COVID-19 Coronavirus current events

[Agent K]

oh and that Americas epicenter footer shows throughout the whole show... for ex:
View attachment 40135
I don't recall seeing palm trees in NYC ever.

I've seen other videos that showed footage of San Francisco when talking about other cities.

 

[Agent K]

These are scenes from New York hospitals.


Source: https://www.youtube.com/watch?v=rgpSC__Nxso


Source: https://www.youtube.com/watch?v=bE68xVXf8Kw

 

[Rory]

I guess there must be a thing in US news (and elsewhere?) that means it's okay to do something like that.

Or maybe not:

"It was an editing mistake," a CBS spokesperson told the Washington Examiner when asked about the footage. "We took immediate steps to remove it from all platforms and shows."

https://www.washingtonexaminer.com/...ears-in-report-on-new-york-coronavirus-crisis

 

[deirdre]

I guess there must be a thing in US news (and elsewhere?) that means it's okay to do something like that.

I think it's ok to do something like that. they didn't say "this is Belleview Hospital" or anything.

I'm not sure you are even allowed to film patients in the United States. (or to bring a camera crew into covid-19 infected areas!), so I personally didn't think it was a NY hospital. Plus.. I did previously see the 'bubbles-over-their-heads' when they ran out of ventilators with Italian footage, so I took/take that shot as "this is the future of NY because Orange Man bad", which is kinda the context of what they are talking about.

But that's me.

 

[Mendel]

I did previously see the 'bubbles-over-their-heads' when they ran out of ventilators with Italian footage

Do you know if they are in use elsewhere? The University of Chicago did a small study of them 4 years ago, and they're apparently clearly superior to face masks.
https://www.nih.gov/news-events/nih...-based-ventilation-eases-respiratory-distress

• Researchers compared noninvasive oxygen delivery methods—a helmet versus a face mask—for patients with acute respiratory distress syndrome.
• The trial was stopped early because the helmets proved more effective than the face masks for treating this condition.

[...]

Intubation was necessary for 24 of the patients wearing a face mask (62%), but for only 8 of those with a helmet (18%). Patients with helmets also had more ventilator-free days on average (28 vs. 12.5) and spent significantly less time in the intensive care unit (4.7 day median vs. 7.8). The helmet group had 15 patient deaths (34%) over the 90 days following treatment randomization, compared to 22 deaths (56%) in the face mask group.

"This is the present New York" is footage of people storing bodies in refrigerator trucks.

 

[Mendel]

"this is the future of NY because Orange Man bad"

Who caused the crisis in the US?
https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world's most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solution.

The C.D.C. also tightly restricted who could get tested and was slow to conduct "community-based surveillance," a standard screening practice to detect the virus's reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were performing tens of thousands of tests daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government's public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.

Mr. Azar, 52, who chaired the coronavirus task force until late February, when Vice President Mike Pence took charge, had been at odds for months with the White House over other issues. The task force's chief liaison to the president was Mick Mulvaney, the acting White House chief of staff, who was being forced out by Mr. Trump. Without high-level interest — or demands for action — the testing issue festered.

At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public's health or the nation's economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: "It's going to disappear. One day — it's like a miracle — it will disappear."

The article is quite long and goes into a detailed timeline, but my take is expressed in the summary above: the CDC didn't get its own test out of the door, and the FDA prevented the WHO test from being used after secretary Azar declared the health emergency:

But the emergency announcement created a new barrier for hospitals and laboratories that wanted to create their own tests to diagnose the coronavirus. Usually, they faced minimal federal regulation. But once Mr. Azar took action, they were subject to an F.D.A. process called an "emergency use authorization."

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the F.D.A.'s approval process. The new tests sat unused at labs around the country.

Does Trump come into it?

"If you look historically in the United States when it is challenged with something like this — whether it's H.I.V. crises, whether it's pandemic, whether it's whatever — man, they pull out all the stops across the system and they make it work," said Dr. Aylward, the W.H.O. epidemiologist.

But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama's global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.

The question is, would a different president have handled this differently, and would that have made a difference?

I personally hate it when the Chinese get blamed for the delays in the US response. The first Covid-19 case on US soil was well apparent on January 21st, that was the point where it was clear to every US epidemiologist that this global challenge concerned the US directly.
http://www.snohd.org/485/Novel-coronavirus-2019-response-Jan-15-2

How a country acts on that knowledge is a matter of internal politics.

