Covid-19 is rapidly becoming America’s leading cause of death

https://www.washingtonpost.com/outlook/2020/04/16/coronavirus-leading-cause-death/?arc404=true&utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

Outlook - The Washington Post

In just weeks, covid-19 deaths have snowballed from a few isolated cases to thousands across the country each day.

The U.S. surgeon general had warned that last week would be like Pearl Harbor as he attempted to create context for the threat — but it turned out that more than five times as many Americans died from covid-19 last week than were killed in the World War II raid.

You can grasp the scale when you compare a single week’s pandemic deaths with how many people die of major causes in a typical week.

In early and mid-March, when America began widespread closures, quarantines and social distancing, covid-19 caused many fewer deaths than other common causes — fewer in a week than chronic liver disease or high blood pressure, and far fewer than suicide or the common flu. By the end of March, the toll was closer to the average weekly deaths from diabetes and Alzheimer’s disease. Into April, weekly covid-19 deaths climbed past those from accidents and chronic lower respiratory disease. And last week, covid-19 killed more people than normally die of cancer in this country in a week. Only heart disease was likely to kill more people that week.

All of those comparisons include only confirmed cases. This week, New York City said it considered an additional 3,700 people who had passed away over the previous weeks to have died of covid-19, even though there were no lab tests proving it. Those deaths have not been added to official state and national counts, though.

Some experts had predicted that the deaths could peak last week, but this week is shaping up to be no better, with new high death tolls Tuesday (2,369) and Wednesday (2,441). Covid-19 is on pace to be the largest single killer of Americans this week, given the normal number of deaths in an April week.

Covid-19 is not killing at the same pace everywhere: In the worst-hit areas, it is killing at an unparalleled rate.

The weekly total of covid-19 deaths in New York state and New York City has dwarfed the scale of normal causes of death — explaining why hospitals are struggling to cope. And although the outbreaks in other cities aren’t as bad, Louisiana and the District of Columbia also had more covid-19 deaths than any typical cause of death last week. In places that started social distancing and restrictions on businesses earlier, the deaths per week are lower: Washington state suffered an early burst of the disease, but covid-19 did not kill as many people there last week as in other hot spots.

California has been spared the intensity of many other states. Covid-19 deaths there last week were well below the national rate.

These charts all compare covid-19 deaths with the normal numbers of deaths at this time of year in the country or in each particular state or city, according to the Centers for Disease Control and Prevention. The death counts are averages from that month over the last five years of data. It will take more than a year for epidemiologists and statisticians to calculate the final official toll of covid-19 and put it into perspective. Measured against typical deaths, however, covid-19 is already the greatest killer in many parts of the country.

 

 

 

W.H.O., Now Trump’s Scapegoat, Warned About Coronavirus Early and Often

W.H.O. Warned Trump About Coronavirus Early and Often - The New ...

The World Health Organization, always cautious, acted more forcefully and faster than many national governments. But President Trump has decided to cut off U.S. funding to the organization.

On Jan. 22, two days after Chinese officials first publicized the serious threat posed by the new virus ravaging the city of Wuhan, the chief of the World Health Organization held the first of what would be months of almost daily media briefings, sounding the alarm, telling the world to take the outbreak seriously.

But with its officials divided, the W.H.O., still seeing no evidence of sustained spread of the virus outside of China, declined the next day to declare a global public health emergency. A week later, the organization reversed course and made the declaration.

Those early days of the epidemic illustrated the strengths and weaknesses of the W.H.O., an arm of the United Nations that is now under fire by President Trump, who on Tuesday ordered a cutoff of American funding to the organization.

With limited, constantly shifting information to go on, the W.H.O. showed an early, consistent determination to treat the new contagion like the threat it would become, and to persuade others to do the same. At the same time, the organization repeatedly praised China, acting and speaking with a political caution born of being an arm of the United Nations, with few resources of its own, unable to do its work without international cooperation.

Mr. Trump, deflecting criticism that his own handling of the crisis left the United States unprepared, accused the W.H.O. of mismanaging it, called the organization “very China-centric” and said it had “pushed China’s misinformation.”

