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  • in reply to: tweets & other bits … 4/8 thru 4/11 #113447
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    Cameron DaSilva@camdasilva
    Over the Cap has Michael Brockers’ contract deets and it’s a team-friendly deal in 2020 ($3.83M cap hit)

    The Rams have just over $325K left in salary cap space now, which is the lowest amount in the NFL. And that doesn’t include Leonard Floyd’s deal.

    Goff is the most likely candidate to restructure his deal

    in reply to: tweets & other bits … 4/8 thru 4/11 #113446
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    J.B. Long@JB_Long
    an AFC assistant claims that Jameis & Cam would both be “instant upgrades” for #LARams at QB.

    Which is a difficult position to validate considering in a 3-yr sample (2017-19) JG16 leads both in rating, TD%, INT%, AY/A, among other categories. Other than that, though…

    Daniel Jeremiah@MoveTheSticks
    The theme of this draft- speed! Every team I talk to mentions the importance of getting faster. Teams like KC & BAL are going to be an obstacle for a LONG time. Need explosive plays/playmakers on both sides of the ball.

    in reply to: tweets & other bits … 4/8 thru 4/11 #113445
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    in reply to: tweets & other bits … 4/8 thru 4/11 #113444
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    ==

    in reply to: draft talk (April) #113442
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    from PFF 3-Round Mock

    Pro Football Focus

    52. Los Angeles Rams — LB Jordyn Brooks, Texas Tech

    The 6-foot-1, 245-pound Brooks looks like a sure thing in run defense after earning a 91.5 grade in that area last season. He also has sideline-to-sideline speed to make plays in coverage.

    84. Los Angeles Rams — IOL Matt Hennessy, Temple

    Hennessy can block on the move as well as any center in this class. He earned a run-blocking grade on outside zone well above 90.0 last season. He’s not a scheme fit for everyone, but he is for the Rams.

    104. Los Angeles Rams — Edge Darrell Taylor, Tennessee

    Taylor came on strong during SEC play last season and finished with a career-high 87.5 pass-rushing grade. He could be an every-down block of granite on the edge for the Rams.

    in reply to: about drafting under these circumstances #113432
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    Steelers GM Pushing For Three Extra NFL Draft Rounds

    https://www.profootballrumors.com/2020/04/steelers-gm-pushing-for-three-extra-nfl-draft-rounds

    The coronavirus has radically changed the NFL Draft process and Steelers GM Kevin Colbert has offered up one proposal to help teams adjust to the lack of workouts and Pro Days. Colbert has asked league officials to add an additional three rounds to this year’s draft, bringing the total number of rounds to ten, as Manish Mehta of the Daily News writes.

    In lieu of drills and auditions, teams are permitted to hold up to three hour-long video conferences per week with any prospect. Still, coaches and executives like Colbert feel like they are flying blind. The draft is already wildly unpredictable; now teams have less intel than ever before. Because there are bound to be many misfires, Colbert believes the Steelers (and other clubs) can offset things a bit with a greater margin for error.

    It’s not immediately clear whether the league is giving real consideration to Colbert’s idea, but anything is possible given these unprecedented conditions. This year’s draft will be “fully virtual” with executives conducting their business in separate locations, rather than the initial plan of allowing teams to gather their front office officials in one room.

    The league has done its best to adjust. For example, Tua Tagovailoa recently underwent a voluntary medical re-check via the league’s combine committee. Ordinarily, his surgically-repaired hip would have been examined by scores of team doctors in separate exams, Instead, every team was allowed to request specific tests and the results were then shared with all 32 clubs.

    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113429
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    Jason Reid@JReidESPN
    Over the past few days, I’ve talked with several sources of mine who work in NFL player personnel. My takeaway is this: The chatter out there about teams being worried about blowing this draft is very, very real.

    ProFootballTalk@ProFootballTalk
    With the crapshoot that is the NFL draft destined to be even more crap than shoot, Steelers G.M. Kevin Colbert reportedly requests three extra rounds

    Jim Nagy@JimNagy_SB
    This is actually a smart, outside-the-box proposal by Kevin Colbert. Undrafted free agency is mass chaos with all scouts and coaches in the same building and there’s no good “virtual” solution. Eliminate UDFA for one year and draft another 200+ players. Makes complete sense.

    Cameron DaSilva@camdasilva
    Sean McVay addressed the Brandin Cooks trade rumors and confirmed LA has gotten calls about the WR

    in reply to: Chloroquine, other approaches #113408
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    BTW there’s a lot of misleading info out there in the right-wing media about treatments and the data regarding them. The 2nd quotation here is from a great article.

    1.

    . https://www.statnews.com/2020/04/06/trump-hydroxychloroquine-fact-check/

    In press releases, the FDA has stressed that “there are no currently approved treatments for COVID-19.” However, the agency says both hydroxychloroquine and chloroquine phosphate “have shown activity in laboratory studies against coronaviruses,” referring to a broad category of illnesses known as coronaviruses, not the 2019 strain that causes Covid-19. A number of federal agencies are currently working to facilitate clinical trials to determine whether or not the drug is effective.

    2.

    . https://rantt.com/right-wing-media-misrepresents-hydroxychloroquine-poll

    The Post incorrectly reported: “Of the 6,227 physicians surveyed in 30 countries, 37 percent rated hydroxychloroquine the ‘most effective therapy’ for combating the potentially deadly illness, according to the results released Thursday.”

    A press release from Sermo, the company that conducted the survey, said: “Hydroxychloroquine was overall chosen as the most effective therapy[b] amongst COVID-19 treaters.”[/b]

    The Sermo survey shows that the subgroup of COVID-19 treaters is 2171 — not 6227, as multiple news outlets have since reported.

    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113400
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    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113399
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    from https://www.therams.com/video/whitworth-on-re-signing-with-the-rams-and-keeping-busy-at-home

    Andrew Whitworth is excited about Henderson’s potential in the Rams’ offense, calling him a “special athlete.”

    “He’s quick. When he puts his foot in the ground and goes, you can see it. A couple games there throughout the season, he got some opportunities and when he touched the football, he looked like lightning in a bottle,” Whitworth said. “It’s one of those things where as a young player, he’s going to learn things over his career and right now, it’s taking care of his body and how he can be in the best shape possible and how he can get through a season. that’s always a tough season for running backs, of course. So the more availability he has for us, I think we look forward to it because he’s a special athlete and somebody who can really help us.”

    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113396
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    Ian Rapoport@RapSheet
    The NFL has announced an all-decade team, highlighted by Tom Brady, Adrian Peterson, and Aaron Donald — among other unanimous selections.

