U.S. Still in First Wave of COVID-19, Fauci Says

https://www.webmd.com/lung/news/20200925/us-still-in-first-wave-of-covid-19-fauci-says

US still in first Covid-19 wave and should be prepared for 'challenge' of  fall and winter, Fauci says

Anthony Fauci, MD, says talk about a second wave of the coronavirus is premature because the United States is still dealing with the first one.

The idea of a second wave is based on the 1918 flu pandemic, when many cases were seen in the spring, he says. The spring cases “literally disappeared” and were followed by a spike in flu cases in the fall, he told CNN’s Sanjay Gupta, MD, on Thursday in an online conversation organized by Emory University.

“Rather than say, ‘A second wave,’ why don’t we say, ‘Are we prepared for the challenge of the fall and the winter?’” said Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force.

Flu shots are an important measure to help the U.S. get through the winter, he said.

He and other health care professionals have observed that the Southern Hemisphere has had a very light flu season, probably because measures to curb the coronavirus, such as social distancing and mask-wearing, have limited the spread of the flu.

“If we listen to the public health measures, not only would we diminish the effect of COVID-19, we might get away with a very, very light flu season if we combine that with getting the flu vaccine,” Fauci said.

In a separate interview, he said the arrival of the coronavirus vaccine will not stop the need for tried-and-true measures such as mask-wearing, hand-washing, and social distancing.

In a Facebook Live conversation with New Jersey Gov. Phil Murphy, Fauci said the coronavirus vaccine will not be 100% effective and won’t be taken by the entire population. That means the virus could still spread.

“So when a vaccine comes, we look at it as an important tool to supplement the public health measures that we do,” he said. “It will allow us to more quickly and with less stringency get back to some degree of normal. But it is not going to eliminate the need to be prudent and careful with our public health measures.”

Fauci said that vaccinating 75% to 80% of the population “would be a really good accomplishment.” He expects 700 million doses to be produced by the end of this year or early 2021.

 

 

 

 

Cartoon – Coronavirus Projections

Cartoon – Coronavirus Projections | HENRY KOTULA

U.K. upgrades COVID alert level as Europe sees worrying rise in infections

https://www.axios.com/coronavirus-united-kingdom-european-cdc-4856ab47-29b2-43f2-b6c4-9a62d6867830.html

U.K. upgrades COVID alert level as Europe sees worrying rise in infections  - Axios

The U.K. could see up to 50,000 coronavirus cases per day by mid-October if current growth continues, top scientific advisers warned in a televised address from Downing Street on Monday.

The big picture: The U.K. has upgraded its coronavirus alert level from three to four as infections appear to be “high or rising exponentially.” Meanwhile, recent European Center for Disease Prevention and Control (ECDC) data shows that over half of all European Union countries are seeing an increase in COVID-19 cases.

What they’re saying: “At the moment, we think that the epidemic is doubling roughly every seven days” in the U.K., chief scientific adviser Patrick Vallance said.

  • England’s chief medical officer Chris Whitty stressed that unemployment and poverty are risks of taking strong action against the virus — like enforcing stay-at-home orders — but that more deaths will occur if aggressive action is not taken.

Where it stands: ECDC data shows that Spain, France, the Czech Republic, Croatia and Romania have recorded more than 120 confirmed COVID-19 cases per 100,000 inhabitants in the last 14 days, according to AP.

  • In Madrid, the rate of infection is nearly three times higher than the national average, at 683 cases per 100,000 inhabitants, per AP. Spain, one of the first epicenters of the virus in Europe, is faring the worst of countries tracked by the ECDC.
  • France has seen 31,285 deaths since the start of the pandemic, one of the highest death tolls in Europe. This weekend, France reported a record 13,000 new infections in 24 hours.
  • The Czech Republic reported 3,000 new cases on Thursday, almost as many as the country saw in all of March.
  • Croatia has recorded over 14,000 new COVID-19 cases per day since Sept. 16, while Romania is seeing over 11,000 new infections per day, according to Johns Hopkins data.

What to watch: Analysts expect the British government to announce short-term restrictions after Prime Minister Boris Johnson met with ministers over the weekend, AP reports.

  • German Chancellor Angela Merkel is planning second-wave prevention with her “Coronavirus Cabinet.” These plans include walk-in “fever clinics” to separate coronavirus patients from others.
  • Police in Madrid are limiting travel in working-class neighborhoods that have seen high transmission rates, while parks are closed and restaurants and shops must limit their occupancy at 50%.
  • Czech Republic’s Health Minister Adam Vojtech resigned Monday because of rising cases.
  • There are 20 new testing centers set to open in Paris and surrounding suburbs this week.

 

 

 

U.S. reaches 200,000 coronavirus deaths

https://www.axios.com/united-states-200000-coronavirus-deaths-17dc9d72-933b-473d-aa65-b7887eafffa2.html?stream=top&utm_source=alert&utm_medium=email&utm_campaign=alerts_all

The U.S. now has more than 200,000 coronavirus deaths - Axios

The coronavirus has now killed 200,000 Americans, according to Johns Hopkins data.

The big picture: Whatever context you try to put this in, it is a catastrophe of historic proportions — and is yet another reminder of America’s horrific failure to contain the virus.

  • The coronavirus has killed a bigger share of the American population than it has in almost any other wealthy country.
  • The death toll here is equivalent to roughly 65 Sept. 11 attacks. Three times more Americans have died from COVID than died in the Vietnam war — in only a fraction of the time.

This crisis has hit people of color especially hard.

  • Black and Latino Americans are dying at about three times the rate of white Americans.
  • They have also suffered far more from the economic fallout, which has fallen largely on lower-wage, service-industry workers.

And deaths keep coming — we’re averaging roughly 830 per day — even as the country increasingly sees the pandemic as background noise, as live sports resume and schools reopen and interest in news about the pandemic wanes.

