Government Response to Coronavirus: With Pence in Charge, We're Doomed

[fraurosena]

42 minutes ago, apple1 said:

Somebody tell me that's not real. I mean - that guy in the hat is actually in charge at CDC? No wonder everything is F'ed up with managing this. Please tell me, if so, he's a figurehead and there are real scientists doing the actual job?

It's real alright -- not the head, as @thoughtful pointed out, but his obsequiousness is. Thankfully, this February 26 Politico article says he's relying heavily on his top civil servants, so it seems he is indeed playing the role of figurehead.

Quote

POLITICO spoke with 10 current and former Trump administration officials, as well as two people close to the administration, who portrayed a leader facing the biggest management challenge of his four-decade career in public health. Several individuals also said that the 68-year-old Redfield — who's working to fend off a virus that the World Health Organization has deemed high risk and that top Trump advisers believe could threaten the president’s reelection — has been relying heavily on his top civil servant deputies as the agency collectively braces for a potential pandemic.

Because if he weren't, and he was handling things the way he did AIDS in the 80s and 90s, you all would be doomed.

Quote

Redfield's early engagement with the AIDS epidemic in the US in the 1980s and 90s was controversial. As an Army major at Walter Reed Medical Institute, he designed policies for controlling the disease within the US military that involved placing infected personnel in quarantine and investigating their pasts to identify and track possible sexual partners. Soldiers were routinely discharged and left to die of AIDS, humiliated and jobless, often abandoned by their families. 

In the 1980s Redfield worked closely with W. Shepherd Smith, Jr. and his Christian organization, Americans for a Sound AIDS/HIV Policy, or ASAP. The group maintained that AIDS was "God's judgment" against homosexuals, spread in an America weakened by single-parent households and loss of family values. 

 

Edited March 7, 2020 by fraurosena

[AuntK]

It doesn't surprise me that COVID-19 can result in permanent lung damage. Some of you may remember H1N1, aka the "swine flu" virus of 2009 which swept the US, and maybe other countries, I can't remember. I contracted it from a young college student we had hired at my job who came to work anyway, blithely announcing her diagnosis while coughing on everyone. Though I tried to avoid her, it didn't work, I caught the flu which then developed into pneumonia, was hospitalized for a week and suffered permanent lung damage. Her case was much less severe, (she was 25 years younger), but this is just one more example of why sick people need to stay home!

Interesting history fact I learned while watching documentary on Trump family, (I know, it was difficult, but I was bored & sick): Trump's grandfather, Friedrich Trump, (the one that ran a hotel/brothel and later got banished from Germany for failure to perform required military service), died in1918 at age 49 in NYC as a result of SPANISH FLU, which was a world-wide epidemic which killed more people than WWI. I'm not quite sure what to make of this, but one would think Trump would be more concerned about the current virus with this family history. Of course, there's always the possibility he doesn't know it, since he often says he doesn't care about the past. Although he certainly brings it up a lot! 

 

[Xan]

Article that I found regarding the coronavirus.  I agree that we probably don't need to panic.  Most people will be fine.  But this IS a very serious situation and is going to get much worse very quickly.  

Spoiler

"Liz Specht, a PhD in biology and the associate director of Science and Technology for the Good Food Institute laid out her concerns in a lengthy Twitter thread on Friday, which you can see here on Twitter, or continue reading below.

I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 

Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate. 

We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts.

We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.

As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.

What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted.

The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).

Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).

By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.)

If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd.

If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.

As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.

Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing).

There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.)

As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day.

One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused.

How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China.

Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.

Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix.

HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.

We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.

Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.

Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.

I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan.

Nothing in the last 6 weeks has dampened my alarm in the slightest. To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong.

But I have no reason to think they’ll be orders-of-magnitude wrong. Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”.

These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.

And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared?

Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.

One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.

Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population.

But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.

That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.

This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.

That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there. 

Liz Specht@LizSpecht"

TL;dr -- Just doing the math, we can expect to see 1 million cases by the end of April.  We may run out of available hospital beds some time in May.