    ===

    from NFL 2010s All-Decade Team (me note: includes 2 Rams)

    http://www.nfl.com/news/story/0ap3000001108338/article/nfl-2010s-alldecade-team-tom-brady-aaron-donald-headliners

    2010s ALL-DECADE TEAM ROSTER
    * — denotes a unanimous selection

    OFFENSE

    QB Tom Brady*
    QB Aaron Rodgers
    RB Frank Gore
    RB Marshawn Lynch
    RB LeSean McCoy
    RB Adrian Peterson*
    WR Antonio Brown
    WR Larry Fitzgerald
    WR Calvin Johnson
    WR Julio Jones
    FLEX Darren Sproles
    TE Rob Gronkowski
    TE Travis Kelce
    OT Jason Peters
    OT Tyron Smith
    OT Joe Staley
    OT Joe Thomas*
    OG Jahri Evans
    OG Logan Mankins
    OG Zack Martin
    OG Marshal Yanda*
    C Alex Mack
    C Maurkice Pouncey

    DEFENSE

    DE Calais Campbell
    DE Cameron Jordan
    DE Julius Peppers
    DE J.J. Watt*
    DT Geno Atkins
    DT Fletcher Cox
    DT Aaron Donald*
    DT Ndamukong Suh
    LB Chandler Jones
    LB Luke Kuechly
    LB Khalil Mack
    LB Von Miller*
    LB Bobby Wagner
    LB Patrick Willis
    CB Patrick Peterson
    CB Darrelle Revis
    CB Richard Sherman
    S Eric Berry
    S Earl Thomas
    S Eric Weddle
    DB Chris Harris Jr.
    DB Tyrann Mathieu

    SPECIALISTS

    P Johnny Hekker
    P Shane Lechler
    K Stephen Gostkowski
    K Justin Tucker*
    PR Tyreek Hill
    PR Darren Sproles
    KR Devin Hester
    KR Cordarrelle Patterson

    COACHES

    Bill Belichick
    Pete Carroll

    in reply to: virus news … (+ some dark humor) #113393
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    in reply to: Dealing with the BNMW crowd #113384
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    I actually think niche-reliance can give us a false sense of the two-party system. My own take is that those niche sources can oftentimes blur the differences via a “a pox on both houses” POV, and a failure to report the daily tic/toc events. The sentiment is understandable, and it floods my own thoughts all too often. But it can bring on its own fog as well.

    Yeah I entirely agree. The trick to being informed, I think, is to read (and watch) a lot of different kinds of sources on an issue or event, so that you are accustomed at the level of habit to constantly seeing how the same details can be framed differently. This puts you in a position to reasonably think through what you’re hearing and reading. I know everyone here knows that–just putting it down in black n white.

    in reply to: Chloroquine, other approaches #113376
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    Heated disagreement breaks out in Situation Room over hydroxychloroquine
    CNN Digital Expansion 2017 Jim AcostaKaitlan Collins byline

    https://www.cnn.com/2020/04/05/politics/white-house-malaria-drug-hydroxychloroquine-disagreement/index.html

    (CNN)There was a heated disagreement in the Situation Room this weekend over the efficacy of the anti-malaria drug hydroxychloroquine — but multiple sources say it was mostly one-sided, as President Donald Trump’s top trade adviser Peter Navarro feuded with other officials over the drug’s unproven effectiveness to treat coronavirus.

    The debate is not a new one inside the coronavirus task force — and medical experts have repeatedly explained to the President that there is a risk in enthusiastically touting hydroxychloroquine in case the drug doesn’t ultimately work to combat the virus. But other aides and outside advisers have sided with Trump, including Navarro, who is still not a formal part of the task force but has wedged himself into the meetings.
    Axios first reported on the disagreement inside the White House about the drug.
    While discussing the latest on hydroxychloroquine this weekend, an exasperated Navarro lashed out at Dr. Anthony Fauci, one of the advisers who has urged caution about the drug, a person familiar with the meeting told CNN.
    Navarro had brought a stack of paperwork with him into the Situation Room on the drug, arguing it was proof that it could work to treat coronavirus, which Fauci, the nation’s top infectious disease expert, disagreed with because it was not data.
    “What are you talking about?” Fauci asked — a question that set Navarro off. He became indignant, and at one point, accused Fauci of opposing Trump’s travel restrictions on China, which confused many in the room, given Fauci was one of the initial few to agree with Trump on the move, the source said.

    A source close to the task force said Fauci is not backing off of his belief that hydroxychloroquine is not a proven treatment for coronavirus. When CNN’s Jeremy Diamond asked Fauci to comment on the matter Sunday night, Trump stepped in and didn’t allow Fauci to answer. But a source said the doctor has already offered his opinion on the drug in other venues and would continue to do so.
    Several aides later said they were unfazed by Navarro’s outburst, given he has them regularly. But the argument highlights how deep the divide runs over the task force’s response to the coronavirus pandemic.
    Another source told CNN that despite the disagreement in the Situation Room between Fauci and Navarro, Fauci continues to have a good relationship with Trump and Pence, though some staffers have shown irritation when his opinions differ.

    in reply to: Dealing with the BNMW crowd #113375
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    Nathan J Robinson@NathanJRobinson
    Joe Rogan saying he’d vote for Trump over Biden shows the exact point we on the left have been making for years: Bernie has a unique appeal to voters who would otherwise vote for Trump and the whole “centrists are more electable” theory is nonsense

    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113374
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    Kevin Johnson@kingkj1962
    @EllardHop85 truly belongs in the Hall of Fame and I hop he makes it in this lifetime. Only player in the HISTORY of the NFL to be top 15 in Receiving yards & Yard per PR. No one else is even close.

    —

    in reply to: Logos/colors Monday … and … here it is #113373
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    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113372
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    in reply to: Sources: Trump says NFL should start on time #113360
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    We’re all asking the wrong question about the return of sports
    When will sports return? That’s the wrong question to be asking amid the fight against COVID-19

    link https://www.mercurynews.com/2020/04/04/kurtenbach-were-asking-the-wrong-question-about-the-return-of-sports/

    When will sports resume? Everyone has a thought. The North American professional sports leagues are hoping for late May, early June. Per ESPN, President Trump told commissioners Saturday that he hopes leagues can resume — with fans in the stands — in August or September.

    Yes, it’s his hope that the NFL starts, with fans in the stands, on time.

    California Governor Gavin Newsom disagrees. “I’m not anticipating that happening in this state,” he said Saturday.

    It’s fair to wonder and project, when normal — or whatever normal will be after this pandemic — will return, but the truth is that no one — not even the world’s best experts — can reasonably put a date when we’ll be able to go to our favorite restaurant, travel to see love ones without having to go into quarantine, or cheer on our favorite teams in person or even on TV once again.

    That’s because the pressing question when it comes to returning to normal isn’t “when?”.

    It’s “how?”.

    Until there is a vaccine, COVID-19 will be a threat. Right now, because it is a novel virus, humans have no antibodies, the world of medicine has no uniform treatment plans, and a safe, effective vaccine is a year away.
    Social distancing and wearing masks when in public are currently our only proven means for fighting back and saving lives.

    And until we no longer have to socially distance, it’s antithetical to expect that we can cram 250 people into a venue, much less 20,000 or 75,000.

    Closed-door games — even at a single venue — are inherently problematic. No matter how hard leagues might try, they won’t be able to fully quarantine every essential person for the operation, and, as we learned with the NBA, one positive test can — for good reason — shut the whole thing down.

    The only surefire way to return to the norm teams traveling all over the country to play in front of sold-out arenas is a vaccine.