But a close look at the record shows that the W.H.O. acted with greater foresight and speed than many national governments, and more than it had shown in previous epidemics. And while it made mistakes, there is little evidence that the W.H.O. is responsible for the disasters that have unfolded in Europe and then the United States.

The W.H.O. needs the support of its international members to accomplish anything — it has no authority over any territory, it cannot go anywhere uninvited, and it relies on member countries for its funding. All it can offer is expertise and coordination — and even most of that is borrowed from charities and member nations.

The W.H.O. has drawn criticism as being too close to Beijing — a charge that grew louder as the agency repeatedly praised China for cooperation and transparency that others said were lacking. China’s harsh approach to containing the virus drew some early criticism from human rights activists, but it proved effective and has since been adopted by many other countries.

A crucial turning point in the pandemic came on Jan. 20, after China’s central government sent the country’s most famous epidemiologist, Zhong Nanshan, to Wuhan to investigate the new coronavirus racing through that city of 11 million people. Dr. Zhong delivered a startling message on national television: Local officials had covered up the seriousness of the outbreak, the contagion spread quickly between people, doctors were dying and everyone should avoid the city.

Dr. Zhong, an eccentric 83-year-old who led the fight against the SARS outbreak of 2002 and 2003, was one of few people in China with enough standing to effectively call Wuhan’s mayor, Zhou Xianwang, a rising official in the Communist Party, a liar.

Mr. Zhou, eager to see no disruption in his plans for a local party congress from Jan. 11 to 17 and a potluck dinner for 40,000 families on Jan. 18, appears to have had his police and local health officials close the seafood market, threaten doctors and assure the public that there was little or no transmission.

Less than three days after Dr. Zhong’s warning was broadcast, China locked down the city, preventing anyone from entering or leaving and imposing strict rules on movement within it — conditions it would later extend far behind Wuhan, encompassing tens of millions of people.

The national government reacted in force, punishing local officials, declaring that anyone who hid the epidemic would be “forever nailed to history’s pillar of shame,” and deploying tens of thousands of soldiers, medical workers and contact tracers.

It was the day of the lockdown that the W.H.O. at first declined to declare a global emergency, its officials split and expressing concern about identifying a particular country as a threat, and about the impact of such a declaration on people in China. Such caution is a standard — if often frustrating — fact of life for United Nations agencies, which operate by consensus and have usually avoided even a hint of criticizing nations directly.

Despite Dr. Zhong’s warning about human-to-human transmission, Tedros Adhanom Ghebreyesus, the W.H.O.’s director-general, said there was not yet any evidence of sustained transmission outside China.

“That doesn’t mean it won’t happen,” Dr. Tedros said.

“Make no mistake,” he added. “This is an emergency in China, but it has not yet become a global health emergency. It may yet become one.”

The W.H.O. was still trying to persuade China to allow a team of its experts to visit and investigate, which did not occur until more than three weeks later. And the threat to the rest of the world on Jan. 23 was not yet clear — only about 800 cases and 25 deaths had been reported, with only a handful of infections and no deaths reported outside China.

“In retrospect, we all wonder if something else could have been done to prevent the spread we saw internationally early on, and if W.H.O. could have been more aggressive sooner as an impartial judge of the China effort,” said Dr. Peter Rabinowitz, co-director of the MetaCenter for Pandemic Preparedness and Global Health Security at the University of Washington.

Amir Attaran, a public health and law professor at the University of Ottawa, said, “Clearly a decision was taken by Dr. Tedros and the organization to bite their tongues, and to coax China out of its shell, which was partially successful.”

“That in no way supports Trump’s accusation,” he added. “The president is scapegoating, dishonestly.”

Indeed, significant shortcomings in the administration’s response arose from a failure to follow W.H.O. advice.

The Centers for Disease Control and Prevention bungled the rollout of diagnostic tests in the United States, even as the W.H.O. was urging every nation to implement widespread testing. And the White House was slow to endorse stay-home restrictions and other forms of social distancing, even after the W.H.O. advised these measures were working in China.