Between the lines: The percentage of infected people who ultimately die from the coronavirus is lower now than it was in the outbreak’s earliest months, partly because doctors have gotten better at treating the virus and partly because outbreaks are now occurring within younger and lower-risk groups.

  • Overall cases are on a downward trajectory right now, following an enormous spike over the summer.
  • But the U.S. has never managed to get the virus firmly under control. Cases and deaths could get worse again as the weather gets colder and people move indoors, and the onset of flu season could make treatment more difficult.

 

 

 

 

COVID-19 vaccine verdicts loom as next big market risk

https://finance.yahoo.com/news/covid-19-vaccine-verdicts-loom-050615809.html

Optimism that vaccines are on the way to end the coronavirus pandemic has been a major factor in this year’s U.S. stock resurgence. That will face a critical test in coming weeks, as investors await clinical data on whether they actually work.

A UBS analysis found that about 40% of the market’s gains since May can be pegged to hopes for vaccines to protect against COVID-19, which has killed over 960,000 worldwide and rocked the global economy.

Global efforts to develop a vaccine are coming to a head, with late-stage data on trials by companies such as Pfizer Inc <PFE.N> and Moderna Inc <MRNA.O> possible as soon as October or November. Disappointing results could further shake markets that have recently grown turbulent on worries over fiscal stimulus delays and uncertainty around the Nov. 3 U.S. presidential election.

“The anticipation is that this stuff is going to work,” said Walter Todd, chief investment officer at Greenwood Capital in South Carolina. “So any news to the contrary could be a risk to the market.”

The number of vaccines in development could blunt the negative market impact of any single setback. More than a half-dozen vaccines globally are in late-stage trials out of over 30 currently being tested in humans, according to the World Health Organization.

“We are setting ourselves up for success in the sense of if you throw enough spaghetti at the wall, hopefully at least one noodle sticks,” said Liz Young, director of market strategy at BNY Mellon Investment Management.

That could explain why stocks overall barely reacted earlier this month, when AstraZeneca Plc <AZN.L> and partner Oxford University paused global trials of one of the leading vaccine candidates after a participant in its U.K. trial became seriously ill. The trials have resumed in Britain, Brazil and South Africa, but remain on hold in the United States.

Some forecasts on vaccine availability have grown less optimistic. Good Judgment, a company whose forecasters make predictions based on publicly available evidence, put the chances that a vaccine will be widely distributed in the United States by the end of March at 54%. That is up from an estimate of less than 20% in early July, but down from above 70% earlier this month.

Pfizer and Moderna could report initial efficacy results in October or November based on an early read of data, followed by data from companies such as AstraZeneca, Johnson & Johnson <JNJ.N> and Novavax Inc <NVAX.O>.

An approval or emergency use authorization this year could lead to a surge in travel, leisure and other stocks that have been decimated by pandemic-related shutdowns, while also fueling a long-awaited shift into value stocks from tech and other growth names that have led the market for years.

Even if a vaccine is approved, questions persist about how easily and quickly it can be distributed. President Trump and his health officials have issued conflicting predictions about when the general public could have access.

“The potential for market disappointment will likely come from the realization that manufacturing and broad distribution will take longer,” said Art Hogan, chief market strategist at National Securities.

An approved, broadly distributed and accepted vaccine could result in a gain of about 300 points to the S&P 500, or more than 8% at the index’s current level, according to Keith Parker, head of U.S. and global equity strategy at UBS.

If a vaccine is widely distributed in the first quarter, BofA Global Research projects global gross domestic product (GDP) growth of 6.3% in 2021, compared with 5.6% if that does not occur until the third quarter.

Disappointing clinical trial news could result in a loss of 100 points from the S&P 500, or about 3%, Parker estimates.

While the market might be able to handle one vaccine setback “reasonably well,” several setbacks could cause a rethink of the vaccine race, he said.

 

 

 

 

Bill Gates: U.S. Needs To ‘Own Up To The Fact That We Didn’t Do A Good Job’

https://www.forbes.com/sites/mattperez/2020/09/20/bill-gates-us-needs-to-own-up-to-the-fact-that-we-didnt-do-a-good-job/?utm_source=newsletter&utm_medium=email&utm_campaign=coronavirus&cdlcid=5d2c97df953109375e4d8b68#54d6544f3fb8

TOPLINE

The United States needs to “own up to the fact that we didn’t do a good job” up until this point of the Covid-19 pandemic, billionaire and philanthropist Bill Gates said during a Fox News Sunday interview, adding that the slow turnaround for testing results remains “outrageous.”

KEY FACTS

“Unfortunately we did a very poor job and you can just see that in the numbers,” Gates said.

Despite having around 4% of the world’s population, the U.S. has around 22% of all cases with 6,782,083 and about 21% of all reported deaths with 199,411.

The inability to create a testing structure as seen in countries like South Korea “led to us having not just a bad spring, we’ve had a pretty tough summer and sadly because of the seasonality, until we get these new tools, the fall is looking to shape up as pretty tough as well,” Gates said.

“Part of the reluctance I think to fix the testing system now is that nobody wants to admit that it’s still outrageous,” Gates said, adding, “The U.S. has more of these machines, more capacity than other countries by a huge amount, and so partly the reimbursement system is creating perverse incentive.”

After remaining fairly stagnant through the end of summer into September, the U.S. performed a record 1,061,106 Covid-19 tests on Saturday, according to Johns Hopkins University, but labs are still dealing with supply shortages and delays in results.

“We’ll have time to look at those mistakes, which in February and March were really super unfortunate, but we can’t pretend like we get a good grade even today,” Gates said.

CRUCIAL QUOTE

“Even today, people don’t get their results in 24 hours, which it’s outrageous that we still have that,” Gates said.

