Trump’s Blame the Governors Strategy and Rural Roulette

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The other day, I laid out how, even if Trump wants to open the country back up by Easter, at least fifteen governors may prevent him, including OH’s Republican governor Mike DeWine, who in the wake of Trump’s comments tweeted out defending his approach again. The WaPo did a similar piece this morning, confirming that the governors aren’t on board with Trump’s hopes.

That said, it’s clear that Trump plans to pressure governors, not just to do his bidding, but also to demand fealty before he heeds their pleas for help. Ultimately, it may be a bid to blame the upcoming crisis on the governors — disproportionately Democrats — struggling most directly with the crisis.

And that could work.

Though I doubt it, for a number of reasons. As US numbers continue to spike, it’s likely the governors who’ve taken more aggressive stances (with the possible but very notable exception of Andrew Cuomo, largely because of NYC’s density) will be able to show significantly better outcomes than those states that have adopted a hybrid approach, shutting down affected cities but not the entire state, to say nothing of those who were doing nothing (this Politico piece shows what each state has done or, in the case of OK and MS, not done at all).

Right now, almost all the identifiable clusters are in big cities, with both the international travel and density that would lead to early exposure. But some (not all — Detroit is an exception) of those cities actually have relatively low levels of the preexisting conditions that make the population more susceptible to the virus and more likely to have an extreme case if they get it. By contrast, much of America’s more rural areas have a higher instance of those pre-existing conditions. And those rural areas don’t have the hospital beds, much less ICU rooms, to treat seriously ill patients. This map, from an MIT project, shows where current outbreaks are and where particularly vulnerable populations are for the country as a whole.

That means in states where governors have not imposed state-wide stay at home orders, there’s a significant risk that clusters will arise in areas that are less prepared to deal with an outbreak. Effectively, the governors who’ve adopted such an approach are playing “rural roulette,” assuming that a focus on the cities will mitigate the biggest risks, even though the rural areas would be easily overwhelmed even with a smaller number of infections.

And that may have an important dynamic given the election. A number of the key swing states — MN, WI, MI, OH — have instituted full state stay-at-home orders. But many of the rest — PA, FL, NC, CO, GA, TX — have not. And in some of the states where that decision is riskiest — GA, FL, and AZ — there’s a Republican governor adopting those strategies in part to adhere to Trump’s views.

Take Georgia. It has had an outbreak in the more rural southwest part of the state, and municipalities are trying to force Governor Brian Kemp to impose a state-wide shutdown.

But the rest of the state has high incidences of some of the preconditions that make the population particularly susceptible to infection. In other words, while Atlanta has the medical resources (including CDC) to respond to the medical crisis, Georgia is already exhibiting an atypical pattern of rural spread in ways that might make Kemp’s refusal to do a state-wide order particularly costly. (As I was writing this, Kemp announced that schools will remain closed through April 24, which suggests he may be budging on a state-wide approach.)

Then there’s Florida.

Jim here.

As the New York Times notes, the municipalities of Miami and Miami Beach have stay home or shelter in place orders that went into effect this week. Also, Alachua, Leon, Orange and Pinellas Counties have stay home orders. Note that while Orange County holds most of the Orlando metro area, Pinellas is only the St. Petersburg portion of the Tampa Bay region. Tampa is in Hillsborough and the population stays fairly high going north into Pasco and south into Manatee and Sarasota Counties.

A very interesting aspect of the Alachua County stay home order, which went into effect here at 12:01 am Tuesday, is that, as noted in the Gainesville Sun, “Non-medical businesses may only allow one customer inside per 1,000 covered square feet, per an Alachua County emergency order.” Here is the line outside a grocery store Tuesday morning in the Sun’s photo accompanying the article:

As the Tampa Bay Times notes, despite multiple public health authorities pleading for a statewide shutdown, DeSantis has instead been listening almost exclusively to business interests, and their message to him has been exactly the one Fox News and Trump have been flogging:

The Florida Chamber of Commerce have spoken frequently with the governor and his staff, urging him not to take drastic measures that might shut down the state’s economy. The Florida Restaurant and Lodging Association has been asking for ways to help their industries stay afloat.

Their message: don’t let the cure be worse than the disease.

But this is ignored:

Public health experts say that a three-week limit on public movement is required to stop the spread of the virus, and they point to a statistical model that shows that Florida may have only one week to act before hospitals become overwhelmed.

Instead, he hears a Republican telling him just how responsible he is to ignore the public health requests:

Sen. Tom Lee, R-Thonotosassa, said DeSantis was under “a tremendous amount of pressure,” but the idea he’s making decisions based on politics — and not public health — was “irresponsible.”

“He’s hearing from a lot of self-interested actors right now who are acting out of self-preservation,” Lee said. “With every executive order, there’s another industry being impacted. Those people are pretty aggressive and pretty vocal, and I think he’s done a pretty good job of ignoring all that.”

What could go wrong?

/Jim

In Florida, on top of the vacation traffic that DeSantis only belatedly shut down, it has significant numbers of seniors and its rural, more vulnerable communities do not have the beds to treat patients in if an outbreak happens (the gray circles here are senior facilities).

To make things worse, DeSantis is not sharing information about which senior facilities have had positive cases, which is likely to lead to clusters outside of locked down areas that lead to community infection. So on top of the rural/urban mix, DeSantis has the likelihood of a breakout at senior facilities.

It’s not just Republican governors who’ve adopted a hybrid strategy though: Pennsylvania Governor Tom Wolf  locked down PA’s major counties without imposing stay at home in their more rural areas. PA is going to experience the community spread of the Eastern Seaboard; it’s a real question what happens as the virus spreads west from the Philadelphia metro area. Plus, it also has a concentration of senior facilities (the family member I’m most worried about now is stuck in one until April 1 fighting several other preexisting conditions).

In bmaz’s Arizona, something that has the possibility of being worse is happening: Republican Governor Doug Ducey is using his authority to prevent cities from imposing more stringent stay at home orders. Thus far, this order strives only to impose a state-wide standard for what amounts to essential businesses (something that has led to confusion even in states with full state-wide orders). Most of his businesses match those adopted by state-wide orders. His order specifically includes golf courses (but not their restaurant facilities) as essential businesses, which I this is reasonable, in AZ, in the name of exercise; bmaz says that the crowds on urban hiking trails, which are also exempted, are far worse. Ducey’s order could override school closures.

