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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.

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.

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?

Three Things: Racist Redirects as GOP Clings to Its Brand

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[Check the byline, thanks!/~Rayne]

No news on the family front with regard to COVID-19 — at least with my family. No news is good news here.

I feel so very sorry for the New Jersey family which lost three of its family members * to COVID-19 this week. It was a blessing to the matriarch she didn’t know she lost her two oldest children; the heartbreak on top of the virus would have been torture beyond human ken.

None of this had to happen, either. Not a lick of it.

And it’s really only just beginning.

~ 3 ~

Let’s get this out of the way: Donald Trump is a racist jerk. He can’t read anything but inch-high print prepared for his ease; he had to go out of his way to make absolutely certain that he referred to COVID-19 as “Chinese.”

This is wholly intentional, deliberate as hell.

The fact COVID-19 emerged from China to become pandemic was sheer dumb luck. Spare us the racist bullshit talking down about eating unfamiliar animals and wet markets.

For Christ’s sake people here in the U.S. eat road kill and celebrate those animals with a festival.

They eat organ meats, blood sausages from across their many ethnic heritages, and they do odd-looking things with products made of proteins extracted from cartilage.

Americans and all the cultures from which they emerged have their own relationships with animals which have spawned biological crises over millennia. Just read Jared Diamond’s Guns, Germs and Steel.

It was simply a crap shoot this pandemic originated in China and not from a hantavirus in the American Southwest, or a flavivirus from South America or Africa. Chances are good we may yet see another emergent threat like a virulent Zika as the climate continues to warm.

Americans don’t have room to criticize. Their president being a racist moron to China about a crappy draw of luck is just plain stupid.

So is his and his party’s escalation of tension with the other largest economy in the world which both owns a lot of our debt. It’s incredibly shortsighted to bash the country which has been incredibly generous with research data based on their harrowing national experience with COVID-19.

I can’t begin to imagine how bad off the U.S. and other countries fighting COVID-19 would be if China hadn’t shared genomic and epidemiological data with the world.

We would not only be as far behind as we are because this administration felt winning re-election was more important than doing its job. We would have had to do much of the genomic and epidemiological research ourselves, on the fly, while our country’s health was in meltdown.

One need only look at how little research material has been published by other countries during this epidemic for comparison. They, too, have relied on China’s research.

Or look at how we continue to rely on China to do human testing – likely cutting corners on human experimentation ethics – just so Americans can obtain the benefit of a successful drug therapy while an American company reaps benefits.

No one of Asian ethnicity and heritage should have to put up with the hate unleashed by that slack-assed racist in the White House and the team of inept and bigoted enablers who are propping him up.

We may have legitimate concerns with China about supply chain integrity and intellectual property theft, but it’s on the U.S. that this is an issue to begin with. Outsourcing so much of what should be critical infrastructure is our own fault.

And failing to act in a responsible timely manner to a pandemic threat is solely that of the racist scumbag at the podium.

~ 2 ~

Speaking of failing to respond to pandemic threat…

If Senator Richard Burr knew by February 13 — when he sold $1.6 million worth of stock — that COVID-19 posed a potential national emergency, who else did and did nothing?

By “did nothing” I mean the way Burr lied to our faces and said, “the United States today is better prepared than ever before to face emerging public health threats, like the coronavirus,” a day before he voted to acquit Trump and six days before he sold his stock.

Think back to the earliest time you heard about the viral illness in China. Do remember when you first heard or read about it?

I do. I had just read about two high-profile deaths from pneumonia in middle and late December. A Chinese actress died, noted in Chinese media. She wasn’t known well to the U.S. so no mention here had been made. Only days later, right around Christmas, a young ESPN anchor also died of an odd pneumonia. This time there was news in the U.S. about his passing.

A week later on New Year’s Eve there was a report in English-language Chinese media about an odd cluster of pneumonia-like illness in Wuhan, China. My awareness of pneumonia had been heightened by the two high-profile deaths so close together.

If I could see a cluster of pneumonia in China by New Year’s Day, you know somebody within the U.S. intelligence community saw it even earlier.

We know now that the Senate Intelligence Committee chair had been briefed, based on a recording made of a meeting Burr had with large-ticket donors. Who else holding elected or appointed office were also briefed by intelligence and then refused to do the right thing to protect the American public?

Now you know why there’s been a full court press from the White House through the GOP congressional caucus to the right-wing media and punditry pushing racist invective against China about the pandemic.

It’s to distract and redirect the public’s attention away from the GOP’s wholesale betrayal of the American public and its allies while COVID-19 ramped up into a pandemic.

By the middle of summer thousands, perhaps tens of thousands of American lives will be lost because Richard Burr and others as yet unnamed helped Donald Trump fuck us over for their own venal aims.

Trump and the GOP had absolutely no intention of doing anything about COVID-19, which explains why Trump has only mentioned but still not used the Defense Production Act to ensure health care workers have adequate personal protection equipment. Crafters across the country are sewing homemade masks of irregular specifications right now to make up the shortfall while health care workers scavenge hardware supplies for mashed-up PPE.

Can’t help wonder how much PPE that $1.6 million would buy.

Or how much the profits from Sen. Kelly Loeffler’s stock sale would buy, or Sen. James Inhofe’s or Sen. Ron Johnson’s stock sale profits. (Sen. Dianne Feinstein’s household also recently liquidated stock but her press secretary said it was in a blind trust with the rest of her assets.)

Loeffler’s financial moves are egregious not only because of profit taking on inside information not shared with the public and then lying directly to the public on camera about the country’s condition. She then acquired stock in a business specializing in remote work, and her spouse is the chairman and CEO of the New York Stock Exchange. There’s absolutely NO excuse for not having her assets in a blind trust to avoid the appearance of a conflict of interest, particularly because of her spouse’s role. But I guess when you’re worth half a billion dollars you just don’t give a shit about annoying little details like ethics.

