U.S. Healthcare COVID-19 2020

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Coronavirus (COVID-19) CDC Situation Summary

A lottery for ventilators? Hospitals prepare for ethical conundrums
While some states have ethics guidelines in place, there is no national standard for who gets access to scarce life-saving machinery.
(Politico) It’s the cruel calculus facing American hospitals as Covid-19 cases skyrocket, our executive health editor Joanne Kenen writes. A shortage of ventilators, hospital beds and other life-saving equipment is forcing providers to develop plans that would help them determine who goes to the front of the line for treatment. There is no uniform, national legal or ethical framework guiding such triage decisions. The American health care system is entirely unprepared to make such moral calls.
Under Intense Criticism, Trump Says Government Will Buy More Ventilators
(NYT) In another day of mixed messages, the president criticized G.M. and authorized the use of the Defense Production Act to force it to make ventilators after the company had already announced it was going to.
Just 24 hours before, he had dismissed the complaints of mayors and governors who said that they were getting little of the equipment they needed for an expected onslaught of serious cases. And this week he praised companies that — General Motors included — were rallying to help provide necessary equipment.
But he turned on G.M. on Friday, accusing it of “wasting time” and seeking to “rip off” the government. “Our fight against the virus is too urgent to allow the give-and-take of the contracting process to continue to run its normal course,” the president said.
The Road to Coronavirus Hell Was Paved by Evangelicals
Trump’s response to the pandemic has been haunted by the science denialism of his ultraconservative religious allies.
By Katherine Stewart

26 March
U.S. Now Has the World’s Largest Coronavirus Outbreak
By Matt Stieb
On Thursday afternoon, the United States, despite woefully insufficient levels of testing, earned the dubious honor of having the most coronavirus cases in the world, with 82,177 American patients surpassing China’s 81,285.
Though that number represents about 15.6 percent of the world’s total of around 510,000 cases, the United States’ 1,176 deaths make up a little under 5 percent of the world total. However, that number is expected to rise as cases and mortality in the U.S. continue to skyrocket each day. On Sunday, the nationwide death total was at 326.

24 March
Let Andrew Cuomo speak for America, not Trump
On Monday, he and Cuomo expressed nearly the same idea but in such different ways. Guess which one was terrifying and which sounded plausible and realistic.
Trump signaled that he was thinking of “opening up” the country to avoid allowing the cure to be worse than the problem. He probably meant that shutting down the economy might hurt the United States more than the virus. His solution, however, would be to end lockdowns even as the virus is spreading.
Cuomo framed nearly the same idea in a vastly different way. Explaining that we had hit pause to grapple with the sudden crisis, he said it was now time to begin thinking about how to reenter the private sector. He suggested that young, healthy people might be able go back to work, as could those who have had the virus and are now immune.
One man drops a word bomb; the other explains his thoughts in logical fashion so that people can follow his reasoning and arrive at the same conclusion.

19 March
Before Virus Outbreak, a Cascade of Warnings Went Unheeded
Government exercises, including one last year, made clear that the U.S. was not ready for a pandemic like the coronavirus. But little was done.
The outbreak of the respiratory virus began in China and was quickly spread around the world by air travelers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later, the World Health Organization declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalized and 586,000 dead.
(NYT) That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.
The simulation’s sobering results — contained in a draft report dated October 2019 that has not previously been reported — drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.
… Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.
In 2016, the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017, outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.
The full story of the Trump administration’s response to the coronavirus is still playing out.

18 March
Trump invokes Defense Production Act as coronavirus response
(The Hill) President Trump announced Wednesday he will invoke the Defense Production Act, which would allow the administration to force American industry to ramp up production of medical supplies that are in short supply in the fight against the coronavirus pandemic.

17 March
Trump, who downplayed pandemic threat, says he ‘always viewed it as very serious’
(Politico) Speaking at the White House coronavirus task force’s daily press briefing, the president was questioned by reporters about his mood at Monday’s news conference, when he struck a graver note relative to his previous appearances discussing the burgeoning outbreak. … “But I didn’t feel different,” he continued. “I’ve always known this is a real — this is a pandemic. I felt it was a pandemic long before it was called a pandemic.”
Kushner Repeatedly Advised Trump the Media Was Exaggerating Coronavirus Threat, Says Report
(Daily Beast) So at least now we know where he was getting his misleading information from. Jared Kushner repeatedly advised President Donald Trump that the media’s coverage was exaggerating the severity of the coronavirus outbreak, according to a report from The New York Times. In the early days of the outbreak, Trump downplayed the threat from the virus, and publicly accused the “Fake News Media” and Democrats of trying “to inflame” the situation.
New Trump Coronavirus Lie: ‘A Month Ago, Nobody Thought About’ It
By Jonathan Chait
President Trump’s Monday coronavirus press conference was his best since the beginning of the crisis. That is, of course, a relative measure. Trump refrained from ostentatious lying, stopped denying the now-undeniable reality that the bad things are happening, and mostly deferred to experts on questions of fact. On the other hand, he was unable to articulate a coherent position on questions like whether states ought to shut down public spaces or what kind of economic stimulus Congress should pass.
His most remarkable utterance — one that would have set off an uproar if a normal president had said it — came when he claimed the coronavirus had snuck up on everybody. “We have a problem that, a month ago, nobody thought about,” he proclaimed.
Uh, well, no. In January, two former Trump administration officials wrote a Wall Street Journal op-ed pleading with Trump to take the coronavirus seriously. Almost two months ago, Joe Biden wrote an op-ed demanding a more forceful response. Trump spent this entire period relentlessly denying the United States faced any danger at all. (David Leonhardt has a timeline of Trump’s delusional public commentary.)