It is impossible to know whether the nations of the world would have acted sooner if the W.H.O. had called the epidemic a global emergency, a declaration with great public relations weight, a week earlier than it did.

But day after day, Dr. Tedros, in his rambling style, was delivering less formal warnings, telling countries to contain the virus while it was still possible, to do testing and contact tracing, and isolate those who might be infected. “We have a window of opportunity to stop this virus,” he often said, “but that window is rapidly closing.”

In fact, the organization had already taken steps to address the coronavirus, even before Dr. Zhong’s awful revelation, drawing attention to the mysterious outbreak.

On Jan. 12, Chinese scientists published the genome of the virus, and the W.H.O. asked a team in Berlin to use that information to develop a diagnostic test. Just four days later, they produced a test and the W.H.O. posted online a blueprint that any laboratory around the world could use to duplicate it.

On Jan. 21, China shared materials for its test with the W.H.O., providing another template for others to use.

Some countries and research institutions followed the German blueprint, while others, like the C.D.C., insisted on producing their own tests. But a flaw in the initial C.D.C. test, and the agency’s slowness in approving testing by labs other than its own, contributed to weeks of delay in widespread testing in the United States.

In late January, Mr. Trump praised China’s efforts. Now, officials in his administration accuse China of concealing the extent of the epidemic, even after the crackdown on Wuhan, and the W.H.O. of being complicit in the deception. They say that lulled the West into taking the virus less seriously than it should have.

Larry Gostin, director of the W.H.O.’s Center on Global Health Law, said the organization relied too heavily on the initial assertions out of Wuhan that there was little or no human transmission of the virus.

“The charitable way to look at this is that W.H.O. simply had no means to verify what was happening on the ground,” he said. “The less charitable way to view it is that the W.H.O. didn’t do enough to independently verify what China was saying, and took China at face value.”

The W.H.O. was initially wary of China’s internal travel restrictions, but endorsed the strategy after it showed signs of working.

“Right now, the strategic and tactical approach in China is the correct one,” Dr. Michael Ryan, the W.H.O.’s chief of emergency response, said on Feb. 18. “You can argue whether these measures are excessive or restrictive on people, but there is an awful lot at stake here in terms of public health — not only the public health of China but of all people in the world.”

A W.H.O. team — including two Americans, from the C.D.C. and the National Institutes of Health — did visit China in mid-February for more than a week, and its leaders said they were given wide latitude to travel, visit facilities and talk with people.

Whether or not China’s central government intentionally misstated the scale of the crisis, incomplete reporting has been seen in every other hard-hit country. France, Italy and Britain have all acknowledged seriously undercounting cases and deaths among people who were never hospitalized, particularly people in nursing and retirement homes.

New York City this week reported 3,700 deaths it had not previously counted, in people who were never tested. The United States generally leaves it to local coroners whether to test bodies for the virus, and many lack the capacity to do so.

In the early going, China was operating in a fog, unsure of what it was dealing with, while its resources in and around Wuhan were overwhelmed. People died or recovered at home without ever being treated or tested. Official figures excluded, then included, then excluded again people who had symptoms but had never been tested.

On Jan. 31 — a day after the W.H.O.’s emergency declaration — President Trump moved to restrict travel from China, and he has since boasted that he took action before other heads of state, which was crucial in protecting the United States. In fact, airlines had already canceled the great majority of flights from China, and other countries cut off travel from China at around the same time Mr. Trump did.

The first known case in the United States was confirmed on Jan. 20, after a man who was infected but not yet sick traveled five days earlier from Wuhan to the Seattle area, where the first serious American outbreak would occur.

The W.H.O. said repeatedly that it did not endorse international travel bans, which it said are ineffectual and can do serious economic harm, but it did not specifically criticize the United States, China or other countries that took that step.

Experts say it was China’s internal travel restrictions, more severe than those in the West, that had the greatest effect, delaying the epidemic’s spread by weeks and allowing China’s government to get ahead of the outbreak.