[clueliss]

@Xan, this is a chart from a Missouri legislator.  Different rate but illustrates your point.  (This one is for cases outside of China, and a doubling rate of every 4 days, the red marks out a match of the rate I believe)  (posted last night)

Spoiler

 

 

[apple1]

@thoughtful

Thank you! (With this administration you never know -- I thought maybe I had missed something).

[JMarie]

16 hours ago, fraurosena said:

He really is the polar opposite of Sergeant Schultz. 

 

(at 0:22) Says "they should be given tremendous credit." yet points to self

[47of74]

Bless their hearts. Republican brown nosers really don’t know how the internetz works.

FJ land y’all know what to do. 
 

Edited March 8, 2020 by 47of74
Ducking autocorrect

[clueliss]

I just watched press conferences for Kansas and Missouri.  Um okay so which is it, is this contagious before it presents or not until.  Because we’ve been to,d that is is contagious before symptoms present and that there’s up to a 14 day incubation period.  And yet both of these press conferences tried to tell everyone not to worry and emphasize that the patients had been isolating since symptoms began.  Which conflicts with my previous understanding of how covid19 works.  
 

both are being treated as “merely” (my term) travel related (Kansas travel was to the NE US - and that was all they would say, no indication of when; Missouri was a recently returned college student who had been on a study abroad in Italy).  
 

 

[Xan]

43 minutes ago, clueliss said:

I just watched press conferences for Kansas and Missouri.  Um okay so which is it, is this contagious before it presents or not until.  Because we’ve been to,d that is is contagious before symptoms present and that there’s up to a 14 day incubation period.  And yet both of these press conferences tried to tell everyone not to worry and emphasize that the patients had been isolating since symptoms began.  Which conflicts with my previous understanding of how covid19 works.  

From an article on "Wired":  

"Researchers are still trying to understand how SARS-CoV-2 spreads between humans. (SARS-CoV-2 is the official name of the germ; the official name of the disease you get from the germ is Covid-19—more on that below.) It’s likely to be transmitted in droplets from coughing or sneezes, and the virus has a two- to 14-day incubation period. That means people could be infectious for quite a while before symptoms like fever, cough, or shortness of breath emerge.

Right now, CDC officials say Americans should prepare for the worst and hope for the best. Based on the number of new cases, the overall risk of getting Covid-19 is still pretty low in most parts of this country. But flaws in testing kits and strict testing requirements have severely limited how many people have so far been tested, which means nobody knows who might actually be infected, or how serious (or mild) their illnesses might be. Growing numbers of cases of community spread in California and Washington suggest that the virus may be circulating more widely than case numbers might indicate."

...........

Under the spoiler, more info on how coronaviruses work.

Spoiler

"Coronaviruses are divided into four groups called genera: alpha, beta, gamma, and delta. These little invaders are zoonotic, meaning they can spread between animals and humans; gamma and delta coronaviruses mostly infect birds, while alpha and beta mostly reside in mammals.

Researchers first isolated human coronaviruses in the 1960s, and for a long time they were considered pretty mild. Mostly, if you got a coronavirus, you’d end up with a cold. But the most famous coronaviruses are the ones that jumped from animals to humans.

Coronaviruses are made up of one strip of RNA, and that genetic material is surrounded by a membrane studded with little spike proteins. (Under a microscope, those proteins stick up in a ring around the top of the virus, giving it its name—“corona” is Latin for “crown.”) When the virus gets into the body, those spike proteins attach to host cells, and the virus injects that RNA into the cell’s nucleus, hijacking the replication machinery there to make more virus. Infection ensues.

The severity of that infection depends on a couple of factors. One is what part of the body the virus tends to latch onto. Less serious types of coronavirus, like the ones that cause the common cold, tend to attach to cells higher up in the respiratory tract—places like your nose or throat. But their more gnarly relatives attach in the lungs and bronchial tubes, causing more serious infections. The MERS virus, for example, binds to a protein found in the lower respiratory tract and the gastrointestinal tract, so that, in addition to causing respiratory problems, the virus often causes kidney failure.

The other thing that contributes to the severity of the infection is the proteins the virus produces. Different genes mean different proteins; more virulent coronaviruses may have spike proteins that are better at latching onto human cells. Some coronaviruses produce proteins that can fend off the immune system, and when patients have to mount even larger immune responses, they get sicker."