BIG NUMBER

4.7%. That’s the average positivity percentage in the past week, according to Johns Hopkins.

TANGENT

President Trump has excused the world-leading cases of the coronavirus as a result of the number of tests performed in the country, even saying that he instructed officials to slow testing down. The Centers for Disease Control and Prevention sparked outrage in August when it published new guidelines on testing, recommending people exposed to the virus but not showing symptoms should not get tested. Reports indicate that the guidance was dictated by the Health and Human Services and Trump administration as opposed to CDC scientists. The guidelines were changed again on Friday.

 

 

 

 

The N95 shortage America can’t seem to fix

https://www.washingtonpost.com/graphics/2020/local/news/n-95-shortage-covid/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

Nurses and doctors depend on respirator masks to protect them from covid-19. So why are we still running low on an item that once cost around $1?

The patient exhaled. She lifted her tongue for a thermometer. She raised her finger for a blood sugar test, and that’s when she started coughing. One cough can send 3,000 droplets into the air, one droplet can contain millions of coronavirus particles, and now some of those particles were heading for the face of emergency department nurse Kelly Williams.

The nurse inhaled. Strapped over her mouth and nose was an N95 respirator, the disposable filtering mask that has become the world’s most reliable and coveted defense against the virus.

N95s were designed to be thrown away after every patient. By this July afternoon, Williams had been wearing the same one for more than two months.

To get to her, the N95 had traveled from a British factory to a Baltimore warehouse, in a supply chain as tangled and layered as the web of microscopic fibers inside the mask’s filter.

It was purchased by Johns Hopkins Hospital, the famed medical institution that has tracked cases of the novel coronavirus around the world since the pandemic’s start. When its map of dots marking clusters of infections began to show pools of red across the United States, Hopkins was quietly unpacking a stock of personal protective equipment it had been building for over a year — a literal lifesaver when the onslaught of covid-19 cases led to a massive shortage of N95s.

Six months later, that shortage persists, leaving health-care workers exposed, patients at risk and public health experts flummoxed over a seemingly simple question: Why is the world’s richest country still struggling to meet the demand for an item that once cost around $1 a piece?

At Hopkins, nurses are asked to keep wearing their N95s until the masks are broken or visibly dirty. Williams, a 30-year-old from Georgia with a marathoner’s endurance and a nurse’s practicality, went into health care after working for three years in the corporate offices of retailers Abercrombie & Fitch and Under Armour. She understood supply chains. She believed that the makers of N95s, anticipating the pandemic’s eventual end, would invest only so much in expanding production. She believed it was her duty, on top of risking her life for her patients, to make her disposable respirator mask last through as many 12-hour shifts as she could.

When the country was short of ventilators, the companies that made them shared their trade secrets with other manufacturers. Through the powers of the Defense Production Act, President Trump ordered General Motors to make ventilators. Other companies followed, many supported by the government, until the terrifying problem of not enough ventilators wasn’t a problem at all.

But for N95s and other respirators, Trump has used this authority far less, allowing major manufacturers to scale up as they see fit and potential new manufacturers to go untapped and underfunded. The organizations that represent millions of nurses, doctors, hospitals and clinics are pleading for more federal intervention, while the administration maintains that the government has already done enough and that the PPE industry has stepped up on its own.

As the weather cools and the death toll climbs, America’s health-care workers fear that when winter comes, they still won’t have enough respirators. And the longer the shortage lasts, the longer N95s will remain largely out of reach for millions of others who could be protected by them — teachers and day-care workers, factory employees and flight attendants, restaurant servers and grocery store clerks.

While the pandemic that has killed almost 200,000 Americans drags on, Williams will keep trying to conserve her respirator, wearing it as she rushes in and out of virus-filled rooms, touches virus-shedding patients, and now, comforts a covid-positive woman who is having a coughing fit.

“How can I help you feel a little more comfortable?” Williams asked her patient, who was in her 80s. The woman was about to be admitted to the hospital. Her oxygen level was too low, so they had to run tubes of air into her nostrils. If her situation didn’t improve, a ventilator could come next.

This was the routine in the part of the emergency department Williams called “Covidland.” She’d just risked exposure to care for this woman, but she would never get to find out what happened to her.

She could only take a deep breath through her N95, roll her patients upstairs and hope that she would never become one of them.

‘The gauntlet’

Before the N95 was on her face, it was in a plastic wrapper, in a box, on a shelf inside an East Baltimore warehouse four miles from the hospital. The 165,000-square-foot building had concrete floors, rolling doors, overhead lighting — unremarkable, except to a man named Burton Fuller.

Fuller, a 38-year-old father of three, had once planned on becoming a doctor. Instead, he went into hospital supply chains. It was the kind of job that didn’t earn many follow-up questions at dinner parties. But six months after Fuller was hired at Hopkins, the pandemic made him the person that everyone relied on and no one envied. It was up to him to keep 40,000 employees in six hospitals safe.

Even before covid-19, masks were key to that equation. There are surgical masks, which protect a patient from a nurse’s germs, and respirator masks, which protect a nurse from the patient. Humans have recognized the need for protective masks since at least A.D. 77, when Pliny the Elder wrote about wearing animal bladders as face coverings to make breathing easier in lead-filled mines.

The evolution of early masks brought leather beaks stuffed with straw and herbs to ward off the bubonic plague, and long beards that firefighters would wet and clamp between their teeth. Once the far more effective gas mask became standard for coal miners breathing in silica and soldiers facing chemical weapons, engineers at the Minnesota Mining and Manufacturing Company, better known as 3M, started trying to make a protective respirator that wasn’t so bulky. They realized in the 1960s that the technology used to make pre-made gift bows could also make a mask that was a lightweight, molded cup. And so began the single-use respirator as it exists today.