~ 1 ~

In previous posts I’ve discussed the different drugs being studied as potential therapies for COVID-19. This is an extremely important point which must be emphasized: all drugs, whether antivirals or monoclonal antibodies or anti-inflammatory meds are subjects of study. Some are being used off-label as last ditch efforts.

By off-label I mean they are NOT approved by the Food and Drug Administration as safe and effective for treatment of COVID-19 infections.

We are relying on off-label medications applied by doctors in desperate conditions in China and Italy on patients who are in dire shape to tell us about their effectiveness. We are literally relying on human experimentation without a consistent ethical framework

Yesterday’s presser with Trump was a disaster not only because of his racist bullshit aimed at China, but because he fucked up and discussed off-label drug therapies. He should have left that all together to the Center for Disease Control and the Food and Drug Administration.

His half-assed, poorly-framed remarks about an anti-malarial drug set off a run on black market chloroquine in Nigeria. The drug had been removed from the Nigerian market more than a decade ago because of the risks it poses to patients. It’s quite likely people will die because of misplaced trust in Trump’s words about this drug.

Two antivirals, lopinavir and ritonavir, used as a cocktail in a study in China failed to perform as needed against COVID-19. A study announcing these unfortunate results was published just Wednesday in  the New England Journal of Medicine. (Yet another example of Chinese researchers providing a benefit to the U.S. and the world, I’ll point out. Can only wonder what happened to the subjects of the test.)

And another antiviral discussed here before, remdesivir, is still under study, and still poses an unexamined conflict of interest for at least one person in the Trump administration.

The media did not catch how bad Trump’s remarks on drugs were — that hack Chris Cillizza offers an example, failing to mention the gross and dangerous errors about these medications in his list of fail.

Trump’s words and deeds, likely the output of his inept team including his son-in-law Jared Kushner and his pet Nazi Stephen Miller, are going to kill more people here and abroad on top of COVID-19. Given Miller’s history with this administration, this may be the desired result.

~ 0 ~

* I started writing this post Thursday mid-day. Before I finished it a fourth family member died.

Meanwhile, in neighboring New York, Gov. Cuomo doesn’t want a “shelter in place” order because it sounds too much like nuclear war and might scare people.

New York City is a COVID-19 hot spot rapidly become an American Wuhan cell. More people are likely to die there of COVID-19 than died during 9/11, and we changed our society dramatically out of fear of another such event. New Yorkers and the rest of the U.S. whose banking is centered in NYC need more than Cuomo’s personal concerns about a turn of phrase.

But as I said earlier, none of this had to happen, either. Not a lick of it. It makes the ongoing daily failures even more ridiculous because most are unforced errors. Much of the daily fail could be so easily stopped if Trump just shut up and left handling COVID-19 to ethical professionals.

This is an open thread.

Three Things: Even More Family Fun with COVID-19

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[Check the byline, thanks!/~Rayne]

I figured it would be the oldsters in the family who would be my first worry. The grandparents still go to church, play bridge and golf, volunteer; they’re living typical retirees’ lives. They haven’t stopped mingling socially until this week.

But no. Last week I had to worry about my younger kid at college first. Fortunately they only had strep.

Last night the older adult child called, complaining of a migraine, dry cough, wheezing, and a tight chest. They’d already called the doctor about their symptoms; the doctor wouldn’t order a test because older adult child didn’t have a temperature.

All the other symptoms of COVID-19 except for a temperature. With so few tests available in Michigan, unless my kid checked ALL the boxes, there’s no way they’d be tested.

We’re pretty sure it’s not flu because the symptoms were slow onset rather than fast and adult child had a flu shot this year.

The kicker is that someone at work tested positive for COVID-19. It just hadn’t been announced across the business, likely because the business still needed to finish its plan for handling this situation.

Because my adult child couldn’t get a test, their spouse can’t say they’ve been exposed to COVID-19 and is likely now at work, probably spreading this around if indeed my adult child has COVID-19.

I won’t see my older kid or their spouse for a least a month now since we don’t yet know for certain if they have COVID-19 let alone how long exposed persons may be contagious. I dare not take the chance to see them because of my autoimmune disorder — not just because I might come down with COVID-19, but because hospitals may not be able to offer me an adequate level of care if there are no hospital beds or ventilators if one was needed.

When I saw this bullshit tweet this morning I almost levitated.

All the stress of our not knowing individual infection status and potentially exposing even more Michiganders is due to Trump, who instead directs his animosity toward an effective governor who isn’t getting the support she needs from the federal government.

My family and many others in Michigan and across the country are going through this Kafkaesque circus of uncertainty because the grossly-incompetent-when-not-corrupt Trump administration chose not to do the right thing and roll out testing back in January-February so that community acquired infections could be pinpointed earlier.

The one piece missing in this equation: why is it some people can get tested and others can’t? What arbitrary ju-ju allows Oklahoma to offer up a sizable percentage of its available tests for the Utah Jazz basketball players? Why are some political figures able to summon a test when others can’t?

Is this an additional layer of fuckery, not only the limitations on the number of tests available but an invisible prioritization of who can be tested? Does one’s political party affiliation make a difference, or the color of their state when it comes to getting a test for COVID-19 on a timely basis?

~ 3 ~

The UK did an about-face in its approach toward COVID-19. Boris Johnson backed off the idiocy of allowing the virus to simply run amok through the population to kill its most vulnerable citizens as well as those with the misfortune of being severly to critically ill while UK hospitals are overwhelmed by COVID-19 case load.