    Still, according to Dr. Anthony Fauci, there might be some relaxation of social distancing in the weeks and months to come.

    “If we get to the part of the curve… when it goes down to essentially no new cases, no new deaths, I think it makes sense that you’re going to relax social distancing,” he said in a White House press conference earlier this week.

    But if social distancing is done correctly — if the curve is “flattened” — then that portion of the curve is, inherently, further away.

    In California, according to the University of Washington projections, that could be in July.

    But no two states are on the same timeline. Some cities, like New York, Miami, Los Angeles, and Detroit, are being hit harder than others, and the virus started spreading in communities at different times, too. Right now, the logistics of a normal schedule are nearly impossible to overcome for leagues that have teams from coast-to-coast.

    And because there was no national lock-down — every state gets to call its own shot — it’s ridiculous to think that there will be a single day where the country “re-opens”.

    No, returning to normal will also have to be a gradual process. Sports and other large gatherings needed to be the first things shut down and, inherently, they should be the last thing to re-open.

    It’s easy to see how Newsom is pessimistic about the fall. Relaxing social distancing, enough as to make it acceptable to fill a stadium, too early is a recipe for creating a second wave of infections. We’re seeing this in China, where movie theaters have been closed again and hopes of re-starting the national basketball league have been put on hold.

    So how will sports resume?

    “The one thing that we hopefully will have in place [if we are to see a second wave] — and I believe we will have in place — is a much more robust system to be able to identify someone that’s infected, isolate them, and then do contact tracing,” Fauci said. “If you have a really good program of containment, that prevents you from ever having to get to mitigation [social distancing]… The ultimate solution to a virus that might keep coming back is a vaccine.”

    So without a vaccine, we’re going to need a lot of T and T: treatment and testing.

    If there is a treatment plan that could obliterate COVID-19’s hospitalization and death rate, putting them in line with, say, the seasonal flu, that could facilitate a swifter return to normalcy.

    Near-free and overwhelmingly accessible and copious testing with near-instant results — the kind we do not have in the United States right now — could take us back to something resembling normal, too.

    But we’re all going to be wearing masks and watching quarantined NBA players play H-O-R-S-E and video games while we wait.

    The wait is all we can do, for now.

    Without a breakthrough, it’s hard to see a circumstance where the Warriors play again this season. The Sharks, too. NBA and NHL playoffs seem far fetched at the moment as well. If they happen, they’ll be closed-door events, perhaps in one venue.

    The Major League Baseball season seems destined to be played behind closed doors, too — at least in San Francisco and Oakland. That’s if they don’t play an entire season in Arizona and Florida.

    And given Newsom’s comments Saturday, September games at Levi’s Stadium will be even more empty than usual. Pandemic is a better excuse than “it’s too hot.”

    The games will resume. I can guarantee that. But this reality TV show won’t have a live studio audience for a while.

    That stinks, but we have to remember that around the world, professional sports leagues were not aggressive enough in shutting down. It’s presumptuous to say there was malicious intent on behalf of the teams and leagues, but it’s impossible to say that those games didn’t contribute to the devastation this virus has wrought. Sports can’t make the same mistake twice.

    In Northern Italy, a Champions League match between Atalanta and Valencia on Feb. 19 in Milan is being called “Game Zero” for the COVID-19 outbreak in that region. The Warriors played the Clippers despite the city of San Francisco’s request that they re-schedule or cancel the contest. Instead, they put some 8.5 by 11 sheets of paper on the doors of Chase Center asking people not to enter if they recently had flu-like symptoms or had traveled to China, Italy, South Korea, or Iran. The NHL, Major League Baseball, and Major League Soccer were planning to ride it out — to keep playing games and making money — until the NBA was forced to shut down because of Rudy Gobert’s positive test.

    It’s worth noting that even after Gobert’s test, the NBA continued to play games that night and planned on tipping off a late Pelicans-Kings game in Sacramento. New Orleans players refused to take the floor and the game was canceled.

    Now that we’re heading towards the other side of the curve, I’d hope the lesson was learned and the leagues will err on the side of caution, not capital. And I’d hope that governments will stop all those who make the wrong decision.

    I’m not holding my breath, but, again, we can hope.

    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113351
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    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113350
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    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113349
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    The U.S. was beset by denial and dysfunction as the coronavirus raged
    From the Oval Office to the CDC, political and institutional failures cascaded through the system and opportunities to mitigate the pandemic were lost.

    https://www.washingtonpost.com/national-security/2020/04/04/coronavirus-government-dysfunction/?arc404=true

    By the time Donald Trump proclaimed himself a wartime president — and the coronavirus the enemy — the United States was already on course to see more of its people die than in the wars of Korea, Vietnam, Afghanistan and Iraq combined.

    The country has adopted an array of wartime measures never employed collectively in U.S. history — banning incoming travelers from two continents, bringing commerce to a near-halt, enlisting industry to make emergency medical gear, and confining 230 million Americans to their homes in a desperate bid to survive an attack by an unseen adversary.

    Despite these and other extreme steps, the United States will likely go down as the country that was supposedly best prepared to fight a pandemic but ended up catastrophically overmatched by the novel coronavirus, sustaining heavier casualties than any other nation.

    It did not have to happen this way. Though not perfectly prepared, the United States had more expertise, resources, plans and epidemiological experience than dozens of countries that ultimately fared far better in fending off the virus.

    The failure has echoes of the period leading up to 9/11: Warnings were sounded, including at the highest levels of government, but the president was deaf to them until the enemy had already struck.

    The Trump administration received its first formal notification of the outbreak of the coronavirus in China on Jan. 3. Within days, U.S. spy agencies were signaling the seriousness of the threat to Trump by including a warning about the coronavirus — the first of many — in the President’s Daily Brief.

    And yet, it took 70 days from that initial notification for Trump to treat the coronavirus not as a distant threat or harmless flu strain well under control, but as a lethal force that had outflanked America’s defenses and was poised to kill tens of thousands of citizens. That more-than-two-month stretch now stands as critical time that was squandered.

    33 times Trump downplayed the coronavirus

    Trump’s baseless assertions in those weeks, including his claim that it would all just “miraculously” go away, sowed significant public confusion and contradicted the urgent messages of public health experts.

    “While the media would rather speculate about outrageous claims of palace intrigue, President Trump and this Administration remain completely focused on the health and safety of the American people with around the clock work to slow the spread of the virus, expand testing, and expedite vaccine development,” said Judd Deere, a spokesman for the president. “Because of the President’s leadership we will emerge from this challenge healthy, stronger, and with a prosperous and growing economy.”

    The president’s behavior and combative statements were merely a visible layer on top of deeper levels of dysfunction.

    The most consequential failure involved a breakdown in efforts to develop a diagnostic test that could be mass produced and distributed across the United States, enabling agencies to map early outbreaks of the disease, and impose quarantine measures to contain them. At one point, a Food and Drug Administration official tore into lab officials at the Centers for Disease Control and Prevention, telling them their lapses in protocol, including concerns that the lab did not meet the criteria for sterile conditions, were so serious that the FDA would “shut you down” if the CDC were a commercial, rather than government, entity.

