Category Archives: Clinical Testing

Murky data fragments about a coronavirus drug

Posted on by • Posted in Clinical Failure, Clinical Research, Clinical Testing, Clinical Trials, Coronavirus, Pandemic, Remdesivir, Scientists • Leave a comment

https://www.axios.com/newsletters/axios-vitals-d53939d5-90fb-4aef-a87d-30cf2b0ceebf.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Fact Check: Politicians on both sides make misleading claims about ...

Depending on the study, remdesivir is either a clinical failure or a godsend for treating the novel coronavirus, Axios’ Bob Herman reports.

The big picture: The grim reality of the coronavirus pandemic has the world itching to know which experimental treatments actually work, but we’re not necessarily getting any smarter from these incremental drips of incomplete information.

Driving the news: Remdesivir — an antiviral drug that some experts have seen as a promising coronavirus treatment — “was not associated with clinical or virological benefits” for coronavirus patients, according to a summary of a clinical trial in China, viewed by STAT and the Financial Times.

Between the lines: The truth is we still don’t really know how effective the drug is in fighting this virus.

  • The Chinese trial has a randomized control group, so it is by far the most reliable study. However, the trial has not gone through peer review, and Gilead said the results were “inconclusive” because the trial had to be terminated early.

The bottom line: Science is slow for a reason, and the deluge of poorly designed trials and early drafts of studies is sowing confusion instead of creating clarity.

What’s next: A more rigorous report from Gilead’s Chinese trial is expected at the end of this month, and data from other trials is expected in late May.

 

 

 

 

The South is vulnerable to a coronavirus nightmare

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Partisanship, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing, Vulnerable Populations • Leave a comment

https://www.axios.com/newsletters/axios-vitals-d53939d5-90fb-4aef-a87d-30cf2b0ceebf.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

COVID-19 vulnerability index, by county

Arrow

 

The South is at risk of being devastated by the coronavirus.

Why it matters: Southern states tend to have at-risk populations and weak health care systems — and they’re the ones moving fastest to loosen social distancing rules. That puts them at risk for the worst-case coronavirus scenarios.

The big picture: To stop the spread of the coronavirus, there are really only two options: stringent social distancing, or stringent public health measures.

Driving the news: Several southern states including Georgia, Tennessee and South Carolina have recently announced that they’re starting to back off of social distancing.

  • Our national testing capacity is still nowhere near where experts say it needs to be, and only some communities have announced efforts to build up contact tracing.

Between the lines: The Surgo Foundation created a coronavirus community vulnerability index that takes into account factors like socioeconomic status, minority status, housing type, epidemiologic factors and health care system factors.

The bottom line: The South is already worse off in almost every way, partially due to policy choices made in these states. Its comparatively unhealthy population is vulnerable to more serious illness, and looser social distancing will enable the virus’ spread.

 

 

US hits grim milestone: 50,000 coronavirus deaths

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Food and Drug Administration (FDA), Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

US hits grim milestone: 50,000 coronavirus deaths

US hits grim milestone: 50,000 coronavirus deaths | TheHill

More than 50,000 people in the United States have died of the COVID-19 disease, a grim milestone in a global pandemic that shows few signs of slowing even as pressure mounts to reopen parts of the U.S. economy.

The death toll is 16 times greater than the number of Americans who died in the 9/11 terrorist attacks and about one-and-a-half times larger than the number of U.S. soldiers who died in the Korean War. At the current pace, the number of coronavirus deaths is likely to surpass the number of Americans who died in the Vietnam War by the middle of next week.

The true number of deaths is likely higher than official figures. Coroners in California this week reclassified the death of a woman in Santa Clara on Feb. 6 as a coronavirus victim, the first known death from the disease in the United States and one that occurred three weeks before what had previously been thought to be the first known death.

About 900,000 people in the United States have tested positive for the virus that causes the disease, according to the most recent figures. That number has doubled in the past two weeks, climbing by 25,000 or more cases per day.

The richest nation in the world now accounts for about one-third of the planet’s 2.7 million cases.

The number of U.S. deaths has increased at a rate of about 2,000 per day in recent weeks as scientists race to understand the new pathogen and health systems in hard-hit areas like New York, Boston, New Orleans and Detroit struggle under the strain placed on hospitals and frontline health care workers.

More than a quarter of a million New Yorkers have tested positive for the virus, as have more than 100,000 residents of New Jersey. There are at least 35,000 cases in California, Illinois, Massachusetts, Michigan and Pennsylvania, and at least 20,000 cases in Connecticut, Florida, Georgia, Louisiana and Texas.

Though the virus was first detected in China, where the authoritarian government locked down entire cities in January, the United States is now home to the largest number of known cases in the world. The number of cases on American soil is nearly four times as high as the second-worst hit country, Spain, and higher than the total case counts in Spain, Italy, France, Germany and the United Kingdom combined, according to data compiled by Johns Hopkins University.

America’s disastrously slow response has stumbled over a number of hurdles other countries cleared easily. President Trump and his administration routinely claimed the virus was under control — he claimed the coronavirus would have “a very good ending for us” on Jan. 30, the same day the World Health Organization declared the virus a public health emergency of international concern.

Scientists now believe the virus began circulating in the United States in early to mid-January, a period when the country had little capacity to test its residents. An early test created by the Centers for Disease Control and Prevention and sent to public health laboratories across the country turned out to have a fatal flaw, setting back crucial testing capacity that could have uncovered the extent of the virus’s spread even as other countries deployed their own tests.

Companies that could have filled that backlog were also slow to develop their own diagnostic tests, and several ran into roadblocks at the Food and Drug Administration, which did not move to approve tests on an emergency basis until late February.

The United States only seemed to begin to take the threat of the outbreak seriously in early March. Almost two weeks later, the first state — California — announced stay-at-home orders.

As a consequence, the slow response has meant the United States has not bent its case curve downward as fast as other nations. The hardest-hit European nations have all seen daily case and death counts bending downward; the United States has, at best, reached a daunting plateau. And though countries like Italy, Spain and France have suffered more deaths per capita, their trajectories are down, while figures in the United States trend up.

There is still no known medicinal treatment for those suffering from COVID-19. And while dozens of laboratories across the globe race to develop a vaccine, experts warn that a finished product will not be available on a mass scale for more than a year — a schedule that would mark the fastest such development in human history. Until those vaccines are ready and widely available, the virus will remain in control.

Left leaderless at the federal level, state governments responded to the mounting crisis in their own ways. A bipartisan roster of governors in New York, California, Washington, Massachusetts, Maryland, Ohio and elsewhere have won praise for quick, decisive action and informative briefings that stand in stark contrast to Trump’s daily appearances at White House press conferences.

California Gov. Gavin Newsom‘s (D) order was followed by most other states, though eight states have yet to require residents to avoid nonessential activities. Even as some states took unprecedented steps to lock down their economies, banning residents from beaches and public parks and shuttering non-essential businesses, others were slow to act.

There is now mounting evidence that dozens of coronavirus cases are tied to an April election in Wisconsin, and to packed beaches during Spring Break in Florida the previous month. At least one man who attended what was dubbed a coronavirus party in Kentucky came down with the disease. Several pastors who defied recommendations against holding church services have died.

Now, as a few hundred protesters in several states demand a reopened economy, some governors are beginning to loosen restrictions. Georgia Gov. Brian Kemp (R) will allow some businesses to begin opening on Friday, even as the number of COVID-19 cases jumped to 21,883 on Thursday. Nearly 900 Georgians, about 4 percent of confirmed cases, have died.

Some nonessential businesses will begin opening in the coming days in Alaska, Indiana, Tennessee and Texas. Beaches have reopened in parts of Florida and South Carolina, even as public health officials have warned of the consequences of reopening too quickly.

“We have to proceed in a very careful, measured way,” Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said at a White House press briefing Wednesday. “The one way not to reopen the economy is to have a rebound that we can’t take care of.”

But there remain signs of strain even within the highest ranks of government. Fauci contradicted Trump’s claim Wednesday that the virus would not return in the fall.

“We will have coronavirus in the fall. I am convinced of that because of the degree of transmissibility that it has, the global nature,” Fauci said.

Fauci did not appear at the White House briefing Thursday, when Trump said he did not agree with the nation’s leading infectious disease expert that the country’s testing capacity had risen to the level required to stamp out the virus.

“No, I don’t agree with him on that. No, I think we’re doing a great job in testing. I don’t agree. If he said that, I don’t agree with him,” Trump said.