However, in spite of the noise made over the Imperial College’s latest assessment of COVID-19’s impact on the UK, nothing is being done. Leadership may have made some noises of surprise over the published mortality numbers but there have been no orders to lock down the country the way France has this past week, or Italy before that.

Instead, Johnson urged Britons to avoid pubs, restaurants and theaters.

He asked that the public only use the NHS “where we really need to.”

Britons were asked to avoid non-essential travel.

In short, a guidance was issued which appears wholly optional. It has no teeth.

Most importantly, Johnson did not order the country’s schools shut down, though young people are believed to be vectors for the virus. Murdoch’s tabloid-y outlet The Sun reports Johnson “hints” at shutting down schools in a few days, though a petition gathered more than 650,000 signatures asking for Johnson to do so immediately.

These numbers were pointedly ignored, though there was moaning at the number of deaths projected by Imperial College’s report — an estimated 250,000 souls. Johnson’s actions to date do little to mitigate let alone suppress COVID-19’S contagion, choices Imperial College explained as approaches to minimizing deaths.

The number of deaths even if Johnson implemented a more aggressive suppression regime in Great Britain* is staggering…

(*Great Britain versus United Kingdom may explain why the numbers shown are lower than a thumbnail analysis based on 67M UK residents x 40% infection rate x 2% case fatality rate.)

\Johnson’s action to date fails to respond adequately to the swamping of UK’s health care system, particularly its intensive care systems.

This past weekend the country continued to go to pubs and concerts, looking much like the revelers partying at the Masque while the Red Death roamed outside the walls of the palace.

Being on an island will not protect them, nor will having expressed a desire to leave the EU.

We won’t be able to help them, either; Trump has done little more than Johnson has for the U.S., relying instead on the states to do the heavy lifting of saving American lives.

If we survive this next year, those of us who are most at risk will owe our lives to the efforts of governors like Gretchen Whitmer, who must not only make the impossible happen with limited resources, but with an ignorant, mean asshat president whining about them at the same time.

~ 2 ~

One of our community members Surfer2099 has been digging away at pharma company Gilead Sciences; the company makes an antiviral drug, remdesivir, which has been used off-label to treat COVID-19 patients. As noted before in previous posts, the medication was shipped to China for tests without normal approval of the FDA.

Bloomberg reported yesterday that China wants to patent remdesivir (link to story at Reddit). It looks like China wants the patent in exchange for having allowed Gilead to test its drug on COVID-19 patients, bypassing the FDA’s test protocols in the U.S.

Surfer2099 noted that Gilead coincidentally launched a merger and acquisition the first week of March. How does such a move fit into the negotiations with China?

Don’t look away from this as remdesivir appears to have widening support in the treatment of COVID-19. If it’s the only drug approved by drug agencies including the FDA, there’s considerable money to be made with tens of millions of COVID-19 patients anticipated over the next 1-2 years.

~ 1 ~

Fortunately there was a little good news yesterday. A COVID-19 vaccine was injected into the first human volunteer in a Phase 1 trial. If successful, the vaccine will not be available for the public for at least a year and likely longer.

NIH Clinical Trial of Investigational Vaccine for COVID-19 Begins

The realistic time frame from this first injection to a public vaccine is at least 12 to 20 months under the best conditions, i.e., no reactions, no other hiccups like supply problems, no interference from outside entities like the Trump administration.

That’s how long we need to practice social distancing — at least 12 to 20 months. Settle in and develop a routine for the long haul.

~ 0 ~

This is an open thread. How are your friends and family doing with the changes we’ve had to make to our lifestyles?

Meanwhile, Over at Foggy Bottom

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“No, you don’t need to be tested. Never mind all those coughing people sitting across the table from you at lunch. I’m sure it’s nothing.”

It’s rough being a career member of the US State Department workforce in the Donald Trump era. In general, much of the work of these people is not particularly affected by the changes in presidential administrations. Passports get issued to US citizens who wish to travel abroad, and visas get processed for those who wish to visit here. Those posted at embassies abroad listen to what is happening around them and report the most interesting stuff back to Foggy Bottom in DC, and they take what they’re told by Foggy Bottom and share it with the country in which they are posted. Big things change, like treaty negotiation postures and diplomatic postures on big picture issues, but the nitty gritty stuff is pretty ordinary and non-controversial.

But now, there’s a new wrinkle: whatever you do, don’t do or say anything that will make the guy who sits in the room with no corners look bad. He does not react well. And that wrinkle makes even the ordinary nitty gritty stuff difficult.

“Domani Spero,” the pseudonym of the author of DiploPundit, means “See you tomorrow, I hope,” which seems a fitting moniker for someone who watches the ins and outs of the State Department. Says he, “DiploPundit wades into leadership and management issues, realities of Foreign Service life, ambassadors and nominations, embassy report cards, current events in countries and regions which may or may not include prominent U.S. interests, and other developments in the international affairs community.” His writing assume that his readers are familiar with State Dept jargon and acronyms, which can put some readers off. On the other hand, for those in and around the US diplomatic community, DiploPundit is a definite place to check in for details that might not make it into general media reporting. Along the way, he occasionally posts items that come from his “burn bag” (State Dept lingo for the receptacle for classified trash that must be burned, rather than taken to the curb), which is his place for receiving anonymous tips. These often come from current State Dept employees, raising issues that they do not feel comfortable in bringing to the attention of their superiors via in-house channels.

Four days ago, DiploPundit noted that the US Embassy in Kingston, Jamaica put out a classic non-denial non-response to a story in the local media. While he didn’t link to the story, he seems to be referring to the Jamaica Observer, which wrote this last Wednesday:

A second case of COVID-19 has been confirmed in Jamaica.

Health Minister Dr Christopher Tufton confirmed the second imported case via Twitter this evening.

Dr Tufton said the second case is a US Embassy employee who returned from the UK.