Inside that cup, and more recently, inside the flat-fold versions, is the key component: fibers 1/50th the width of a human hair, blown together in an intricate web that creates an obstacle course for dangerous particles. An electrostatic charge works like a magnet to trap the floating menaces and attach them to the fibers. If an N95 is fitted properly — a metal nose piece folded snugly, no beard in the way — less than 5 percent of even the most difficult-to-catch particles will make it into the lungs.

At Hopkins, Fuller’s job was to get manufacturers to deliver N95s and other equipment directly to the warehouse, rather than through a distributor. In 2019, the shelves started to fill up, and on one of them was the N95 that would make its way to nurse Kelly Williams. The respirator had been made by 3M at a plant in Aycliffe, a town of 7,000 in northern England.

But this Hopkins stockpile was rare in the world of hospitals, where costs were cut by using medical supply companies to provide equipment when it was needed, rather than letting PPE pile up.

Hospital administrators knew that in cases of natural disaster, chemical warfare or what global health officials used to call “Disease X,” the federal government had its own warehouses in secret locations, filled with PPE.

Except that in 2009, while Fuller was in his first job out of college, the H1N1 flu epidemic depleted 85 million N95s from the national stockpile — and the supply was never replenished. In 2013, 2014, 2016 and 2017, public health officials published alarming reports warning of a “massive gap” in what remained. Even more concerning, they said, the vast majority of N95s and the materials needed to manufacture them were now being made in Asia.

The Department of Health and Human Services did fund the invention of a “one-of-a-kind, high-speed machine” that could make 1.5 million N95s per day. But when the design was completed in 2018, the Trump administration did not purchase it.

This year, as the virus spread from Wuhan to Washington state, HHS turned down a January offer from a manufacturer who could make millions of N95s. The agency didn’t start ordering N95s from multiple companies until March 21. Paul Mango, deputy chief of staff for policy at HHS, would later call that timeline “friggin’ light speed … the fastest this has ever been done.”

By then, the United States had 8,000 reported coronavirus cases and 85 deaths, and health-care workers were panicking over PPE shortages.

Fuller’s orders began being canceled. As the Hopkins emergency department was being readied for covid-19 patients, and Williams was being told she would need to start wearing an N95, the hospital’s administration decided not to reveal how many N95s were in the warehouse.

“Only a half a dozen people know,” Fuller said. “Behavioral economics say that if we communicate a number someone perceives as high, they will use the supply more gratuitously. If we communicate a number they perceive as low, they may hoard to ensure there is enough.”

As the boxes of N95s were loaded into trucks headed for Hopkins hospitals, Fuller and a dozen staff members entered what he would come to call “the gauntlet.” Every hospital and health department in the country was competing for N95s and other PPE, a mess of bidding wars, price gouging and worthless knockoff masks. Fuller uncovered one scam when a company CEO, claiming to be based in Indianapolis, didn’t recognize the name of the city’s most famous steakhouse.

“For every mask shipment we have been able to bring in,” Fuller said, “there are 10 or 15 transactions we have had to terminate.”

He worked so much that his wife, home with their children, received flowers from Hopkins executives. He joked about the other crucial stockpile in his life, his wine collection.

Fuller was desperate to make the stockpiled N95s last as long as possible. He wanted every employee wearing one to also wear a face shield, but those, too, were impossible to find.

So at the end of March, the warehouse filled with folding tables spaced six feet apart. Volunteers were given foam strips, elastic straps and sheets of plastic to make homemade shields. At one of the most prestigious medical institutions in the country, they were trying to fix the problem for themselves, with scissors, staplers and hot glue guns.

‘Bracing yourself’

A face shield was clipped to Williams’s belt in the middle of May, when for only the fourth time during the pandemic, she unwrapped a new N95.

After nine weeks in and out of Covidland, she had come to trust in her disposable respirator. It hurt her nose, gave her acne and made breathing hard. But the power of its protection was starting to give her back the feeling of safety she’d lost in March when she and the dozens of colleagues who worked alongside her each shift watched the areas where they’d cared for gunshot victims and heart attack patients turn into isolation rooms. They were tested to make sure the N95s fit their faces and taught to use other respirators that looked like gas masks or blew clean air into a hood.

And then, they were slammed. The first covid patient to go on a ventilator at Hopkins was a 40-year-old who worked out every day. The ambulance bay became a testing center. Williams’s co-workers were crying in the break room. Her patients couldn’t breathe, and then tubes were going down their throats, and then it felt like she couldn’t breathe, like everything she knew about nursing would never be enough.

“Our lives changed overnight,” she said. “You’re bracing yourself for people to die.”

She started silently saying a prayer she knew, every morning, every few hours, then sometimes 20 times a day in Covidland.

God, grant me the serenity to accept the things I cannot change, it began. She said it before her patient started violently shaking and flailing, seizing in his bed. She couldn’t run out the door to ask for help, because to leave the room without potentially taking the virus out, she had to sanitize her gloves, trash them, take her gown off, trash it, exit into an antechamber, take off her first layer of gloves, sanitize her hands and wipe down her face shield. So she ran to the window and banged on it, then ran back to her patient, trying to hold him down, her face inches from his.

Courage, to change the things I can, the prayer continued. Williams said it in the car that she drove to work and wouldn’t let any member of her family touch. Its speakers blared Lizzo-filled playlists she used to pump herself up for what she told her friends was an “awesome learning experience.” She had been a nurse for only two years. Her job in merchandising at Under Armour had brought her to Baltimore, where she met her husband, Sean, and his two children. They were the ones to make her realize that she wanted a job where she could actually see the impact of all those hours she worked. Now, every day might be the day she took the virus home to them.