 

 

 

 

 

Interim Coronavirus Relief Bill

Posted on by • Posted in 2020 Election Issues, Bankruptcy, Clinical Testing, Coronavirus, Economic Crisis, Economic Stimulus, Economy, Emergency Preparedness, Employee Furlough, Employee Layoffs, Health Policy, Health System, Hospital, Hospital Industry, Job Market, Job Search, Job Security, Mortality, Pandemic, Partisanship, Physician, Unemployment, Unemployment Insurance • Leave a comment

https://heathercoxrichardson.substack.com/p/april-23-2020

Congress expected to announce deal on latest coronvirus relief bill

Today the House of Representatives passed a new $484 billion coronavirus relief bill by a vote of 388-5. The Senate passed it Tuesday. $381 billion is for small businesses left out in the cold when the money from the previous coronavirus relief package quickly ran dry. Republicans wanted to stop there, but Democrats demanded $75 billion for hospitals, and $25 billion for coronavirus testing, as well as a requirement that the administration figure out a strategy to get tests to states.

The relief bill comes as more than 26 million Americans are out of work and almost 50,000 Americans have died of Covid-19. The representatives had to drive to Washington, D.C., or fly unusual routes because regular flights are canceled. They arrived for the vote in the Capitol building in alphabetical groups of 50 to 60 so they could keep their distance from each other. A number of Republicans refused to wear masks during the vote, while all but one Democrat wore one.

Democrats inserted into the bill a new committee to oversee the administration’s “preparedness for and response to the coronavirus crisis,” chaired by Jim Clyburn (D-SC). The committee has the power to subpoena witnesses and documents. Republicans and Trump objected.

But the Democrats did not get any more aid to states, crippled by the crisis, than the $150 billion previously provided. The bipartisan National Governors Association, headed by Maryland Governor Larry Hogan, a Republican, has asked for $500 billion to help the states replace lost tax revenues. Democrats wanted such aid, but Republicans refused.

Senate Majority Leader Mitch McConnell (R-KY) went on talk radio host Hugh Hewitt’s show on Wednesday and tried to make the question of state aid partisan. He said that he opposed granting money to states whose problems, he said, stemmed from their underfunded state pension plans. Instead, the states should consider bankruptcy. A document put out by McConnell’s office called aid to the states a “blue state bailout.”

In fact, Michael Leachman, the senior director of state fiscal research at the Center on Budget and Policy Priorities, said that McConnell has it wrong. States have not been overspending; their expenses for education and infrastructure are actually significantly below what they were in 2008, despite more inhabitants, and they have put about 7.6% of their budgets into rainy day funds, a historic high, up from the previous high of 5% they held in reserve in 2006 before the Great Recession.

The problem is that states have to balance their budgets annually, and they depend on sales and income taxes for 70% of their revenue. The shutdowns have decimated tax revenues as shopping ends and people lose their jobs. At the same time, unemployment claims are climbing dramatically. States are looking at a $500 billion loss between now and 2022.

States need money to avoid massive layoffs and deep spending cuts, actions that would make the economic crisis continue much longer than it would if they do not have to make them. They would not use bailout money on pensions, Leachman writes, but put it in state general funds, which are collapsing. Pensions come out of a separate trust fund (although the general fund does put money toward future pensions, that’s less than 5% spending from the general fund). Federal bankruptcy law currently does not allow states to declare bankruptcy, but in any case, Leachman writes, there is no need for it. Bankruptcy relieves high debt levels, but state debt is not high, and once the pandemic passes, the states should be financially sound again.

If Leachman’s explanation was scholarly, New York Governor Andrew Cuomo was blunt. “New York puts into that federal pot $116B more than we take out. Kentucky takes out $148B more than they put in,” he said at a press conference. “Senator McConnell, who’s getting bailed out here? It’s your state that’s living on the money that we generate.” A recent study by the Rockefeller Institute of Government shows that New Yorkers as a group pay in to the federal government $1,792 per capita more than they take out, while for every dollar Kentucky puts in, it gets $2.61 back.

Cuomo called McConnell out for trying to turn the crisis into a political fight: “That’s not what this country is all about,” Cuomo said. “It’s not red and blue, it’s red, white and blue.”

Today’s other big news was Trump’s suggestion at his coronavirus briefing that it would be worth studying whether injecting disinfectant into patients would kill the novel coronavirus. “And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?” he said. “Because, you see, it gets on the lungs, and it does a tremendous number on the lungs. So it’d be interesting to check that. So that you’re going to have to use medical doctors, but it sounds — it sounds interesting to me.” He also suggested using heat and light to kill the virus.

Doctors were horrified at his comment, calling it irresponsible and dangerous. Disinfectants are poisonous and are deadly if they are used inappropriately. “To be clear:” emergency medicine physician Dara Kass tweeted, “Intracavitary UV light and swallowing bleach or isopropyl alcohol can kill you. Don’t do it.”

Trump’s emphasis on dramatic cures for Covid-19 reinforces his disagreement with health experts that we must dramatically increase our testing for the disease so we can identify hot spots and isolate them before they spread. At today’s briefing, Trump disagreed with Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and one of the administration’s top medical advisors about the pandemic, who recently said “We absolutely need to significantly ramp up, not only the number of tests but the capacity to actually perform them.” Today, Trump said: “I don’t agree with him on that, no, I think we’re doing a great job on testing.”

In fact, the U.S. lags behind other nations in per capita tests, and Trump’s continuing reluctance to support getting them seems to me mystifying. It is this odd gap Congress is trying to address with its requirement in the new coronavirus package that the administration must figure out a strategy to get tests to states. The bill now heads to the Oval Office for Trump’s signature.

For all the dark nitty-gritty of politics today, it is also a day that begins a joyous month, and that seems to me a far better way to leave you all tonight than with the day’s troubles. For those who celebrate, Ramadan Mubarak.

 

 

 

The Health 202: States are ending their coronavirus lockdowns earlier than health roadmaps recommend

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Economic Crisis, Economy, Emergency Preparedness, False Hope, Health Policy, Infection Control, Infectious Virus, Mistake, Pandemic, Public Health, Public Safety, Social Distancing, Ventilators, Wishful Thinking • Leave a comment

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2020/04/23/the-health-202-states-are-ending-their-coronavirus-lockdowns-earlier-than-health-roadmaps-recommend/5ea09b5988e0fa34528d6eb8/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202

The Health 202: States are ending their coronavirus lockdowns ...

The Health 202: States are ending their coronavirus lockdowns earlier than health roadmaps recommend.
Over a nearly three-week span in March, most state governors across the nation locked down their states because of the novel coronavirus.

Gradually opening things up will take even longer — and probably will vary considerably from state to state.

Governors are feeling pressure from two sides. Many troubling questions about the coronavirus remain unanswered, such as how to get more Americans tested and whether the United States even has enough capacity to track and isolate virus cases. At the same time, they’re feeling immense pressure to restart economic activity, with tens of millions of Americans out of work and the country stuck in a deepening economic crater.

As governors weigh when and how to reopen public gathering spots, there are several road maps they could look to.

Yesterday the National Governors Association released a 10-point guide for states. The first point is to make coronavirus testing broadly available. It urges states to improve surveillance to detect outbreaks, ensure hospitals are equipped to respond to surges and create a plan to reopen in stages.

Maryland Gov. Larry Hogan, chair of the National Governors Association. (Salwan Georges/The Washington Post)

The plan also warns states against opening prematurely. 

“Opening without the tools in place to rapidly identify and stop the spread of the virus … could send states back into crisis mode, push health systems past capacity and force states back into strict social distancing measures,” it says.

Then there’s guidance from the Trump administration, which says states should first see a decrease in confirmed coronavirus cases over a 14-day period. That guidance is in line with what public health experts have recommended — although Trump has also frequently suggested he’d like to see states open sooner.

So far, governors vary widely in how they’re approaching the issue.

Some, like Trump, are chomping at the bit. Georgia Gov. Brian Kemp (R) is allowing businesses including gyms and barber shops to reopen on Friday. Colorado Gov. Jared Polis (D) has said some businesses may reopen on Monday, and retailers can have a limited number of in-store shoppers starting May 1.

Polis puts on a Denver Broncos face mask during a news conference on Monday. (David Zalubowski/AP)

Other governors are much more cautious. Virginia Gov. Ralph Northam (D), for example, has issued a stay-at-home order in effect until June 10. California Gov. Gavin Newsom (D) declined yesterday to name a date for easing restrictions, saying the state hasn’t reached its six goals before reopening the economy.

Newsom, however, did indicate progress has been made with his detailed playbook for reopening the state. After a phone conversation with Trump, the governor said the two had agreed to significantly ramp up testing across California, with hundreds of thousands of new swabs on the way and 86 new testing sites opening.

