Top Trump adviser bluntly contradicts president on covid-19 threat, urging all-out response

https://www.washingtonpost.com/health/2020/11/02/deborah-birx-covid-trump/

“This is not about lockdowns. … It’s about an aggressive balanced approach that is not being implemented,” says internal White House report that challenges many of Trump’s pronouncements.

A top White House coronavirus adviser sounded alarms Monday about a new and deadly phase in the health crisis, pleading with top administration officials for “much more aggressive action,” even as President Trump continues to assure rallygoers that the nation is “rounding the turn” on the pandemic.

“We are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality,” said the Nov. 2 report from Deborah Birx, coordinator of the White House coronavirus task force. “This is not about lockdowns — it hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”

Birx’s internal report, shared with top White House and agency officials, contradicts Trump on numerous points: While the president holds large campaign events with hundreds of attendees, most without masks, she explicitly warns against them. While the president blames rising cases on more testing, she says testing is “flat or declining” in many areas where cases are rising. And while Trump says the country is “rounding the turn,” Birx notes that the country is entering its most dangerous period yet and will see more than 100,000 new cases a day this week.

Through a spokesperson, Birx did not respond to a request for comment.

Other health experts, including Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, have warned of record surges in cases and hospitalizations as the United States records more than 9 million cases and 230,000 deaths.

“We’re in for a whole lot of hurt,” Fauci told The Washington Post late Friday, predicting a long and potentially deadly winter unless there’s an “abrupt change” — prompting Trump to suggest that he planned to fire the scientist after the election.

But Birx’s daily missives go further, revealing how much the administration’s internal reports are in direct conflict with Trump’s public pronouncements that downplay the seriousness of the threat and erroneously suggest that few people are dying. They also speak to the increasing desperation of health officials to spotlight the risks of a pandemic that is forecast to take thousands more lives as the weather worsens unless people change their behaviors. Some officials are also concerned about recouping their reputations in a post-Trump era.

The increasingly dire tone of Birx’s reports has gotten little traction, according to an administration official who works with her and spoke on the condition of anonymity to share sensitive information. “She feels like she’s being ignored,” the official said.

Birx’s message “has been urgent for weeks,” said another administration official, “as has the plea for the administration to ask the American people to use masks, avoid gatherings and socially distance, basically since it became apparent that we were heading into a third surge.”

The report hits hard on the worsening situation: “Cases are rapidly rising in nearly 30 percent of all USA counties, the highest number of county hotspots we have seen with this pandemic,” it said. “Half of the United States is in the red or orange zone for cases despite flat or declining testing.”

Sounding a similar theme to past reports, it calls for “much more aggressive action from messaging, to testing, to surging personnel around the country before the crisis point.”

What is “essential at this time point,” the report said, is “consistent messaging about uniform use of masks, physical distancing and hand washing with profound limitation on indoor gatherings especially with family and friends.”

It adds: “This is about empowerment Americans with the knowledge and data for decision-making to prevent community spread and save lives.”

The president appears unpersuaded by such messages, convinced by new medical adviser Scott Atlas, a neuroradiologist with no infectious-disease experience, that allowing healthy people to return to daily activities without restrictions will hasten herd immunity and bolster the economy, say some advisers who spoke on the condition of anonymity because they were not authorized to speak publicly.

Trump plans to hold a large indoor gathering for 300 to 400 guests at the White House on Tuesday to watch the election returns, only a few weeks after a White House event to announce his Supreme Court nominee Amy Coney Barrett became a superspreader event.

White House communications director Alyssa Farah disputed the report’s suggestion that the administration’s response has been inadequate to the crisis. She said the White House has “significantly increased” the U.S. national stockpile to ensure the country has sufficient personal protective equipment; bought 150 million coronavirus tests and distributed them to the most vulnerable populations, including nursing homes, assisted-living facilities and Native American tribal areas; and sent special teams to states and nursing homes with the most cases.

In addition, she said, the administration continues to work to “safely rush therapeutics” to the sick and develop vaccines. “We are working around-the-clock to safely treat the virus and ultimately defeat it,” Farah said.

Birx’s report goes to pains to dispute Trump’s false claims that coronavirus cases are increasing only because of increases in testing. Monday’s report notes that although testing is flat, a rising number of tests are positive, suggesting “community spread is much worse than is evident by current [measurements].”

An earlier, Oct. 17 report sounded the same theme: It cited increasing daily hospital admissions, rising fatalities and emergency room visits, and bluntly stated, “this is not due to increased testing but broad and ever-increasing community spread.”

That report added these words highlighted in bold: “There is an absolute necessity of the Administration to use this moment to ask the American people to wear masks, physical distance and avoid gatherings in both public and private spaces.” On that day, Trump held two large rallies, according to his public schedule, one in Michigan and one in Wisconsin.

Birx’s report goes to pains to dispute Trump’s false claims that coronavirus cases are increasing only because of increases in testing. Monday’s report notes that although testing is flat, a rising number of tests are positive, suggesting “community spread is much worse than is evident by current [measurements].”