As you might guess, the US Embassy in Kingston started getting calls about this, their response boils down to “we’re aware of the report and will not confirm or deny it, but we’re working with Jamaican authorities and doing a really deep cleaning of all embassy facilities.”

Three days ago, DiploPundit wrote up a Burn Bag post, sent to him by “sickdips”:

“Members of the Embassy community at one post have fallen seriously ill with COVID-19 symptoms, but the State Department will not test them for COVID-19 or *MEDEVAC them. There is already limited medical capacity at many posts, which will be completely overwhelmed as the pandemic spreads. What is MED waiting for? Protecting our people should be our NUMBER ONE PRIORITY.”

MEDEVAC is exactly what it sounds like – medically evacuate – and MED is the acronym for the State Dept’s Bureau of Medical Services. When I went to MEDs page at State.gov, it had nothing but standard “here’s what we do” language and no news items related to COVID-19 among US embassy staffers.

This led me back to that non-denial non-response. In the middle, there’s one sentence that jumped out at me: “The U.S. Department of State has no greater responsibility than the safety and security of U.S. citizens overseas and locally-employed staff.” Remember what I said at the top? Don’t say or do anything to make the guy who sits in the room with no corners look bad. That’s what’s going on in this statement. “Make sure you tell everyone that we take care of US citizens!”

If sickdips saw this (whether Jamaica is the post about which sickdips was writing or not), it’s probably what prompted sickdips to drop a note to the Burn Bag. Fancy words about protecting the safety of embassy staffers are nice, but actions on the ground like refusing to test after exposure to a known carrier of COVID-19 suggest otherwise.

That was three days ago. The following day, DiploPundit posted a roundup of items about COVID-19 at various embassies, which laid out nine different countries (including Jamaica and Italy) where ordinary services are restricted or the embassies and consulates are completely closed for all but the most extreme emergencies. The list included this observation at the top: “As of this writing, we have not seen any public announcement or guidance from the State Department on COVID-19 for employees or family members. Let us know if we missed any statement from Pompeo or [Undersecretary of State for Management Brian] Bulatao.”

That last sentence was DP poking Pompeo and his chief aide for running the State Department with a very sharp stick, and doing it in a place where everyone in the diplomatic community could and would see it.

That was two days ago. Today, the State Department put out an updated health warning for US citizens thinking about traveling abroad. The short version is this: don’t. The longer version is this:

Global Level 3 Health Advisory – Reconsider Travel

March 15, 2020

The Department of State advises U.S. citizens to reconsider travel abroad due to the global impact of COVID-19. Many areas throughout the world are now experiencing COVID-19 outbreaks and taking action that may limit traveler mobility, including quarantines and border restrictions. Even countries, jurisdictions, or areas where cases have not been reported may restrict travel without notice.

On March 14, the Department of State authorized the departure from any diplomatic or consular post in the world of US personnel and family members who have been medically determined to be at higher risk of a poor outcome if exposed to COVID-19.

The first part of that is the language you’d find in a standard State Department warning, albeit these kinds of warning are usually aimed at specific countries or regions, not the whole world. But the second part of that — the part that begins “On March 14 . . . ” — is not standard. Not at all. It sounds to me as if someone at Foggy Bottom who read DiploPundit’s poke tried to address the concern, but “put it out with the trash” late on Saturday, hoping it wouldn’t get too much attention from the general media, and thus incur the wrath of that guy in the room with no corners.

This is a deeply serious development. This kind of “we’ll pull anybody out of anywhere” statement is damn near unheard of, and the only reason I say “damn near” is to give myself wiggle room should someone with greater historical knowledge step up. I can’t think of anything close, ever.

But even so, as broad and sweeping and unheard-of as this is, I don’t think on it’s face it is enough. As DiploPundit notes, “So the ‘authorized departure’ or voluntary evacuation depends on the determination of the local MED unit or based of current medical clearance?” You remember MED – the same folks that wouldn’t authorize testing personnel who had been in contact with an infected person?

Poke, poke, poke.

UPDATE from DiploPundit:

The cable released by State/M Brian Bulatao says: “Effective March 14, 2020, I hereby approve authorized departure (AD) from any diplomatic or consular post of U.S. direct hire employees or eligible family members (EFMs) as listed on employee orders and defined in 14 FAM 511.3 who, after confidential consultation with MED, have determined they are at higher risk of a poor outcome if exposed to COVID-19, or who have requested departure based on a commensurate justification in foreign areas.”

Our source, not from Public Affairs, interpret this to mean that MED approval is not specifically required but you need to refer to MED when you go tell your boss you want out.

The  last time we had a global authorized/ordered departure order was probably during Y2K, was it? (The State Department at that time also issued an edict stating that all embassies must be prepared to be self-sufficient for 30 days by January 1, 2000).

When Trump gave his speech last week about the “foreign virus” and the need to blockade the EU but not the UK, it was clear that Trump was acting out of his usual playbook: xenophobia, build bigger walls, get revenge on your foes and carve out loopholes for your friends. Since then, clearer heads have pushed Trump to include the UK in his travel blockade, as viruses do not care about the color of your passport. I suspect those clearer heads are folks like Anthony Fauci on the medical side and whoever at State authorized the evacuation of any diplomatic staff from any post over medical concerns.

God bless them both, because it clearly takes the concerted effort of a group of people who are willing to make the guy in the room with no corners look bad if he’s doing stuff that will kill innocent people. And make no mistake: he *is* doing stuff that will kill innocent people. (See Jim’s post on the Customs mess at airports last night.)

Domani spero, everybody. See you tomorrow, I hope.