But virtually every governor is working on plans, some in coordination with other governors, on how to shape the post-quarantine world.

Here are the states opening things up first:

Georgia: Certain businesses may open on Friday; theaters and restaurants can reopen on Monday. Bars, nightclubs and music venues will remain closed; schools have been closed through the end of the school year.

Kemp explained his decision to reopen tanning salons, barber shops, massage parlors and bowling alleys, saying on Monday: “I see the terrible impact of covid-19 on public health as well as the pocketbook.” Kemp said he will urge businesses to take precautions, such as screening for fevers, spacing workstations apart and having workers wear gloves and masks “if appropriate,” my Washington Post colleagues William Wan, Carolyn Y. Johnson and Joel Achenbach report.

“Georgia, according to some models, is one of the last states that should be reopening,” they write. “The state has had more than 830 covid-19 deaths. It has tested fewer than 1 percent of its residents — low compared with other states and the national rate. And the limited amount of testing so far shows a high rate of positives, at 23 percent.”

Trump blasted Kemp’s decision during his briefing last night, saying it violates his administration’s phase 1 guidelines for when to reopen.

 

Colorado: Polis is allowing the state’s stay-at-home order to expire Sunday, after which the state will gradually reopen businesses. Starting May 4, nonessential offices may have 50 percent of their workforce at the site, although large workplaces will be advised to conduct symptom and temperature checks.

Polis has warned the restrictions won’t all be lifted at the same time.

“The virus will be with us,” he said earlier this month. “We have to find a sustainable way that will be adapted in real time to how we live with it.”

 

South Carolina: Gov. Henry McMaster (R) said Monday he was allowing nonessential businesses such as department stores and retailers to open, followed by beaches on Tuesday.

But businesses must follow three rules for operating: They must limit the number of customers in the store; require patrons to be six feet apart; and follow sanitation guidelines from the Centers for Disease Control and Prevention.

“I urge everyone to remember we are still in a very serious situation,” McMaster said at a news conference. “We know that this disease, this virus, spreads easily, and we know it is deadly. So we must be sure that we continue to be strict and disciplined with our social discipline and taking care not to infect others.”

 

Tennessee: Gov. Bill Lee (R) said he plans to allow some businesses to reopen once his “safer-at-home” order expires in one week. But the state’s biggest cities will make their own reopening determinations. Lee has appointed a 30-member economic recovery group to create a plan.

Lee, along with Kemp and McMaster, have met with the governors of Mississippi, Alabama and Florida to consider how to reopen their economies in a coordinated way in the country’s southeast region. The number of new cases and deaths in Florida has leveled off somewhat — something the state’s governor, Ron DeSantis (R), has been pointing to as he urges a speedy reopening in his state.

Ahh, oof and ouch

AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he’d been “misquoted.”
Trump claims his CDC director was ‘misquoted’ on second wave of covid-19
Director of the Centers for Disease Control and Prevention Robert Redfield said April 22 that his statement on covid-19 in the fall is “accurately quoted.” (The Washington Post)

The president took issue with the portrayal of comments from Redfield following an interview with our Post colleague Lena H. Sun. In that interview, Redfield warned that a second wave of the coronavirus could be worse than the current one.

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Redfield told Lena. He added: “We’re going to have the flu epidemic and the coronavirus epidemic at the same time.”

The president again repeated the claim at his daily White House coronavirus task force briefing – this time, with Redfield standing awkwardly next to him.

Redfield then said this: “I’m accurately quoted in The Washington Post.”

But Redfield also sought to “soften his words as the president glowered next to him,” Lena, Ashley Parker, Josh Dawsey and Yasmeen Abutaleb write.

“The remarkable spectacle provided another illustration of the president’s tenuous relationship with his own administration’s scientific and public health experts, where the unofficial message from the Oval Office is an unmistakable warning: Those who challenge the president’s erratic and often inaccurate coronavirus views will be punished — or made to atone,” they write.

Ahh, oof and ouch

AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he’d been “misquoted.”
Trump claims his CDC director was ‘misquoted’ on second wave of covid-19

It’s apparent “Trump is again bristling at a health official offering too dire a scenario,” our colleague Aaron Blake writes. He points out that Trump was set off a previous time when another top CDC official warned in February that the spread of the coronavirus was inevitable.

OOF: The former head of the U.S. agency pursuing a coronavirus vaccine says he was ousted for opposing efforts to promote hydroxychloroquine, a drug Trump has insistently touted as a weapon against the virus despite a lack of scientific proof.

Rick Bright, previously the director of the Biomedical Advanced Research and Development Authority, said he was dismissed and pushed into a narrower role after he called for strictly vetting supposed treatments like anti-malarials repeatedly embraced publicly by the president. 

“I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” Bright said in a statement, according to the New York Times’s Michael D. Shear and Maggie Haberman.

He added: “I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way.” 

The president was asked about Bright during last night’s briefing and whether the official was pushed out.

“Maybe he was and maybe he wasn’t. I don’t know who he is,” Trump responded.

OUCH: There were early missteps by Health and Human Services Secretary Alex Azar that bogged down the government’s response to the virus.

In late January, days after the first coronavirus case was confirmed in the United States, Azar told Trump in a meeting the coronavirus spread was “under control,” the Wall Street Journal’s Rebecca Ballhaus and Stephanie Armour report. Azar also told the president more than a million diagnostic tests would be available in weeks and that it was the “fastest we’ve ever created a test.”

These promises didn’t pan out.

“Six weeks after that Jan. 29 meeting, the federal government declared a national emergency and issued guidelines that effectively closed down the country,” Rebecca and Stephanie write. “Mr. Azar, who had been at the center of the decision-making from the outset, was eventually sidelined.”

There were numerous factors that slowed the administration’s initial coronavirus response, but “interviews with more than two dozen administration officials and others involved in the government’s coronavirus effort show that Mr. Azar waited for weeks to brief the president on the threat, oversold his agency’s progress in the early days and didn’t coordinate effectively across the health-care divisions under his purview,” they report.

Earlier this year, Azar tapped an aide to lead HHS’s day-to-day coronavirus response who had joined the agency after running a dog-breeding business for six years. 

The aide, Brian Harrison, was derisively called “the dog breeder” by some within the White House, Reuters’s Aram Roston and Marisa Taylor report.

“Azar’s optimistic public pronouncement and choice of an inexperienced manager are emblematic of his agency’s oft-troubled response to the crisis,” they add. “… Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. In 2006, he joined HHS in a one-year stint as a ‘Confidential Assistant’ to Azar, who was then deputy secretary. He also had posts working for Vice President Dick Cheney, the Department of Defense and a Washington public relations company.”

There’s much we don’t know about the coronavirus

Scientists say a mysterious blood-clotting complication may be causing a number of the coronavirus-related deaths.

Doctors are learning that covid-19, once believed to be a straightforward respiratory virus, is much more frightening. Since the earlier waves of coronavirus cases, doctors have learned that the disease attacks not just lungs but kidneys, the heart, intestines, liver and the brain. Autopsies also have shown that some coronavirus patients lungs were filled with hundreds of microclots, our Post colleague Ariana Eunjung Cha reports.

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” said Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine. “We don’t know. And therefore, we are scared.”

“In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs,” Ariana writes.

New data provide troubling statistics about coronavirus patients on ventilators.

A study found 88 percent of 320 coronavirus patients on ventilators in New York state’s largest health system died.

It’s an uptick from pre-pandemic figures. “That compares with the roughly 80 percent of patients who died on ventilators before the pandemic, according to previous studies — and with the roughly 50 percent death rate some critical care doctors had optimistically hoped when the first cases were diagnosed,” Ariana reports.

The research, published in the journal JAMA, also notes many of the hospitalized had other conditions.

“The paper also found that of those who died, 57 percent had hypertension, 41 percent were obese and 34 percent had diabetes, which is consistent with risk factors listed by the Centers for Disease for Control and Prevention,” she adds. “Noticeably absent from the top of the list was asthma. As doctors and researchers have learned more about covid-19, the less it seems that asthma plays a dominant role in outcomes.”

The economic fallout

If there’s a recovery from the current economic downswing this year, it could be temporary, economists warn.

There’s a growing chance of a second economic downturn if there’s another surge of the coronavirus or if there’s an increase in bankruptcies and defaults, our Post colleague Heather Long reports.

Instead of a V-shaped recovery, economists say, it is increasingly likely that the recovery will be W-shaped, in which there are improvements before another downturn later this year or in the following year. That possibility is “in part because creating a vaccine is likely to take at least a year and millions of Americans and businesses are piling up debt without an easy ability to repay it,” Heather writes.