Grant me the serenity to accept the things I cannot change, courage, to change the things I can, and wisdom to know the difference. Another day in Covidland, and Williams was wearing her new N95, pumping her palms into an unconscious man’s chest, not thinking of all the particles flying out of his airways. Another, and her face shield popped off and clattered to the floor. Another, and a young Latina mother told Williams she couldn’t self-quarantine because she could not afford to stay home from work.

Another, and Williams was watching the chest of a middle-aged man rise and fall by the force of a ventilator. Outside the walls of the hospital on this day in July, America seemed to have moved on from the conversation about the shortage of N95s. Instead, people were fighting over simple cloth masks.

Maybe this patient had worn one. Maybe he’d said he didn’t believe in them. Either way, it was her job to take care of him. Williams suctioned virus-filled fluid from his airways, and breathed in again.

‘Not profitable’

The radio advertisements could be heard across South Dakota, playing inside cars passing billboards plastered with the same message: 3M is hiring in Aberdeen. In a state that hosted 460,000 people at an August motorcycle rally and requires no one to wear a mask sits the largest respirator plant in the United States.

Its N95 manufacturing lines have been running 24 hours a day, 7 days a week since Jan. 21, the same day public health officials announced the arrival of the coronavirus in Washington state.

Plant manager Andy Rehder hired 200 new employees this year and was still looking for more this summer so he could staff another N95 line being built. Rehder, whose wife wears an N95 as a hospital social worker, had a Bloomberg Magazine article from March displayed in his office. The headline asked, “How do you make more masks yesterday?”

The question still hangs over the plant, and the entire country, nearly six months after that article was published.

Ask the Trump administration, and the N95 shortage is nearly solved. Rear Adm. John Polowczyk, whom Trump put in charge of securing PPE, said that by December, 160 million N95s will be made in the United States per month. By his calculations, that will be enough to handle a “peak surge” from hospitals, clinics, independent physicians, nursing homes, dentists and first responders. The Strategic National Stockpile has 60 million N95s on hand, and states are rebuilding their stockpiles.

“I’ve got production up to what we think is the limits of what we need,” Polowczyk said. “I believe now that hospital systems are making management decisions that might lead to an appearance that we still don’t have masks, which is the farthest from the truth.”

But ask the people inside hospitals, and the shortage is far from over. An August survey of 21,500 nurses showed 68 percent of them are required to reuse respirators, many for more than the five times recommended by the CDC, and some even more than Kelly Williams. One Texas nurse reported she’s still wearing the same five N95s she was given in March.

Many health-care facilities that ordered KN95s, Chinese-made masks meant to have a similar filtering efficiency, gave up on them after realizing that the looser fit left workers in danger. The N95 shortage is more acute for primary care physicians, home health aides and hospice workers. But even for many hospital systems, the situation remains “fragile and challenging,” the American Hospital Association said this month.

“Maddening, frustrating, mind-blowing, aggravating, that’s the polite language for it,” said American Medical Association President Susan Bailey, who still hears from doctors who do not have respirators. “There has been such an outpouring for support for ‘health-care heroes.’ Everybody knows now how important it is for our front-line health-care workers to be able to work in a safe environment. … And yet, that desire doesn’t seem to be turning into a reality.”

The AMA, AHA, American Nurses Association and the AFL-CIO all point to the same solution: broader use of the Defense Production Act, which gives the president power over funding for the production and distribution of critical supplies during crises.

In August, Trump stood before a group of socially distanced reporters, praising himself for using the DPA “more comprehensively than any president in history.”

“There was a time,” he said, “when the media would say, ‘Why aren’t you using it? Why aren’t you using it?’ Well, we have used it a lot, where necessary. Only where necessary.”

That’s not what it looks like to the man who used to run Trump’s DPA program within the Federal Emergency Management Agency. Larry Hall, who retired last year, said the authority has been executed in an “ad hoc, haphazard fashion.”

Along with ordering 3M to import 166.5 million masks from China, the administration has used the DPA to invest $296.9 million in bolstering the N95 and filter-making supply chains. The Department of Defense, which oversees that funding, spends more per year on instruments, uniforms and travel for military bands.

“By not having a national strategy,” Hall said, “we have fewer masks.”

Ask the PPE industry and the refrain is that without long-term guarantees that the government will keep buying respirators, N95 manufacturers are wary of investing too much, and other companies that could start making respirators or the filters for them are hesitant to do so.

Peter Tsai, the scientist who invented a method to charge the fibers inside the respirator filter, knows why: “It is not profitable to make respirators in the United States,” he said. It can take six months just to create one manufacturing line that makes the N95′s filter.

But there is a workaround, Tsai said. Companies that already make similar filters — for vehicle emissions, air pollution and water systems — can modify their equipment to make N95 filters.

While Tsai, 68, has been fielding hundreds of calls from hospitals and researchers trying to sanitize N95s with heat and ultraviolet light, he has been working with Oak Ridge National Laboratory in Tennessee to woo the 15 to 20 American companies that have the potential to produce respirator filters more quickly.

The government has funded just three of these companies through the DPA.

Others have gradually joined in on their own. But then those filters have to be made into respirators, and those respirators have to be approved by NIOSH, the National Institute for Occupational Safety and Health.

The entire process has moved at a glacial pace in comparison with the flurry of activity that rid the country of its ventilator shortage. Ventec, a company known for its efficient, toaster-size ventilators, handed its plans over to General Motors so that the auto company, under the DPA, could mass produce a product that was known to work. Other ventilator companies followed, handing over their trade secrets to Ford, Foxconn and other major manufacturers.

But when GM started making N95s, engineers with expertise in car interiors and air bags were charged with figuring out the process from scratch, the company said. Although they received advice from major mask makers, there were no groundbreaking corporate partnerships this time. The first N95s GM made were rejected by NIOSH. The second design didn’t correctly fit most people.