    Other failures cascaded through the system. The administration often seemed weeks behind the curve in reacting to the viral spread, closing doors that were already contaminated. Protracted arguments between the White House and public health agencies over funding, combined with a meager existing stockpile of emergency supplies, left vast stretches of the country’s health-care system without protective gear until the outbreak had become a pandemic. Infighting, turf wars and abrupt leadership changes hobbled the work of the coronavirus task force.

    It may never be known how many thousands of deaths, or millions of infections, might have been prevented with a response that was more coherent, urgent and effective. But even now, there are many indications that the administration’s handling of the crisis had potentially devastating consequences.

    Even the president’s base has begun to confront this reality. In mid-March, as Trump was rebranding himself a wartime president and belatedly urging the public to help slow the spread of the virus, Republican leaders were poring over grim polling data that suggested Trump was lulling his followers into a false sense of security in the face of a lethal threat.

    The poll showed that far more Republicans than Democrats were being influenced by Trump’s dismissive depictions of the virus and the comparably scornful coverage on Fox News and other conservative networks. As a result, Republicans were in distressingly large numbers refusing to change travel plans, follow “social distancing” guidelines, stock up on supplies or otherwise take the coronavirus threat seriously.

    “Denial is not likely to be a successful strategy for survival,” GOP pollster Neil Newhouse concluded in a document that was shared with GOP leaders on Capitol Hill and discussed widely at the White House. Trump’s most ardent supporters, it said, were “putting themselves and their loved ones in danger.”

    Trump’s message was changing as the report swept through the GOP’s senior ranks. In recent days, Trump has bristled at reminders that he had once claimed the caseload would soon be “down to zero.”

    More than 7,000 people have died of the coronavirus in the United States so far, with about 240,000 cases reported. But Trump has acknowledged that new models suggest that the eventual national death toll could be between 100,000 and 240,000.

    Beyond the suffering in store for thousands of victims and their families, the outcome has altered the international standing of the United States, damaging and diminishing its reputation as a global leader in times of extraordinary adversity.

    “This has been a real blow to the sense that America was competent,” said Gregory F. Treverton, a former chairman of the National Intelligence Council, the government’s senior-most provider of intelligence analysis. He stepped down from the NIC in January 2017 and now teaches at the University of Southern California. “That was part of our global role. Traditional friends and allies looked to us because they thought we could be competently called upon to work with them in a crisis. This has been the opposite of that.”

    This article, which retraces the failures over the first 70 days of the coronavirus crisis, is based on 47 interviews with administration officials, public health experts, intelligence officers and others involved in fighting the pandemic. Many spoke on the condition of anonymity to discuss sensitive information and decisions.

    Scanning the horizon

    Public health authorities are part of a special breed of public servant — along with counterterrorism officials, military planners, aviation authorities and others — whose careers are consumed with contemplating worst-case scenarios.

    The arsenal they wield against viral invaders is powerful, capable of smothering a new pathogen while scrambling for a cure, but easily overwhelmed if not mobilized in time. As a result, officials at the Department of Health and Human Services, the CDC and other agencies spend their days scanning the horizon for emerging dangers.

    The CDC learned of a cluster of cases in China on Dec. 31 and began developing reports for HHS on Jan. 1. But the most unambiguous warning that U.S. officials received about the coronavirus came Jan. 3, when Robert Redfield, the CDC director, received a call from a counterpart in China. The official told Redfield that a mysterious respiratory illness was spreading in Wuhan, a congested commercial city of 11 million people in the communist country’s interior.

    Redfield quickly relayed the disturbing news to Alex Azar, the secretary of HHS, the agency that oversees the CDC and other public health entities. Azar, in turn, ensured that the White House was notified, instructing his chief of staff to share the Chinese report with the National Security Council.

    From that moment, the administration and the virus were locked in a race against a ticking clock, a competition for the upper hand between pathogen and prevention that would dictate the scale of the outbreak when it reached American shores, and determine how many would get sick or die.
    \
    The initial response was promising, but officials also immediately encountered obstacles.

    On Jan. 6, Redfield sent a letter to the Chinese offering to send help, including a team of CDC scientists. China rebuffed the offer for weeks, turning away assistance and depriving U.S. authorities of an early chance to get a sample of the virus, critical for developing diagnostic tests and any potential vaccine.

    China impeded the U.S. response in other ways, including by withholding accurate information about the outbreak. Beijing had a long track record of downplaying illnesses that emerged within its borders, an impulse that U.S. officials attribute to a desire by the country’s leaders to avoid embarrassment and accountability with China’s 1.3 billion people and other countries that find themselves in the pathogen’s path.

    China stuck to this costly script in the case of the coronavirus, reporting Jan. 14 that it had seen “no clear evidence of human-to-human transmission.” U.S. officials treated the claim with skepticism that intensified when the first case surfaced outside China with a reported infection in Thailand.

    A week earlier, senior officials at HHS had begun convening an intra-agency task force including Redfield, Azar and Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. The following week, there were also scattered meetings at the White House with officials from the National Security Council and State Department, focused mainly on when and whether to bring back government employees in China.

    U.S. officials began taking preliminary steps to counter a potential outbreak. By mid-January, Robert Kadlec, an Air Force officer and physician who serves as assistant secretary for preparedness and response at HHS, had instructed subordinates to draw up contingency plans for enforcing the Defense Production Act, a measure that enables the government to compel private companies to produce equipment or devices critical to the country’s security. Aides were bitterly divided over whether to implement the act, and nothing happened for many weeks.

    On Jan. 14, Kadlec scribbled a single word in a notebook he carries: “Coronavirus!!!”

    Despite the flurry of activity at lower levels of his administration, Trump was not substantially briefed by health officials about the coronavirus until Jan.18, when, while spending the weekend at Mar-a-Lago, he took a call from Azar.

    Even before the heath secretary could get a word in about the virus, Trump cut him off and began criticizing Azar for his handling of an aborted federal ban on vaping products, a matter that vexed the president.

    At the time, Trump was in the throes of an impeachment battle over his alleged attempt to coerce political favors from the leader of Ukraine. Acquittal seemed certain by the GOP-controlled Senate, but Trump was preoccupied with the trial, calling lawmakers late at night to rant, and making lists of perceived enemies he would seek to punish when the case against him concluded.

    In hindsight, officials said, Azar could have been more forceful in urging Trump to turn at least some of his attention to a threat that would soon pose an even graver test to his presidency, a crisis that would cost American lives and consume the final year of Trump’s first term.

    But the secretary, who had a strained relationship with Trump and many others in the administration, assured the president that those responsible were working on and monitoring the issue. Azar told several associates that the president believed he was “alarmist” and Azar struggled to get Trump’s attention to focus on the issue, even asking one confidant for advice.

    Within days, there were new causes for alarm.

    On Jan. 21, a Seattle man who had recently traveled to Wuhan tested positive for the coronavirus, becoming the first known infection on U.S. soil. Then, two days later, Chinese authorities took the drastic step of shutting down Wuhan, turning the teeming metropolis into a ghost city of empty highways and shuttered skyscrapers, with millions of people marooned in their homes.