“It could be triggered by reopening the economy too quickly and seeing a second spike in deaths from covid-19, the disease the coronavirus causes,” she adds. “… This could cause many businesses, which were barely hanging on, to close again. Many Americans could become even more afraid to venture out until a vaccine is found.”

“Pretending the world will return to normal in three months or six months is just wrong,” said Diane Swonk, chief economist at Grant Thornton, told The Post. “The economy went into an ice age overnight. We’re in a deep freeze. As the economy thaws, we’ll see the damage done as well. Flooding will occur.”

https://www.nga.org/wp-content/uploads/2020/04/NGA-Report.pdf?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202

 

 

 

 

Here are the innovations we need to reopen the economy

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Health Policy, Healthcare Providers, Hydroxychloroquine, Infection Control, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Social Distancing, Vaccination, Vaccine • Leave a comment

https://www.washingtonpost.com/opinions/2020/04/23/bill-gates-here-are-innovations-we-need-reopen-economy/?arc404=true

Bill Gates: Here are the innovations we need to reopen the economy ...

Bill Gates is a co-chair of the Bill & Melinda Gates Foundation. This article is adapted from his blog post “Pandemic I: the First Modern Pandemic,” available at gatesnotes.com.

It’s entirely understandable that the national conversation has turned to a single question: “When can we get back to normal?” The shutdown has caused immeasurable pain in jobs lost, people isolated and worsening inequity. People are ready to get going again.

Unfortunately, although we have the will, we don’t have the way — not yet. Before the United States and other countries can return to business and life as usual, we will need some innovative new tools that help us detect, treat and prevent covid-19.

It begins with testing. We can’t defeat an enemy if we don’t know where it is. To reopen the economy, we need to be testing enough people that we can quickly detect emerging hotspots and intervene early. We don’t want to wait until the hospitals start to fill up and more people die.

Innovation can help us get the numbers up. The current coronavirus tests require that health-care workers perform nasal swabs, which means they have to change their protective gear before every test. But our foundation supported research showing that having patients do the swab themselves produces results that are just as accurate. This self-swab approach is faster and safer, since regulators should be able to approve swabbing at home or in other locations rather than having people risk additional contact.

Another diagnostic test under development would work much like an at-home pregnancy test. You would swab your nose, but instead of sending it into a processing center, you’d put it in a liquid and then pour that liquid onto a strip of paper, which would change color if the virus was present. This test may be available in a few months.

We need one other advance in testing, but it’s social, not technical: consistent standards about who can get tested. If the country doesn’t test the right people — essential workers, people who are symptomatic and those who have been in contact with someone who tested positive — then we’re wasting a precious resource and potentially missing big reserves of the virus. Asymptomatic people who aren’t in one of those three groups should not be tested until there are enough for everyone else.

The second area where we need innovation is contact tracing. Once someone tests positive, public-health officials need to know who else that person might have infected.

For now, the United States can follow Germany’s example: interview everyone who tests positive and use a database to make sure someone follows up with all their contacts. This approach is far from perfect, because it relies on the infected person to report their contacts accurately and requires a lot of staff to follow up with everyone in person. But it would be an improvement over the sporadic way that contact tracing is being done across the United States now.

An even better solution would be the broad, voluntary adoption of digital tools. For example, there are apps that will help you remember where you have been; if you ever test positive, you can review the history or choose to share it with whoever comes to interview you about your contacts. And some people have proposed allowing phones to detect other phones that are near them by using Bluetooth and emitting sounds that humans can’t hear. If someone tested positive, their phone would send a message to the other phones, and their owners could get tested. If most people chose to install this kind of application, it would probably help some.

Naturally, anyone who tests positive will immediately want to know about treatment options. Yet, right now, there is no treatment for covid-19. Hydroxychloroquine, which works by changing the way the human body reacts to a virus, has received a lot of attention. Our foundation is funding a clinical trial that will give an indication whether it works on covid-19 by the end of May, and it appears the benefits will be modest at best.

But several more-promising candidates are on the horizon. One involves drawing blood from patients who have recovered from covid-19, making sure it is free of the coronavirus and other infections, and giving the plasma (and the antibodies it contains) to sick people. Several major companies are working together to see whether this succeeds.

Another type of drug candidate involves identifying the antibodies that are most effective against the novel coronavirus, and then manufacturing them in a lab. If this works, it is not yet clear how many doses could be produced; it depends on how much antibody material is needed per dose. In 2021, manufacturers may be able to make as few as 100,000 treatments or many millions.

If, a year from now, people are going to big public events — such as games or concerts in a stadium — it will be because researchers have discovered an extremely effective treatment that makes everyone feel safe to go out again. Unfortunately, based on the evidence I’ve seen, they’ll likely find a good treatment, but not one that virtually guarantees you’ll recover.

That’s why we need to invest in a fourth area of innovation: making a vaccine. Every additional month that it takes to produce a vaccine is a month in which the economy cannot completely return to normal.

The new approach I’m most excited about is known as an RNA vaccine. (The first covid-19 vaccine to start human trials is an RNA vaccine.) Unlike a flu shot, which contains fragments of the influenza virus so your immune system can learn to attack them, an RNA vaccine gives your body the genetic code needed to produce viral fragments on its own. When the immune system sees these fragments, it learns how to attack them. An RNA vaccine essentially turns your body into its own vaccine manufacturing unit.

There are at least five other efforts that look promising. But because no one knows which approach will work, a number of them need to be funded so they can all advance at full speed simultaneously.

Even before there’s a safe, effective vaccine, governments need to work out how to distribute it. The countries that provide the funding, the countries where the trials are run, and the ones that are hardest-hit will all have a good case that they should receive priority. Ideally, there would be global agreement about who should get the vaccine first, but given how many competing interests there are, this is unlikely to happen. Whoever solves this problem equitably will have made a major breakthrough.

World War II was the defining moment of my parents’ generation. Similarly, the coronavirus pandemic — the first in a century — will define this era. But there is one big difference between a world war and a pandemic: All of humanity can work together to learn about the disease and develop the capacity to fight it. With the right tools in hand, and smart implementation, we will eventually be able to declare an end to this pandemic — and turn our attention to how to prevent and contain the next one.

 

 

 

Melinda Gates: This is not a once-in-a-century pandemic.

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Research Funding, Clinical Testing, Clinical Trial Recruitment, Clinical Trials, Communication, Coronavirus, Crisis, Crisis Management, Emergency Preparedness, Food and Drug Administration (FDA), Health Policy, Herd Immunity, Infection Control, Infectious Virus, Intensive Care (ICU), Leadership, Leadership Cares, Leadership Trust, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing, Vaccination, Vaccine • Leave a comment

https://www.businessinsider.com/melinda-gates-coronavirus-interview-vaccine-timeline-2020-4?linkId=87026774

Melinda Gates

‘We will absolutely have more of these.’ The billionaire philanthropist predicts a timeline for going back to normal.

  • Business Insider spoke with Melinda Gates about COVID-19, the prospect and timeline of making an effective vaccine, and how the world will be permanently changed by the coronavirus.
  • Gates said it would likely take about 18 months for a vaccine to become widely available, and that it should first go to healthcare workers to help them keep others safe.
  • She said this pandemic was not a once-in-a-century situation, like the Spanish flu. Because the world is now a global community, we’re likely to see other pandemics in our lifetimes, Gates said.
  • Even after things get back to normal, “our psyches are going to permanently changed … I hope we change to realize that we’re a global community.”

Melinda Gates is the cochair of the Bill & Melinda Gates Foundation, which has donated more than $45 billion to tackle some of the world’s toughest problems, including vaccination research and combating pandemics, from coronavirus to Ebola.

Gates and her husband have long been concerned about a pandemic and have warned that we need to be more prepared at a global level.

In a wide-ranging interview with Gates on Thursday afternoon, she gave her thoughts on the coronavirus pandemic, the inequality of it all, and how the world can go back to semi-normal. The highlights:

  • The world needs a vaccine delivered at mass scale to go back to “normal.” A realistic timeline is about 18 months, the same time it took to create an Ebola vaccine.
  • It is possible we won’t be able to find an effective vaccine for coronavirus, although Gates thinks that is highly unlikely.
  • The idea of herd immunity solving coronavirus is far-fetched. Gates said that would require more than half the population to get coronavirus (which isn’t anywhere close to happening) and a lot of death along the way.
  • To effectively roll out a vaccine, Gates believes you need to first give it to health workers, then to high-risk groups, then distribute it equitably to different countries and communities. The vaccine also has to cost very little with a fund to cover it for everyone. What the US is doing right now, pitting states against each other for supplies and allowing wealthy individuals to access tests first, would be disastrous for a vaccine rollout.
  • To prepare for the second wave of coronavirus this fall, or even a next pandemic, we need mass testing from the get-go, voluntary data sharing from people so that we can trace who has been tested and where they have been, and vaccine stockpiles so that you can distribute those as soon as you see signs of an outbreak.
  • Gates said there would “absolutely” be more pandemics in our lifetime. Coronavirus is not a once-in-a-century occurrence like the Spanish flu.
  • If you want to help vulnerable, poor communities survive coronavirus, Gates recommends giving to the WHO COVID Solidarity Fund, United Way, or America’s Food Fund.