Or, the order as a whole could suggest he’s being pushed closer to where other states are, full stay at home orders.

Arizona faces a particular rural challenge, but one Ducey can’t manage: the Native American reservations, which already have cases and which have a real dearth of health resources. But they’re sovereign.

North Carolina’s Democratic Governor Roy Cooper is another person who is having to be pressured to impose a more stringent state-wide stay at home order.

If states can access adequate testing, it’s still unproven whether state-wide or city-by-city orders will be most effective (though the testing is clearly not there yet).

What is clear, however, is that there will be at least as much political pressure on the states that have incomplete stay at home orders as those with statewide orders. And that just happens to include many of the states where November’s election will be decided.

Update: Trump has just sent a letter to governors suggesting the Feds are going to roll out new standards for identifying high and low risk counties, suggesting he wants to adopt the piecemeal shutdowns of the states discussed here. Such a regime will make orders like Doug Ducey and Mississippi Governor Tate Reeves’ orders standardizing shut-downs at the state level dangerous in a way they aren’t now, because both cite Trump’s guidelines for protective measures.

The Tick-Tock to COVID-19’s Explosion

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[Check the byline, thanks! /~Rayne]

When epidemiologists, virologists, and public health officials first began talking about flattening the curve — using social distancing to reduce the number of COVID-19 cases needing hospitalization at any one time to prevent collapse of hospitals and massive mortality — I kept a running mental tick-tock, resetting this clock as data emerged and events unfolded. We learned from Washington state how the virus spread rapidly because of cryptic transmission, but tracking the virus’s dispersion hasn’t been clear to observers let alone elected officials and business leaders. Missing a concrete picture of how the virus emerges and spreads over time to affect our health care systems, officials have been easily badgered to issue delayed and weak containment orders to suppress COVID-19’S contagion.

The Biogen management conference offered a discrete example of how COVID-19 contagion spread and the time from exposure to illness to new infection:

26-27 February — Biogen, a biotech company, held a management conference in Boston at the Marriott Long Wharf hotel [Day 1-2]

01 March — Biogen employee of Chinese heritage who attended the conference developed a cough. [Day 5]

02 March — A Biogen employee from Indiana developed symptoms; they traveled to Biogen’s facility in Research Triangle Park, NC.

03 March — Biogen conference attendees were notified of a potential COVID-19 exposure [7 days after conference began]

06 March — Attendees received confirmation that they were exposed to COVID-19. Four cases were identified in Boston; two had symptoms. The Biogen employee from Indiana drove home. [10 days after conference began]

09 March — At least 32 cases of COVID-19 of 41 total in Massachusetts on this date were associated with the Biogen conference. [13 days after conference began]

11 March — Chinese Biogen employee flew from Boston to Los Angeles with spouse and child.

12 March — Chinese Biogen employee flew from LA to Beijing with spouse and child.

12 March — 82 cases in Massachusetts have both been confirmed and associated with the Biogen conference. The Marriott hotel at which the conference was held closed for disinfection.

13 March — Chinese Biogen employee tested positive for COVID-19 on arrival.

14 March — 104 of 138 total COVID-19 cases in Massachusetts were associated with the Biogen conference. Two new cases related to Biogen appeared in the cities of  Worcester and Malden.

16 March — Spouse of Biogen employee tested positive for COVID-19 in Beijing. [20 days after conference began]

The case of Biogen’s Chinese employee is incredibly important. The woman visited a hospital in Boston repeatedly for her symptoms, potentially infecting multiple people including health care workers, was given an ineffective antiviral (technically off label for COVID-19), and ended up flying to China, exposing other passengers and airline employees to COVID-19 en route because she couldn’t get tested for the virus until she arrived in Beijing.  She risked prosecution by Chinese authorities for failing to disclose her health status in order to get tested.

The U.S. literally exported two new cases of COVID-19 to China because Trump has dicked around with testing and lied to us about their availability since he first learned about the virus and risk of pandemic.

~ ~ ~

I’ve made up a calendar — not exactly pretty, mind you, since I didn’t quite know how I wanted to present this when I started. But you’ll see the Biogen-based outbreak, the airport terminal debacle thanks to the Trump EU travel ban, and the last holiday during which people gathered en masse in closed quarters (that’s St. Patrick’s Day).

Four states with the largest populations out of the top 11 most populous states issued shelter-in-place/stay home orders after March 17. You’ll see those effective dates noted on the calendar here as well.

Calender - COVID-19 contagion, Feb-April 2020

Note carefully the weekend of March 14-15 when airports across the U.S. were crammed with people, many of whom were likely exposed to COVID-19. As I said in a previous post, this is a hurricane; the mounting deaths over the last couple of days are only the leading edge of a hurricane-like explosion fomented by Trump’s minions’ ineptitude. Every death is on their heads and hands.

The reason for my mental tick-tock and the calendar is the course of the virus and its contagion: exposed persons are contagious about five days after infection; infected persons may begin to show symptoms from 5 to 14 days after exposure; persons who recover are contagious for at least another seven days.

The total 21 days from exposure to the point where an infected person is  clear of virus is optimistic. The WHO China mission report indicated persons may shed COVID-19 for 4-5 weeks in total.

Which brings me to the ultimate point of this post: In no fucking way is it safe to assume the risk of contagion will have been broken by Easter.

No matter what Trump wants or needs to believe, especially since shelter-in-place/stay home orders have not been given across the entire country and not to a uniform standard since states assumed the responsibility to issue these orders and not the federal government.

Perhaps the contagion will be stemmed by the states which gave shelter-in-place/stay home orders, but COVID-19’s spread could resume as rapidly as a trucker can cross a state line or an airplane land at an airport.

A partial lifting of the shelter-in-place/stay home orders might work if everyone had been screened with an antibody test for exposure, and only those persons with active COVID-19 infections were quarantined for the full 4-5 weeks.

But no — we don’t yet have antibody tests. We still don’t have adequate numbers of tests for COVID-19 infections.