Regardless of what the government is saying, this is worse than the flu.  We know how the flu works, we understand the incubation period, and we have vaccines against the flu.  Since not everyone gets deathly ill right away, we have no way now of knowing who is contagious and who isn't.  And this virus appears to be able to live longer on surfaces, is not as easily cleaned away, and is more contagious that the usual flu.  

We still don't know the fatality rate.  Since we aren't testing anyone but sicker patients, we don't yet know what percentage of cases will be fatal.

[Dandruff]

58 minutes ago, Xan said:

Right now, CDC officials say Americans should prepare for the worst and hope for the best.

I think a lot of people just don't get what's going on.  I spoke to two intelligent people today, one a woman in her 80s (NY metro area) and the other a guy in his 20s (DC metro area), and they both seemed to think that the situation is overblown and people are worrying too much.  The woman said she's been out and about and hasn't noticed anyone who seems sick.  I tried to explain that by the time she notices that someone nearby is sick, it may be too late.  The guy told me that a lot more people die of the flu.  I told him this is because COVID-19 hasn't really taken hold yet in the US, but the mortality rate is much higher than the flu.  I had him look up the respective mortality rates and he reacted.  I hope I encouraged both of them to take some precautions.

If most people were to choose to assume the worst and take appropriate steps then I'm guessing the spread of the virus, at least in metropolitan areas, could be substantially slowed.  This should lower both the overall infection rate and the ability of people to be treated if they do get sick.  Common sense, folks.

 

[Xan]

4 minutes ago, Dandruff said:

If most people were to choose to assume the worst and take appropriate steps then I'm guessing the spread of the virus, at least in metropolitan areas, could be substantially slowed.  This should lower both the overall infection rate and the ability of people to be treated if they do get sick.  Common sense, folks.

I agree.  If we had gotten more test kits earlier, advised the public about symptoms and contagion, started screening at airports, and isolated exposed people earlier, we'd be in better shape.  If everyone took this seriously, we would have fewer deaths.

[fraurosena]

We are a tiny little country that is extremely densely populated. In a mere two weeks time we have now got 188 cases. This illness spreads fast.

Thankfully we have only had one 86 year old man who was already in vulnerable health die after being infected. We are being well informed on a daily basis. We wash our hands, cough and sneeze into the crook of our elbows and generally take care not to get infected as best we can. We have a good healthcare system, and our social security system covers your pay should you get ill. People are self isolating and getting tested as soon as they have the slightest symptoms— if they’ve been to a risk area or in contact with someone who is infected. I get the feeling that we have things as much in control as we can, and still we have enormous spikes in numbers of new cases. This virus is hella contagious. Things are going to get a lot worse, before it gets better.

In Italy sixteen million people have been quarantined. Sixteen million! Let that sink in. For comparison, that’s only a million less people than there are in the whole of my country.

This is what is happening while governments are taking this seriously and doing their best. I shudder to think of what is going to happen in a country that is sticking its head in the sand and ignoring it; that has a shitty healthcare system and no real social security system to fall back on when you fall ill.

[Ozlsn]

I just read about the Italian quarantine as well.. the numbers are mind boggling. And that's before looking at the Chinese numbers, which are insane. I've been reading ProMedMail which is the infectious diseases update bulletin. It's fascinating, and somewhat disturbing.

[fraurosena]

The chances of Trump being infected by the virus have just gone up even more:

 

[ItalianSceptic]

Here in Italy, the government is doing its best and our health care system is good, but it's already suffering.
What is severely lacking is people's sense of responsibility: there are a lot of students and workers that are running away from contagious areas before they get closed in.
They are coming back to their hometowns in the South, risking to spread contagion where it is still under control.
The whole matter is concerning, for sure...

[clueliss]

The first case in my state was a case where a student returned from Italy due to a university study abroad program shutdown in the middle of this.  I’m now thinking, why did we just allow those people to return via regular travel means.  
 

and the inability in the Us to test at the level we really need to is ridiculous.  Contaminated test kits that don’t work is ridiculous.  Heck. I just read this morning that they just now got enough tests to the Kirkland Washington facility to test all nursing home residents (and I hope staff).  
 

it is supposed to be early this coming week that Quest and LabCorp (private testing/lab companies that handle a lot of testing done at dr offices in the US) will be “going to market”. 