We need a vaccine to be widely distributed before the world will start to feel normal again. Gates says we won’t get that for at least 18 months.

Alyson Shontell: How is it going in the Gates household?

Melinda Gates: Like all other families, it’s been a complete change of life for all of us. But we are also incredibly privileged, and we know that, and our kids know that. But yes, life has changed drastically. The kids are studying online. Bill and I are doing all of our meetings via video teleconference. I’m a terrible cook, so I’m heating things up a lot more, and everybody’s trying to pitch in to do what needs to get done in terms of things around the house.

And the other thing I would just say is every night, we’ve had this tradition for a long time of saying grace before meals. And what that looks like is that we all go around and say something we’re thankful for. Pretty much every night what comes up from the kids and us is we’re thankful for our health and for the fact that we’re not going hungry and the fact that we can still do our work and the kids can still learn. It’s kind of amazing.

Shontell: We heard Dr. Fauci say earlier this week that things probably won’t return to normal until we have a vaccine. What do you think is a realistic timeline for a wide distribution of a vaccine? Is anything faster than 18 months really safe?

Gates: I think it’s likely 18 months. Just from everything we know from working with our partners for many, many years on vaccines, you have to test the compounds. Then, you have to go into preclinical trials, then full-scale trials. And even though I’m sure the FDA will fast-track some of these vaccine trials like they did with Ebola, still by the time you get it through the trials safety- and efficacy-wise, then you have to manufacture the vaccine and manufacture at scale. I think it really is 18 months.

The good news that I’m seeing on that front, though, is so many scientists are coming forward, and I’m seeing CEOs come forward and say, “I have this platform we can use.” Pharmaceutical companies are coming together already to say, “How do we build up the manufacturing capacity so it’s there when we get a vaccine and we can basically just run it through the manufacturing process?” I’m seeing lots of good things come forward, but it’s a process that needs to run its full course, because you don’t want to put something in someone’s body that is harmful.

Shontell: Right. It seems like, in addition to creating something we’ve never had before, you do really have to do these human tests in a way that’s safe so that you’re not creating a vaccine that maybe cures coronavirus but gives you something else.

Gates: I’d add also that we need to know who it’s safe to give the vaccine to and in what dosages. We know COVID-19 is affecting people who are particularly vulnerable health-wise if they have diabetes, or a heart condition, or they have asthma. You have to make sure that, safety-wise, you’re not giving somebody a vaccine that’s going to affect their heart. So yeah, there are lots of issues there that have to be tested.

It’s possible we won’t be able to create a coronavirus vaccine, although Gates thinks that’s highly unlikely. Also, herd immunity is not the solution.

Shontell: If at the end of this 18-month period, or however long it is, we do feel like we’ve got a vaccine, what do you think that vaccine will actually look like? Is it possible that we actually won’t be able to create a vaccine at all? Could that be one scenario?

Gates: Well, it’s possible. We have to look at how far science has come even in the last five years. And the number of compounds we have, there’s something like 14,000 compounds that we, with our partners alone, have. And there are many, many, many others testing compounds that we’re looking at to see, “Is this promising?” Could that one be promising? And we have high throughput screening now of compounds. I really think we’re going to find a vaccine.

We found a vaccine for Ebola, right? And we did that in about an 18-month time frame, and that was hard. When I see the scientific community all coming together the way they are around the globe and sharing data and sharing information, we’re going to get a vaccine.

Shontell: OK, so you’d say that it’s a high likelihood.

Gates: High likelihood.

Shontell: That’s very, very good to know.

Gates: The other thing to think about is, in the meantime, there’s another whole strand of work going on, which is the therapeutics accelerator. Through the accelerator, we’re trying to find medicines so that if you get COVID-19, hopefully we can boost your immune system or tamp down the effect of the disease on you. So again, hopefully, we’ll come up with some medicines that will also help so people don’t get as sick as they’re getting and landing in the ICU, which is what’s truly tragic.

Shontell: Is there anything to this idea of herd immunity? Could we be closer than we think on that, or is that far-fetched thinking?

Gates: That’s still very far-fetched today. You don’t get herd immunity until you have a huge percent of your population that has had the disease. We know that from all the diseases in the past that humans have had. So no, we’re still a long way from herd immunity. And you can’t count on that because a lot of people are going to die in the meantime if you let the experiment run and you just let the disease run its course in communities. Sure, we could get herd immunity and we will get so much death. That’s why it’s so important to remind people the only tools we have today are physical distancing, handwashing, and wearing masks in public. We have to go with what we know works.

How to distribute a coronavirus vaccine to the masses: 1. Make it cheap and buy it for everyone. 2. Give it to healthcare workers. 3. Give it to the highest-risk people. 4. Come up with an equitable way for everyone else to get it (the US is screwing that up right now).

Shontell: Once we have a vaccine, what do you think is the best way to distribute it to the masses? Who should get it first? How would we do it on such a big scale?

Gates: We have to make sure that the vaccine is very low priced and that there’s a fund for buying it for everyone, whether you’re in a low-, middle-, or a high-income country. And that’s doable. We’ve done that with the Vaccine Alliance that exists today. That’s been in existence since 1990, so we know how to do that piece.

But we also have to distribute very carefully. The very first people that need to get this vaccine are healthcare workers, because if you can keep them safe, they can help keep others safe. Then you need to distribute it to the people who are the very most vulnerable. That is, they have underlying health conditions, some of the ones that we’ve talked about before. And from there, you then make it distributed completely equitably across society.

And even the United States is going to have to really work at that. COVID-19 is exposing all the inequities we have in our healthcare system. And so we need to look at, OK, does Mississippi get this vaccine at the same time California gets it and New York gets it? We can’t do this game that we’re playing right now where you have 50 different states competing for resources for masks and PPE, that makes zero sense. You need a national strategy that will equitably distribute this vaccine and we first look at the vulnerable populations.

Shontell: To touch on that point, as you mentioned, there are so many inequalities coming to light with this pandemic, from who has been able to get initial testing on to how it’s affecting different genders in different ways, to more African Americans in the US dying of this than other races. When you think about it, social distancing, stocking up on food, and handwashing are all privileges that some of the poorest communities don’t have.

You’ve done a lot of work on equality efforts, and you’ve said it’s the best way to fix everything in society is to level the playing field. How do we start leveling the playing field so the next time it’s better for everybody? How do we help the people who are in the poorest, most vulnerable communities right now?

Gates: We have to start by remembering that COVID-19 anywhere is COVID-19 everywhere. And if we keep that front and center in our minds, then we will start to think really deeply about these most vulnerable populations.

The thing that keeps me up at night — because I’ve traveled to Africa so many times and been in so many townships and slums — is if you are a person living in those conditions, you can’t begin to handwashing or social distance. In those situations, we need to start with food. People need to be able to feed themselves. And then if they feel like they have COVID symptoms, then they don’t have to go out of the house looking for food.

When I think forward about how we would do this, right now, we have to focus on the pandemic today right in front of us. We have to take the tools we have and try and distribute them as equitably as we possibly can. That means a national response that is thought out and strategic. So you start there.

When you plan for the future, you start to plan it out the way we did for other diseases that came into the world. You would create a vaccine stockpile. We’ve actually been quite involved with that for cholera, which we don’t get much in the United States anymore, but you get in a lot of places in the developing world or in refugee camps. And when there’s a stockpile of vaccine, then when you see an outbreak or a vulnerable population get it, it’s already basically paid for and you ship the vaccines out.

We have to have not a national stockpile of vaccines but an international stockpile of vaccines for something like COVID. We can predict some of these types of disease outbreaks; we just haven’t been planning it. We plan for things like an earthquake or a fire. We need to plan for disease. We are a global community. People travel. We’ve just learned that New York mostly got infected from people coming back from Europe. We have to plan for these things as a global community in the future.

How to be ready for the 2nd wave to hit this fall: Are you ready to give up your personal data and get tracked?