Without testing and uniform shelter-in-place/stay home orders across the country, lifting shelter-in-place/stay home orders by Easter only increases the odds there will be another wave of infections on the heels of the first wave. Hospitals and health care workers would not have a break between these successive waves, further stressing the system.

~ ~ ~

Let’s cut through the bullshit here. If Trump wanted to look like a hero to the American public, he’d listen to virologists, epidemiologists, and public health experts.

He’d make sure the health care system had the resources it needs to protect themselves, to treat those who were ill, and to test everyone so the public, their first responders, and their elected state officials knew the status of the virus and where to direct their attentions most effectively.

He’d make sure every American stayed home and had no reason to leave until the contagion was broken.

But this is exactly what he isn’t doing.

He’s even withholding funds from states which are battling to save Americans’ lives from COVID-19 while containing the virus’s spread.

Why?

Why is Trump not doing what he’s supposed to do to insure domestic Tranquility, provide for the common defense, promote the general Welfare as executive of the United States?

Why has he ignored the hundreds of deaths to date, all of which can be blamed on his ongoing failures?

Why has Trump only been able to maintain kayfabe — the appearance of being a president without actually being one, like professional wrestlers who don’t actually wrestle?

If this was the reality TV show The Apprentice, Trump should have been fired already for dereliction of his duties and escorted off studio property by security personnel for deliberately hurting cast and crew.

~ ~ ~

Finally, two more groups of people need to be asked why they aren’t acting in the best interests of the country, let alone their constituents whether voters, donors, or shareholders.

Republican senators have rejected the math — like that selfish yard-waste-pile Rand Paul who continued to use the Senate pool in spite of his exposure to COVID-19.

Why are they actively refusing to do the right things to save Americans’ lives including their own?

Corporate leaders like Lloyd Blankfein whine about getting American workers back on the job instead of worrying whether there will be an economy left if workers continue to get sick in the workplace and die.

Why can’t a fucking investment banker like Blankfein and other business leaders responsible for P&L figure out the numbers?

Fire them all come November.

A Virus Does Not Care

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There’s a right way to deal with a pandemic, and a wrong way to deal with a pandemic

A virus does not care. A virus simply wants to reproduce, and for that it needs a host. A virus does not care about who that host is. A virus just wants a place to live, eat, and reproduce. A virus does not care if it makes the host sick. A virus does not care if it kills the host. This is the First Rule of Viruses: A virus does not care.

In 1918, as WWI was being fought in Europe, a virus emerged at Camp Funston, in the area of Fort Riley, Kansas. This virus did not care about the war. The virus did not care about Our Boys who were preparing to go fight that war. The virus did not care about the farmers in the Kansas fields, who dropped at their plows in the fields when the virus attacked.

A virus does not care.

The soldiers from Fort Riley went to the front lines in Europe with their guns, their ammo, their packs, and their gear, and they took that virus with them. It attacked their comrades in arms, and it attacked their enemies across the trenches.

A virus does not care.

The virus attacked King Alphonso XIII of Spain. Wherever the virus appeared, people began to speak of “the Spanish Flu,” going back to the widely-reported news of the mighty king it brought low. But the virus didn’t care. The virus attacked soldiers. The virus attacked ordinary villagers. Some lived, and some died.

A virus does not care.

The virus spread across the US, just as the war was beginning to come to an end. Bonds were being sold to pay for the war, and soldiers were starting to come home. The virus did not care about the bonds. The virus did not care about the homecoming celebrations being planned.

A virus does not care.

But people care, and they care about lots of things, and that’s where things got worse. People care about their status. People care about their businesses and their livelihoods. People care about parades the celebrate the end of a long and ugly war. People care about gathering in the corner bar with their friends, and playing sports in the local parks. People care about staying safe when danger threatens. People care about singing and dancing and enjoying life. People care about a million and one things, but a virus does not care about any of those things.

A virus does not care.

By 1918, people knew how to deal with a spreading virus in two broad ways: quit interacting so closely with others and practice good hygiene (both individually and as a community). They knew that beating a virus requires that a community care about itself just as much as the virus does not care at all. Give the virus an inch, and it will continue its deadly spread.

Because a virus does not care.

Some communities enacted a wide variety of what epidemiologists today call “nonpharmaceutical interventions” – prohibiting large public gatherings, closing businesses, shutting down churches, suspending schools, and so on. Other communities enacted some of these measures, but not all of them. Some communities took few measures, or decided “We’ll prohibit large gatherings, but not until after the big parade next week.” On the spectrum from “we need to shut everything down” to “we need business as usual,” St. Louis was on one end of the spectrum, and Philadelphia was in the other.

St. Louis:

By late September, Jefferson Barracks [a US military post in St. Louis] went under quarantine as the first soldiers came down with the flu.

In early October, city health commissioner Dr. Max C. Starkloff ordered the closure of schools, movie theaters, saloons, sporting events and other public gathering spots. Churches were told to suspend Sunday services. At the time, with nearly 800,000 residents, St. Louis was among the top 10 largest American cities. . . .

Theater owners, as some of the largest taxpayers at the time, protested the closures. Musicians and entertainers claimed the quarantine threatened their careers. Others were delighted — anti-alcohol leagues that were forming in the runup to Prohibition went on the lookout for taverns that violated the shutdown, [director of library and collections at the Missouri History Museum Chris] Gordon said.

Within two days of the quarantine, eight soldiers at Jefferson Barracks were dead, another eight residents died at St. Louis City Hospital and the number of area flu cases topped 1,150.

Jacob Meeker, a St. Louis congressman, died Oct. 16, six days after touring Jefferson Barracks. He was 40.

With the flu continuing its rampage, Starkloff imposed a stricter quarantine in November, closing down all businesses with few exceptions including banks, newspapers, embalmers and coffin makers, according to Post-Dispatch archives.

The American Red Cross shifted from making bandages to face masks. Volunteers passed around blankets and vats of broth to flu sufferers. An ambulance waited at Union Station to take any sickly train passengers directly to the hospital upon arrival. Police officers and mail carriers wore masks on their daily routes.

And as these measures took hold, it slowed the virus down.