[fraurosena]

Trump is still heavily relying on his magical thinking.

 

[laPapessaGiovanna]

2 hours ago, ItalianSceptic said:

What is severely lacking is people's sense of responsibility: there are a lot of students and workers that are running away from contagious areas before they get closed in.
They are coming back to their hometowns in the South, risking to spread contagion where it is still under control.
The whole matter is concerning, for sure...

Preach it sister! And I'd sentence to a long detention the irresponsible shithead that leaked the goverment's quarantine plan beforehand prompting the irresponsibles to escape crowding traina and stations. 

I think the goverment thought that it was possibile to scare people into not going around spreading the disease, but they didn't take into account our penchant for defying rules.

I am also very worried about the potential for catastrophe in the south, if Lombardy's hospitals are collapsing under the strain I don't want to even think about what could happen in Campania for example, where admittedly the healthcare system isn't as efficient.

My provincia (Vicenza) isn't quarantined right now, but let's see how next week goes, since we are surrounded by quarantined zones, we may be next.

[Ticklish]

Just found out this morning that a couple from my small town are quarantined on the cruise ship (Grand Princess?) in California. So it's likely only a matter of time before it's in my small town now, as I'm not sure they've been quarantining people long enough from the sounds of things. We are relatively young (under 40, children under 9) so I'm hoping we will be ok. I'm very worried for my parents and in laws, as both fathers have medical conditions (my father recently completed chemo which I understand depletes immune system for a while, and my father in law has a whole host of medical issues and has been hospitalized for pneumonia multiple times). 

I wish I had more faith in our government to handle this effectively, but it's been a giant shitshow from the start. 

Edited March 8, 2020 by Ticklish

[WiseGirl]

My Senator is not amused by the government response. 

[fraurosena]

Could Trump have been rage-tweeting (see Trump thread) about this article?

Inside Trump Administration, Debate Raged Over What to Tell Public

Quote

After weeks of conflicting signals from the Trump administration about the coronavirus, the government’s top health officials decided late last month that when President Trump returned from a trip to India, they would tell him they had to be more blunt about the dangers of the outbreak.

If he approved, they would level with the public.

But Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, got a day ahead of the plan. At noon on Feb. 25, just as Mr. Trump was boarding Air Force One in New Delhi for his flight home, she told reporters on a conference call that life in the United States was about to change.

“The disruption to everyday life might be severe,” she said. Schools might have to close, conferences could be canceled, businesses might make employees work from home. She had told her own children, she said, to prepare for “significant disruption to our lives.”

The stock market plummeted, cable news blared apocalyptic headlines and by the time Mr. Trump landed at Joint Base Andrews early the next morning, his critics were accusing him of sowing confusion on an issue of life or death.

The president immediately got on the phone with Alex M. Azar II, his secretary of health and human services. That call scared people, he shouted, referring to Ms. Messonnier’s warnings. Are we at the point that we will have to start closing schools? the president added, alarmed, according to an official who heard about the call.

To health officials, the message needed to change with the outbreak. “The epicenter was shifting” as the number of new cases outside China surpassed those inside, said Dr. Anne Schuchat, the principal deputy director of the C.D.C. “The issue of what this might mean to us became more important.”

From the beginning, the Trump administration’s attempts to forestall an outbreak of a virus now spreading rapidly across the globe was marked by a raging internal debate about how far to go in telling Americans the truth. Even as the government’s scientists and leading health experts raised the alarm early and pushed for aggressive action, they faced resistance and doubt at the White House — especially from the president — about spooking financial markets and inciting panic.

“It’s going to all work out,” Mr. Trump said as recently as Thursday night. “Everybody has to be calm. It’s going to work out.”

Health experts say that telling people to remain calm is an effective message in an epidemic, and it is appropriate that it come from the president. Clear, honest communication is also crucial, and the United States has at times criticized China and other governments for being less than transparent.

But from Mr. Trump’s first comments on the virus in January to rambling remarks at the C.D.C. on Friday, health experts say the administration has struggled to strike an effective balance between encouraging calm, providing key information and leading an assertive response. The confused signals from the Trump administration, they say, left Americans unprepared for a public health crisis and delayed their understanding of a virus that has reached at least 28 states, infected more than 300 people and killed at least 17.