Shontell: Clearly, we were caught flat-footed and unprepared here in the US especially. There’s talk of a second wave of coronavirus potentially hitting in the fall. What are the things we need to do to plan for it? What has to be done by the end of the summer to put us all in a much better shape for it? And then I’m curious what we need to have in place to prevent something like this moving forward, if that’s even possible.

Gates: In terms of what we need to do to prepare ourselves this fall, first of all, all the way through this, we need to listen to the medical experts and the science experts. They know what’s real. We need to do the disease modeling to see where the outbreaks are going. We need to plan resources appropriately and share them in the United States with all the states in an equitable way.

And then we need to do massive testing. We have to have testing at wide scale so that you can get a test and you can know if you’re positive. And if you’re positive, then you self-isolate. Unless you get further disease, you then get telemedicine. You figure out if you need to go to the health system. And you have different tiers of the health system, places people can go for oxygen versus people who go to the ICU.

We can do that, kind of. You can do that triage of people if you have a test. To be frank, we also need to be able to share all that testing data so that eventually the US would be a place like South Korea, where I can literally prove on my phone “I took a test this morning — I’m COVID-free” or “Guess what? I had COVID before and I tested for antibodies in my system. I can be out in society working maybe now.” You could literally have a code on your phone that says, “Tested this morning” or “See? I have a COVID antibody.”

And so we can start to see who can be in society versus who needs to self-isolate. But without testing and contact tracing and some way of being able to prove to one another we’re safe, you can’t plan for a full eventual reopening of society. We need to do get that up and running at scale at a national level.

Preparing for the next epidemic is a whole different conversation. You’d have tests available from the get-go. You would have fought through the civil-liberties issues of people sharing their health information willingly or not willingly. Am I willing to share my health data so that you know if I got it?

Early on, people with COVID had symptoms we didn’t know to track. If we had known that from the get-go because they were able to share their information into a national database voluntarily, we would have known to tell people, “Look for these symptoms. Self-isolate just in case you have it.” We have to be able to start thinking through those types of systems as a country so that we’re prepared for whatever comes next.

Whose job is it to solve a pandemic, the elite’s or the government’s?

Shontell: Yes to all of that. Edelman put out on their annual Trust Barometer in January. They found that trust in media is really low right now. Trust in the government is really low too. But trust in business leaders is the highest group, and people seem to put the most faith in business leaders to solve some of society’s biggest problems.

You and Bill have done a tremendous amount with the foundation. You’re seeing Mark Zuckerberg giving a ton of money toward this. Sheryl Sandberg is doing the same. Jack Dorsey just pledged a big chunk of net worth to help fight COVID. Lots of people are stepping up. Bezos as well.

Is it the responsibility of business leaders to do this versus the government? Is this something we should come to expect? How do you kind of view the responsibility of the people who are in positions of the most privilege as we tackle something as wide-scale is this?

Gates: What I’m seeing is people stepping up. I sometimes wish people could see the number of emails we’re receiving daily at the foundation, not just Bill and me, but our scientists and our head of global health. We’re seeing CEOs come forward. We’re seeing philanthropists come forward. We’re seeing people who have knowledge and data saying, “Should we look at this? What should we do?” I am seeing the best of humanity come out right now in some of these leaders who are stepping forward and doing the right thing.

“Is this the responsibility of business?” was your question. It’s the responsibility of all of us. Business won’t be able to solve this. There’s no way business or philanthropy can solve this alone. It takes the government. It’s government who puts out huge amounts of money into our healthcare system to take care of everybody, to take care of the most vulnerable. It’s philanthropy and business and nonprofits coming together with government to have a national response. That is the only way we’re going to be able to care for all Americans.

But what I see is amazing scientists like Dr. Fauci stepping up and giving all the right messages. Those are the people we should be listening to, and I am seeing so many people come together behind the scenes to try and do the right thing. While the vulnerable is what keeps me up at night, one of the things that keeps me encouraged when I wake up in the morning is seeing so many people doing the right thing.

This is not just a once-in-a-century pandemic. ‘We are absolutely going to have more of these.’

Shontell: Is this a once-in-a-century pandemic like the Spanish flu, or do we need to expect to face more pandemics like this moving forward?

Gates: This is not a once-in-a-century pandemic. We are absolutely going to have more of these. This thing is highly infectious, COVID-19. But it is not nearly as infectious as measles. And we dealt with measles in the world. We know how to deal with measles. We’re going to see more, so we need to plan for them. And we haven’t planned for them as a global community.

Shontell: Why do you think we’ll see more pandemics?

Gates: We’ll see more because of all kinds of reasons, but mainly because we’re a global community and we travel and we spread disease.

Alyson: To end on a positive note, we are going to get through this, right? It will be hard, but we will get through this. I’m curious from your estimation: What timeline are we looking at for life to feel normal again? Or are we in a new normal, and are there things that we should expect to be permanently changed?

No one really knows when things will feel normal again. But be prepared for some permanent changes, including to your psyche.

Gates: I definitely think there are going to be things that are permanently changed. Our psyches are going to be permanently changed. We are learning some things about how to do more meetings online. We’re learning how to take care of each other online. People are reaching out to the elderly in their homes and doing video calls and sending emails or dropping a meal off. What’s going to change is our psyche, and I hope we change to realize that we’re a global community.

To the question of when does society reopen in what we think of as our normal form, nobody really knows the answer to that. It really is when we get a vaccine at scale.

Will we get, over time, probably some partial reopenings of society where you can do certain smaller group things or be out walking with one friend or two friends? I think we will start to see some partial reopenings.

We have to follow the data, though, of how is that working in Wuhan right now? How did it work in South Korea? How does it work in Germany? The places that are kind of ahead of us on both their response and when they got the disease? And then, we’ll start to be able to see, OK, where can we open up pockets of society over time? For right now, we need to be physically distant from one another.

Shontell: If the average person wants to give to help a vulnerable person or community, what’s the best way to do that other than social distancing? Is there some cause to give to or something that’s most helpful?

Gates: Yes. You could go globally. You could go to the WHO COVID Solidarity Fund. Locally, you could go to United Way. America’s Food Fund is another place you can go. I would give also to local domestic-violence organizations. We see domestic violence on the rise for many, many people, particularly women. Any of those would be amazing places to go and to give, even if you only give $10 — $10 or $100, it all makes a difference.

Shontell: I’m leaving this conversation very hopeful. Thank you for all efforts you and Bill and the foundation are doing in helping fight this. You were early to realizing the problems of pandemics, and we are grateful that you’re on it.

Gates: Thanks, Alyson. Be safe. Be well.

 

 

 

In front of White House, nurses read names of colleagues killed by coronavirus

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Core Values, Coronavirus, Crisis, Crisis Management, Front Lines, Health Policy, Healthcare Providers, Infection Control, Infectious Virus, Labor Union, Nurses, Nurses Union, Occupational Safety and Health Administration (OSHA), Pandemic, Personal Protective Equipment (PPE), Physician, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.washingtonpost.com/local/nurses-read-names-of-colleagues-who-died-of-the-coronavirus-in-front-of-the-white-house/2020/04/21/fc93184c-83e6-11ea-878a-86477a724bdb_story.html?fbclid=IwAR3uHwtfPR-JqZaeFCfIrwmVEzDRSN574QocAt932Pa2pyUt6oL9KC3Kka8&fbclid=IwAR2VQF-oNTrPWkrGFODp9d_WMPOzIUW-imvhPWPGZlU2SN32I6W7trHrjEA&fbclid=IwAR2vXZ6AGvzXd9kZp1naBhLYA8Z2MzWVpYi2zbfXUNM9ybmRZ6FhW1hASEU&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Coronavirus deaths: Nurses read names at White House of colleagues ...

Registered nurses gathered Tuesday in front of the White House to read the names of health-care workers who have died fighting the coronavirus pandemic.

Wearing masks and standing six feet apart, the nurses held up photographs of the deceased as Melody Jones, a member of the National Nurses United union, addressed the news media in an otherwise empty Lafayette Square.

The names came from all over the country — New York and Alabama, Puerto Rico and Nevada, California and Michigan, Florida and Maryland, New Jersey and the District.

A man in blue scrubs stood behind Jones as she read, holding a metallic gold sign painted with the message: “20 seconds won’t scrub ‘hero’ blood off your hands.”

“Let us remember and honor the ultimate sacrifice these nurses paid,” Jones said. “We commit ourselves to fight like hell for the living.”