An earlier, Oct. 17 report sounded the same theme: It cited increasing daily hospital admissions, rising fatalities and emergency room visits, and bluntly stated, “this is not due to increased testing but broad and ever-increasing community spread.”

That report added these words highlighted in bold: “There is an absolute necessity of the Administration to use this moment to ask the American people to wear masks, physical distance and avoid gatherings in both public and private spaces.” On that day, Trump held two large rallies, according to his public schedule, one in Michigan and one in Wisconsin.

Officials describe Birx as frustrated with Atlas’s growing influence. She has challenged his views in task force meetings, suggesting that reopening society without any restrictions would lead to thousands of deaths.

In recent weeks, Birx has crisscrossed the country, traveling to dozens of virus hot spots, where she has urged state and local officials to mandate masks, close bars and restaurants and encourage distancing.

Birx is said to be close to Vice President Pence, but he’s been on the road campaigning in recent weeks, taking his attention away from the coronavirus, according to a senior administration official who spoke on the condition of anonymity to share internal discussions.

Unlike Fauci, a highly regarded civil servant who Trump has criticized as a “Democrat,” Birx was chosen by the administration to helm the response and has been lavishly praised in the past by Trump.

Fauci said in his interview Friday that he and Birx lost the president’s ear as Trump worried increasingly about a sputtering economy and his reelection prospects.

“They needed to have a medical message that was essentially consistent with what they were saying, and one of the ways to say: ‘The outbreak is over. [Mitigation strategies are] really irrelevant because it doesn’t make any difference. All you need to do is prevent people from dying and protect people in places like the nursing homes,’ ” Fauci said.

U.S. reports record-breaking number of daily COVID-19 cases, but experts say the worst is yet to come

https://www.healthcarefinancenews.com/news/us-reports-record-breaking-number-daily-covid-19-cases-experts-say-worst-has-yet-come

US coronavirus cases break global daily record, and experts warn -  WRCBtv.com | Chattanooga News, Weather & Sports

Last Friday, the CDC reported 99,750 new cases, a record high from the day before.

The United States reported its highest number of new COVID-19 cases in a single day on Friday as cases across the country have been rising since mid-September, according to the Centers for Disease Control and Prevention’s COVID-19 data tracker.

Last Friday, the CDC reported 99,750 new cases, a record high from the day before when there were 90,155 new cases.

The overall national percentage of positive COVID-19 tests increased from 6.6% from the week ending on Oct. 17 to 7.1% for the week ending on Oct. 24, according to the CDC’s weekly surveillance summary.

WHAT’S THE IMPACT

With the spike in cases, the U.S. now has 9,182,628 total COVID-19 cases, with 565,607 of these coming in the last week.

Hospitalization rates have also increased since September, according to the CDC’s weekly COVID-19 summary. In the most recent report, the COVID-19-related hospitalization rate was about 200 hospitalizations per 100,000 population.

States that are being hardest hit with the most cases in the last week are Illinois (44,570), Texas (42,480), Wisconsin (32,506), California (28,505) and Florida (28,149).

While hospitals in surge areas of Texas, South and North Dakota, Utah and Wisconsin are reportedly overwhelmed, The New York Times reported that the death rate for seriously ill COVID-19 patients has declined. At one New York hospital system, the report said, where 30% of coronavirus patients died in March, the death rate dropped to 3% by the end of June.

Racial minorities continue to be harder hit by the pandemic; the hospitalization rate for Hispanic or Latino people was approximately 4.4 times that of non-Hispanic whites. The rate was 4.3 times higher for non-Hispanic American Indian or Alaska Native and 4.2 times higher for non-Hispanic Black individuals compared with non-Hispanic whites.

COVID-19 deaths in the U.S. have remained fairly consistent at 700 to 800 deaths per week since the beginning of September. The current death toll sits at 230,383, according to the CDC.

THE LARGER TREND

Congress has been unable to agree on legislation for more relief funding that might help hospitals, as the Coronavirus Aid, Relief and Economic Security Act did.

The recent surge in cases marks the country’s third and highest peak. Meanwhile, as other countries began locking down after their own increases in COVID-19 cases, President Trump criticized the preventative measures as “draconian.”

This is only the beginning of a new wave of COVID-19 cases, according to public health officials. Dr. Anthony Fauci, the nation’s leading infectious disease expert, told The Washington Post, “We’re in for a whole lot of hurt,” as the winter months come closer. Former FDA Commissioner Dr. Scott Gottlieb warned on CBS News’ “Face the Nation” that Thanksgiving is going to be the point where the country will begin to see “exponential growth in a lot of states,” with December likely being the hardest hit month.

With what hospitals and health systems learned from the first wave of COVID-19, ensuring their medical supply chains are intact and their telehealth offerings remain easy to use will be critical. Other strategies from the CDC include creating a written and structured COVID-19 plan that includes communication, triage and visitor protocols.

It’s 2020. Now You Can Vote From Your Hospital Room.