A Very Big Deal

Mr. Azar was at his home in suburban Washington, on Friday, Jan. 3, when Dr. Robert R. Redfield, the C.D.C.’s director, called to tell him China had potentially discovered a new coronavirus. Mr. Azar, a former pharmaceutical executive who helped manage the response to earlier SARS and anthrax outbreaks, told his chief of staff to make sure that the National Security Council was aware.

This is a very big deal, Mr. Azar told him.

The Trump administration had eliminated the global health unit that had been part of the National Security Council, but within days, a team was meeting daily in the basement of the West Wing, pleading with Chinese officials to allow doctors from the C.D.C. into their country.

For weeks, the Chinese refused offers of public health cooperation. “China nice-talked it for a month,” said Kenneth T. Cuccinelli, a top official at the Department of Homeland Security who was working on the coronavirus effort. “‘Oh, well, thank you for the offer. Blah, blah.’”

On Saturday, Jan. 18, a day after the C.D.C. dispatched 100 people to three American airports to screen travelers coming from Wuhan, China, Mr. Azar made his first call to Mr. Trump about the virus, dialing him directly at Mar-a-Lago, his Florida estate. The president insisted on talking about e-cigarettes first, but Mr. Azar steered him to the virus.

Four days later, during a two-day trip to the World Economic Forum in Switzerland, the president chose to focus on the positive.

“We have it under control,” he said. “It’s going to be just fine.”

On the evening of Jan. 28, a new kind of crisis broke out in the skies.

The State Department had ordered the evacuation of the American Consulate in Wuhan and a 747 was in the air. But as it headed for the United States with hundreds of passengers who possibly carried the virus, administration officials in Washington were in a frantic scramble about where it should land.

Dr. Robert Kadlec, the assistant health secretary for preparedness and response, tried to secure some kind of military base in California, but was struggling to cut through Pentagon red tape. In a panic, his staff started booking hundreds of rooms at three hotels in the Los Angeles area, asking for full floors so they could separate potentially infected evacuees from other guests.

One idea was to land the plane at the Ontario airport outside Los Angeles, and officials went so far as to schedule, then cancel, a briefing for some members of the California congressional delegation. After hours of wrangling, and with the plane still in the air, Mark T. Esper, the defense secretary, said the plane could land at March Air Reserve Base in Riverside County, which had space to house all of the passengers.

Inside the White House, a debate broke out, centered on concerns that had become ever-present since the virus first emerged: How would the government’s actions be perceived by the public? And what would the president think?

At issue was whether to impose a federal quarantine order on the evacuees to prevent them from leaving for 14 days. Such authority had not been used since a smallpox outbreak in 1969. But officials had to find some way to make sure the passengers did not leave the base until it was clear they were not infected.

Mr. Azar pushed for the order but others were wary, concerned it could cause panic. They decided to ask the passengers to voluntarily stay at the military base. One woman balked, so California officials, who use quarantine authority more often, stepped in and forced the passengers to stay.

Time to Provoke China?

By the end of January, the virus was veering out of control in China, the source of 23,000 visitors to the United States each day. Any one of them could be the trigger for a new and undetected American outbreak.

Over four days in the White House Situation Room, the nation’s top public health and national security officials engaged in a fierce debate over whether to take the extraordinary step of banning travel from China.

Public health officials were initially wary. Experts have long recommended against restricting travel during outbreaks, arguing that it is often ineffective and can stymie the response by limiting the movements of doctors and other health professionals trying to contain the disease. A ban would anger China, they worried, ending any hope of cooperation with American medical teams.

Officials at the National Security Council and Department of Homeland Security argued that China had already proved unwilling to cooperate. A third group inside the White House was worried that the move would incite panic and could roil the financial markets.

By Thursday, Jan. 30, the public health officials had come around. Mr. Azar, Dr. Redfield and Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, agreed that a ban on travel from the epidemic’s center could buy some time to put into place prevention and testing measures. “There was so much we didn’t know about this virus,” Dr. Redfield said in an interview. “We were rapidly understanding it was much more transmissible, that it had a great ability to go global.”