Other potential manufacturers went through the same challenges as GM, failing tests and making flat-fold N95s that experts worry do not offer a tight enough seal.

“If there was some kind of intellectual sharing, they wouldn’t be doing that,” said Christopher Coffey, who was the associate director for science in the NIOSH approvals program before retiring in January.

The DPA does have a provision that would allow manufacturers to work together without being subject to antitrust laws. But it has yet to be used for N95s.

Instead, established U.S. makers of N95s, whose products have been successfully protecting miners, construction workers and health-care professionals for decades, have continued to protect their processes as intellectual property.

Though 3M helped Ford make the far more expensive powered respirators, which blow clean air into a hood, the company has not entered into any major partnerships with outside manufacturers to make N95s. Asked why, 3M declined to explain, instead pointing to its other pandemic partnerships.

Ford gained its own approval to manufacture disposable respirators but has made just 16,000 of them while focusing instead on face shields and surgical masks. Other major U.S. manufacturers of N95s, including Honeywell and Moldex, have kept their manufacturing in-house, too.

“Folks aren’t likely to share that information outside of their own company,” said Jeff Peterson, who now oversees NIOSH approvals. NIOSH employees may know how 3M makes its respirators and the filters inside them. But by contract, they can’t tell other manufacturers how to do the same.

Meanwhile, 3M continues to dominate the American N95 market. While other parts of its business, such as office supplies and industrial adhesives, have struggled during the pandemic, 3M has invested $100 million to expand domestic production of respirators from 22 million to 50 million per month. Once the new production line is up and running in South Dakota in October, that number is expected to reach 95 million per month in the United States.

It still won’t be enough.

“Even though we are making more respirators than ever before and have dramatically increased production,” 3M spokeswoman Jennifer Ehrlich said, “the demand is more than we, and the entire industry, can supply for the foreseeable future.”

‘I just don’t get it’

Her N95 was already on, but Williams’s hands were slipping as she tried to force on a pair of gloves. She could hear the alarms going off. One of her patients was crashing, and she had to get into the room.

She should be able to just go, her runner’s legs carrying her to the bedside. But in Covidland, there were two closed doors standing in her way. She had started wearing her N95 all day so she could be ready for this moment. She pulled on her gown and another set of gloves and her face shield, reached for the door — and realized the patient inside was her 13-year-old stepson Kellen.

She jolted awake. She was in her bed. Her husband was asleep beside her. She slid out from her sheets and went downstairs to check on her stepchildren. Kellen and 19-year-old Alle were sleeping, too.

The nurse inhaled. She could still hear the alarms.

This is what it meant now, to be a health-care worker: across the country, nurses and doctors were reporting increased sleeplessness, anxiety, depression and post-traumatic stress.

Williams reminded herself that she’d always had an N95, and the heavier, more protective respirators she sometimes wore instead.

But she knew, too, that covid-19 had taken the lives of more than 1,000 health-care workers, including a New Jersey primary care doctor who, determined to keep his practice open, doubled up on surgical masks when his N95 orders didn’t come. And a California nurse who rushed into a covid patient’s room to perform chest compressions. She saved his life, then doused her hair in hand sanitizer. She hadn’t been given an N95 at the beginning of her shift.

And then there was the news that shook every health-care worker Williams knew: Less than two miles from Hopkins, the head of the ICU at Mercy Hospital died after contracting the virus in July.

Joseph Costa was one of the people who’d guided the hospital through its PPE shortage early in the pandemic. His husband, David Hart, remembered him coming home and saying, “This is my mask for the week.” Neighbors pushed N95s through their mailbox slot.

“This is the United States of America, and we can’t seem to get factories built to deliver this stuff? I just don’t get it,” Hart said.

He will never know exactly how his husband, who insisted on caring for covid patients alongside his staff, became infected. Costa died in the ICU, the gloved hands of his colleagues on him as he went. Minutes later, they returned to caring for other patients.

At Mercy, at Hopkins, at every hospital that had found a way to get N95s, health-care workers wore their PPE to try to save the lives of people who contracted the virus because they had none.

Williams and her colleagues didn’t need to see the statistics to know that the pandemic was disproportionately affecting Black and Brown people, especially those deemed essential workers. They saw it in their patients and heard it from their families and friends.

Williams worked side by side with Shanika Young, a nurse whose brother seemed to have every known covid-19 symptom before he started to recover.

Afraid of infecting anyone in her community, Young went weeks without seeing her parents and newborn niece. She adopted a hound-mix puppy to have a friend when she couldn’t see her own. In the weeks that followed the killing of George Floyd, she agonized over her decision to stay away from the protests. She knew there wouldn’t be N95s there.

On a sweltering August morning, she left her dog in her apartment and packed her respirator in her car. She, too, re-wore her mask, but usually for four or five 12-hours shifts.

Now Young was taking it across Baltimore, not toward the hospital, but to a predominantly Hispanic neighborhood with one of the worst infection rates in the city.

During the pandemic, Baltimore has seen outbreaks in its homeless shelters, its trash-collecting facility and its jail. Now every place Young drove by fell on one side or the other of a new dividing line in America: those who have PPE and those who don’t. Bodegas, restaurants, nail salons and funeral homes. Downtown, a nonprofit’s dental clinic remained shuttered. She passed a mental health counseling center where sessions were still conducted only by video, and a physical therapist who wore KN95s to see clients. She parked near a school that, without N95s, had no way of ensuring its teachers were protected. It serves primarily Latino children, all of whom would be forced to learn online.

In the parking lot of the church, a booth that used to sell $1 snow cones had been transformed into a coronavirus testing center run by a team of Hopkins doctors and nurses.

On her day off, Young volunteered to work with them, spending hours sweating in her scrubs, sending swabs deep into nose after nose. She wore a surgical mask on top of her N95.