    “That was like, whoa,” said a senior U.S. official involved in White House meetings on the crisis. “That was when the Richter scale hit 8.”

    It was also when U.S. officials began to confront the failings of their own efforts to respond.

    Azar, who had served in senior positions at HHS through crises including the 9/11 terrorist attacks and the outbreak of bird flu in 2005, was intimately familiar with the playbook for crisis management.

    He instructed subordinates to move rapidly to establish a nationwide surveillance system to track the spread of the coronavirus — a stepped-up version of what the CDC does every year to monitor new strains of the ordinary flu.

    But doing so would require assets that would elude U.S. officials for months — a diagnostic test that could accurately identify those infected with the new virus and be produced on a mass scale for rapid deployment across the United States, and money to implement the system.

    Azar’s team also hit another obstacle. The Chinese were still refusing to share the viral samples they had collected and were using to develop their own tests. In frustration, U.S. officials looked for other possible routes.

    A biocontainment lab at the University of Texas medical branch in Galveston had a research partnership with the Wuhan Institute of Virology.

    Kadlec, who knew the Galveston lab director, hoped scientists could arrange a transaction on their own without government interference. At first, the lab in Wuhan agreed, but officials in Beijing intervened Jan. 24 and blocked any lab-to-lab transfer.

    There is no indication that officials sought to escalate the matter or enlist Trump to intervene. In fact, Trump has consistently praised Chinese President Xi Jinping despite warnings from U.S. intelligence and health officials that Beijing was concealing the true scale of the outbreak and impeding cooperation on key fronts.

    The CDC had issued its first public alert about the coronavirus Jan. 8, and by the 17th was monitoring major airports in Los Angeles, San Francisco and New York, where large numbers of passengers arrived each day from China.

    In other ways, though, the situation was already spinning out of control, with multiplying cases in Seattle, intransigence by the Chinese, mounting questions from the public, and nothing in place to stop infected travelers from arriving from abroad.

    Trump was out of the country for this critical stretch, taking part in the annual global economic forum in Davos, Switzerland. He was accompanied by a contingent of top officials including national security adviser Robert O’Brien, who took a trans-Atlantic call from an anxious Azar.

    Azar told O’Brien that it was “mayhem” at the White House, with HHS officials being pressed to provide nearly identical briefings to three audiences on the same day.

    Azar urged O’Brien to have the NSC assert control over a matter with potential implications for air travel, immigration authorities, the State Department and the Pentagon. O’Brien seemed to grasp the urgency, and put his deputy, Matthew Pottinger, who had worked in China as a journalist for the Wall Street Journal, in charge of coordinating the still-nascent U.S. response.

    But the rising anxiety within the administration appeared not to register with the president. On Jan. 22, Trump received his first question about the coronavirus in an interview on CNBC while in Davos. Asked whether he was worried about a potential pandemic, Trump said, “No. Not at all. And we have it totally under control. It’s one person coming in from China. . . . It’s going to be just fine.”

    Spreading uncontrollably

    \The move by the NSC to seize control of the response marked an opportunity to reorient U.S. strategy around containing the virus where possible and procuring resources that hospitals would need in any U.S. outbreak, including such basic equipment as protective masks and ventilators.

    But instead of mobilizing for what was coming, U.S. officials seemed more preoccupied with logistical problems, including how to evacuate Americans from China.

    In Washington, then-acting chief of staff Mick Mulvaney and Pottinger began convening meetings at the White House with senior officials from HHS, the CDC and the State Department.

    The group, which included Azar, Pottinger and Fauci, as well as nine others across the administration, formed the core of what would become the administration’s coronavirus task force. But it primarily focused on efforts to keep infected people in China from traveling to the United States even while evacuating thousands of U.S. citizens. The meetings did not seriously focus on testing or supplies, which have since become the administration’s most challenging problems.

    The task force was formally announced on Jan. 29.

    “The genesis of this group was around border control and repatriation,” said a senior official involved in the meetings. “It wasn’t a comprehensive, whole-of-government group to run everything.”

    The State Department agenda dominated those early discussions, according to participants. Officials began making plans to charter aircraft to evacuate 6,000 Americans stranded in Wuhan. They also debated language for travel advisories that State could issue to discourage other travel in and out of China.

    On Jan. 29, Mulvaney chaired a meeting in the White House Situation Room in which officials debated moving travel restrictions to “Level 4,” meaning a “do not travel” advisory from the State Department. Then, the next day, China took the draconian step of locking down the entire Hubei province, which encompasses Wuhan.

    That move by Beijing finally prompted a commensurate action by the Trump administration. On Jan. 31, Azar announced restrictions barring any non-U.S. citizen who had been in China during the preceding two weeks from entering the United States.

    Trump has, with some justification, pointed to the China-related restriction as evidence that he had responded aggressively and early to the outbreak. It was among the few intervention options throughout the crisis that played to the instincts of the president, who often seems fixated on erecting borders and keeping foreigners out of the country.

    But by that point, 300,000 people had come into the United States from China over the previous month. There were only 7,818 confirmed cases around the world at the end of January, according to figures released by the World Health Organization — but it is now clear that the virus was spreading uncontrollably.

    Pottinger was by then pushing for another travel ban, this time restricting the flow of travelers from Italy and other nations in the European Union that were rapidly emerging as major new nodes of the outbreak. Pottinger’s proposal was endorsed by key health-care officials, including Fauci, who argued that it was critical to close off any path the virus might take into the country.

    This time, the plan met with resistance from Treasury Secretary Steven Mnuchin and others who worried about the impact on the U.S. economy. It was an early sign of tension in an area that would split the administration, pitting those who prioritized public health against those determined to avoid any disruption in an election year to the run of expansion and employment growth.

    Those backing the economy prevailed with the president. And it was more than a month before the administration issued a belated and confusing ban on flights into the United States from Europe. Hundreds of thousands of people crossed the Atlantic during that interval.

    A wall of resistance

    While fights over air travel played out in the White House, public health officials began to panic over a startling shortage of critical medical equipment including protective masks for doctors and nurses, as well as a rapidly shrinking pool of money needed to pay for such things.

    By early February, the administration was quickly draining a $105 million congressional fund to respond to infectious disease outbreaks. The coronavirus threat to the United States still seemed distant if not entirely hypothetical to much of the public. But to health officials charged with stockpiling supplies for worst-case-scenarios, disaster appeared increasingly inevitable.

    A national stockpile of N95 protective masks, gowns, gloves and other supplies was already woefully inadequate after years of underfunding. The prospects for replenishing that store were suddenly threatened by the unfolding crisis in China, which disrupted offshore supply chains.

    Much of the manufacturing of such equipment had long since migrated to China, where factories were now shuttered because workers were on order to stay in their households. At the same time, China was buying up masks and other gear to gird for its own coronavirus outbreak, driving up costs and monopolizing supplies.

    In late January and early February, leaders at HHS sent two letters to the White House Office of Management and Budget asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. Azar and his aides also began raising the need for a multibillion-dollar supplemental budget request to send to Congress.

    Yet White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.