The debate moved that afternoon to the Oval Office, where Mr. Azar and others urged the president to approve the ban. “The situation has changed radically,” Mr. Azar told Mr. Trump.

Others in the room urged being more cautious, arguing that a ban could have unforeseen consequences. “This is unprecedented,” warned Kellyanne Conway, the president’s counselor. Mr. Trump was skeptical, though he would later claim that everyone around him had been against the idea. The two countries were in delicate trade negotiations. Was this the time to provoke China? he asked. And what about the consequences on the economy?

The president sided with his more aggressive aides, and announced the ban next day.

Still, Mr. Trump was publicly upbeat about the effects of the virus. At a campaign rally in New Hampshire in early February, as the World Health Organization was announcing new cases by the tens of thousands, he said of the coronavirus, “By April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

In fact, the fight against the virus was already beginning to stumble.

A system used to track travelers returning from China went offline just as state officials were told to begin monitoring them. Mr. Azar said at a congressional hearing that he needed at least 300 million respirator masks for health care workers, but the national emergency stockpile, the government’s reserve of disaster supplies, held only 12 million, and many of those had expired.

And a C.D.C. coronavirus test distributed to state labs had a flawed component that led to sometimes inconclusive results, crippling the nation’s testing capacity for weeks, despite assurances by the administration that it was quickly being resolved.

Americans stranded in Japan on a cruise ship, the Diamond Princess, were finally returned home Feb. 17, but the president became enraged when he learned that 14 of the passengers had tested positive for the virus in the process of being transferred to government planes.

He later said that he was worried that bringing back people who tested positive for the virus would increase the public tally of people infected in the United States.

The month ended with a whistle-blower’s claim that workers from the Department of Health and Human Services had been sent to greet returning Americans from China at two military bases in California without the personal protective gear that is required for anyone coming into contact with potentially exposed patients. None of the workers tested positive for the virus, but the allegation shook Congress.

‘I Like the Numbers Being Where They Are.’

The president’s motorcade pulled onto the main C.D.C. campus in Atlanta just before 4:30 p.m. on Friday, passing protesters holding signs that said “Have faith in science” and “We need a vaccine against Trump.”

Ten weeks after the virus first emerged in China, the total number of confirmed cases in the world surged past 100,000 and public health experts warned darkly that the outbreak was far from over. The United States, they said, faces weeks, if not months, of uncertainty and continued disruptions in education, businesses, commerce, medicine, government and daily life.

“Time matters,” Dr. Redfield said in an interview on Friday.

Last week, Vice President Mike Pence was given control of the public messaging, and although Mr. Pence has had some mixed messages of his own — he promised more tests before they were available — the White House has since displayed more discipline. Mr. Pence holds twice daily conference calls with officials from across the country, and a virus task force he leads issues daily talking points, with comment from the health professionals, to make sure the message is consistent.

But the president still has his bullhorn. During his visit to the C.D.C., Mr. Trump told reporters that he was not inclined to let 21 people who tested positive for the virus on a cruise ship off the coast of California onto American soil.

“They would like to have the people come off,” he said. “I would like to have the people stay.” The president said he would allow health experts to make the final decision, but he made clear again where he stood.

His concern? It would increase the tally for the number of people infected in the United States. “Because I like the numbers being where they are,” the president said.

 

[fraurosena]

This bodes well.

/s

 

[fraurosena]

Good grief.

White House didn’t want to tell seniors not to fly

Quote

The White House overruled health officials who wanted to recommend that elderly and physically fragile Americans be advised not to fly on commercial airlines because of the new coronavirus, a federal official told The Associated Press.

The Centers for Disease Control and Prevention submitted the plan as a way of trying to control the virus, but White House officials ordered the air travel recommendation be removed, said the official who had direct knowledge of the plan. Trump administration officials have since suggested certain people should consider not traveling, but have stopped short of the stronger guidance sought by the CDC.

The person who spoke to the AP on condition of anonymity did not have authorization to talk about the matter. The person did not have direct knowledge about why the decision to kill the language was made or who made the call.