While voter suppression efforts are making it harder to vote in places like Texas, Georgia and Florida, one strategy makes voting during the pandemic a little easier: voting from your hospital bed.

State rules and deadlines vary, but at least 38 states allow emergency absentee ballots for registered voters who unexpectedly cannot vote in person, including patients who are suddenly hospitalized. 

With Covid-19 cases and hospitalizations spiking, hospital-room voting has become especially relevant in 2020. 

Patients and family members staying with them are often surprised to learn that they can vote from the hospital, said Dr. Kelly Wong, resident physician in emergency medicine at the Warren Alpert Medical School of Brown University and founder of Patient Voting, a nonpartisan organization that helps hospitalized patients and family members vote. 

As a medical student in her home state of South Dakota during the 2016 election, Wong noticed a surprising and potentially dangerous pattern: sick patients were delaying trips to the emergency room or arguing against being admitted to the hospital because they didn’t want to miss the chance to vote. 

Wong thought patients shouldn’t have to choose between voting and their health. 

But she didn’t know the process for registered voters to vote from the hospital; she didn’t even know there was a process. When she found it was possible, she realized how difficult it was to figure out how to do it.

She was not alone. 

“The biggest barrier to patient voting is that they don’t know they can,” Wong said. 

In 2018, she founded Patient Voting to close the knowledge gap—just in time for the midterm elections. 

The group now publishes state-specific processes for all 50 states, and operates with volunteers in 38 states. They partner with 25 medical schools and 15 hospitals in eight states—including battleground states of Florida, Michigan and Pennsylvania where the 2020 presidential candidates are fighting for every vote.

Wong keeps the organization staunchly nonpartisan. Her motivation is to safeguard patients’ health. 

“I joke that in a selfish way, this is a way that patients don’t have to leave the hospital,” Wong said. “If they can accomplish their priorities while staying in the hospital, that’s good for their health.” 

This year, voting is a priority for many Americans. 

“This is a really defining moment in our history,” said Dr. Sarah Welsh, medical director of the pediatric intensive care unit at Hasbro Children’s Hospital in Rhode Island. “It is our duty as citizens not only to vote ourselves, but to lift our heads up and realize that there are others around us that we interact with on a daily basis that would have limitations.”

Hospitalized patients, or those who are in and out of hospitals with chronic illnesses, may be especially vulnerable to being disenfranchised, according to Dr. Alison Hayward, faculty advisor and board member of Patient Voting and assistant professor of emergency medicine at Brown. “Those people need to have their voices heard because there are huge issues at stake that will really affect their lives.”

A Small Army

In June, Brown University medical students Katie Barry and Meghan McCarthy, both 23, signed on as national medical student coordinators for Patient Voting. 

“We are really interested in helping to empower patients, especially those who otherwise might have their voices not heard or overlooked,” said Barry. She realized Covid-19 was not going to be gone by November. “I wanted to help out in any way I could.”

According to Barry and McCarthy, the current generation of doctors in training are especially focused on social determinants of health such as civil rights, housing, and food.

“Along with biology and science, there’s a big emphasis on the social factors that affect some patients’ health,” McCarthy said. “It’s hard to ignore once we get into the hospitals how all these factors affect your patients’ health.”

Barry agreed. “We realize now that in order to care for people, we need to do more than provide the medical care.” 

Going Digital

Patient Voting is getting some help to spread the word about hospital-room voting. At Hasbro Children’s Hospital, Patient Voting is newly embedded into the interface patients use to watch TV and get health and hospital information. 

GetWellNetwork, a patient engagement company that provides digital health technology and serves 10 million patients a year in 700 hospitals and clinics nationwide, operates that platform.

The company jumped on the opportunity to help enable parents vote so they wouldn’t have to leave their child’s bedside. GetWellNetwork incorporated Patient Voting into the platform within a day of hearing about the program.

“Our whole philosophy is to help people take an active role in their journey,” said Michael O’Neil, Jr., GetWellNetwork’s founder and CEO. 

The company takes what is a typically powerless human experience and uses digital tools to “put the patient in the pilot’s seat,” O’Neil said. 

Partnering to enable patient voting fits their philosophy. “It’s a perfect opportunity to spring into action and follow this notion of empowerment,” O’Neil said. “It just happens to be in the context of voting in this case.” 

It’s Not Too Late

In the run-up to the election, Patient Voting has experienced a frenzy of requests for help, though it’s not clear how many people vote this way. After the 2018 midterms, Wong and her team contacted state boards of elections to gather such data; they found that most states do not track the number of ballots from hospitalized voters. 

Wong herself is spending part of Monday requesting an emergency absentee ballot on behalf of a patient in Rhode Island. She wouldn’t be allowed to do that everywhere; in North Carolina, for example, healthcare employees are prohibited from witnessing emergency absentee ballots. 

“I see how thankful people are when they’re able to get the information they needed to be able to vote,” said Hayward, who has been responding to patient and family inquiries. “It feels really good to be involved in a nonpartisan effort in this time…Everyone wants to be able to vote and to have their voice heard.”

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