Philadelphia:

In an effort to boost morale for the war and also to sell bonds, the city of Philadelphia threw a parade that drew 200,000 people, despite warnings that the Spanish flu was spreading among the soldiers who were about to head off to World War I and would be in the parade.

That didn’t turn out to be a good idea.

Days later, hospitals in the area were filled with patients suffering or dying from the Spanish flu.

Weeks later, more than 4,500 people in the Philadelphia area died from the virus.

The graph at the top of the post, from a 2007 article in the Proceedings of the National Academy of Sciences, paints the picture of these two approaches in stark, and by now familiar, terms.

Unlike a virus, people get to choose what they care about and how that care will be expressed. In 1918, to borrow from the Grail Knight, the leaders of Philadephia chose . . . poorly, while the leaders in St. Louis chose wisely.

Today, like many places, I and my neighbors in metro Kansas City (on both sides of the state line) are living under a locally-imposed “stay-at-home” order, with school buildings closed, business activity limited to those deemed essential and curtailing large public gatherings completely, including weddings and funerals.

You see, the leaders here know that a virus does not care. Other leaders, however . . .

From an interview on Fox:

Trump: I saw wouldn’t it be great to have all of the churches full—you know the churches aren’t allowed to have much of a congregation there. And most of them, I watched on Sunday online—and it was terrific, by the way—but online is never going to be like being there. So I think Easter Sunday and you’ll have packed churches all over our country—I think it will be a beautiful time. And it’s just about the timeline that I think is right.

A virus does not care about whether churches are full or empty on Easter. A virus doesn’t care if it is beautiful. A virus doesn’t care about your personal faith or lack thereof. In Omaha in 1918, Rev. Siefke S. de Freese, a seemingly healthy 35 year old pastor, led worship on a Sunday, then quickly died days later. A virus does not care.

From yesterday’s coronavirus task force presser:

Q: Mr President, you just reiterated that you hope to have the country reopened by Easter. You said earlier you would like to see churches packed on that day. My question is, you have two doctors on stage with you. Have either of them told you that’s a realistic timeline?

Trump: I think we’re looking at a timeline, we’re discussing it. We had a very good meeting today. If you add it all up. That’s probably nine days plus another two and a half weeks. It’s a period of time that’s longer than the original two weeks, so we’re going to look at it. We’ll only do it if it’s good and maybe we do sections of the country. We do large sections of the country. That could be too, but we’re very much in touch with Tony and with Deborah whenever they [crosstalk].

Q: Who suggested Easter? Who suggested that day?

Trump: I Just thought it was a beautiful time, a beautiful timeline. It’s a great day. . . . I’d love to see it come even sooner, but I just think it would be a beautiful timeline.

A virus does not care if it is a beautiful time. A virus does not care if it is a great day. A virus does not care what you think. A virus does not care what you love.

A virus Does. Not. Care.

We can choose how we respond to an uncaring virus. We can choose like St. Louis did, or we can choose like Philadelphia. And for far too many people, my friends, that is a choice between life and death. And in 1918, even St. Louis didn’t get it completely right:

The quarantine was temporarily lifted Nov. 18 but reinstated when the flu roared back in December. By Dec. 10 the flu peaked in the city with 60 deaths in one day. After illnesses declined sharply, the quarantine was lifted just after Christmas.

Look at that graph again, and you can see the bump at the end of November when the quarantine was prematurely lifted. The virus came back, because a virus does not care.

I’m a pastor. I’d love to see my church packed to the rafters on Easter. I’d love to hear the trumpets leading a 1000 voices in grand hymns of celebration. But that’s not going to happen, because while a virus does not care, I do.

We’re going to be closed this year. Not because we want to be. Not because we lack faith. Not because we don’t care about worship. Not because we’re giving in to the virus. It’s because we care about ourselves and our community so much that we’ll give up this kind of gathering to defeat the virus. Anything less than a full community commitment to a choice like that, and the virus will not be slowed, because the virus does not care.

I pray that more local leaders, state leaders, and national leaders choose wisely, even as Trump seems determined to choose . . . poorly.

I pray this, because I know the First Rule of Viruses: a virus does not care.

Donald Trump Just Killed A Man. Now He Wants To Kill A Million Americans.

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It wasn’t in the middle of Fifth Avenue, but yesterday, Donald Trump killed a man. The man’s wife survived, and did not have good things to say about him. Here’s NBC News on the death:

An Arizona man has died after ingesting chloroquine phosphate — believing it would protect him from becoming infected with the coronavirus. The man’s wife also ingested the substance and is under critical care.

The toxic ingredient they consumed was not the medication form of chloroquine, used to treat malaria in humans. Instead, it was an ingredient listed on a parasite treatment for fish.

The man’s wife told NBC News she’d watched televised briefings during which President Trump talked about the potential benefits of chloroquine.

The wife talked further with NBC:

This death and near-death drive home the danger of Trump’s daily “press briefings” which he is now using as a replacement for his political rallies. His touting of chloroquine on Friday has now killed someone in the US. Recall that Nigeria had to put out a warning Friday as well, as NBC in the same article reported that there were at least two known chloroquine poisonings there right after Trump’s presser. (Chloroquine is more widely available in areas where malaria is endemic.)

But the chloroquine story is far from the biggest problem with Trump’s daily gaslighter. It’s hard to believe that we are only at one week since the publishing of the epidemiological model that really seemed to get the attention of even those who felt COVID-19 fears were overblown. Here’s a summary of the US findings of this modeling, as written by University of Minnesota researchers:

To understand how mitigation or suppression would play out, the Imperial College team, led by Neil Ferguson, OBE, ran a model based on three scenarios. In the first, US officials do nothing to mitigate the spread of COVID-19, schools and businesses are kept open, and the virus is allowed to move through the population.

This would result in 81% of the US population, about 264 million people, contracting the disease. Of those, 2.2 million would die, including 4% to 8% of Americans over age 70. More important, by the second week in April, the demand for critical care beds would be 30 times greater than supply.

If mitigation practices are put in place, including a combination of case isolation, home quarantine, and social distancing of those most at risk (over age 70), the peak critical care demand would reduce by 60%, and there would be half the number of deaths. But this scenario still produces an eightfold demand on critical care beds above surge capacity.