Trump’s Customs And Border Protection Just Created Hundreds Of New COVID-19 Superspreaders

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Earlier this week, Donald Trump announced Vladimir Putin’s dream of travel restrictions in response to the the COVID-19 pandemic, “banning” travel from Europe, but excepting the UK, where there are many more cases than in a number of European countries. Trump eventually was forced to add the UK to the ban. As the new policy began to roll out yesterday in the major international US airports, there was nothing less than a clusterfuck of epic proportions. The feature image for this post comes from a Brooke McDonald tweet showing a huge crowd trying to clear customs at O’Hare. Here is a tweet from a Fox station in Texas showing the crowd trying to clear customs at DFW:

What could possibly go wrong? With large crowds of people coming back from infection hot zones, milling about for what was reported to be up to seven stress-filled hours, it’s hard to imagine a scenario more conducive to efficient spread of the virus.

Here is the New York Times on what unfolded:

Under the new screening rules, when travelers arrive at 13 designated airports they are to be interviewed by a Customs officer, who will also review the person’s travel history using a Homeland Security database. The officer will ask them about their current medical condition. If they don’t show symptoms, they will be asked to quarantine in their homes for 14 days. Depending on their symptoms and previous medical history, travelers could be subject to an additional screening by a medical professional at the airport. They could also be subject to a federal quarantine.

Seems simple enough. But in Trump’s era of never having enough of the right employees in the right place, this simple screening resulted in the massive delays. Here is the Acting Head of Customs and Border Protection on the situation last night:

Yeah, right. Nothing is more important that the health of our citizens, so you trap thousands of people into tight spaces that are virtually guaranteed to have symptom-free people shedding large amounts of virus.

Here’s how that happens.

First, we know that virus can be spread by folks not showing symptoms. From CNN:

New studies in several countries and a large coronavirus outbreak in Massachusetts bring into question reassuring assertions by US officials about the way the novel virus spreads.

These officials have emphasized that the virus is spread mainly by people who are already showing symptoms, such as fever, cough or difficulty breathing. If that’s true, it’s good news, since people who are obviously ill can be identified and isolated, making it easier to control an outbreak.

But it appears that a Massachusetts coronavirus cluster with at least 82 cases was started by people who were not yet showing symptoms, and more than half a dozen studies have shown that people without symptoms are causing substantial amounts of infection.

Next, as the CNN article notes, the Boston cluster of cases arising from the Biogen conference resulted in many people being infected from a small number who were infected but asymptomatic at the time. From WBUR:

Among the coronavirus numbers that Massachusetts officials have shared recently, one is particularly striking: Of the state’s 95 cases detected as of late Wednesday, they say 77 stemmed from a meeting that the Cambridge biotech company Biogen held in late February.

In public health parlance, the Biogen meeting is looking like a “superspreading event.”

The article continues:

Yale professor Nicholas Christakis, a physician and sociologist who studies networks, says the current outbreak in Italy also stemmed from a “superspreader.”

“We know from genetic analyses in Italy that the epidemic there was started, we think, by two people, one of whom gave it to 43 other people,” he says.

But here’s the kicker:

Christakis from Yale says other factors could cause people to become superspreaders — like even a propensity to cough.

“Maybe they have a lung disease, for example,” he says. “And so they’re doing more coughing anyway. And so compared to a person who doesn’t cough, they transmit it more.”

The environment can contribute to spreading, too, he says — poor ventilation, overcrowding.

Yep. There we have it. Overcrowding can create superspreaders. And Customs and Border Protection just overcrowded thousands of people for long periods last night. In thirteen different airports.

I keep re-reading the description of the “screening” and don’t see how the outcome of screening would be any different if people cleared Customs in a normal way but were given a set of printed instructions informing them that if they were returning from Europe they should self-quarantine for at least 14 days and that if they have or develop any symptoms they should notify their health provider and/or county health department. At that point it would seem safer to have them call a call center where they can share their travel history with someone coordinating the DHS database. Making people mill around for so long really appears to have accomplished nothing other than spreading the virus.

Update

I started writing this post before finishing my coffee this morning, and so I missed this great article in the Washington Post:

Airports around the country were thrown into chaos Saturday night as workers scrambled to roll out the Trump administration’s hastily arranged health screenings for travelers returning from Europe.

Scores of anxious passengers said they encountered jam-packed terminals, long lines and hours of delays as they waited to be questioned by health authorities at some of the busiest travel hubs in the United States.

The administration announced the “enhanced entry screenings” Friday as part of a suite of travel restrictions and other strategies aimed at slowing the spread of the coronavirus. Passengers on flights from more than two dozen countries in Europe are being routed through 13 U.S. airports, where workers check their medical histories, examine them for symptoms and instruct them to self-quarantine.

And WaPo even went there:

But shortly after taking effect, the measures designed to prevent new infections in the United States created the exact conditions that facilitate the spread of the highly contagious virus, with throngs of people standing shoulder-to-shoulder in bottlenecks that lasted late into the night.

Three Things: Good (Family) News, Bad (COVID-19) News

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[NB: Check the byline, thanks! / ~Rayne]

It’s absurd that I’m happy my college student child tested positive for strep throat. Whew, what a freaking relief that they only had a bacterial infection which has killed humans throughout history! Thanks to science we have effective antibiotics to treat this kind of infection, one of which is already working away and making said student feel better. …

Literally just heard from my student that Michigan State University now has one confirmed case associated with its campus. I can’t find a published report yet, more details later; so much for the brief respite provided by streptococcus.

Brace yourself for the bad news which so far is the nature of COVID-19.

~ 3 ~

Drugs. Let’s get into them.

Beleaguered Italy is using the rheumatoid arthritis medication tocilizumab off-label to treat patients in ICU. It may become their protocol for treatment of patients who develop acute respiratory distress syndrome (ARDS).