The W.H.O. later conceded that China had done the right thing. Brutal as they were, China’s tactics apparently worked. Some cities were allowed to reopen in March, and Wuhan did on April 8.

The Trump administration has not been alone in criticizing the W.H.O. Some public health experts and officials of other countries, including Japan’s finance minister, have also said the organization was too deferential to China.

The W.H.O. has altered some of its guidance over time — a predictable complication in dealing with a new pathogen, but one that has spurred criticism. But at times, the agency also gave what appeared to be conflicting messages, leading to confusion.

In late February, before the situation in Italy had turned from worrisome to catastrophic, Prime Minister Giuseppe Conte and other government officials, citing W.H.O. recommendations, said the regional governments of Lombardy and Veneto were doing excessive testing.

“We have more people infected because we made more swabs,” Mr. Conte said.

In fact, the W.H.O. had not said to limit testing, though it had said some testing was a higher priority. It was — and still is — calling for more testing in the context of tracing and checking people who had been in contact with infected patients, but few Western countries have done extensive contact tracing.

But the organization took pains not to criticize individual countries — including those that did insufficient testing.

On March 16, Dr. Tedros wrote on Twitter, “We have a simple message for all countries: test, test, test.” Three days later, a W.H.O. spokeswoman said that there was “no ‘one size fits all’ with testing,” and that “each country should consider its strategy based on the evolution of the outbreak.”

The organization was criticized for not initially calling the contagion a pandemic, meaning an epidemic spanning the globe. The term has no official significance within the W.H.O., and officials insisted that using it would not change anything, but Dr. Tedros began to do so on March 11, explaining that he made the change to draw attention because too many countries were not taking the group’s warnings seriously enough.

 

 

 

Testing Falls Woefully Short as Trump Seeks an End to Stay-at-Home Orders

Coronavirus Testing Falls Woefully Short as Trump Seeks to Reopen ...

As President Trump pushes to reopen the economy, most of the country is not conducting nearly enough testing to track the path and penetration of the coronavirus in a way that would allow Americans to safely return to work, public health officials and political leaders say.

Although capacity has improved in recent weeks, supply shortages remain crippling, and many regions are still restricting tests to people who meet specific criteria. Antibody tests, which reveal whether someone has ever been infected with the coronavirus, are just starting to be rolled out, and most have not been vetted by the Food and Drug Administration.

Concerns intensified on Wednesday as Senate Democrats released a $30 billion plan for building up what they called “fast, free testing in every community,” saying they would push to include it in the next pandemic relief package. Business leaders, who participated in the first conference call of Mr. Trump’s advisory council on restarting the economy, warned that it would not rebound until people felt safe to re-emerge, which would require more screening.

And Gov. Andrew M. Cuomo of New York reiterated his call for federal assistance to ramp up testing, both for the virus and for antibodies.

“The more testing, the more open the economy. But there’s not enough national capacity to do this,” Mr. Cuomo, a Democrat, said at his daily briefing in Albany. “We can’t do it yet. That is the unvarnished truth.”

As the governor spoke, a PowerPoint slide behind him said, “WE NEED FEDERAL SUPPORT.”

At his own briefing later in the day, Mr. Trump boasted of having “the most expansive testing system anywhere in the world” and said that some states could even reopen before May 1, the date his task force had tentatively set. Twenty-nine states, he added, “are in good shape.”

From the beginning of the coronavirus crisis, lapses by the federal government have compromised efforts to detect the pathogen in patients and communities. A diagnostic test developed by the Centers for Disease Control and Prevention proved to be flawed. The F.D.A. failed to speed approval for commercial labs to make tests widely available. All of that means that the U.S. has been far behind in combating the virus.

Whether in New York City, with its densely packed 8.4 million residents, or Nebraska, with fewer than two million spread across mostly rural expanses, widespread diagnostic and antibody testing will be crucial for determining a number of factors: How many in a community are infected but asymptomatic? Who has the protective antibodies that might allow them to go about their lives without fear? Are workplaces and schools safe?