In order to suppress the pandemic to an R0 of below 1, a country would need to combine case isolation, social distancing of the entire population, and either household quarantine or school and university closure, the authors found. These measures “are assumed to be in place for a 5-month duration,” they wrote.

So, with no social distancing, this model predicts over 2 million deaths in the US. Even with fairly strong mitigation practices, there are still over a million deaths and we will need more than 8 times the number of ICU beds we have now. Sadly, from what I can tell, we are somewhere around that level of mitigation with perhaps a few states going a bit more stringent. The UK just yesterday went to social distancing of the entire population, a move that Trump has resisted. Note also that even should the US move to full distancing, the model suggests a need to do so for five months. I’ve seen some pushback against this model, but I would argue instead that if anything, it is an underestimate because I fully expect compliance to fall far short of the assumptions in the model. I’ve seen suggestions that lack of compliance with early distancing orders drove much of the rapid outbreak in Italy.

It appears that the World Health Organization agrees that the US is far short of the level of distancing needed to quash the outbreak here. From Reuters:

The World Health Organization said on Tuesday it was seeing a “very large acceleration” in coronavirus infections in the United States which had the potential of becoming the new epicentre. Asked whether the United States could become the new epicentre, WHO spokeswoman Margaret Harris told reporters: “We are now seeing a very large acceleration in cases in the U.S. So it does have that potential.”

I can only imagine Trump’s presser on the day we become “number one” for the virus.

So even though there was a push for distancing as the Imperial College model was released, we’re already hearing that Trump has had enough. To be fair, Trump and his team were only talking about a 15 day process from the start, but any fool can see that we are still moving in the wrong direction in terms of new cases being discovered to even contemplate letting up on social distancing.

David Farenthold suggests one reason Trump wants to ease restrictions in the Washington Post:

President Trump’s private business has shut down six of its top seven revenue-producing clubs and hotels because of restrictions meant to slow the spread of the novel coronavirus, potentially depriving Trump’s company of millions of dollars in revenue.

Those closures come as Trump is considering easing restrictions on movement sooner than federal public health experts recommend, in the name of reducing the virus’s economic damage.

In a tweet late Sunday, Trump said the measures could be lifted as soon as March 30. “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” he wrote on Twitter.

Heaven forbid that Trump should lose a few dollars to save some lives. Sadly, though, Trump isn’t the only one spouting the bullshit. In fact, it’s pretty clear that Trump’s tweet about the cure being worse than the problem came right after he heard that phrase on Fox News. And to soften the territory for easing distancing, Fox yesterday had the Lieutenant Governor of Texas on to suggest that old grandparents like me need to be prepared to sacrifice our lives so that the economy can get going again. Of course, that’s complete bullshit, as once distancing is reduced anywhere, the effects will be spread over a huge area and across age groups. Anyway, here it is:

So that’s where we find ourselves today. We are perched at a spot where WHO is convinced that the US will be the epicenter of the outbreak within a few days. Instead of moving ahead with the full nationwide lockdown that will be needed actually flatten the curve, Fox News is helping Donald Trump to prepare the public for losing grandma and grandpa so that Trump properties can generate income again and Trump can hold his ego-stoking rallies. If distancing is reduced in a week, as Trump is wanting, the death toll in the US will reach catastrophic levels somewhere between the 1 and 2 million mark Imperial College calculated.

What is likely to interrupt Trump’s desire here, though, is the rate at which New York hospitals are filling. It sounds like they will be overwhelmed as soon as this weekend, so I’d like to think that there will be too much pressure to increase rather than decrease distancing once that reality strikes.

With Trump, though, there are no guarantees and reality often gets left in the dust.

Air Traffic: A Lesson on Pandemic Economics from the Airlines

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As yesterday’s presser and tweets make clear, Donald Trump is jonesing to reopen the economy in the United States. He’s doing that even as the airline industry is weighing whether to voluntarily shut down.

Thus far, according to NBC, Trump has opposed such a shutdown because he fears how the optics will affect his own political fortunes.

One point of tension as Trump tries to balance public and economic health has been air travel. He has repeatedly raised concerns in meetings about the optics of grounded planes and empty airports, according to two people familiar with the meetings. He’s argued that those images would look bad for him and could further drag down the economy, they said, while others have made the case for sharply curtailing air travel.

But according to the WSJ, airlines are considering shutting down voluntarily anyway. There are several reasons the airlines want to shut down (and would prefer to be ordered to do so).

The first and most obvious is that what flights are flying now are so empty they’re losing revenue.

On Monday, thousands of  flights were canceled, in some cases because planes weren’t full enough to justify the trip, with passengers numbering in the single digits. Some planes that did take off have been emptier than ever before. For example, a flight between New York’s LaGuardia Airport and Washington DC had just three passengers. American Airlines Group Inc. and United Airlines Holdings Inc. canceled over 40% of scheduled flights Monday, according to Flightaware.com, a flight tracking site. Some airline officials expect planes to be even emptier as the week goes on.

[snip]

But in the past few days, according to some of these officials, the prospect of an eventual halt has increased for various reasons, including mounting red ink from flying nearly empty planes.

There’s a bit in the story about concerns on the part of flight crews and onerous efforts to adjust schedules to minimize the possibility that crews can infect each other.

But by far, the biggest reason the nation’s airlines may shut down, voluntarily or not, is that infections at a number of air-traffic control facilities have shut down “nearly a dozen” facilities, including towers at Chicago’s Midway and Las Vegas’ McCarran Airports.

Airlines are preparing for the possibility that contagion-driven staffing emergencies at air-traffic control facilities could force the issue, making it impossible to continue operating in parts of the country.

Airport towers at Chicago’s Midway International Airport and McCarran International Airport in Las Vegas remain closed after nearly a week of cleaning.

[snip]

A separate important factor is that Federal Aviation Administration officials fear that additional positive tests for Covid-19, the disease caused by the novel coronavirus, among agency controllers and technicians who maintain their equipment could unravel the nation’s air-traffic control system. Nearly a dozen traffic-control facilities from New York to Chicago to Las Vegas have been temporarily closed to disinfect and clean them, with many more employees at home on self-quarantine while others are being investigated for potential contacts with infected workers.

