producing COVID-19 covfefe on Twitter and from the Oval Office, is back to attacking him. Even Sanders, who announcedhe would stay in at least through Sunday’s debate, admits that Biden may be winning the “electability” contest.

Which brings us to turnout. The Sanders campaign regularly prophesied that new voters — voters who grew up with student debt, bank failures, rapacious capitalism and endless wars — would be impelled to the polls by the promises of a revolution that would lift up the working class.

That prediction missed the mark, but Tuesday’s polling places were hardly empty. Indeed, there was record-breaking turnout, especially in Michigan. It’s just that the votes were cast for Biden, from a formidable group now considered Biden’s coalition: African Americans, suburban women and non-college-educated whites.

It’s admittedly hard to imagine Biden spiking anyone’s adrenaline. He’s low-key in the extreme on the stump. He’s regularly praised for “humility” now — an odd quality for a presidential candidate, from whom voters usually want dreams, ambitions, plans, pep rallies.

But for a country suffering from tinnitus after four years of a headbanger president, Biden’s quietude is welcome.

Election forecaster and political scientist Rachel Bitecofer calls the powerful force that keeps prospective voters away from the polls “comfort.” When choosing a candidate, you ask yourself for whom (and for what) you’re going to forfeit your comfort — get a babysitter, change clothes, jump on a bus and stand in line at a polling place, or even make sure a mail-in ballot gets to the registrar on time. For decades, Democrats have given one answer: a dreamy candidate who makes their hearts race.

Not this time. If Democrats have long been accused of wanting “savior” presidents — and staking everything on presidential elections while ignoring the rest — this election may mark a turning point.

If the Biden wave is any indication, Democrats are no longer looking for that kind of perfection. They’ll settle for a break from the jackhammer noise — from Trump, from Michael Bloomberg, from Sanders, from cable news, from their bloviating relatives, from Twitter.

The lesson going into next week’s primaries seems to be that voters will give up “comfort” because their situation now is not all that comfortable. Discomfort is ever-present even when we’re at home on the sofa self-quarantined with our hand sanitizer. A virus is stalking the planet. Kids are shut out of schools. Our savings are plummeting. The president is disturbed, senseless and tyrannical.

What’s driving turnout now, and what will drive it in November, isn’t infatuation with a savior. We aren’t head over heels. We aren’t buying Big Ideas. We’ll move heaven and earth to get to the polls, to turn in our ballots, because we want to stop tossing and turning and get some sleep again.

And sleepy Joe is just the guy for bedtime stories and lullabies.

@page88

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