“I don’t think there’s any science that says this is actually safer,” she said. “But it’s just a mental thing.”

The line of people sweating on the asphalt was so long, Young couldn’t see the people at the end: a man in painter’s clothes, a mother pushing a stroller and a woman who, like Young, was wearing scrubs. Stitched onto the chest was the name of a retirement home.

‘Hazard’

The coughing patient was starting to fall asleep when Williams left her in the covid unit. Her shift had been over for more than 30 minutes. She checked in to make sure there was no one else who needed her help and headed for the locker room. She washed her hands twice. She used alcohol wipes to sanitize her phone, glasses, ID badges and pens.

She took off her N95, and she inhaled.

For the first time in two months, she decided that this respirator was done. Its straps were starting to feel too stretched. The shape of it looked just a little too warped.

Instead of hanging the N95 from a hook in her locker to air dry, she stuffed it in a bag marked “hazard.”

A new mask, still in its plastic packaging, was waiting for her next shift. She would wear it as long as possible, especially after learning that the Hopkins stockpile had run out of the British-made mask she wore and couldn’t get any more. She needed to change to a different type of N95, one that felt unfamiliar once again. She told herself that she was grateful just to have it. She told herself that it would protect her just the same.

 

 

 

 

 

COVID-19 Goes Viral on College Campuses

COVID-19 Goes Viral on College Campuses

Freshman Sarah Anne Cook carries her belongings as she packs to leave the University of North Carolina at Chapel Hill, on August 18, because of a COVID-19 outbreak. All in-person undergraduate learning was canceled.

On August 10, students at the University of North Carolina at Chapel Hill (UNC) began the fall semester in person. Freshman Jasmine Baker was cautiously optimistic — as an incoming student in the Hussman School of Journalism, she was excited to experience college and get to know her suitemates. But she also worried that the university’s health and safety protocols would not prevent the spread of the coronavirus on campus.

She was right. Just one week after classes started, UNC announced that all undergraduate classes would move to remote learning for an indefinite period following a surge of COVID-19 cases. The case positivity rate on campus jumped from 2.8% to nearly 14%, Colleen Flaherty reported in Inside Higher Ed. After the second week, the positivity rate skyrocketed to 31%.

Baker, an out-of-state student, learned about the change in learning plans while attending an in-person class. “The email was very vague about housing,” she told Slate. “There were no specifics. Everyone kind of started freaking out. . . . We learned about it at the same time the professors did.” To top it off, she and a roommate soon tested positive for COVID-19. “We were all in such close quarters,” Baker said. “I know people that barely left their dorms, and they still ended up catching it.”

The situation at UNC is not unique.New York Times tracker has revealed at least 88,000 COVID-19 cases and 60 deaths at American colleges since the pandemic began. Photos and videos of students flouting public health guidelines at indoor parties or other gatherings have gone viral. Some university administrators have condemned the socializing as “reprehensible” and reprimanded students for “disrespectful, selfish, and dangerous” behavior.

Experts like Julia Marcus, PhD, MPH, an epidemiologist at Harvard Medical School, and Jessica Gold, MD, MS, a psychiatrist at Washington University, saw this coming from a mile away.Students will get infected, and universities will rebuke them for it; campuses will close, and students will be blamed for it,” they warned in the Atlantic over the summer. “Relying on the self-control of young adults, rather than deploying the public-health infrastructure needed to control a disease that spreads easily among people who live, eat, study, and socialize together, is not a safe reopening strategy.”

If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases. . . . I don’t know what colleges were expecting.

—UNC epidemiologist Whitney Robinson

As the Editorial Board of the Daily Tar Heel, UNC’s student newspaper, wrote one week into the semester, “Reports of parties throughout the weekend come as no surprise. Though these students are not faultless, it was the University’s responsibility to disincentivize such gatherings by reconsidering its plans to operate in person earlier on.” The local health department recommended that UNC implement remote learning for the first five weeks of the fall term, but administrators ignored that advice.

Lack of Guidelines for Safe Return

Throughout the summer, even as COVID-19 hot spots emerged across the country, President Donald Trump aggressively pushed for schools to reopen in person. Without federal guidance on how to do this safely, university administrators were left to cobble together their own plans for preventing coronavirus from spreading into the community.

“I don’t think there are two universities that have the same protocol,” Irwin Redlener, director of the Pandemic Resource and Response Initiative at Columbia University, told Politico. “It’s national chaos.

Universities have a strong financial incentive to reopen in person. Many are hoping to recover revenue from housing fees and out-of-state tuition payments that were lost when the pandemic forced them to suspend in-person classes in March. But as many universities have learned in recent weeks, reopening in person comes at a cost to the health of students, faculty members, and the surrounding community.

The New York Times reviewed 203 counties in which college students comprise at least 10% of the population and found that about half experienced their worst weeks of the pandemic after August 1, around the time students returned to campus. An analysis by USA Today revealed that communities with a significant college student population represent 19 of the 25 largest current coronavirus outbreaks in the US.

What has happened on campus hasn’t stayed on campus,” Shawn Hubler and Anemona Hartocollis wrote in the New York Times.

California Fares Better Than Other States

While California is not represented on USA Today’s list of big outbreaks, it is dealing with surges on some campuses. According to the New York Times campus tracker, there are nearly 2,600 coronavirus cases at 57 schools in California. (Because there is no national tracking system for coronavirus cases on college campuses, the New York Times is believed to have the most comprehensive count available.)

I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control.

—Boston University epidemiologist
Eleanor Murray

With 444 confirmed cases, San Diego State University tops the list among California schools, followed by the University of Southern California with 358 cases and UC San Diego with 237. By comparison, North Carolina has nearly 5,200 coronavirus cases at 42 schools, including 1,150 cases at UNC.