So far, longstanding FAA contingency plans have managed to deal with the closures by imposing temporary flight restrictions, rerouting planes and shifting responsibilities among backup facilities and employees. Inside the agency, though, concern is growing that new employee infections, especially at key locations, could upend existing contingency options. In some cases, replacing controllers removed from their radar screens would be extremely difficult because it typically takes months of training to get them up to speed to do specific jobs.

Three days ago, traffic for the entire NYC area shut down briefly after a trainee who had been working at a Long Island air traffic control facility tested positive.

Flights into major New York City-area airports were briefly halted on Saturday, as the coronavirus continues to cause staffing issues at air-traffic control facilities around the country,  the Federal Aviation Administration said.

An air traffic controller-trainee based at a control center on Long Island tested positive for the virus, COVID-19, the FAA said. The trainee hadn’t been in the facility since March 17 but the agency is working with local health authorities to sanitize and clean affected areas. The center is operational, it said.

The FAA map of disruptions show the NYC area remains a problem.

This seems to offer an illustration that advisors can use to explain to Trump and his Fox News enablers why he may not be able to reopen the economy next week, and he seems headed to do. Aside from the fact that states and (unless Trump actually does use the Defense Production Act, which FEMA will only start using today) corporations can simply ignore him, there are critical functions of our economy that are proving unmanageable given the way infections can shut down key cogs of national and global systems. Until there’s testing and disinfecting regime that can ensure a single sick person doesn’t bring that network down, it’s not clear Trump has the ability to reopen the economy.

We would be better off, in my opinion, if Trump’s advisors had given him a list of things that had to happen — testing, medical equipment, and a screening regime like the ones used in Asia — before he could reopen the economy. Thus far, Trump’s efforts to meet those needs have been inadequate.

For now, however, he might look to the airlines’ inability to manage a relatively small number of infections among air traffic controllers, even during a time of sharply curtailed flights, to understand why it’s not as simple as saying we’ll just have to tolerate some illnesses.

Calling ‘Bullshit’ on Trump’s Hoocoodanode

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[Check the byline — yes, it’s me!/~Rayne]

“But the president said nobody could see this coming!” the Trumpists say.

Trump actually said, “No one knew this was going to happen! No one saw this coming!”

Bull shit. Bull. Shit. Lying, fibbing, prevaricating bullshit.

Community members have already seen this in comments, but it bears repeating because the propaganda machine is trying to grant absolution to Trump for his gross failure to act from January onward.

I saw this on New Year’s Eve in my Twitter feed. It was publicly available and should have given pause to anyone charged with this nation’s security. This is what SARS looked like when it started in late 2002 — but the Chinese government didn’t report it to WHO until February 2003.

This time a commercial media outlet may have reported the outbreak within 4-5 weeks of the index case.

Don’t tell me our intelligence community didn’t already know about this outbreak.

Don’t tell me Trump and White House personnel couldn’t and wouldn’t already have been notified.

It was right there in front of anyone who could read the news, begging for further investigation.

Why was Hong Kong so anxious about this — and why wasn’t the White House especially given the heightened tensions at the time between Hong Kong, China, and the U.S.?

What was so “mysterious” about this virus? Why wasn’t it already recognized?

How were the dozens who were infected being treated?

Was this pneumonia another SARS?

If CDC ‘knew’ three or four days after this article there was a new SARS-like illness, why did nothing come out of CDC for the public?

There are no good answers to this. There are only more questions.

Did the CDC’s director simply not do his job?

Did the National Security Adviser not do his job?

Did Trump not do his job?

Well, we know the answer to the that one: Trump chose not to act. We just don’t know exactly what happened at the top of the CDC and NSC. We know the NSC was also hampered by the loss of the pandemic response team, killed by then- National Security Adviser John Bolton in 2018.

We don’t know if Trump’s decision was ignorance,  arrogance, or a belief that hiding this would prevent any damage to his re-election campaign.

Which suggests stupidity was a key factor since Trump could have come out looking like a hero had he simply made a little effort. He could have pointed to successfully preventing a pandemic and done all the self-applied back patting he wanted.

But no. He did absolutely dick-doodley-squat.

Worse, he claims now, “Hoocoodanode?”

Bull shit. Bull. Shit. Lying, fibbing, prevaricating bullshit.

And now people are literally dying because of Trump’s bullshit, including his obscene attempt to practice medicine without a license claiming an anti-malarial was approved by the FDA for use against COVID-19.

There’s more blood on his hands; there will be yet more. How many more lives will he claim before we figure out how to work around his fatal bullshit?

Let’s not forget that the Republican Party owns this mess. He’s theirs. They tied their wagon to his. They could have removed him but they were afraid of his mean tweets.

And now their base — elderly voters — are most at risk of dying during this pandemic Trump could have headed off. The same elderly voters are also at risk of losing their lifetime savings as the economy crashes because Trump still can’t manage his way out of a wet paper bag. Where will the GOP call for easy donations after Trump kills off their base?

One more thing: Trump and his administration have been told what to expect from best and worst case scenarios, and those in between as recently infected persons become sick and need medical attention, and as contagion spreads.

They’ve also been told what will happen to our health care system, how burdened our for-profit hospitals will be and how short of ICU beds and ventilators and personal protection equipment we’ll be.

In some cases, how short we already are and have been.

Trump has done very little about the PPE, left the states to fend for themselves. A few hundred masks from the federal strategic reserve for any one state won’t go far when a single large hospital can use thousands a day during normal business. Suggesting masks should be reused revealed not only Trump’s gross ignorance and cheapness but a shocking lack of understanding about basic infection control.

In spite of estimates which have surely made it to the CDC and DHS, and estimates from the American Hospital Association we’ve seen here more than two weeks ago, the administration has done little to nothing to meet the anticipated shortfall.

This estimate now appears on the light side and yet almost nothing has been done to help hospitals fulfill patients’ needs as they are today, let alone what they will be as the full depth of the pandemic wave hits.

Naval hospital ships arriving in another 3 to 4 weeks time are an insult not unlike the fatal insult Trump offered to Puerto Rican Americans in 2017.