 

[deirdre]

Do you know if they are in use elsewhere?

your article there says

Multicenter trials will be needed to confirm these results and standardize the procedures before the helmet could be used routinely in intensive care units.

but that is from 2016. so maybe they are using them in US hospitals more now. ?

 

[Mick West]

The question is, would a different president have handled this differently, and would that have made a difference?

I think you've only got to look at the range of responses from the state governors, or even mayor and councils, to see that different people handle it differently. Mike DeWine (R-OH) was reportedly very proactive, as was Gavin Newsom (D-CA). Greg Abbot (R-TX) maybe less so. State responses have varied quite a bit, but only time will tell what the ultimate effect of their actions will be. This site ranks states by the aggressiveness of their response. There's a variety right now, and it's changed over time.
https://wallethub.com/edu/most-aggressive-states-against-coronavirus/72307/

I'm not sure there's much to gain from finger-pointing, especially at Trump. What was done right or wrong two months ago does not really inform what we should be doing right now. Lessons will be learned.

 

[deirdre]

Who caused the crisis in the US?

what does that have to do with Cuomo blaming Trump because Cuomo didn't lock down his city/state/subways soon enough and now he's angry that NY isn't being sent all the federal supplies when other states might need some too? yesterday or the day before Cuomo even said he thinks other NY hospitals are hoarding ventilators and not sending them to the city.

It's a horrible situation all around. and I think it is enlightening that the federal government (ie cdc) and state governments obviously did not have any pandemic plans written up, even though we knew about a pandemic possibility for years and years! everyone is to blame. it is ridiculous all this infrastructure wasn't set up before hand by federal and state health agencies... years ago!

 

[Mendel]

I'm not sure there's much to gain from finger-pointing, especially at Trump.

This would be easier to heed if Trump didn't point the finger elsewhere at every opportunity. The finger-pointing at him seems to have gotten him to invoke the defense production act, so it does serve some purpose.

 

[Mendel]

everyone is to blame.

I just quoted you the facts why that is not true.
The states did not have any idea of the magnitude of the problem developing for their population because they did not have access to sufficient testing, and that was the fault of the FDA and the CDC, which are federal agencies with regulatory powers, and I believe their heads are appointed by the president?
Plus the president communicated that there is no problem.
So the states were being lied to and had no means to discover the truth, and that's why the US was caught out while other countries did containment by tracking and testing possible infection vectors.
That is the main reason why the states were left with less time to prepare than they could have, and why the curve is not as flat as it could have been.
Obama had an office for this that ran simulations, and they ran one in late 2016 with Trump staff. If you blame the lack of planning, there is a responsibility there, too.

That the crisis responses differ so much among the states appears like a lack of leadership from my perspective, because the German chancellor did coordinate the state responses (without dictating them).

This is a difficult crisis, and it's hard to get everything right, and everyone is doing their best; but some blunders are larger than others.

 

[Agent K]

This would be easier to heed if Trump didn't point the finger elsewhere at every opportunity. The finger-pointing at him seems to have gotten him to invoke the defense production act, so it does serve some purpose.

The DOD uses the DPA 300K times a year.
https://www.nytimes.com/2020/03/31/us/politics/coronavirus-defense-production-act.html

The Defense Department estimates that it has used the law's powers 300,000 times a year. The Department of Homeland Security — including its subsidiary, FEMA — placed more than 1,000 so-called rated orders in 2018, often for hurricane and other disaster response and recovery efforts, according to a report submitted to Congress in 2019 by a committee of federal agencies formed to plan for the effective use of the law.

 

[deirdre]

The DOD uses the DPA 300K times a year.

but the report linked in your quote says

2.2 Allocation of Resources

DPA allocations authority may be used to control use of materials, services, and facilities under certain conditions that are determined necessary or appropriate to promote the national defense. The allocations authority could be used to control the general distribution of a material in the civilian market. The allocations authority also could be used when there is insufficient supply of a material, service, or facility to satisfy national defense requirements through use of the rated orders authority alone. Additionally, the allocations authority could be used to mitigate severe or prolonged disruptions caused by the use of the priorities authority. While procedures for use of this authority have been established in FPAS regulations, no allocation action has been taken since the end of the Cold War.