14 March
Straight-talking Fauci explains outbreak to a worried nation
(AP) — If Dr. Anthony Fauci says it, you’d be smart to listen. As the coronavirus has upended daily life across the globe, Fauci has become the trusted voice in separating fact and fiction.
The fear and confusion of outbreaks aren’t new to Fauci, who in more than 30 years has handled HIV, SARS, MERS, Ebola and even the nation’s 2001 experience with bioterrorism — the anthrax attacks.
At 79, the government’s top infectious disease expert is by age in the demographic group at high risk for COVID-19. But he’s working round the clock and getting only a few hours of sleep. He’s a little hoarse from all the talking about coronavirus, and he’ll be on the TV news shows Sunday. Yet his vigor belies his age, and he credits it to exercise, including running. As of Thursday, he had not been tested for coronavirus. The National Institutes of Health, where he works, said that’s because he hasn’t needed to be.

13 March

Trump declares national emergency in latest bid to combat coronavirus

Trump said the move would free up $50 billion in additional funding and waive requirements to speed up coronavirus testing and care.
Trump touted partnerships with private companies that he claimed would allow patients to learn if they need to be tested and locate a testing site, some of which will be drive-thru facilities at big box retailers across the country.
Yet even as Trump unleashed $50 billion in government funding, the announcement had a distinct market-first flavor.
Trump outlined a series of agreements with private companies, including Google, Target and Walmart, to facilitate swifter coronavirus testing for Americans. Target and Walmart said they will set aside parking lot space for testing sites, while Google pledged to set up a website to determine whether a person needs a test, and where one is available.
Infighting, missteps and a son-in-law hungry for results: Inside the Trump administration’s troubled coronavirus response
Although Trump is the final decision-maker, as his aides are quick to remind people, a number of principals — including Pence, Kushner, Health and Human Services Secretary Alex Azar, National Economic Council Director Larry Kudlow, Domestic Policy Council Director Joe Grogan and Centers for Disease Control and Prevention Director Robert Redfield — operate as power centers with their own fiefdoms. They compete with one another over ideas, often developed by their own staffs, and at times move to undercut rivals in meetings.