“It is great that we are flattening the curve,” said Dr. Mark McClellan, director of the Margolis Center for Health Policy at Duke University, who worked in the George W. Bush administration and is advising state and federal policymakers on the virus response.

“But for this next phase, where we are really aiming to detect and stamp out smaller outbreaks before they get so big, testing is critical for that,” he said. “So we have to plan ahead now for much larger capacity.”

By the end of May, he added, “we will maybe be up to two million tests a week, but we are definitely not at that level now.”

Nationally, an average of 145,000 people have been tested for the virus each day over the past week, according to the Covid Tracking Project, which reported a total of nearly 3.1 million tests across the United States as of Tuesday night.

State health officials and medical providers around the country say they are unable to test as many people as they would like. Many of them say the biggest challenge is getting not the diagnostic tests themselves but the supplies to process them, including chemical reagents, swabs and pipettes. Manufacturers are facing a huge global demand as every country fights the pandemic, with many attempting the widest-scale testing they have ever undertaken.

“We’re at a really critical juncture and the supply chain has not yet caught up,” Scott Becker, chief executive of the Association of Public Health Laboratories, said on Wednesday.

Yet even as people waited hours for drive-through testing in California, Florida, New Jersey and elsewhere, some laboratories reported having ample capacity.

Two weeks ago, officials at University of California San Diego Health rushed to scale up testing, setting up a second laboratory devoted only to Covid-19. “You know the saying, ‘If you build it, they will come’?” said Dr. David T. Pride, director of the molecular microbiology laboratory there. “We built it and nobody has come. ” He said confusion over which laboratories were accepting tests, and “convoluted” systems connecting providers to labs, meant his facilities were running about 200 to 300 tests per day when they could handle 1,000.

Quest Diagnostics, one of the nation’s biggest testing laboratories, said on Wednesday that it could now process more tests than it was receiving, and that it was reaching out to state health departments, doctors and nursing homes. After dealing with backlogs for weeks, the company said it was returning results in less than two days for ordinary patients, and in less than one day for priority patients.

In Nebraska, as of Wednesday afternoon, 11,757 people had been screened for Covid-19, and of those, 901 were positive, according to state health data.

Peter C. Iwen, director of the Nebraska Public Health Laboratory, said that chemicals and equipment needed to run the tests were going to places like New Orleans and New York. “We’re trying to compete with those people, and we’re just not getting the reagents sent to us,” he said in an interview with the Omaha television station KETV.

The nonprofit Community Health of South Florida is operating three drive-through sites in the Miami area and the Florida Keys, where it has provided free testing to 1,300 people.

Tiffani Helberg, the group’s vice president for communications, said a tight supply of testing swabs as well as staffing numbers meant the nonprofit was not screening as many people as it would like.

“Is it a struggle every day? Absolutely,” she said.

The lack of testing is hitting minority communities especially hard, according to Dr. James E.K. Hildreth, president and chief executive of Meharry Medical College in Nashville, one of the nation’s largest historically black medical schools.

“Testing should be a priority for vulnerable populations — that would be prisons, nursing homes, assisted living facilities and, last but not least, minorities and disadvantaged communities,” said Dr. Hildreth, an infectious disease expert. “Because in those communities, we know there are many individuals with underlying conditions, and they are more likely to get severe disease and die.”

But even as short supplies are limiting who can get tests, some laboratories say they have extra capacity.

The American Clinical Laboratory Association, a trade group representing large diagnostic companies like LabCorp and Quest, has recently reported a dip in the daily testing volumes of its members. On Monday, its members processed 43,000 tests, the lowest number since March 20. At one point in early April, members were processing more than 100,000 a day.

“They are reaching out to providers to make sure they know that we have more testing capacity,” said Julie Khani, president of the lab association.

But even as testing for active coronavirus infections is struggling to meet demand, public health officials and major laboratories say they are gearing up for the next wave: antibody testing. A well-designed antibody test will detect whether someone has been exposed to the virus and generated an immune response, and whether the person may be protected from further illness.