COVID-19 apparently spawns a “cytokine storm” the same way the 1918 Spanish flu virus did. Health care professionals say COVID-19 kills via fulminating viral cardiomyopathy, (inflamed heart tissue), not hypoxia (suffocation due to lung failure).

The onset of inflammation can be sudden with the cytokine action but at a later stage in the infection, which is different from the 1918 bug. The Spanish flu affected mostly younger people whose immune systems over-responded to the virus, where COVID-19 affects older people whose bodies may already have inflammatory responses at work because of cardio vascular disease or diabetes.

(We don’t know yet why some young people without preexisting conditions have become very ill and in some cases have died. Some may be related to smoking, others could be related to an undiagnosed condition. More study will be necessary; in the mean time, young people should protect both themselves and the older and sicker people who could catch COVID-19 from them.)

China tried tocilizumab on roughly 20 patients and found this monoclonal antibody halted the storm, acting on interleukin 6. There’s a preprint unreviewed study online but I can’t open it now or would include it. An immunologist in Italy came to similar conclusion about the use of this med and consulted with Chinese docs. See this story in an Italian news outlet (open in Chrome and translate).

There are other meds being tested in China — antivirals remdesivir (mentioned in a previous post), favipiravir, lopinavir/ritonavir, umifenovir — but there I haven’t seen any information about their application treating COVID-19 cases as detailed as there is for tocilizumab.

Pharma manufacturer Roche has agreed to provide to Italy the tocilizumab which should not only help reduce burden on hospitals’ intensive care units but build a body of data about the drug’s success in short order. China has also approved the drug’s use on certain COVID-19 patients.

I want to emphasize here this is NOT a cure for COVID-19. It’s a treatment for patients whose heart and lungs are in distress, requiring intensive care and a ventilator. What this drug may do for many of these patients is prevent them from needing ICU and ventilation, while their bodies continue to fight off the virus.

~ 2 ~

And more drugs — this time, antivirals.

A number of existing drugs have been revisited for repurposing against COVID-19 instead of their original intended purpose. Antiviral remdesivir and antimalarial chloroquine are among them.

Chinese researchers posted a paper about in vitro results, not peer reviewed (at least I didn’t see that it was).

There’s a paper about chloroquine alone; in vitro studies suggest it may work against COVID-19. Chinese researchers have a number of in vivo studies in progress, but no data has been released.

Chloroquine by itself as an effective therapy would be a miracle in that it’s an old drug now off patent and available as a generic, super cheap to produce. Can’t imagine Big Pharma would like this. But we won’t even face this conflict if we don’t get data from in vivo studies.

What I haven’t seen yet is adequate research related to the ACE2 receptor to which the COVID-19 binds itself to attack the body. There’s a study under way about a decoy protein drug called APN01, but I haven’t seen any details yet. A discussion about the ACE2 receptor can be found at this link.

I’d like to see more work done in related to ACE2 receptor mechanism. I’m worried we’ll end up too focused on antiviral remdesivir because there may be some political hijinks behind this drug.

Gilead Sciences, the drug’s manufacturer, shipped a bunch of this drug to China without federal approval, for tests which I assume mean human experimentation on actual COVID-19 patients.

About the same time this happened two weeks ago Gilead launched a merger/acquisition of Forty-Seven Inc, a clinical-stage immuno-oncology firm. It looks fishy yet likely to go unexamined because of the mounting desperation to have a drug therapy in hand before the anticipated explosion of cases arrives at hospital doors. In short, it’d be too easy to extort the U.S. into using this drug.

What really takes the cake is that a former Gilead lobbyist, Joe Grogan, is now the director of White House Domestic Policy Council. Grogan has already undermined Trump’s drug pricing initiative to the benefit of pharmaceutical companies. How do we know Grogan isn’t still representing Gilead’s interests, perhaps encouraging the government to turn a blind eye to corner-cutting on remdesivir?

~ 1 ~

Now it’s time for some more blunt talk with the family members.

I have a health care power of attorney or a health care directive prepared, signed, witnessed, copies distributed with one copy in my fire safe. If the worst should happen and the doctors need direction if I become incapacitated, my patient advocate is authorized to order what I want done. I have more than one advocate in a chain in case the primary advocate can’t act on my behalf.

I also have a will prepared, signed, witnessed, etc. If I’m picked off this month my kids will be disappointed that I haven’t yet finished Swedish Death Cleaning in the basement, but such is life and death. (Sorry, kids. You’re stuck dealing with all of the grandmas’ china sets and fragile antique lamps. Heh.)

I put the question to you now: are you ready? Have you done the legal legwork to help your loved ones whether family and/or friends if you’re incapacitated or *knock-on-wood* die?

Get it done if you haven’t. Stop putting it off because there’s no more time for lollygagging. We’d all like to deny we could get very sick, lose control of our lives, even die, but nature has a way of having the very last word if you don’t provide one.

Need a resource for that health care directive? See the folks at AARP — they have links to free resources for each state.

Just as important is establishing a plan for what friends/family should do if they can’t reach you. Trusted friends/family members should have current phone numbers, addresses, alternate key locations, emergency contacts, so on. They should also know who the patient advocates are and how to obtain access to the relevant documents if advocates don’t already have them.

This doesn’t have to be heavy; some of this effort we should have been doing all along as part of your disaster preparedness planning. Think about the families and friends affected by hurricanes Katrina and Maria, and imagine COVID-19 as a kind of hurricane which won’t flood your house but could certainly upend your life. You’d be prepared for a hurricane. Be ready for this one.

~ 0 ~

Treat this as an open thread. Tell us what’s in your basement or closets you need to unload because no one in your family wants it.

We Are In A Liminal Space In The COVID-19 Outbreak

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Jim here.

This will be a short post, mostly to give us a new conversation thread.