    Joe Grogan, head of the Domestic Policy Council, clashed with health officials over preparedness. He mistrusted how the money would be used and questioned how health officials had used previous preparedness funds.

    Azar then spoke to Russell Vought, the acting director of the White House Office of Management and Budget, during Trump’s State of the Union speech on Feb. 4. Vought seemed amenable, and told Azar to submit a proposal.

    Azar did so the next day, drafting a supplemental request for more than $4 billion, a sum that OMB officials and others at the White House greeted as an outrage. Azar arrived at the White House that day for a tense meeting in the Situation Room that erupted in a shouting match, according to three people familiar with the incident.

    A deputy in the budget office accused Azar of preemptively lobbying Congress for a gigantic sum that White House officials had no interest in granting. Azar bristled at the criticism and defended the need for an emergency infusion. But his standing with White House officials, already shaky before the coronavirus crisis began, was damaged further.

    Trump on his ‘natural ability’ for medical science: ‘I really get it’

    White House officials relented to a degree weeks later as the feared coronavirus surge in the United States began to materialize. The OMB team whittled Azar’s demands down to $2.5 billion, money that would be available only in the current fiscal year. Congress ignored that figure, approving an $8 billion supplemental bill that Trump signed into law March 6.

    But again, delays proved costly. The disputes meant that the United States missed a narrow window to stockpile ventilators, masks and other protective gear before the administration was bidding against many other desperate nations, and state officials fed up with federal failures began scouring for supplies themselves.

    In late March, the administration ordered 10,000 ventilators — far short of what public health officials and governors said was needed. And many will not arrive until the summer or fall, when models expect the pandemic to be receding.

    “It’s actually kind of a joke,” said one administration official involved in deliberations about the belated purchase.

    Inconclusive tests

    Although viruses travel unseen, public health officials have developed elaborate ways of mapping and tracking their movements. Stemming an outbreak or slowing a pandemic in many ways comes down to the ability to quickly divide the population into those who are infected and those who are not.

    Doing so, however, hinges on having an accurate test to diagnose patients and deploy it rapidly to labs across the country. The time it took to accomplish that in the United States may have been more costly to American efforts than any other failing.

    “If you had the testing, you could say, ‘Oh my god, there’s circulating virus in Seattle, let’s jump on it. There’s circulating virus in Chicago, let’s jump on it,’ ” said a senior administration official involved in battling the outbreak. “We didn’t have that visibility.”

    The first setback came when China refused to share samples of the virus, depriving U.S. researchers of supplies to bombard with drugs and therapies in a search for ways to defeat it. But even when samples had been procured, the U.S. effort was hampered by systemic problems and institutional hubris.

    Among the costliest errors was a misplaced assessment by top health officials that the outbreak would probably be limited in scale inside the United States — as had been the case with every other infection for decades — and that the CDC could be trusted on its own to develop a coronavirus diagnostic test.

    The CDC, launched in the 1940s to contain an outbreak of malaria in the southern United States, had taken the lead on the development of diagnostic tests in major outbreaks including Ebola, zika and H1N1. But the CDC was not built to mass-produce tests.

    The CDC’s success had fostered an institutional arrogance, a sense that even in the face of a potential crisis there was no pressing need to involve private labs, academic institutions, hospitals and global health organizations also capable of developing tests.

    Yet some were concerned that the CDC test would not be enough. Stephen Hahn, the FDA commissioner, sought authority in early February to begin calling private diagnostic and pharmaceutical companies to enlist their help.

    FDA leaders were split on whether it would be bad optics for Hahn to be personally calling companies he regulated. When FDA officials consulted leaders at HHS, they understood it as a direction to stand down.

    At that point, Azar, the HHS secretary, seemed committed to a plan he was pursuing that would keep his agency at the center of the response effort: securing a test from the CDC and then building a national coronavirus surveillance system by relying on an existing network of labs used to track the ordinary flu.

    In task force meetings, Azar and Redfield pushed for $100 million to fund the plan, but were shot down because of the cost, according to a document outlining the testing strategy obtained by The Washington Post.

    Relying so heavily on the CDC would have been problematic even if it had succeeded in quickly developing an effective test that could be distributed across the country. The scale of the epidemic, and the need for mass testing far beyond the capabilities of the flu network, would have overwhelmed the plan, which didn’t envision engaging commercial lab companies for up to six months.

    The effort collapsed when the CDC failed its basic assignment to create a working test and the task force rejected Azar’s plan.

    On Feb. 6, when the World Health Organization reported that it was shipping 250,000 test kits to labs around the world, the CDC began distributing 90 kits to a smattering of state-run health labs.

    Almost immediately, the state facilities encountered problems. The results were inconclusive in trial runs at more than half the labs, meaning they couldn’t be relied upon to diagnose actual patients. The CDC issued a stopgap measure, instructing labs to send tests to its headquarters in Atlanta, a practice that would delay results for days.

    The scarcity of effective tests led officials to impose constraints on when and how to use them, and delayed surveillance testing. Initial guidelines were so restrictive that states were discouraged from testing patients exhibiting symptoms unless they had traveled to China and come into contact with a confirmed case, when the pathogen had by that point almost certainly spread more broadly into the general population.

    The limits left top officials largely blind to the true dimensions of the outbreak.

    In a meeting in the Situation Room in mid-February, Fauci and Redfield told White House officials that there was no evidence yet of worrisome person-to-person transmission in the United States. In hindsight, it appears almost certain that the virus was taking hold in communities at that point. But even the country’s top experts had little meaningful data about the domestic dimensions of the threat. Fauci later conceded that as they learned more their views changed.

    At the same time, as the president’s subordinates were growing increasingly alarmed, Trump continued to exhibit little concern. On Feb. 10, he held a political rally in New Hampshire attended by thousands where he declared that “by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

    The New Hampshire rally was one of eight that Trump held after he had been told by Azar about the coronavirus, a period when he also went to his golf courses six times.

    A day earlier, on Feb. 9, a group of governors in town for a black-tie gala at the White House secured a private meeting with Fauci and Redfield. The briefing rattled many of the governors, bearing little resemblance to the words of the president. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.

    That month, federal medical and public health officials were emailing increasingly dire forecasts among themselves, with one Veterans Affairs medical adviser warning, ‘We are flying blind,’” according to emails obtained by the watchdog group American Oversight.

    Later in February, U.S. officials discovered indications that the CDC laboratory was failing to meet basic quality-control standards. On a Feb. 27 conference call with a range of health officials, a senior FDA official lashed out at the CDC for its repeated lapses.

    Jeffrey Shuren, the FDA’s director for devices and radiological health, told the CDC that if it were subjected to the same scrutiny as a privately run lab, “I would shut you down.”

    On Feb. 29, a Washington state man became the first American to die of a coronavirus infection. That same day, the FDA released guidance, signaling that private labs were free to proceed in developing their own diagnostics.

    Another four-week stretch had been squandered.

    Life and death

    One week later, on March 6, Trump toured the facilities at the CDC wearing a red “Keep America Great” hat. He boasted that the CDC tests were nearly perfect and that “anybody who wants a test will get a test,” a promise that nearly a month later remains unmet.