 

[Mendel]

but the report linked in your quote says

2.2 Allocation of Resources

DPA allocations authority may be used to control use of materials, services, and facilities under certain conditions that are determined necessary or appropriate to promote the national defense. The allocations authority could be used to control the general distribution of a material in the civilian market. The allocations authority also could be used when there is insufficient supply of a material, service, or facility to satisfy national defense requirements through use of the rated orders authority alone. Additionally, the allocations authority could be used to mitigate severe or prolonged disruptions caused by the use of the priorities authority. While procedures for use of this authority have been established in FPAS regulations, no allocation action has been taken since the end of the Cold War.

This is the said report:
https://www.fema.gov/media-library-...8a6b92617188/2018_DPAC_Report_to_Congress.pdf
The Defense Production Act Committee Report to Congress
Calendar Year 2018
Report to Congress June 24, 2019

DPA section 101 authorizes the President to:
1) Require that performance under contracts or orders (other than contracts of employment) which he deems necessary or appropriate to promote the national defense shall take priority over performance under any other contract or order, and, for the purpose of assuring such priority, to require acceptance and performance of such contracts or orders in preference to other contracts or orders by any person he finds to be capable of their performance; and
2) Allocate materials, services, and facilities in such manner, upon such conditions, and to such extent as he shall deem necessary or appropriate to promote the national defense.

Your quote says that number 2) has not been invoked. But to get a company to accept and fulfil (perform) a government contract, they use number 1). See section 2.1 in that report.

 

[Rory]

Regarding the Czech Republic and their "what we did to significantly flatten the curve was introduce mandatory facemask wearing" video, here's their latest case graph:

So it does look like they're doing pretty well.

Still, while having everyone wear facemasks outdoors is obviously better than not doing so, I still feel somewhat uneasy about the boldness of that video's claims. Early isolation measures must have played a huge part - they introduced a nationwide quarantine before they had 200 confirmed cases - and, perhaps most importantly:

In South Korea mass testing efforts were successful. The South Korean national testing capacity reached 15,000 tests per day. Compared to population size, the Czech Republic reached the same rate of testing on 23 March 2020.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_Czech_Republic#Epidemic_curve

I also notice that the death data on the Wikipedia page has changed:

Previously, for the eight days from the 25th of March it read 3-3-0-2-5-7-8-8, and now it's 7-0-2-4-6-6-7-7.

 

[deirdre]

Your quote says that number 2) has not been invoked. But to get a company to accept and fulfil (perform) a government contract, they use number 1). See section 2.1 in that report.

I already read 2.1. I think 'under contract' means companies they already have contracts with.
and the 'services and facilities' in 2.2 would mean forcing GM (a car company) to make ventilators.

I could be wrong of course, but that is how i'm reading it. and it makes sense because i don't recall in my lifetime the government forcing a company to do anything contrary to what their company was set up to do. (ie making new product).

 

[Mendel]

I already read 2.1. I think 'under contract' means companies they already have contracts with.
and the 'services and facilities' in 2.2 would mean forcing GM (a car company) to make ventilators.

I could be wrong of course, but that is how i'm reading it. and it makes sense because i don't recall in my lifetime the government forcing a company to do anything contrary to what their company was set up to do. (ie making new product).

You are wrong, just check the facts.

PRESIDENTIAL MEMORANDA

Memorandum on Order Under the Defense Production Act Regarding General Motors Company
NATIONAL SECURITY & DEFENSE

Issued on: March 27, 2020

[...]
Sec. 2. Presidential Direction to the Secretary of Health and Human Services (Secretary). The Secretary shall use any and all authority available under the Act to require General Motors Company to accept, perform, and prioritize contracts or orders for the number of ventilators that the Secretary determines to be appropriate.

https://www.whitehouse.gov/presiden...duction-act-regarding-general-motors-company/

Note the use of the "accept, perform and prioritize" language, which is the same language as used in part 1) of my quote. The memorandum does not use the word "allocate".

 

[deirdre]

You are wrong, just check the facts.

PRESIDENTIAL MEMORANDA

Memorandum on Order Under the Defense Production Act Regarding General Motors Company
NATIONAL SECURITY & DEFENSE

Issued on: March 27, 2020

[...]
Sec. 2. Presidential Direction to the Secretary of Health and Human Services (Secretary). The Secretary shall use any and all authority available under the Act to require General Motors Company to accept, perform, and prioritize contracts or orders for the number of ventilators that the Secretary determines to be appropriate.

https://www.whitehouse.gov/presiden...duction-act-regarding-general-motors-company/

Note the use of the "accept, perform and prioritize" language, which is the same language as used in part 1) of my quote. The memorandum does not use the word "allocate".