California’s relative success at mitigating the spread of COVID-19 on campus can be attributed in part to the conservative reopening plans of many schools. The California State University (CSU) system, California Community Colleges, and University of California (UC) schools moved nearly all fall classes online. UC Berkeley is fully remote for the fall semester. Stanford University planned to have half of its undergraduate students on campus during different quarters, but it switched to mostly remote learning as coronavirus cases continued to rise in the Bay Area over the summer.

Even a hybrid learning model, however, has failed to stave off new coronavirus cases on campuses. Chico State University and San Diego State University, both part of the CSU system, became the first and second California campuses to pause in-person classes after COVID-19 cases spiked, Ashley Smith reported for EdSource.

Resources are a factor in prevention efforts. Chico State’s health center doesn’t have coronavirus tests for students. San Diego State, which has more resources, has two coronavirus testing sites on campus. Across the CSU system, only 2 out of 23 campuses (CSU Maritime Academy and Humboldt State University) have tested all students living in dorms, according to CalMatters. The UC system, which has a budget roughly four times that of the CSU system, is testing all students living in dorms across all 10 campuses. (The UC system has restricted on-campus housing to students who have no alternative housing options.)

An Avoidable Situation

With the academic year off to a rocky start and students being sent home amid coronavirus outbreaks on campuses, experts across the country are nervously tracking the spread of the virus. “I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control,” Eleanor Murray, ScD, MPH, an epidemiologist at Boston University, told Ed Yong in the Atlantic.

COVID-19 surges on college campuses were preventable. “If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases,” Whitney Robinson, PhD, an epidemiologist at UNC, told Yong. “I don’t know what colleges were expecting.”

 

 

 

 

CDC pulls revised guidance on coronavirus from website

https://thehill.com/policy/healthcare/517387-cdc-says-revised-guidance-on-airborne-coronavirus-transmission-posted-in

National coronavirus updates: CDC provides detailed guidance on reopening -  ExpressNews.com

The Centers for Disease Control and Prevention (CDC) said Monday pulled revised guidance from its website that had said airborne transmission was thought to be the main way the coronavirus spreads, saying it was “posted in error.”

The sudden change came after the new guidance had been quietly posted on the CDC website on Friday.

“CDC is currently updating its recommendations regarding airborne transmission of SARS-CoV-2 (the virus that causes COVID-19),” the CDC wrote. “Once this process has been completed, the update language will be posted.”

The CDC guidance on the coronavirus is now the same as it was before the revisions.

The change and the the reversal comes as the CDC comes under extensive scrutiny over whether decisions by and guidance from government scientists are being affected by politics.

Just last week, President Trump contradicted CDC Director Robert Redfield on the timing of a vaccine and the necessity of wearing masks. 

Public health experts were pleased with the updated guidance, saying evidence shows COVID-19 can be spread through the air and that the public should be made aware of that fact. 

The World Health Organization issued a warning in July, saying that coronavirus could be spread through people talking, singing and shouting after hundreds of scientists released a letter urging it to do so.

The CDC said the guidance posted Friday was a “draft version of proposed changes.”

It is not clear if that draft will eventually become the CDC’s guidance, or if it will go through additional changes.

CNN first reported the new guidance on Sunday.

The now-deleted guidance had noted that the coronavirus could spread through airborne particles when an infected person “coughs, sneezes, sings, talks or breaths.”

“There is growing evidence that droplets and airborne particles can remain suspended in the air and be breathed in by others, and travel distances beyond 6 feet (for example, during choir practice, in restaurants, or in fitness classes),” the agency had written. “In general, indoor environments without good ventilation increase this risk.”

“These particles can be inhaled into the nose, mouth, airways, and lungs and cause infection,” the deleted guidance said. “This is thought to be the main way the virus spreads.”

 

 

 

 

Administration’s Record on Health Care

President Trump’s Record on Health Care

President Trump's Record on Health Care | KFF

A review of Trump’s health care record so far. Avoiding the problematic issue of Trump’s alleged plan, analysts at the nonpartisan Kaiser Family Foundation released a report this week that examines President Trump’s record on health care over the last three and half years. Some highlights from the overview and the full analysis:

  • On the Affordable Care Act: “From the start of his presidential term, President Trump took aim at the Affordable Care Act, consistent with his campaign pledge leading up to the 2016 election. He supported many efforts in Congress to repeal the law and replace it with an alternative that would have weakened protections for people with pre-existing conditions, eliminated the Medicaid expansion, and reduced premium assistance for people seeking marketplace coverage. While the ACA remains in force, President Trump’s Administration is supporting the case pending before the U.S. Supreme Court to overturn the ACA in its entirety that is scheduled for oral arguments one week after the election.”

 

  • On Medicare and Medicaid: “The Administration has proposed spending reductions for both Medicaid and Medicare, along with proposals that would promote flexibility for states but limit eligibility for coverage under Medicaid (e.g., work requirements).”

 

  • On drug prices: “The President has made prescription drug prices a top health policy priority and has issued several executive orders and other proposals that aim to lower drug prices; most of these proposals, however, have not been implemented, other than one change that would lower the cost of insulin for some Medicare beneficiaries with diabetes, and another that allows pharmacists to tell consumers if they could save money on their prescriptions. The Trump Administration has also moved forward with an initiative to improve price transparency in an effort to lower costs, though it is held up in the courts.”

 

  • On the response to the coronavirus: “The Trump administration has not established a coordinated, national plan to scale-up and implement public health measures to control the spread of coronavirus, instead choosing to have states assume primary responsibility for the COVID-19 response, with the federal government acting as back-up and ‘supplier of last resort.’ The President has downplayed the threat of COVID-19, given conflicting messages and misinformation, and often been at odds with public health officials and scientific evidence.”

 

President Trump’s Record on Health Care – Issue Brief