    He also professed to have a keen medical mind. “I like this stuff. I really get it,” he said. “People here are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ ”

    In reality, many of the failures to stem the coronavirus outbreak in the United States were either a result of, or exacerbated by, his leadership.

    For weeks, he had barely uttered a word about the crisis that didn’t downplay its severity or propagate demonstrably false information. He dismissed the warnings of intelligence officials and top public health officials in his administration.

    At times, he voiced far more authentic concern about the trajectory of the stock market than the spread of the virus in the United States, railing at the chairman of the Federal Reserve and others with an intensity that he never seemed to exhibit about the possible human toll of the outbreak.

    In March, as state after state imposed sweeping new restrictions on their citizens’ daily lives to protect them — triggering severe shudders in the economy — Trump second-guessed the lockdowns.

    The common flu kills tens of thousands each year and “nothing is shut down, life & the economy go on,” he tweeted March 9. A day later, he pledged that the virus would “go away. Just stay calm.”

    Two days later, Trump finally ordered the halt to incoming travel from Europe that his deputy national security adviser had been advocating for weeks. But Trump botched the Oval Office announcement so badly that White House officials spent days trying to correct erroneous statements that triggered a stampede by U.S. citizens overseas to get home.

    “There was some coming to grips with the problem and the true nature of it — the 13th of March is when I saw him really turn the corner. It took a while to realize you’re at war,” Sen. Lindsey O. Graham (R-S.C.) said. “That’s when he took decisive action that set in motion some real payoffs.”

    Trump spent many weeks shuffling responsibility for leading his administration’s response to the crisis, putting Azar in charge of the task force at first, relying on Pottinger, the deputy national security adviser, for brief periods, before finally putting Vice President Pence in the role toward the end of February.

    Other officials have emerged during the crisis to help right the United States’ course, and at times, the statements of the president. But even as Fauci, Azar and others sought to assert themselves, Trump was behind the scenes turning to others with no credentials, experience or discernible insight in navigating a pandemic.

    Foremost among them was his adviser and son-in-law, Jared Kushner. A team reporting to Kushner commandeered space on the seventh floor of the HHS building to pursue a series of inchoate initiatives.

    One plan involved having Google create a website to direct those with symptoms to testing facilities that were supposed to spring up in Walmart parking lots across the country, but which never materialized. Another centered on an idea advanced by Oracle chairman Larry Ellison to use software to monitor the unproven use of anti-malaria drugs against the coronavirus pathogen.

    So far, the plans have failed to come close to delivering on the promises made when they were touted in White House news conferences. The Kushner initiatives have, however, often interrupted the work of those under immense pressure to manage the U.S. response.

    Current and former officials said that Kadlec, Fauci, Redfield and others have repeatedly had to divert their attentions from core operations to contend with ill-conceived requests from the White House they don’t believe they can ignore. And Azar, who once ran the response, has since been sidelined, with his agency disempowered in decision-making and his performance pilloried by a range of White House officials, including Kushner.

    “Right now Fauci is trying to roll out the most ambitious clinical trial ever implemented” to hasten the development of a vaccine, said a former senior administration official in frequent touch with former colleagues. And yet, the nation’s top health officials “are getting calls from the White House or Jared’s team asking, ‘Wouldn’t it be nice to do this with Oracle?’ ”

    If the coronavirus has exposed the country’s misplaced confidence in its ability to handle a crisis, it also has cast harsh light on the limits of Trump’s approach to the presidency — his disdain for facts, science and experience.

    He has survived other challenges to his presidency — including the Russia investigation and impeachment — by fiercely contesting the facts arrayed against him and trying to control the public’s understanding of events with streams of falsehoods.

    The coronavirus may be the first crisis Trump has faced in office where the facts — the thousands of mounting deaths and infections — are so devastatingly evident that they defy these tactics.

    After months of dismissing the severity of the coronavirus, resisting calls for austere measures to contain it, and recasting himself as a wartime president, Trump seemed finally to succumb to the coronavirus reality. In a meeting with a Republican ally in the Oval Office last month, the president said his campaign no longer mattered because his reelection would hinge on his coronavirus response.

    “It’s absolutely critical for the American people to follow the guidelines for the next 30 days,” he said at his March 31 news conference. “It’s a matter of life and death.”

    in reply to: virus news … (+ some dark humor) #113347
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    in reply to: virus news … (+ some dark humor) #113346
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    michael_nielsen@michael_nielsen
    Bill Gates is setting up factories to manufacture 7 leading vaccine candidates before we know which is best & safest; we can test the vaccines in parallel, and then throw away all but the factory for the best vaccine. May save many months.

    in reply to: MMQB: To prevent future pandemics #113345
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    “It’s tough to make predictions, especially about the future.” — Yogi Berra

    in reply to: tweets (Rams & NFL) … 4/4 thru 4/7 #113342
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    Cameron DaSilva@camdasilva
    Linebacker and pass rush are huge question marks. Secondary and D-line are looking great though. Go get a pass rusher at 52 and you’re in business

    in reply to: Chloroquine, other approaches #113339
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    Clinical Trials Set To Determine If Anti-Malaria Drug Effective Against COVID-19

    https://www.npr.org/sections/coronavirus-live-updates/2020/03/31/824572119/clinical-trials-set-to-determine-if-anti-malaria-drug-effective-against-covid-19

    A pack of Plaquenil, (Hydrochloroquine) is displayed in a Parisian pharmacy on Tuesday in Paris, France. Chloroquine or Hydroxychloroquine, is now one treatments being evaluated in clinical trials as a possible preventative or treatment for COVID-19.
    Laurent Viteur/Getty Images
    A nationwide trial is underway to see if the drug hydroxychloroquine can prevent disease in people exposed to the novel coronavirus. A second trial will test to see if the drug can prevent severe disease in people who are already showing COVID-19 symptoms.

    The trials are being run by David Boulware, an infectious disease scientist at the University of Minnesota.

    “My normal research is doing clinical trials in Africa for fungal meningitis of the brain,” Boulware says.

    But the COVID-19 demanded his attention. “Somebody needed to do something,” he says, “so I got my team together and we sort of jumped on this.”

    That was on March 9. Eight days later, the trial was up and running. Hydroxychloroquine has been used for decades as a treatment for malaria. The rationale for trying it as a preventative for COVID-19 is based on laboratory studies that show the drug is capable of keeping the coronavirus from entering cells.

    In the prevention part of the trial, Boulware and his colleagues are looking for people who recently had contact with someone who tested positive for the virus, for example healthcare workers or people living with someone who is infected. Recruiting is done online.

    Once someone joins the study, they take either the drug or a placebo for five days. As of March 31, Boulware says he and his team had enrolled 558 volunteers. The aim is to recruit 1,500 people. With that number of volunteers, they should be able to determine if the drug is able to reduce the progression to disease by half or more.

    The trial is double blind — neither the patients participating nor the doctors providing it know who is getting the active drug and who is getting the placebo.

    Boulware says the trial has the approval of the Food and Drug Administration. Although the final results are several weeks off, a committee of independent experts known as the data safety and monitoring board will take an initial look at the results next week.