“Antibody testing is not a cure-all,” Gov. Doug Ducey of Arizona, a Republican, said on Tuesday as he announced a partnership with the University of Arizona to provide antibody tests for 250,000 health care workers and emergency responders. “But learning more about it is an important step to identifying community exposure, helping us make decisions about how we protect our citizens and getting us to the other side of this pandemic more quickly.”

Most of the available antibody tests can say only whether someone has antibodies, not how many they have or how powerful they are at fighting the virus. Many of the tests are also flawed and signal the presence of antibodies even when there are none. The F.D.A. has granted emergency approval to three companies to begin selling the tests, but dozens more have entered the market after the agency loosened the guidelines in March.

“We have to to make sure it’s an accurate test with good specificity,” said Dr. Rachel Levine, Pennsylvania’s health secretary. “And we really need to know that antibodies are truly protective and how long-lasting they are.”

Dr. Jon R. Cohen, the executive chairman of BioReference Laboratories, which is processing tests at drive-through sites in New York and New Jersey and other locations around the country, said he was still evaluating different antibody tests but planned to begin offering them soon. Other large laboratories said the same.

“It’s a huge factor, we believe, in terms of people regaining confidence and jump-starting the economy,” he said. “To me, it’s an absolute moral imperative.”

 

 

 

 

 

 

Another 5.2 million jobless claims filed last week amid coronavirus crisis

https://www.axios.com/coronavirus-unemployment-filings-caded026-fce4-43cc-8dc0-5f0037747b69.html?stream=top&utm_source=alert&utm_medium=email&utm_campaign=alerts_all

Arrow

Another 5.2 million Americans filed for unemployment last week, the Labor Department announced Thursday.

Why it matters: With the more than 16 million jobless claims filed over the past three weeks, more jobs have now been lost in the last month than were gained since the Great Recession.

The big picture: The weekly unemployment filings report has become a must-watch for Wall Street and economists. It offers the timeliest glimpse into how efforts to contain the coronavirus outbreak are ravaging the job market.

  • And economists say that as bad as these weekly numbers look on the surface, they’re likely even higher. There are widespread complaints that state labor departments are having trouble processing the never-before-seen wave of jobless filings.

The bottom line: In just one month, the coronavirus economic shutdown has caused a staggering 22 million Americans to lose their jobs.

 

 

 

Quest Diagnostics furloughing 4,000 employees

https://www.beckershospitalreview.com/supply-chain/quest-diagnostics-furloughing-4-000-employees.html?utm_medium=email

Quest Diagnostics is a monopoly, schemed with insurers, California ...

Quest Diagnostics, the commercial lab that has performed about 800,000 COVID-19 tests, is furloughing more than 4,000 employees, which is about 9 percent of its workforce, CBS News reports.

Demand for COVID-19 testing has only partially offset a sharp drop in business for the company, according to CEO Steve Rusckowski.

The Secaucus, N.J.-based company has so far performed about 800,000 COVID-19 tests, making up about 40 percent of all testing done by commercial labs in the U.S. The company can process 45,000 diagnostic tests per day. 

But, Quest saw its overall testing volumes drop by more than 40 percent in the last two weeks of March, CBS News reported.

In addition to the furloughs, members of the company’s executive board are all taking 25 percent pay cuts for the next 12 weeks and other employees’ salaries are being cut between 5 percent and 20 percent. 

Quest has also suspended 401(k) matching for its employees and is dismissing temporary contract workers. 

The company said its cost-cutting efforts won’t impact COVID-19 testing.

Read the full article here.

 

 

 

Beaumont reports $278M Q1 loss, cites pandemic

https://www.beckershospitalreview.com/finance/beaumont-reports-278m-q1-loss-cites-pandemic.html?utm_medium=email

Beaumont Health to Study Whether Radiation Helps with Alzheimer's ...

Southfield, Mich.-based Beaumont Health reported a net loss of $278.4 million in the first quarter of 2020, a decrease of $407.5 million compared to the same period one year prior. 

The health system said that the loss is largely due to the COVID-19 pandemic, which negatively affected operating and nonoperating income for the three-month period ended March 31.