But GM had already agreed to make ventilators.

Trump, in a tweet on Friday, excoriated General Motors and its CEO, Mary Barra, for not moving quickly enough to produce needed ventilators amid the coronavirus pandemic and wanting "top dollar" for the contract.

"As usual with 'this' General Motors, things just never seem to work out," Trump tweeted. "They said they were going to give us 40,000 much needed Ventilators, 'very quickly'. Now they are saying it will only be 6000, in late April, and they want top dollar. Always a mess with Mary B. Invoke 'P.'"

https://www.nbcnews.com/politics/do...orce-gm-make-ventilators-coronavirus-n1170746

so I still think making a company produce something they wouldn't normally produce, would be section 2.2.

 

[Mendel]

so I still think making a company produce something they wouldn't normally produce, would be section 2.2.

This is from paragraph 4511 of the law:

Allocation of materials, services, and facilities
The President is hereby authorized (1) to require that performance under contracts or orders (other than contracts of employment) which he deems necessary or appropriate to promote the national defense shall take priority over performance under any other contract or order, and, for the purpose of assuring such priority, to require acceptance and performance of such contracts or orders in preference to other contracts or orders by any person he finds to be capable of their performance, and (2) to allocate materials, services, and facilities in such manner, upon such conditions, and to such extent as he shall deem necessary or appropriate to promote the national defense.

https://uscode.house.gov/view.xhtml?path=/prelim@title50/chapter55&edition=prelim

"by any person he finds capable of their performance" means General Motors (remember that corporations are legal persons), if they can build ventilators, it applies

"require acceptance ... of such contracts" means they can be forced to accept a contract; it basically means they can be ordered to accept it

"require ... performance of such contracts" means they can be forced to work on the contract and deliver on it

"shall take priority over performance under any other contract or order" means they have to work on this contract before they work on any other contract

And then the provisions in the other paragraphs apply concerning loans etc.

Allocation like in Part (2) does not involve government contracts at all, the word "contract" is never mentioned. I imagine it could be used to direct companies to supply doctors and hospitals first, or for alcohol-producing companies to sell their output to medical companies before they sell it to liquor or cosmetics producers. That is similar to how I read the summary in the congress report: that if the goverment depletes a market with its priority contracts, it can now regulate that market to avoid undue hardship.

Edit: P.S. I note that you have been shifting the goal posts.
1) I said the finger pointing made Trump use the DPA
2) Agent K said FEMA used it routinely, but it hadn't been used in this crisis
3) You said that there were zero allocations ever
4) I show that Trump's use of the DPA is not an allcation
5) you claim that your comment was not actually meant to address Trump's use of the DPA

 

[DavidB66]

Rory:
The figures from Austria are also interesting. 'Daily new cases' seem to have peaked within about 3 weeks of the first reported case.
https://www.worldometers.info/coronavirus/country/austria/
I don't know what the Austrians were doing at this time, but it may be that they succeeded where most other countries have failed, in containing the outbreak by contact-tracing, etc, at an early stage.
I suggested in a comment a few days ago that Germany and a cluster of nearby countries - Austria, Belgium, Switzerland, Denmark, Sweden - all seemed to have unusually low mortality rates (deaths per infection), and wondered if for some reason they were getting a less virulent form of the virus. This no longer seems to be the case (if it ever was). Measured by the number of deaths per head of population (probably a better measure than deaths per reported infection, which depends heavily on the testing regime), Switzerland and Belgium now have quite high mortality rates (as does the Netherlands, which I don't think I included in this group anyway). Sweden unusually decided against strict 'lockdown' measures, and both new cases and deaths are rising fast. The rate in Austria and Denmark might be called 'moderate'. The mortality rate in Germany itself is still relatively low, but the number of 'daily new deaths' is increasing. It is not clear whether the number of new infections per day is still rising. A few days ago it looked as if it might have reached a peak, but then started rising again.
Several countries (France, Spain, Italy and the UK at least) have recognised that their headline death figures are too low, as they count deaths in hospitals and not elsewhere, notably residential care homes. France has made a big one-off adjustment to the figures. Belgium has stated that its figures have always included these non-hospital deaths, which may help account for their relatively high figures. (I base this on a report in today's UK Times. )