“Hoocoodanode” won’t fly here. There’s no excuse. Trump and his minions were warned.

They own every American death for their failure to fulfill their duty to this nation.

This is an open thread.

Trump Considers Getting Hospitals Ventilators Nationalization But a Bailout for Him and His Rich Buddies Necessity

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Yesterday, Trump sent remarkably mixed signals in his press conference. He was asked whether he was going to use the Defense Production Act to address the shortage in key medical supplies. He replied by suggesting that using DPA to push manufacturers to prioritize urgently needed supplies amounts to nationalization.

We’re a country not based on nationalizing our business. Call a person over in Venezuela, ask them how did nationalization of their businesses work out? Not too well. The concept of nationalizing our business is not a good concept.

He went on to suggest his Administration doesn’t know who could fill urgent needs, which sounds like a confession that he shouldn’t have fired the pandemic experts.

Later however, Trump treated the socialization of big business losses — of his big business losses — as an acceptable step to save great businesses. After Seung Min Kim asked whether Trump would commit that none of the funds from a $500 billion bailout of big businesses would go to his company, he complained that he hasn’t been thanked for things like taking no salary. He ultimately said he would see, the kind of deferral he often uses to avoid saying yes.

He returned to his complaints later in the presser. In response to a question about whether he had sold stock, he first lied, and claimed that he didn’t own any. He rambled for minutes complaining about being booed. Ultimately, however, he complained about how much it cost rich people to run for office.

A big part of the reason the economy had to be shut down is because Trump did not respond in January when he was warned of the pandemic. And now he’s treating taking steps to provide medical workers the equipment they need as some kind of socialism but bailing himself out as a necessity.

Hurricane COVID-19

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[Check the byline, thanks! /~Rayne]

This is a hurricane. You recognize the threat such a storm poses especially if you live in a coastal region; you know that you must be ready by the time the outer bands begin to lash your home. You must be hunkered down and ready to ride it out.

This, too, is a hurricane. Our nation’s problem is that an overwhelming number of Americans didn’t recognize this impending storm when this first man-made outer band hit the airports the weekend of March 15.

Thanks to the incredible incompetence and/or malignancy of Trump’s minions Jared Kushner and Stephen Miller, this hurricane gathered energy in airport terminals across the country.

All the people who were exposed to those who were contagious in these confined and inadequately vented airport spaces are now into their first week of their own contagious state, with and without symptoms.

All the people in this photograph who are going to experience moderate/severe/critical symptoms are beginning to do so now and over the next week.

All the people in this picture who are asymptomatic or have mild, cold-like symptoms are still functioning as they did before their trips which took them through the airports. They are contagious and have no clue that they are for the most part.

The hurricane has only just begun and you had better be hunkered down, staying in your shelter.

The hurricane has only just begun and states need to lock down these contagious persons.

The White House’s bullshit 15-day period is just that, bullshit. The public has NO idea when those inept and corrupt jackasses began counting their 15 days. More importantly, to break this contagion will require MORE than 15 days because there hasn’t been a uniformly-applied, well-communicated lockdown, and because the federal government continues to yank us around on both testing and personal protection equipment.

I’m begging businesses small and large to understand there is NO economy ahead if this hurricane wipes a broad swath of consumers off the map, if this hurricane sweeps away resources through sustained illness and dealing with the fallout from deaths.

Small and large businesses must also come to the same conclusion as governors and other state leaders: the Trump administration has failed, is failing, and will continue to fail just as it did in 2017 before, during, and after Hurricane Maria.

Thousands of Americans died on a small island because of gross negligence by Donald Trump and his administration. They were in better shape then, had more resources than they do now, because there has been continued gross neglect of the government systems required to respond to emergencies and disasters.

The tests are not coming. The personal protection equipment isn’t coming. Assume you must find alternatives in your own backyard. Build them and protect your own. Work with state and local government to identify shortfalls and fill them. Do what the Trump administration has refused to do — be competent, be pro-active, care for your state and communities.

Do it right the fuck now before the next band of this hurricane comes within the week.

Not everyone will be able to take shelter even as states like Michigan order lockdown — it’s expected at 11:00 a.m. today that Gov. Gretchen Whitmer will announce all non-essential businesses shut down. Those folks who must continue to work need our understanding and our efforts to protect them.

So, too, do the folks who can’t afford to take time off work but will and have been forced to do so. Their bills continue even as their work stops.

Call your representatives and senators and ask them to pass aid packages which help the working people of this country, those in the lower 50% of income, because money given to them in aid is immediately plowed back into the economy.

The Trump tax cuts clearly didn’t put money back into the economy; savings from the cuts were used to buy back stock and boost share prices rather than create jobs or invest in equipment. Corporations received aid with those cuts; they shouldn’t get more after having abused the chance to build more robust business able to withstand this hurricane.

Nor should any business which pays zero taxes or operate in a different country — like cruise ship lines operating under foreign flags to avoid U.S. taxes — receive any consideration.

The Senate is scheduled to reconvene at noon E.T. — contact your representatives and senators NOW, whether by phone, fax, or @Resistbot.

Congressional switchboard: (202) 224-3121

Above all, #StayTheFuckHome.

This is an open thread.

Three Things: The GOP’s Trumpian Death Panels [UPDATE-1]

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[Check the byline, thanks! Update at the bottom of this post. /~Rayne]

Remember all the squealing by conservatives and Republican members of Congress back in 2009-2010 during the debate about health care, crying crocodile tears about “death panels“?

Well here they are, death panels brought to you by the same whiny selfish leeches who claimed socialized medicine would result in Democratic bureaucrats picking off Americans to limit health care.

~ 3 ~

I won’t embed video here. Open these links at your own risk, knowing these may be triggering to those who’ve had bad experiences in hospitals.

1 — Bergamo Italy hospital

2 — Brescia and Rome Italy hospitals

But this I’m going to share.

Those are Italian military trucks carrying away the dead to churches and cremation facilities, some outside of Bergamo because Bergamo’s own facilities are at capacity.

This, in a very much pro-life country which is predominantly Catholic.

This, in a country which has more hospital beds per 1000 persons than the U.S.