11 – 12 March
Biden offers coronavirus plan, rebuking Trump’s ‘America First’ approach
Joe Biden delivered a call for swift and urgent action to combat the coronavirus outbreak on Thursday, in a speech that rebuked the Trump administration’s isolationist response and sought to preview how he would steer the nation through a crisis as its president.
The 2020 Democratic frontrunner offered a detailed new roadmap for stemming the virus, emphasizing the need for solidarity and championing science.
Trump’s European Travel Ban Doesn’t Make Sense
The president’s decision to bar travelers from Europe is an early indication of the power of a pandemic to infect international relations.
(The Atlantic) President Donald Trump’s decision to ban most European citizens from traveling to the U.S., except those from the United Kingdom and Ireland, appears to make no sense, and to inject past grievances and prejudices into delicate scientific and political equations. In this spiraling thriller cum horror novel, Trump’s emergence, full of hostility and conspiracy, with warnings of foreign viruses, heralds a darkening turn—an early indication of the power of a pandemic to infect global decision making and international relations.
Trump’s travel ban sidesteps his own European resorts
The president announced new travel restrictions on Europeans as the coronavirus pandemic escalated, but a few key spots on the continent were spared.
The U.S. government proclamation initiating the ban targets 26 European countries that comprise a visa-free travel zone known as the Schengen Area.
The United Kingdom, which is home to Trump Turnberry and Trump International Golf Links, and Ireland, which is home to another Trump-branded hotel and golf course at Doonbeg, do not participate in the Schengen Area. Bulgaria, Croatia and Romania are also not part of the Schengen Area. All three of the resorts are struggling financially.
In Rare Oval Office Speech, Trump Voices New Concerns and Old Themes
He described the dangers of “a horrible infection” during an address whose inaccuracies required immediate clarification.
The president who until now has tried to project a “business as usual” demeanor, even comparing the coronavirus to the everyday flu, confronted the fact that he faces a global pandemic that required a new set of rules, referred to the virus not as a workaday cold but as a “horrible infection” and announced new travel restrictions that he said would stop its spread.
But his rare evening address to the nation also contained accusatory language and a defensive tone that were vintage Trump.
Read a full transcript of President Trump’s remarks.
He blamed European and Chinese people for bringing the outbreak to the United States, describing it ominously as a “foreign virus,” language that reflected the isolationist views of his chief speechwriter, Stephen Miller, who alongside Jared Kushner, the president’s son-in-law, helped draft the address.
Trump’s coronavirus task force is reportedly awaiting ‘research’ from Jared Kushner before making an emergency declaration
(Business Insider) Jared Kushner’s involvement is part of a discombobulated White House response to the virus, with Trump “reluctant to declare an expansive emergency to combat the escalating coronavirus outbreak, fearful of stoking panic with such a dramatic step,” according to Politico.
White House Coronavirus Expert: ‘It’s Going to Get Worse’
[Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases]’s comments stand in contrast to President Trump’s attempts to dismiss the seriousness of the coronavirus outbreak that has so far infected 1,026 Americans and left 31 dead.
“It will go away. Just stay calm. It will go away,” Trump told reporters Tuesday. “Be calm. It’s really going to work out. A lot of good things are going to happen.”
Trump’s Dangerously Effective Coronavirus Propaganda
The president’s effort to play down the pandemic is being amplified by a coalition of partisan media, digital propagandists, and White House officials.
(The Atlantic) From the moment the coronavirus reached the United States, President Donald Trump has seemed determined to construct an alternate reality around the outbreak. In the information universe he has formed, COVID-19, the disease caused by the virus, is no worse than the seasonal flu; criticism of his response to it is a “hoax”; and media coverage of the virus is part of a political conspiracy to destroy his presidency.

9 March
The coronavirus is Trump’s Chernobyl
Brian Klaas
(WaPo) By putting dangerous myths above objective facts, Trump has turned the crucial early phases of government response into a disaster. Some public health experts in government have undoubtedly kept quiet, having seen repeatedly what happens to those who publicly contradict this president. And Trump himself, along with those who surround him, has tried to construct a reality that simply does not exist.
Two weeks ago, today, Trump tweeted that “The coronavirus is very much under control in the United States … Stock market is starting to look very good to me!” At that point, there were a small number of cases, but public health experts clearly stated that the number was likely to spike. Nonetheless, Trump accused his critics of perpetrating a “hoax” and said their concerns was overblown. He said that the number of cases — 15 at the time — would soon be “close to zero.”
Today, there are more than 500 cases. There will soon be thousands.
… “The threat of pandemic flu is the No. 1 health security concern,” one official in the White House’s global health security unit warned early in the Trump administration. “Are we ready to respond? I fear the answer is no.” The following day, Trump shut that office in a reorganization.

8 March
The U.S. Isn’t Ready for What’s About to Happen
Even with a robust government response to the novel coronavirus, many people will be in peril. And the United States is anything but prepared.
By Juliette Kayyem, Former Department of Homeland Security official and author of Security Mom
(The Atlantic) A threat as dire as the new coronavirus exposes the weaknesses in our society and our politics. If Americans could seek testing and care without worrying about co-pays or surprise bills, and if everyone who showed symptoms had paid sick leave, the United States could more easily slow the spread of COVID-19. But a crisis finds a nation as it is, not as its citizens wish it to be.
1 March

U.S. officials worried about Chinese control of American drug supply
(ABC news) Antibiotics, which turn life-threatening infections into minor nuisances, are considered the single biggest advance in modern medicine.
But imagine if the supply of antibiotics to the United States was suddenly cut off.
American national security officials are worrying about that scenario as they come to grips with this little understood fact: The vast majority of key ingredients for drugs that many Americans rely on are manufactured abroad, mostly in China.
As the U.S. defense establishment grows increasingly concerned about China’s potentially hostile ambitions, the pharmaceutical supply chain is receiving new scrutiny.
“If China shut the door on exports of medicines and their key ingredients and raw material, U.S. hospitals and military hospitals and clinics would cease to function within months, if not days,” said Rosemary Gibson, author of a book on the subject, “China Rx.”
Other generic drugs whose key ingredients are manufactured in China include medicines for blood pressure medicine, Alzheimer’s, Parkinson’s, epilepsy and depression, Gibson says. (12 Sep. 2019)