 

[deirdre]

) you claim that your comment was not actually meant to address Trump's use of the DPA

no I didn't. I waqs responding to Agent K, not to you. I was pointing out to Agent K that even though the government often uses parts of DPA that (selling to our government before other countries etc) that we have never forced a company to make product or provide a service outside of it's original company statement.

and then.. while responding to our disagreement I found out that we didn't force Gm to make ventilators. They already started voluntarily. I apologize that i didnt clarify the point i was making to @Agent K

The Detroit automaker is farthest along in the effort to make more of the critical breathing machines. It's working with Ventec Life Systems, a small Seattle-area ventilator maker to increase the company's production and repurpose a GM auto electronics plant in Kokomo, Indiana, to make the machines. The company said Friday it could build 10,000 ventilators per month starting in April with potential to make even more.

After Trump invoked the act, GM said in a statement that it has been working around the clock for more than a week with Ventec and parts suppliers to build more ventilators. The company said its commitment to build Ventec's ventilators "has never wavered."

https://time.com/5811806/trump-general-motors-ventilators/

 

[Mendel]

@DavidB66
Death figures are problematic for several reasons:
a) they lag infections (I'd say ~2 weeks) as the virus needs a bit of time to kill someone
b) most of the dead (>90%) are older than 60, so if you scale by population, you need to scale by that age group
c) a small number retirement home infection events can skew the numbers drastically

Denmark had a dip that lasted 2 weeks and has rising numbers again.
Austria is now one of the few countries with over 1 in 1000 people infected, but they do seem to have their new infections trending down. They're north of Italy and have been hit quite hard as a result (as has Bavaria in Germany). Generally, you can observe quite a variety of infection rates all across Germany, even though public measures were largely the same all across the country. So how small countries are doing may have a moment of randomness to it.

https://www.rki.de/DE/Content/InfAZ...chte/2020-04-03-en.pdf?__blob=publicationFile

From the same report:

The RKI is monitoring ILI (influenza-like illnesses), they're easier to test for than Covid-19 since they're much more widespread, and we have historical data. The German public measures have had an immediate very noticeabole effect on these, so if Covid-19 spreads like influenza, we have it beat, we just don't know it yet because the incubation time is so long.

Source: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/Ausgaben/16_20.pdf?__blob=publication
The green lines are adults, the reddish lines are children, the grey area is flu season, and the blue vertical lines denote when the public measures were started.

 

[Mendel]

we have never forced a company to make product or provide a service outside of it's original company statement.

The main point of using rated orders isn't to compel companies to help. From what I remember of Gov. Cuomo's press conference in Javits Center, the point is that the government can loan companies money for this (e.g. GM has to change their factory to make the new product, this costs money, and they can do it more easily if the government provides it) and that companies are protected against some liabilities (they might have delivery dates with penalties for other customers, and if these get delayed, it could become expensive; but if the delay was caused by working on rated orders, the penalty doesn't apply). It effectively helps companies to do this work if FEMA or the HHS use these rated orders ( DPA contracts).

If you read somewhere that companies have to be forced, that's a hoax.

 

[derwoodii]

Claim,, 6000+ doctors support a C19 drug remedy is being made..

https://thedonald.win/p/FMSpHEaP/6000-doctors-now-rate-hydroxychl/c/

However when i look at data source its someplace between 19% & 37% of 6227 = 1833 or 2304 out of 6227 but i am having trouble interpreting this correctly..

hope this link works as had to circumnavigate a wall

https://public-cdn.sermo.com/covid1...QW4dL_WvCYSXo2ZoKKAPq6pLdZoRPDnhIzLufnoR6jVgQ

any other to help proof this be grateful

 

[deirdre]

If you read somewhere that companies have to be forced, that's a hoax.

it is literally the headline of every article about the issue. (including the articles I linked). You are obviously experiencing different media then we are here in America.

 

[Mendel]

it is literally the headline of every article about the issue. (including the articles I linked). You are obviously experiencing different media then we are here in America.