Some of those patients who are not in ICU have likely been labeled “codice nero” — death is imminent, do not resuscitate — during triage due to the shortage of ventilators. They are more likely to be over 60 years old because they are prioritizing critical care services and equipment for those more likely to survive.

This is what conservatives and Republicans really wanted: death panels, but conducted by the poor overtaxed health care workers who are themselves at risk because of incompetent governance by conservatives and Republicans.

I hope Americans are ready to see the dead hauled away by the truck load after the GOP’s death panel is through with them.

~ 2 ~

$34,927.43.

That’s the price for multiple tests and trips to the ER over seven days for COVID-19 an uninsured Boston-area patient was charged. You can imagine some people aren’t going to want to deal with that bill — or that swamped hospitals may discourage the uninsured — leading to a lack of treatment and more deaths. Many patients will be too sick to hassle with chasing a lower cost approach as charges can vary widely across many health care providers.

A death panel by health care expense.

Capitalism unto death.

~ 1 ~

Death panels may be composed of single individuals.

John Bolton, with Trump’s imprimatur, chose to kill the National Security Council’s pandemic response team, which has now lead to the deaths of Americans.

Mike Pompeo’s crappy diplomatic work failed to develop and build relationships with China, South Korea, other countries facing the same pandemic threat in order to obtain and share usable information and assistance to reduce American deaths.

Jared Kushner and Stephen Miller pulled a grossly negligent EU travel ban out of their asses, executing it so poorly that the resulting crush of travelers in the airports last week will sure increase American deaths in the weeks ahead many times over.

And the malignant narcissist-in-chief continues to push bad information jeopardizing lives both here and abroad after more than two months of inaction. Trump pushed a non-peer reviewed study on hydrochloroquine and azithromycin by tweet today after pushing this drug combo during a presser. There’s already been a run on the anti-malarial potentially hurting lupus patients for whom this has been prescribed; there’ve also been reports of poisonings in Nigeria after users self-medicated with the anti-malarial.

Trump has also mentioned and then lied about the Defense Production Act. There has been no real effort to order production of personal protection equipment for health care workers under the DPA. He’s choosing to expose first responders to COVID-19.

Mass death panels by Trumpism.

~ 0 ~

Sadly, it’s not just Americans who will face so-called conservatives’ death panels. The UK is already entering a state of crisis as its hospitals’ ICUs exceed capacity. There is no sign of constructive decision making by Boris Johnson to alleviate the capacity problem nor realistically halt the rate of infection.

Instead, Johnson’s government and now Trump’s Department of Justice are seeking powers to detain people instead of doing what is already within their ability and purview to do to stem contagion and aid respective health care systems.

Death panels by Tory conservatives and Trump fascists.

By the way, where’s Sarah Palin now? Still licking her polyester-pink wounds after her recent fiasco appearance on The Masked Singer when the show’s death panel gave her the much-deserved axe?

This is an open thread.

UPDATE-1 — 22-MAR-2020 — 11:00 P.M. ET

This video features Rep. Katie Porter’s sister who’s an emergency room physician. She breaks down what the Trump-GOP death panel will decide by the numbers.

Are you one in 50? Or are you one of the 49 which Trump and the GOP have decided in their pro-life hypocrisy won’t be saved?

The Costs of Letting Trump Believe His Authoritarian Buddies Instead of His Intelligence Community

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WaPo has a story confirming something that has long been implicit (based on Trump’s treatment, for a period, of COVID-19 briefings as classified). The intelligence community was tracking and briefing on the COVID-19 outbreak long before it rose to public attention.

U.S. intelligence agencies were issuing ominous, classified warnings in January and February about the global danger posed by the coronavirus while President Trump and lawmakers played down the threat and failed to take action that might have slowed the spread of the pathogen, according to U.S. officials familiar with spy agency reporting.

[snip]

Intelligence agencies “have been warning on this since January,” said a U.S. official who had access to intelligence reporting that was disseminated to members of Congress and their staffs as well as to officials in the Trump administration, and who, along with others, spoke on the condition of anonymity to describe sensitive information.

[snip]

The warnings from U.S. intelligence agencies increased in volume toward the end of January and into early February, said officials familiar with the reports. By then, a majority of the intelligence reporting included in daily briefing papers and digests from the Office of the Director of National Intelligence and the CIA was about covid-19, said officials who have read the reports.

The money line repeats one the CIA used to describe how George Bush ignored warnings about 9/11: the system was blinking red.

“Donald Trump may not have been expecting this, but a lot of other people in the government were — they just couldn’t get him to do anything about it,” this official said. “The system was blinking red.”

What’s key though (and, because of editing decisions, doesn’t get a lot of focus in the story) is one reason why Trump didn’t heed the warnings of his briefers: because he believed Xi Jingpeng more than he believed the US intelligence community.

The intelligence reports didn’t predict when the virus might land on U.S. shores or recommend particular steps that public health officials should take, issues outside the purview of the intelligence agencies. But they did track the spread of the virus in China, and later in other countries, and warned that Chinese officials appeared to be minimizing the severity of the outbreak.

[snip]

Robert Kadlec, the assistant secretary for preparedness and response — who was joined by intelligence officials, including from the CIA — told committee members that the virus posed a “serious” threat, one of those officials said.

Kadlec didn’t provide specific recommendations, but he said that to get ahead of the virus and blunt its effects, Americans would need to take actions that could disrupt their daily lives, the official said. “It was very alarming.”

Trump’s insistence on the contrary seemed to rest in his relationship with China’s President Xi Jingping, whom Trump believed was providing him with reliable information about how the virus was spreading in China, despite reports from intelligence agencies that Chinese officials were not being candid about the true scale of the crisis.

We all pay for Robert Kadlec to make sure policymakers get warnings about such things. And yet, Trump refused to believe those warnings because someone he trusted more — Xi — told him differently.

Trump has been permitted to believe his authoritarian buddies over the intelligence community on all manner of things. It derives from two things: first, his own innate fondness for authoritarians. But also, his need to believe Vladimir Putin’s assurances that Russia didn’t help him get elected.

The enabling of Trump’s fondness for dictators will end up being very costly for the United States.