But there are a few things that show us that reality is setting in in our society, if not necessarily in the White House. Virtually all professional and college sports are now shut down. Most universities are online only now. Many public schools have closed. More and more businesses are allowing employees to work from home.

We are now in a liminal space. Our church introduced me to that term while we are searching to replace a minister who recently retired. A liminal space is that time between what was and what will be. Thanks to COVID-19, normal is what was. It is gone and will be gone for quite some time.

Sadly, the beneficial effects of the social distancing that is finally coming into being will be delayed. Before we get to the benefits, we will experience the whirlwind that has been unleashed by months of denying the virus. This is just my estimate, but from all the published comparisons between the US outbreak and Italy’s, we are just a few days, probably less than a week, away from hospitals in the hot zones being over capacity and having to resort to excruciating levels of triage, literally choosing who lives and who dies.

Also, Republicans are being dragged kicking and screaming into the realization that our healthcare system and our gig economy mean that huge swathes of our population, without government intervention, face bankruptcy and death with no chance of treatment.

Each of us will have to choose how we live in this liminal space. For those who are able to go along with social distancing, we will need to learn to eat all our meals at home. We will need to find ways to occupy our time if we aren’t working and the usual sports entertainment is unavailable. But it is vital that we realize that despite being physically separated, we must embrace our shared humanity and the shared experience of facing the unknown together.

Maybe there’s someone who lives close to you who is even higher risk than you are. Perhaps you can give them a call and ask if they’d like you to leave a meal at their door. Maybe you have acquaintances whose employment has disappeared today. Maybe you can slip them a few bucks if you can afford it. Maybe they’d also like a meal at their door.

Even more frightening, is the “what will be” for folks who must continue working. Somehow, grocery stores will have to stay open. Police and fire services have to continue, along with EMS, of course. Healthcare workers are soon to be completely overwhelmed and most likely sequestered for the duration of the outbreak in areas where hospitals near capacity. If you know families of those workers, maybe they could use a hand with errands or meals. They will be terrified about their loved ones staying healthy while on the front lines of this battle. Support those families any way you can.

In the meantime, many thanks to all in this wonderful emptywheel community who have been chiming in with timely updates and analysis. Please keep it coming. So many people are getting so much help from you. But also, let’s have some fun too, to ease the tension. Share a joke. Share ideas for entertainment streaming for those sequestered. Above all, know that we are all in this together and our best bet for getting through it is to work together (just don’t cough on me or touch me).

Three Things: More Family Fun with COVID-19

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[NB: Check the byline, thanks! / ~Rayne]

My second kid, who attends a Big 10 university, is sick. They’re running a temp, have a headache and sore throat. Fortunately they have no other symptoms like a dry cough and chest congestion. They wouldn’t meet the criteria for COVID-19 testing even if they develop a dry cough common to 68% of those infected with the virus

We had the awkward conversation about avoiding coming home for at least two weeks — even if the school shuts down, which it now has. This scenario is increasingly likely for all other Michigan and Midwestern colleges/universities. With the damage to my lungs from an autoimmune disorder we can’t take the chance my kid has something besides a common cold. I never expected to have to tell one of my kids not to come home.

~ 3 ~

By now you’ve probably heard about the initial quarantine of Lombardy region of Italy, and then the subsequent quarantine of the entire country. It’s bad. Italy is about two weeks ahead of Washington state in the virus’s spread.

A Twitter thread by a UK anesthesia and intensive care registrar passes on a report from a friend in A&E (ER department) in northern Italy (includes Lombardy).

Tweets by an academic in Austria (next to Italy):

The “codice nero” or “black code” to which she refers is a label applied to patients who are DOA or for whom death is imminent. During triage they are apparently applying this to patients over 60-65 years old who arrive in respiratory distress because they have no equipment for them. Other accounts from Italy mirror both the news reports about hospital conditions.

A news report from France covering Italy’s crisis (open in Chrome and translate) notes concerns about COVID-19’s possible impact on southern Italy because it has even fewer resources. Hence the failed quarantine in the north.

In this news report from Brescia which is in northern Italy (open in Chrome and translate) you’ll note they are out of beds and are putting patients on cots, evident in the photo at the top  of the page.

Some better news: China agreed to supply Italy with 1,000 ventilators and 2 million masks. Additionally, they are donating 100K respirators, 20K protective suits, and 50K test kits as part of an aid package. Must have leftover supplies now that China is closing down their rapidly-built emergency COVID-19 dedicated hospital. See story (open in Chrome and translate).

These purchases and aid will not be enough fast enough, though. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has now published a guidance document today which appears to codify triage under current conditions. It’s grim.

Tom Bossert, Trump’s first Homeland Security Advisor, wrote an op-ed for the Washington Post published yesterday. He told Ken Dilanian/NBC, “We are 10 days from the hospitals getting creamed.”

ER doctor Rob Davidson from Ottawa County in West Michigan spelled out the anticipated challenge at video in this link:

Up to this video, Michigan had been lucky, having 39 negative tests out of the 375 tests it was allotted by CDC. Last night the state announced there had been two positive cases; Gov. Gretchen Whitmer then declared a state of emergency. In an email today, Michigan State University indicated a third likely case was associated with its campus — hence an announcement moving coursework offline as of noon today. MSU is one of four Michigan schools to make such a move.

We need to see more moves like this to increase social distance if we are going to “flatten the curve” of demand for medical services. It will not be just COVID-19 cases affected by the additional demand on the system, but all other health care needs including emergencies. If we don’t slow down the spread of the virus, ALL mortality may increase in addition to COVID-19 cases.

~ 2 ~

Particularly aggravating as the U.S. tries to wrap its head around this growing crisis is the active, malign action of the White House.