The protest stood in stark contrast to demonstrations in recent days in some parts of the country in which protesters have demanded the reopening of nonessential businesses. Nurses have been spotted at those gatherings, too, standing arms crossed, in opposition to demonstrators, many of whom are unmasked and milling in crowds.

More than 9,000 health-care workers in the United States have tested positive for the novel coronavirus, according to figures from the Centers for Disease Control and Prevention. Those numbers are believed to be an undercount of infections due to a lack of tests in many areas.

The nurses said Tuesday that they wanted to bring their demands for more personal protective equipment directly to President Trump’s doorstep.

Health-care providers in hospitals, clinics, nursing homes, assisted-living facilities and rehabilitation centers have for weeks asked lawmakers and government agencies for more protective equipment to shield themselves and their vulnerable patients from the spread of covid-19.

National Nurses United last month petitioned the Occupational Safety and Health Administration to institute an emergency safety standard that would provide nurses with more protective gear, including N95 respirator masks, face shields, gowns, gloves and shoe coverings.

Health-care workers, governors and other officials have for weeks demanded that Trump enforce the Defense Production Act to order mass production of those materials. Many have also petitioned Congress to mandate Trump use his authority to help boost the production of such gear.

Last week, a protest in the shadow of the Capitol displayed the faces of health-care workers demanding better protection on 1,000 signs. The sign represented protesters that organizers said would not have been safe if gathered together on the Capitol lawn.

 

 

 

 

The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 Crisis

Posted on by • Posted in 2020 Election Issues, Camaraderie, Clinical Testing, Cooperation, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership, Leadership Alignment, Leadership Cares, Leadership Culture, Leadership Integrity, Leadership Trust, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Trust, Truth, Vaccination, Vaccine • Leave a comment

https://khn.org/news/the-inside-story-of-how-the-bay-area-got-ahead-of-the-covid-19-crisis/

The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 ...

Sunday was supposed to be a rare day off for Dr. Tomás Aragón after weeks of working around-the-clock.

Instead, the San Francisco public health officer was jolted awake by an urgent 7:39 a.m. text message from his boss.

“Can you set up a call with San Mateo and Santa Clara health officers this a.m., so we can discuss us all getting on the same page this week with aggressive actions, thanks,” said the message from Dr. Grant Colfax, director of San Francisco’s Department of Public Health.

“Will do, getting up now,” Aragón responded.

It was March 15, two days before St. Patrick’s Day, a heavy partying holiday and nightmare scenario for public health officials.

The novel coronavirus was spreading stealthily across the San Francisco Bay Area and public health officials were alarmed by the explosion of deaths in Italy and elsewhere around the globe. Silicon Valley would be next, case counts indicated.

Until then, they had primarily focused on banning mass gatherings. But they knew more had to be done — and wanted to present a united front.

Within a few hours of the text, Bay Area public health leaders jumped on a series of calls to debate options, including the most dramatic — a lockdown order that would shutter businesses, isolate families and force millions of residents to stay home.

They decided they had no choice. And they were able to move swiftly because they had a secret weapon: a decades-long alliance seeded in the early days of the AIDS epidemic that shields them from political blowback when they need to make difficult decisions.

Together, they would issue the nation’s first stay-at-home order, likely saving thousands of lives and charting the course for much of the country. Three days later, Gov. Gavin Newsom followed with his own order for California. New York came next, as have dozens of states since.

“This was one exhausting and difficult day for all of us,” Aragón later wrote in his journal. “We all wish we did not have to do this.”

Now, officials nationwide are weighing how to lift isolation orders as the rate of COVID-19 transmission slows — and protests against the orders mount. The Bay Area is again poised to lead, but with a warning: All of this could be for naught if it isn’t done right.

The coalition of county public health officers didn’t set out to lock down the Bay Area that fateful Sunday morning in mid-March. But as they discussed the exponential increase in Santa Clara County cases, where the hospitals were becoming overwhelmed by infected patients falling ever sicker, what they needed to do “started to crystalize,” said Dr. Sara Cody, the county’s public health officer.

“It felt huge to me,” she recalled, “because I knew how disruptive it would be.”

Elsewhere in the region, diagnosed cases were sparse. But decades of experience had shown the health officers that while they represent different jurisdictions, they are one region when it comes to infectious diseases. “We knew that it would be a matter of time before that was our experience,” said Dr. Matt Willis, Marin County’s public health officer, who contracted COVID-19 days later.

Cody told her colleagues that Italy was under siege, and her county was just two weeks away from a similar fate. If she could have locked down sooner, she told them, she would have.

“That was compelling,” said Dr. Lisa Hernandez, the public health officer for the city of Berkeley, which had not yet recorded any cases of community transmission. “We knew there was going to be St. Patrick’s Day parades and celebrations, so the timing was critical.”

Dr. Scott Morrow, California’s longest-serving public health officer, who heads operations in San Mateo County, said he also felt the urgency. “We thought, ‘Yes, the clock is ticking,’” he recalled.

County health officers in California have immense power to act independently in the interest of public health, including the authority to issue legally binding directives. They don’t need permission from the governor or mayors or county supervisors to act.

Even for this group, though, with all its collective strength, telling millions of Californians to shelter in place seemed risky at first. But the health officers involved had grown to trust one another, even if they don’t always see eye to eye.

For instance, they currently disagree on whether to require residents to wear face coverings. Some counties, including San Francisco and Marin, are requiring them in public, while others, like Santa Clara, are not.

On the first Sunday morning call, Aragón floated the idea of developing a coordinated recommendation that Bay Area residents stay at home. By the next confab, Cody, Santa Clara County’s health official, made the case that for social distancing to work, it had to be an order.

“Sara Cody was the courageous leader!” Aragón later wrote in his journal.

So forceful a move can be unpopular, but evidence shows it can also be the most effective, in the absence of treatment or a vaccine. “Here’s the rub on these methods — they only work if you do it really early,” said Dr. Howard Markel, a medical historian at the University of Michigan and an expert on the 1918 flu pandemic.

“When you do a quarantine, you stop the commerce, you stop the flow of money,” he said. “But on the other side of that are those whose lives are saved.”

This isn’t the group’s first pandemic. The alliance, formally called the Association of Bay Area Health Officials, was born in 1985 in the early days of the AIDS epidemic.

Dr. David Werdegar, who became health officer for San Francisco that year, was analyzing AIDS data for surrounding counties and asked their health officers to join him for dinner at Jack’s, an old bordello-turned-political hangout in the city that has since shuttered.

Most of the infectious disease research was happening in San Francisco at the time, but HIV was spreading, and one city couldn’t fight it alone.

“It was important that we share all the information we had,” said Werdegar, now in his 80s and retired.

Dr. Robert Melton, a former Monterey County health officer, said that working for nearly two decades with Bay Area public health giants taught him tremendous lessons. “Camaraderie is important in maintaining the energy to be able to focus on the common good, through good and bad,” he said.

That close-knit relationship among the 13 health officers — representing counties stretching across a large swath of Northern California from Napa to Monterey — continues to this day. Collectively, their public health actions touch about 8.5 million people.

They meet monthly and communicate regularly on Slack, a messaging app. Their diverse backgrounds and expertise, especially in an era of funding cuts, provide a deep well of public health knowledge from which to draw. Together, the group has joined forces to combat youth vaping, air pollution and measles outbreaks.

And they have also tackled various influenza scares, which is why they had an emergency response blueprint at the ready when cases of what would later be called COVID-19 first cropped up in Wuhan, China.

“We spent a couple years as a region thinking about pandemic planning, and that really helped us come a long way thinking about these policies for COVID-19,” said Dr. Erica Pan, the interim health officer for Alameda County.

So when they jumped on the call that Sunday, they were already in mid-conversation about how to respond. They brought their lawyers and, working into the predawn hours, translated their lockdown plan into legalese, one that would be enforceable with fines and misdemeanor charges.

They would make prime-time announcements across the region the next day, alongside elected officials. “This is not the moment for half-measures,” said San Jose Mayor Sam Liccardo. “History won’t forgive us for waiting an hour more.”

At first, the stay-at-home order applied just to the “Big Seven” counties surrounding the San Francisco Bay, whose officers peeled off from the larger group to issue it first. They shared their model ordinance with the others, who quickly followed.

Dr. Gail Newel, an OB-GYN and Santa Cruz County’s health officer, is not an infectious disease expert. She has relied heavily on the group’s expertise throughout her career, and especially now.

“It’s this incredible bank of knowledge and wisdom and experience that’s freely shared among the members,” she said. “And the whole Bay Area benefits by that shared knowledge bank.”