Beaumont saw its operating revenue fall to $1.07 billion in the first quarter of 2020, compared to operating revenue of $1.15 billion in the same period in 2019.

In addition, the system saw its operating income drop $91.7 million year over year.

Nonoperating losses for the first quarter totaled $224.6 million, compared to a nonoperating gain of $91.6 million in the same period in 2019. 

“The shelter-in-place order and community concerns about the virus have led to significant reductions in emergency center visits, nonessential surgeries and diagnostic services. We believe these reductions will continue well into the second quarter and negatively impact financial performance in a significant way,” Beaumont Health CFO John Kerndl said.

To help improve its financial performance, Beaumont said it will defer all nonessential capital expenditures, fine-tune staffing levels and cut other expenses.

“We will continue to explore and pursue all options and plans that will help our organization survive this crisis and return to a position of strength after COVID-19 is no longer a threat to our community,” Mr. Kerndl said.

 

 

 

 

Medical supply scramble continues

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What's Really To Blame For Drug Shortages

The U.S. is still scrambling to get health care workers the personal protective equipment, ventilators and lab testing materials that they need.

Between the lines: President Trump has repeatedly said that governors are responsible for obtaining supplies for their states, but industry groups are asking the federal government to play a larger role.

  • The American Medical Association asked FEMA to create a national system to acquire and distribute personal protective equipment, in light of ongoing shortages.
  • David Skorton, president and CEO of the Association of American Medical Colleges, wrote a letter to coronavirus task force coordinator Deborah Birx asking for more federal help with diagnostic testing supply shortages.

Meanwhile, the private sector is shifting into gear on its own and in partnership with the government.

  • The Trump administration and 20 major health care systems launched a new ventilator loan program that will allow hospitals to ship unused machines to areas where they are needed most to fight the coronavirus pandemic, Axios’ Joann Muller reports.
  • General Motors started manufacturing ventilators on Tuesday under a $489.4 million federal contract. But it will take until August to produce all 30,000 the government ordered under the Defense Production Act.
  • Space-focused organizations around the U.S. are now looking to manufacture ventilators and other much-needed health equipment to aid the pandemic relief effort, Axios’ Miriam Kramer reports.

1 scary stat: Prescription drugs needed by patients on ventilators are being filled only 53% of the time so far in April, as demand has skyrocketed, according to Vizient, a health care purchasing group.

 

 

 

 

California governor unveils roadmap for relaxing coronavirus lockdowns

https://www.axios.com/california-newsom-coronavirus-restrictions-3195f1b4-cbf8-4205-aeda-500d1e965486.html

California governor unveils roadmap for relaxing coronavirus ...

California Gov. Gavin Newsom released a roadmap on Tuesday that will guide how he will make the decision to relax the stay-at-home policies his state implemented to combat the spread of the coronavirus.

The big picture: While there is no timeline for modifying the stay-at-home order, Newsom’s office said California would use a “gradual, science-based and data-driven framework” to determine when it would be safe to do so. Newsom indicated efforts to flatten the curve in California “have yielded positive results.”

  • California had 24,421 confirmed cases of COVID-19 as of Tuesday afternoon, per the LA Times.
  • On Monday, Newsom announced California would create a task force with Oregon and Washington to coordinate the reopening of the regional economy. Northeastern states have announced a similar plan.

Details: Newsom said California would use six indicators to determine when to relax social distancing measures:

  1. “The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed.”
  2. “The ability to prevent infection in people who are at risk for more severe COVID-19.”
  3. “The ability of the hospital and health systems to handle surges.”
  4. “The ability to develop therapeutics to meet the demand.”
  5. “The ability for businesses, schools, and child care facilities to support physical distancing.”
  6. “The ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary.”

Newsom’s roadmap also notes that life will be different even after stay-at-home orders are eased. For example, restaurants will likely reopen with fewer tables and face coverings will be more common in public.

What he’s saying: “While Californians have stepped up in a big way to flatten the curve and buy us time to prepare to fight the virus, at some point in the future we will need to modify our stay-at-home order,” Newsom said.