Trump is pushing a dangerous, false spin on coronavirus — and the media is helping him spread it
By Margaret Sullivan
Trump and his chosen spokespeople are attempting to dramatically play down the seriousness of the coronavirus and to blame the legitimate news media for doing their jobs of informing the public.
In reporting what Trump has to say, the news media has a huge responsibility not to repeat and amplify his misleading spin — a spin that may serve his political interests but is not in the public interest.
It’s not always easy, though, for mainstream journalists to put his claims in the proper context.
After all, it had always been normal to let a president have his say — to let his statements top the news while letting the fact checks follow.
That has changed somewhat during the lie-ridden Trump administration, but not nearly enough. The reflexive media urge, deep in our DNA, is still to quote the president without offering an immediate challenge.
… Some months ago, I wrote about the linguist George Lakoff’s prescription for handling the president’s false statements and lies, an approach that’s become known as the “truth sandwich.”
Rather than lead with the falsehood and then try to debunk it, Lakoff — an expert on how propaganda works — suggested flipping that formula: Lead with the truth, air the falsehood, and then follow with the fact check. Avoid giving prominence to lies, he advises. Don’t put them in headlines, leads or tweets. It is that very amplification that gives them power, even if they are proclaimed false in the next beat.

28 February
(Business Insider via Yahoo!) The Trump administration barred a top US disease expert from speaking freely to the public after he warned the coronavirus might be impossible to contain
Pence Will Control All Coronavirus Messaging From Health Officials
(NYT) The White House’s attempt to impose a more disciplined approach to communications about the virus was undermined by President Trump, who complained the news media was overstating the threat.
The attempt to demonstrate a unified administration voice was undercut early in the day, when Mr. Pence said that he had selected Dr. Deborah L. Birx, the director of the United States effort to combat H.I.V. and AIDS, to serve as the coronavirus response coordinator for the White House, enlisting an experienced scientist and physician to address the potential spread of the virus.
But Dr. Birx is now the third person to have been designated as the administration’s primary coronavirus official, along with Mr. Pence and Alex M. Azar II, the secretary of health and human services.
Mr. Trump said Wednesday that “Mike is going to be in charge, and Mike will report back to me.” Mr. Pence said it would be Dr. Birx. Mr. Azar, for his part, remains the chairman of the government’s coronavirus task force.

Trump picks Pence to be coronavirus czar despite botched response to HIV outbreak in Indiana
Mike Pence’s “defining moment” as a one-term governor was “enabling an HIV outbreak” in 2015
(Salon) Trump’s announcement “blindsided” Health and Human Services Secretary Alex Azar, who had spearheaded the administration’s efforts, according to The Washington Post. Journalists quickly reminded Trump that he slammed former President Barack Obama for appointing someone with “zero experience in the medical area and zero experience in infectious disease control” during the Ebola crisis in 2014.
Why the Trump Administration’s Coronavirus Response Continues to Raise Concerns
(New York) Though there have been just over two dozen confirmed cases of the coronavirus in the U.S., and CDC officials say the risk of exposure for the American public remains low, there continue to be troubling signs that the Trump administration has been mismanaging the U.S. response and may not be adequately prepared for whatever happens next.
While some of the White House’s response has been praised, its approach has also included a mix of xenophobic policy, improvisation, and suddenly sharp turns in decision-making. And long before the first case of COVID-19 was discovered in mainland China, the administration had been putting off years of back-end work which may undermine the government’s ability to prepare for and handle a breakout of the scale that coronavirus may reach.
Undetected U.S. cases, a lack of testing, and problems at the CDC
… Very little testing has been done, however. Last week, Politico reported that problems with a CDC-developed coronavirus test delayed the agency’s plans to expand its testing — and thus get a sense of whether or not the virus is already spreading in the U.S.
It’s not clear when the new CDC test will be ready and distributed, but because of the test failure, only three out of 100 public-health labs in the U.S. have been able to test for COVID-19, according to the Association of Public Health Laboratories. In addition, the cost of each test is as much as $250, according to Politico, and the HHS has already been running out of money to pay for its response to the outbreak.
On Saturday, Politico reported that the White House is planning to ask Congress for emergency funds to handle coronavirus in the United States. The sum, however, could be as little as $1 billion, which public-health experts believe would be drained all too quickly by vaccine research and lab tests. (To compare to a recent health crisis, the Obama administration requested $6 billion in emergency funding for the 2014 Ebola outbreak and eventually received $5.4 billion.) Though Democrats in Congress have pushed the administration to call for emergency coronavirus funding since early February, Politico states that “White House officials have been hesitant to press Congress for additional funding, with some hoping that the virus would burn itself out by the summer.”
But as Foreign Policy’s Laurie Garrett recently explained, the administration has spent years enacting policies and putting forth budgets that have weakened the U.S. government’s ability to prepare for and respond to an outbreak like this one, both in the U.S. and abroad. In addition, as Garrett highlights, the administration’s notoriously dysfunctional personnel drama and haphazard efforts to reduce the size of the government haven’t helped either.


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