Administration officials disputed the person’s account. In a tweet, the press secretary for Vice President Mike Pence, Katie Miller, said that “it was never a recommendation to the Task Force” and called the AP story “complete fiction.” On Sunday, Dr. Anthony Fauci — the head of infectious diseases at the National Institutes of Health and a member of the White House Coronavirus Task Force — said “no one overruled anybody.” 

On Friday, the CDC quietly updated its website to tell older adults and people with severe medical conditions such as heart, lung or kidney disease to “stay home as much as possible” and avoid crowds. It urges those people to “take actions to reduce your risk of exposure,” but it doesn’t specifically address flying.

Pence, speaking Saturday after meeting with cruise ship industry leaders in Florida, targeted his travel advice to a narrower group: older people with serious health problems. 

“If you’re a senior citizen with a serious underlying health condition, this would be a good time to practice common sense and to avoid activities including traveling on a cruise line,” Pence said, adding they were looking to cruise line officials for action, guidance and flexibility with those passengers. 

Health and Human Services Secretary Alex Azar suggested older Americans and those with health problems should avoid crowds “especially in poorly ventilated spaces.”

Speaking on “Fox News Sunday,” Fauci said people with underlying conditions — particularly those who are elderly — should take steps to distance themselves from the risk of infection, including avoiding crowds and long plane trips “and above all don’t get on a cruise ship,” he said.

“No one has told us not to say that,” he added.

For most people, the flu-like viral illness causes only mild or moderate symptoms, such as fever and cough. But — like the flu — it can cause pneumonia and be much more lethal to people made frail by old age and by conditions that make it harder for their bodies to fight infections. 

Dr. Peter Hotez, dean of tropical medicine at Baylor College of Medicine, last week warned U.S. lawmakers against minimizing the viruses risk for vulnerable people. During a Congressional hearing, he said the coronavirus “is like the angel of death for older individuals.”

Some experts said they’ve been hoping for clearer and louder guidance from the government, to prod vulnerable people to take every possible step to avoid settings where they might more easily become infected.

“The clear message to people who fit into those categories is; ‘You ought to become a semi-hermit. You’ve got to really get serious in your personal life about social distancing, and in particular avoiding crowds of any kind,’” said Dr. William Schaffner, a Vanderbilt University expert on infectious diseases.

That can include not only avoiding essential commercial travel but also large church services and crowded restaurants, he added.

Dr. Tom Frieden, a former CDC director, said whether to recommend the frail and elderly avoid air travel is “a difficult question,” but clearly this is a time when such conversations should be taking place.

“At this point the risk in the U.S. remains low, but we are seeing it spread rapidly. We are going from the calm before the storm to the beginning of the storm,” said Frieden, who now heads Resolve to Save Lives, an organization promoting global public health.

The new virus is a member of the coronavirus family that can cause colds or more serious illnesses such as SARS and MERS. Health officials think it spreads mainly from droplets when an infected person coughs or sneezes, similar to how the flu spreads.

The virus first emerged late last year in mainland China, but this year has increasingly been spreading around the world. More than 100,000 illnesses have been reported globally, in more than 90 countries and territories. the count includes more than 3,500 deaths.

For weeks, cases in the U.S. remained very low, but the count has been accelerating in the last several days. 

President Donald Trump visited the CDC in Atlanta on Friday, where he defended his administration’s handling of the outbreak and tried to reassure Americans that the government had the virus under control. But Trump also detoured from that message, calling Washington state’s governor a “snake” and saying he’d prefer that people exposed to the virus on a cruise ship be left aboard so they wouldn’t be added to the nation’s tally.

 

[apple1]

Another one who sold their soul - US Surgeon General Jerome Adams. His appearance on Jake Tapper's SOTU today was a series of lies. FTR - Surgeon General is an appointment by POTUS that requires congressional approval. He was appointed in 2017.

Among the numerous lies and deflections regarding COVID-19, he had to go somewhat off-top and say that POTUS is in great health, healthier than himself (Adams is in his forties), blah, blah, blah.

His medical license should be revoked.

ETA: If Ben Carson still has a medical license, his should also be revoked.

These two are in positions now of greater potential to inflict harm than they ever were when formally practicing medicine.

Edited March 8, 2020 by apple1

[47of74]

I got a suggestion for fuck face