Roughly one month after they made the unprecedented decision to close the local economy, the risk seems to have paid off. It will be years before researchers have fully analyzed its impact, but officials across the Bay Area are cautiously optimistic. Others haven’t been so lucky.

Though there are important differences between the two regions, New York City, which issued a stay-at-home order four days after the Bay Area, saw its hospitals completely overwhelmed and had recorded more than 14,600 deaths as of Monday.

By comparison, the counties represented by the alliance have documented more than 215 deaths and hospitals haven’t been overtaken by a surge. In fact, hospitals brought online specifically to accommodate an overflow of patients are sitting largely empty.

Even within California, communities that waited to issue lockdown orders have emerged as COVID-19 hot spots, including Los Angeles, where Mayor Eric Garcetti followed suit three days after the Bay Area.

Internally, some of the Bay Area health officials have wondered if they made the right call. But “anytime I have any doubt, I just read another news report from New York or Detroit or New Orleans,” said Dr. Chris Farnitano, Contra Costa County’s health officer.

And the close-knit band is already undertaking its next task: reopening the economy without causing another spike in cases.

Before the orders are lifted, the officials say there must be rapid, widespread testing across the population. They want to hire disease investigators by the hundreds, if not the thousands, to trace the virus and quarantine those who have been infected. And until there is a vaccine, they may ask people to wear masks in public and continue social distancing, even in bars, restaurants and schools when they reopen.

“I was concerned that we might get a lot of resistance and it might get interpreted as alarmist and overreach,” said Marin County’s Willis. “Time has shown that it was really a vital step to take when we took it.”

 

 

 

 

Governors Reject Pence’s Claim on Virus Testing

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Core Values, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Mislead, Misleading, Pandemic, Public Health, Public Safety, Social Distancing, Supply Chain • Leave a comment

Coronavirus and Reopening: Governors Say They Lack Tests as Trump ...

Democratic and Republican governors bristled at claims from the Trump administration that the supply of tests was adequate to move firmly toward reopening the country.

Governors facing growing pressure to revive economies decimated by the coronavirus said on Sunday that a shortage of tests was among the most significant hurdles in the way of lifting restrictions in their states.

“We are fighting a biological war,” Gov. Ralph Northam of Virginia said on “State of the Union” on CNN. “We have been asked as governors to fight that war without the supplies we need.”

In interviews on Sunday morning talk shows, Mr. Northam was among the governors who said they needed the swabs and reagents required for the test, and urged federal officials to help them get those supplies.

The governors bristled at claims from the Trump administration that the supply of tests was adequate. On NBC’s “Meet the Press,” Vice President Mike Pence said “there is a sufficient capacity of testing across the country today for any state in America” to go to the first of three phases that the administration says are needed for the country to emerge from the coronavirus shutdown.

Mr. Northam, a Democrat, called Mr. Pence’s claim “delusional.” In Michigan, Gov. Gretchen ​Whitmer, also a Democrat, said the state could perform “double or triple” the number of tests it is doing now “if we had the swabs or reagents.” ​Gov. Larry Hogan​ of Maryland, a Republican, said that it was “absolutely false” to claim that governors were not acting aggressively enough to pursue as much testing as possible.

“It’s not accurate to say there’s plenty of testing out there, and the governors should just get it done,” Mr. Hogan ​said​ on “State of the Union​.​”​ “That’s just not being straightforward.”

The conflicting messages come as the debate over how and when to reopen the economy has intensified. President Trump on Saturday expressed his confidence in the nation’s testing capability and said some governors have “gotten carried away,” while state officials said they feared moving too early could cause the virus to flare again.

“As tough as this moment is,” Ms. Whitmer said in an interview with CNN, “it would be devastating to have a second wave.”

In a news conference on Sunday evening, Mr. Trump expressed his confidence in the federal response, including his administration’s relationship with governors and the capacity for testing.

Mr. Trump said the administration was preparing to use the Defense Production Act to compel one U.S. facility to increase production of test swabs by over 20 million per month. The announcement came after he defended his response to the accusations that there was an insufficient amount of testing to justify reopening the economy any time soon.

“You’ll have so many swabs you won’t know what to do with them,” Mr. Trump said.

Officials at every level have faced increasingly competing pressures, balancing maintaining stay-at-home orders against the exasperation and economic toll they are producing. On Saturday and Sunday, modest protests took place in several cities across the country, where demonstrators flouted social distancing rules as they demanded that restrictions be relaxed.

Yet there was also a widespread sense that much of the public understood the governors’ concerns and shared them. Nearly 60 percent of American voters said they were worried that measures would be relaxed too soon, causing deaths to rise, according to a new poll from NBC News and The Wall Street Journal.

Officials in various states said they had started staging plans for reopening their economies and were working in concert with neighboring states in determining when to lift restrictions.

In South Carolina, Gov. Henry McMaster said that he had spoken with the governors of other southeastern states, including Florida and Tennessee. “Told them South Carolina was ready,” Mr. McMaster, a Republican, said on Twitter on Saturday.

On Sunday, governors from across the Northeast, including New York, New Jersey, Connecticut and Pennsylvania, said they were creating a regional council focused on restoring the economy and addressing unemployment.

Still, many governors, including Andrew M. Cuomo of New York and Philip D. Murphy of New Jersey, said that testing still needed to be ramped up considerably before moving forward, and that they needed federal help to do so.

There are currently about 150,000 diagnostic tests conducted each day, according to the Covid Tracking Project. Researchers at Harvard estimated last week that in order to ease restrictions, the nation needed to at least triple that pace of testing.

Dr. Deborah Birx, the coronavirus response coordinator for the White House, also pushed back against criticism that not enough people were being tested, saying that not every community required high levels of testing and that tens of thousands of test results were probably not being reported.

“We need to predict community by community the testing that is needed,” Dr. Birx said Sunday on CBS’s “Face the Nation​.” “Each will have a different testing need, and that’s what we’re calculating now.”

On the ABC program “This Week,” Dr. Birx said she thought statistics on testing were incomplete: “When you look at the number of cases that have been diagnosed, you realize that there’s probably 30,000 to 50,000 additional tests being done that aren’t being reported right now.”

Shortages of supplies have restricted the pace of testing, according to commercial laboratories. Dr. Birx said that a team at Walter Reed National Military Medical Center was calling hundreds of labs around the country to determine exactly what supplies they need “to turn on full capacity, which we believe will double the number of tests that are available for Americans.”

In the news conference on Saturday, Mr. Trump said the criticism of the administration was driven by Democrats. “Unfortunately, some partisan voices are trying to politicize the issue of testing,” he said.

Yet, Gov. Jay Inslee of Washington noted that governors from both parties had been among those voicing frustration over a lack of federal support with testing. He also criticized what he saw as a discordant message from Mr. Trump, which, he argued, undermined governors’ stay-at-home orders and inspired “people to ignore things that actually can save their lives.”

“These orders actually are the law of these states,” Mr. Inslee, a Democrat, said in an interview with “This Week.” He added: “And, again, these are not just Democrats. These are Republican-led states as well. To have an American president to encourage people to violate the law, I can’t remember any time during my time in America where we have seen such a thing.”

Now, with states transitioning away from addressing the peak of the pandemic, governors stand to face a difficult landscape to navigate.

Governors across the political spectrum have stepped into the spotlight during the coronavirus crisis, holding daily news briefings and going back and forth with the president. But if they drew praise for taking quick action to protect public health, taking responsibility for when and how to reopen could prove far more politically perilous, said Ray Scheppach, a public policy professor at the University of Virginia and a former longtime executive director of the National Governors Association.

“That is one of the reasons you’re seeing groups of governors and states get together,” he said, noting the alliances made by clusters of governors around the country.

“Doing something with the surrounding states does give you a certain amount of political cover,” both with constituents and the White House, Professor Scheppach said. “They don’t want to get pushed around by this president and they are stronger in a group.”

Having claimed responsibility for reopening the country, governors are now offering hesitant timelines. Offering no date for reopening may leave people feeling despondent at a time when “people need more certainty as opposed to less,” Professor Scheppach said. But being too firm comes with the risk of having to push out deadlines and test the public’s patience.

“You can do it once,” he said, as Mr. Cuomo and others have done. “But you begin to lose if you do that two or three times.”

Governors said they had become acutely aware of the dilemmas they face.

In his appearance on CNN, Mr. Hogan was shown footage of a long line winding around a supermarket in a Maryland suburb of Washington where free food was being handed out. The video was an unsettling avatar of the economic damage wrought by the virus. He said he shared in the frustration over the economy, but he also noted that his state had not yet reached its peak in cases.

“My goal is to try to get us open as quickly as we possibly can,” he said, “but in a safe way.”