    In the other part of the study, Bouware says his team is recruiting patients who are already showing signs of the disease. They are not giving the drug to people who are hospitalized.

    Here again, patients will take hydroxychloroquine for five days to see if it slows the progression of the disease.

    Many people, including President Trump, have been touting the promise of hydroxychloroquine without much data to back that up.

    “Our goal is to find out, does this actually work,” Boulware says.

    in reply to: Chloroquine, other approaches #113338
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    “Solidarity” clinical trial for COVID-19 treatments

    https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments

    “Solidarity” is an international clinical trial to help find an effective treatment for COVID-19, launched by the World Health Organization and partners.

    The Solidarity trial will compare four treatment options against standard of care, to assess their relative effectiveness against COVID-19. By enrolling patients in multiple countries, the Solidarity trial aims to rapidly discover whether any of the drugs slow disease progression or improve survival. Other drugs can be added based on emerging evidence.

    Until there is sufficient evidence, WHO cautions against physicians and medical associations recommending or administering these unproven treatments to patients with COVID-19 or people self-medicating with them. WHO is concerned by reports of individuals self-medicating with chloroquine and causing themselves serious harm. WHO guidance on compassionate use can be found here.

    Key Links
    Landscape analysis of therapeutics

    21 March 2020

    18 March 2020
    WHO Director-General’s opening remarks at the media briefing on COVID-19 – 18 March 2020
    Rationale
    The pressure COVID-19 puts on health systems means that WHO considered the need for speed and scale in the trial. While randomized clinical trials normally take years to design and conduct, the Solidarity trial will reduce the time taken by 80%.

    Enrolling patients in one single randomized trial will help facilitate the rapid worldwide comparison of unproven treatments. This will overcome the risk of multiple small trials not generating the strong evidence needed to determine the relative effectiveness of potential treatments.

    Participation in Solidarity
    The Solidarity trial provides simplified procedures to enable even overloaded hospitals to participate, with no paperwork required. As of March 27 2020, over 70 countries have already confirmed they will contribute to the trial, with many others in the process of joining.

    The greater the number of participating countries, the faster results will be generated. WHO is facilitating access to thousands of treatment courses for the trial through donations from a number of manufacturers. WHO is also inviting developers and companies to collaborate on ensuring affordability and availability of the treatment options if they prove effective.

    Treatment options under study
    Based on evidence from laboratory, animal and clinical studies, the following treatment options were selected: Remdesivir; Lopinavir/Ritonavir; Lopinavir/Ritonavir with Interferon beta-1a; and Chloroquine or Hydroxychloroquine.

    Remdesivir was previously tested as an Ebola treatment. It has generated promising results in animal studies for Middle East Respiratory Syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS), which are also caused by coronaviruses, suggesting it may have some effect in patients with COVID-19.

    Lopinavir/Ritonavir is a licensed treatment for HIV. Evidence for COVID-19, MERS and SARS is yet to show it can improve clinical outcomes or prevent infection. This trial aims to identify and confirm any benefit for COVID-19 patients. While there are indications from laboratory experiments that this combination may be effective against COVID-19, studies done so far in COVID-19 patients have been inconclusive.

    Interferon beta-1a is used to treat multiple sclerosis.

    Chloroquine and hydroxychloroquine are very closely related and used to treat malaria and rheumatology conditions respectively. In China and France, small studies provided some indications of possible benefit of chloroquine phosphate against pneumonia caused by COVID-19 but need confirmation through randomized trials.

    Support for Solidarity
    “The quest for knowledge about the coronavirus is a global effort. The Solidarity trial is an import part of the puzzle. I am proud that Norway will contribute both by having the first patient included in the study. I would like to commend the WHO for the global leadership and its initiative in setting up the Solidarity trial.”

    – Bent Høie, Minister of Health and Care Services, Norway

    “There is only one way the world can exit this pandemic – and that is through science. We need diagnostics to detect and limit the spread of this virus, vaccines to provide long-term protection, treatments to save lives in the shorter-term and social science to understand the behavioural and societal implications. It’s critical that the global research effort is rapid, robust and is conducted at scale and co-ordinated across multiple countries. The World Health Organization’s Solidarity trial will provide this by testing existing and new drugs to treat COVID-19 and ensure equitable access to any drugs that prove effective. The start of these clinical trials is hugely important and an incredible achievement. Global powers must now step-up to ensure the WHO has all the support needed.”

    – Dr Jeremy Farrar, Director of Wellcome and Chair of the WHO R&D Blueprint Scientific Advisory Group

    How the Solidarity trial works
    Adults with COVID-19 admitted to participant hospitals can join this study. Eligible patients will be asked to sign to show they understand the possible risks and benefits and consent to joining the study. The medical team responsible for each patient will check whether any of the study treatments would definitely be unsuitable.

    After those checks, brief identifying details and any other conditions are digitally recorded for the patient, who is then randomly allocated to one of the study options. This may or may not involve one of the study treatments. Neither the patient nor the medical staff choose which of the study options a patient will receive, as a computer makes this allocation at random.

    Critical anonymized information for the trial will only be collected at the randomization stage and when the patient is discharged or dies: which study drugs were given (and for how many days); whether ventilation or intensive care was received (and, if so, when it began), date of discharge, or date and cause of death while still in hospital.

    Interim trial analyses are monitored by a Global Data and Safety Monitoring Committee, which is an independent group of experts.

    Countries, or particular groups of hospitals, may want to collaborate in making further serial measurements or observations, relating to areas such as virology, blood gases or chemistry and lung imaging. It also possible to incorporate documentation of other aspects of disease status, for example, through linking in electronic healthcare records and routine medical databases. While well-organised additional research studies of the natural history of the disease or of the effects of the trial treatments could well be valuable, they are not core requirements.

    Adults (age ≥18 years) recently hospitalised, or already in hospital, with confirmed COVID-19 and, in the view of the responsible doctor, no contra-indication to any of the study treatments will be randomly allocated between

    ● Local standard of care,

    OR local standard of care plus one of

    ● Remdesivir

    ● Chloroquine or Hydroxychloroquine

    ● Lopinavir with Ritonavir

    ● Lopinavir with Ritonavir plus Interferon beta-1a.

    Underlying conditions recorded are: diabetes, heart disease, chronic lung disease, chronic liver disease and asthma, extending to HIV and tuberculosis in the African region.

    Severity of illness at entry is determined by recording: shortness of breath, being given oxygen, already on a ventilator, and, if lungs imaged, major bilateral abnormality.

    in reply to: Sources: Trump says NFL should start on time #113330
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    Andrew Brandt@AndrewBrandt
    A veteran NFL player reached out to me this week with this question: “If they tell us we’re playing again, even without fans, do we have to play? What if our personal doctor advises against it?” Good questions; so many more like it will be raised.

    LindseyThiry@LindseyThiry
    California Governor Gavin Newsom said during his daily news briefing today that he does not anticipate the NFL season starting on time with fans in the stands in California.

    Ronald Brownstein@RonBrownstein
    @GavinNewsom tells me flatly re #NFL starting season on time w/fans in stands in the CA stadiums: “I’m not anticipating that happening in this state.”

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