Yes, but both the time and the NBC article state the facts: that GM's commitment to the ventilator production has "never wavered", and that Trump's intent is to "ensure the quick production of ventilators that will save American lives." The aim is to make it happen faster, not to force it to happen at all.

 

[deirdre]

The aim is to make it happen faster,

and cheaper apparently. the aim is to force them to make them faster. "require acceptance" "require performance".

require also means 'force'.

I think we are having a language misunderstanding.

not to force it to happen at all.

I know. that's what I said.

 

[Mendel]

@derwoodii

Sermo, the largest online physician network in the United States, today announced the launch of Sermo Sponsorship, a portfolio of offerings that provides new opportunities for pharmaceutical, biotechnology and life sciences companies to engage physicians and educate them on new products and programs.

https://www.sermo.com/press-release...product-for-pharma-biotech-and-life-sciences/

It sounds like pharma advertising disguised as "education" is part of their business model. Their questionaire feels like telemarketing, most of the questions are designed to raise concern about treating Covid-19 with medication, and a few are designed to suggest that existing medications are effective.

The "or have seen used" question is fishing for hearsay, basically if a GP has patients that are threated by 3 doctors in the hospital, and one of them prescribed Chlorquine to 1 patient, then he's "seen it used" when the file comes back to him.

None of this is a study, this isn't data, and 3/4 of the questions are about epidemiology that the physicians are not well placed to answer. Which is an indication that the answers don't matter, because this is marketing.

Page 4 states:
a) "3 most commonly prescribed treatments amongst COVID-19 treaters are 56% analgesics, 41% Azithromycin, and 33% Hydroxychloroquine."
"Globally, 19% of physicians prescribed or have seen Hydroxychloroquine prophylactically used for high risk patients, and 8% for low risk patients."
This tallies with page 20, which states that only 35% of respondents "Been involved in the care of a patient who has tested positive for COVID-19". And 33% of these prescribed Chloroquine, which is 12% of the total sample. Maybe 700 physicians?

b)
Page 18 states that 47% want more information on the efficacy of existing medications.

Note that N=6227, so all respondents were asked this question.

But 47% aren't involved with Covid-19 patients in any way. So how can the table above have high percentages for almost every country?

This question has N=2171, so it was only put to those who answered that they've "been involved" in the care of a Covid-19 patient. Note that the percentages add up to more than 100, so it was possible to give multiple answers. Also note that "doing nothing" ranks 3rd (first in the US). Another thing to note is that plasma treatment ranks low, but the number of doctors who have used this is also very low. It would be interesting to find out how many of those doctors who actually used it prefer it.

The biggest problem with medication use outside of double-blind studies is the placebo effect: for most conditions, doctor confidence improves the outcome, so if a doctor prescribes Chloroquine, it may affect the outcome even if it does nothing; and the doctor may be inclined to judge the outcome more positively because of confirmation bias.

37% of 2171 = 800 doctors think Chloroquine is among the most effective medications available now, but we don't hear how effective they think it is. 32% = 700 think doing nothing is as effective or better. And 47% of 6227 (2925) think we urgently need more data on how well it works.

What worries me is that 33% of these "physicians" lack information on how healthcare workers can protect themselves against an infection that uses the same transmission method as the flu. It kinda makes me wonder where they got their degrees.

I'm also wonder why physicians treating severe cases of Covid-19 take the time to answer 22 minute long unpaid marketing surveys.

 

[Arugula]

I guess there must be a thing in US news (and elsewhere?) that means it's okay to do something like that.

I used to work in broadcast news and it is extremely common to reuse b-roll like that. It's a mistake but not a malicious one. Editors, production assistants, or interns download footage from satellite feeds, syndication wire, or photographer, label it, and then it exists on the server forever (some more descriptive than others.) So an editor putting together a package searches for terms like "coronavirus hospital ventilators", finds a 5 second clip, and pulls it into their story to illustrate ventilators in hospitals. Happens all the time, especially with followup stories or long-term "developing" stories like this.

 

[Mendel]

NY Gov Andrew Cuomo on March 22nd on what he wants the Federal government to achieve with the DPA (press conference). I thought he also mentioned that the DPA helped with the funding, but that may have been in the Q&A afterwards that is not in the transcript.