A House Oversight and Reform Committee (HORC) hearing today focused on U.S. coronavirus response; the White House interfered with its continuation by calling an emergency meeting requiring the attendance of the hearing’s witnesses, including CDC Director Robert Redfield, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Terry Rauch, director of the defense medical research and development program for the National Institute of Health.

The HORC meeting was cut short without having answered all questions the committee had, although not before Dr. Fauci was able to provide a reality check to the committee.

“Is the worst yet to come, Dr. Fauci?” Rep. Carolyn Maloney, chairwoman of the House Committee on Oversight and Reform, asked Fauci on Wednesday.

“Yes, it is,” Fauci replied.

While this coronavirus is being contained in some respects, he testified, the U.S. is seeing more cases emerge through community spread as well as international travel.

“I can say we will see more cases, and things will get worse than they are right now,” Fauci said. “How much worse we’ll get will depend on our ability to do two things: to contain the influx of people who are infected coming from the outside, and the ability to contain and mitigate within our own country.”

He added: “Bottom line, it’s going to get worse.”

A report published at 12:29 p.m. after the meeting was suspended revealed the Trump White House ordered public health officials to treat certain meetings on COVID-19 as classified.

The sources said the National Security Council (NSC), which advises the president on security issues, ordered the classification.”This came directly from the White House,” one official said.

This is absolutely unacceptable. The public has both a right and need to know about the course of the virus’s spread and its government’s response. There is no constructive, positive reason for secrecy apart from hiding corrupt or incompetent decisions, which in this case could result in Americans’ deaths.

In fact, this arbitrary secrecy may already have resulted in Americans’ deaths if state and local public health authorities could not make informed decisions because necessary information was denied them.

U.S. Vice-President Mike Pence, the administration’s point person on coronavirus, vowed on March 3 to offer “real-time information in a steady pace and be fully transparent.” The vice president, appointed by President Donald Trump in late February, is holding regular news briefings and also has pledged to rely on expert guidance.

The classification order also makes Pence’s vow look like a lie to the public if on March 3 Pence knew there was information about the government’s response withheld by classification.

Constituents should demand their representatives and senators address this both by holding more investigative hearings into this unwarranted secrecy, and by disclosing whatever information they can obtain about COVID-19 and executive branch response so that the public and their health care system can act appropriately. Further, they need to provide support in a way that states can use without interference by the White House.

Congressional switchboard: (202) 224-3121

~ 1 ~

This weekend’s real live drama revolving around cruise ship Grand Princess’s docking at the port of Oakland hints at a solution to the bullshit obstruction and abuse of power surrounding the federal government’s COVID-19 response.

Note in the video that California’s Gov. Gavin Newsom takes center stage, leads and directs the release of information.

And yet the docking and debarking and transportation to quarantine facilities required considerable effort on the part of federal officials. Newsom thanked Pence, saying “His team is truly exceptional.”

Gilding the lily a bit, because the real work was done much farther below Pence’s office.

What was particularly interesting was the lack of response from Trump. We could have expected him to badmouth Newsom the way he badmouthed Inslee, but he didn’t. Perhaps Trump was too busy playing golf.

Or perhaps he didn’t want to draw attention to Newsom.

The docking happened, people were moved, and it happened without a lot of hullabaloo.

That’s exactly what we want — effective, speedy resolution meeting the problem head on.

This same model could work across the entire country if governors work cooperatively and collaboratively to share information and best practices, and are willing to be the point person out in front. The National Governors Association could provide the bipartisan vehicle for networking; it’s outside the purview of the White House, can’t be forced to operate under federal classification.

Granted, taking this approach means governors run the risk of mean tweets from Trump. Screw him and his germy iPhone. Residents in every state want calm and effective leadership they can trust and see in the days ahead. Governors should provide it — particularly since governors are a lot closer to their constituents than Trump is.

Every state should already have in place a process by which their residents can decide what action to take if they believe that they or their family members are infected with COVID-19. There have been far too many reports of individuals making calls to 911 and asking for ambulance rides to the hospital for testing. Such unnecessary use of resources, from calls to 911 operators to ambulance response to demands on hospital personnel represent heightening the curve, not flattening it.

States’ departments of health should have a published decision tree online for residents to use to decide their next course of action. It’s clearly not enough to tell the public “What to do if you’re sick” if they are calling 911 for non-emergency situations.

Website design has also been poor, forcing people who may already be panicky for lack of information to wade through a website to get what they need to make a health care decision, and in some cases design ignores that many residents rely on mobile devices.

Nor has the information process made it all the way down to county and city level.

More effective outreach across broadcast and social media is also needed to manage expectations in the days and weeks ahead.

A collaborative effort by governors could reduce costs to create a comprehensive communication plan across each state and across the U.S. — all while avoiding the obstructive influence of the White House.

Until governors catch on, though, each of us will have to push our state and local health departments to do better BEFORE the coming crisis. There is no extra time, there is no room for failure. Check to see how your state and local health departments are working right now.

And in saying this I’ll tell you my own county is screwed up. The web page with FAQ about COVID-19 doesn’t render on mobile devices. It doesn’t tell residents what to do if they have symptoms matching COVID-19. I really need to call and have a little constructive chat with them because the county hospital is less than a mile from my house. I don’t want problems I can anticipate on my back porch.

A pretty good example of how a county health department’s COVID-19 website should look is Santa Clara County, CA. See SCCPHD — the only nit I have with the site is that it needs a decision tree, something a little less fuzzy to help residents who are either panicky or not well educated.

Santa Clara County has also published a nice handout on social distancing. Really worth copying by other state and local health departments.

Wish I could give you a link to the websites and phone numbers you’ll need to address this personal assignment but I can’t. Do share in comments what you’ve learned in your search.

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One more thing for the physicians among us who might be willing to translate this into layperson’s English:

Threadroll link here.

This is an open thread.