  • “As we contemplate reopening parts of our state, we must be guided by science and data, and we must understand that things will look different than before.”
  • “There is no light switch here. Think of it as a dimmer. It will toggle between less restrictive and more restrictive.”

 

 

 

 

We can’t just flip the switch on the coronavirus

https://www.axios.com/coronavirus-slow-recovery-econony-deaths-27e8d258-754e-4883-bebe-a2e95564e3b6.html

The end of the coronavirus lockdown won't be like flipping a ...

It feels like some big, terrible switch got flipped when the coronavirus upended our lives — so it’s natural to want to simply flip it back. But that is not how the return to normalcy will go.

The big picture: Even as the number of illnesses and deaths in the U.S. start to fall, and we start to think about leaving the house again, the way forward will likely be slow and uneven. This may feel like it all happened suddenly, but it won’t end that way.

What’s next: Nationally, the number of coronavirus deaths in the U.S. is projected to hit its peak within the next few days. But many big cities will see their own peaks significantly later — for them, the worst is yet to come.

  • The White House is eyeing May 1 as the time to begin gradually reopening the economy. But that also will not be a single nationwide undertaking, and it will be a halting process even in the places where it can start to happen soon.
  • “In principle it sounds very nice, and everyone wants to return to normalcy. I think in reality it has to be incredibly carefully managed,” said Claire Standley, an infectious-disease expert at Georgetown University.

The future will come in waves — waves of recovery, waves of more bad news, and waves of returning to some semblance of normal life.

  • “It’s going to be a gradual evolution back to something that approximates our normal lives,” former Food and Drug Administration Commissioner Scott Gottlieb said.

What the post-lockdown world will look like:

  • Some types of businesses will likely be able to open before others, and only at partial capacity.
  • Stores may continue to only allow a certain number of customers through the door at once, or restaurants may be able to reopen but with far fewer tables available at once.
  • Some workplaces will likely bring employees back into the office only a few days a week and will stagger shifts to segregate groups of workers from each other, so that one new infection won’t get the whole company sick.
  • Large gatherings may need to stay on ice.

And there will be more waves of infection, even in areas that have passed their peaks.

  • “Everything doesn’t just go down to zero” once a city or region gets through its initial crush of cases, said Janet Baseman, a professor of epidemiology at the University of Washington.
  • This is happening now in Singapore, which controlled its initial outbreak more effectively than almost any other country in the world but is now seeing the daily number of new cases climb back up.

This is all but inevitable in the U.S., too, especially as travel begins to pick back up. Some places may need to shut down again, or at least tighten back up, if these new flare-ups are bad enough.

  • Part of the reason to lock down schools, businesses and workplaces is to prevent an outbreak from overwhelming the local health care system. If new cases start to pile up too quickly, leaders may need to pump the brakes.
  • “If you go back to normal too fast, then cases start to go up quickly, and then we end up back where we started,” Baseman said.
  • The good news, though, is that hospitals should have far more supplies by the fall, thanks to the coming surge in manufacturing for items like masks and ventilators.

What we’re watching: We’ll still need a lot more diagnostic testing to make this process work. Public health officials need to be able to identify people who might be spreading the virus before they begin to feel sick, and then identify the people they may have infected.

  • Most of the U.S. does not seem prepared for that undertaking, at least on any significant scale.
  • Another kind of test — serology tests, which identify people who have already had the virus and may be immune to it — will also help. We can’t test everyone, but identifying potential immunity could be important in knowing who can safely return to work in high-risk fields like health care.

The real turning point won’t come until there’s a proven, widely available treatment or, even better, a widely available vaccine.

  • A vaccine is still about a year away, even at a breakneck pace and if everything goes right. A treatment isn’t likely to be available until the fall, at the earliest.
  • In the meantime, all we can do is try to manage a slow recovery, using a less aggressive version of the same tools that are in place today.

The bottom line: “I’m not going back to Disneyland, I’m not going to take a cruise again, until we have a very aggressive testing system or we have very effective therapeutics or a vaccine,” Gottlieb said.