Spoiler

You have the nation's role in this situation, you also have the state's role. This is what they call an emergency management situation and there are rules for emergency management - who does what. Basically, the state governments, local governments manage an emergency unless the emergency overwhelms the capacity of the local government. Then, the higher level of government takes over. That happens even on the state level. A city will be in charge, a county will be in charge unless it overwhelms their capacity and then the state comes in and takes over. The federal government has made a decision to leave the states in charge of deciding quarantine procedures, whether to open, whether to close. That's why you see New York taking certain actions, Illinois taking certain actions, different states taking certain actions. Because the federal government, this far, has said different situations in different states, let the states decide dependent upon the number of cases they have. I think that has been right, to date. That could change, but it's been right to date. However, the federal government should nationalize medical supply acquisition. The states simply cannot manage it. This state cannot manage it, states all across the country can't manage it. Certainly the states who are dealing with the highest case load can't handle it. But you're hearing it all across the country from states - they just can't deal with finding the medical supplies that they need. That's why I believe the federal government should take over that function of contracting and acquiring all the medical supplies that we need.

Currently, when states are doing it, we are competing against other states. In some ways, we're salvaging other states. I'm trying to buy masks - I'm competing with California and Illinois and Florida and that's not the way it should be, frankly. Price gouging is a tremendous problem and it's only getting worse. There were masks we were paying 85 cents for, we're not paying 7 dollars. Why? Because I'm competing against every other state and, in some cases, other countries around the world. Ventilators, which are the most precious piece of equipment for the situation, they range in price from 16,000 dollars to 40,000 dollars each. And New York State needs 30,000 ventilators. This is just an impossible situation to manage. If we don't get the equipment, we can lose lives that we could have otherwise saved if we had the right equipment.

The federal government has two options to handle this. Voluntary partnership with companies, where the federal government says to companies I would appreciate if you would work with us and do this. And the President has done that and he seems to have gotten a good response on a voluntary basis. The other way is what is called the Defense Production Act where the federal government has the legal authority to say to companies you must produce this now. It is invoking a federal law. It is mandating that that private companies do something. But I think it is appropriate. If I had the power, I would do it in New York State because the situation is that critical. I think the federal government should order factories to manufacture masks, gowns, ventilators, the essential medical equipment that is going to make a difference between life and death.

It is not hard to make a mask or PPE equipment or a gown, but you need companies to do it. We have apparel companies that can make clothing, well then you can make a surgical gown and you can make a mask. But they have to be ordered to do it. If the federal government does it, then they can do it in a very orderly way. They can decide how many they need. They can designate how many each factory should produce, and then they could distribute those goods by need rather than having the states all compete against each other.

It would also be less expensive because it would avoid the price gouging that is now happening in this marketplace. I can tell what is happening. I will contract with a company for 1,000 masks. They will call back 20 minutes later and say the price just went up because they had a better offer and I understand that. Other states who are desperate for these good literally offer more money than we were paying. And it is just a race that is raising prices higher and higher. We even have hospitals competing against other hospitals. If the federal government came in, used the Defense Production Act, you could resolve all of that immediately.

Also, we need the product now. We have cries from hospitals around the state. I have spoken to other governors across the country. They have the same situation. They need these materials now and only the federal government can make that happen. So I believe the federal government should immediately utilize the Defense Production Act. Implement it immediately, let's get those medical supplies running and let's get that moving as quickly as possible.

https://www.governor.ny.gov/news/vi...oing-covid-19-pandemic-governor-cuomo-accepts

 

[deirdre]

e DPA helped with the funding,

i think it can. I was reading about the car industry and WW11, but its a bit tricky to iron out even what "nationalizing" is.

but in this link, funding is an element it seems. ie. "investment". and guaranteed contracts would be funding because they are guaranteeing a purchase of the items.

The DPA's three active titles offer the President an array of authorities aimed at bolstering the defense industrial base. These include, but are not limited to, the prioritization of contracts, allocation of materials, loan guarantees, and direct investment

https://www.heritage.org/defense/re...rtant-national-security-tool-it-requires-work

I thought he also mentioned

it might have been diBlasio.? he is the mayor of NYCity. here is an opinion piece he wrote March 18

Here's how that might look. It could involve a federal government stimulus to get every out-of-work factory back up and running, hiring workers to churn out these critical provisions. It might mean significant government contracts awarded to any company that can produce these supplies. And at its most extreme, it could mean the government temporarily taking over one of these companies, deciding how many supplies should be produced and where to send them.

https://www.usatoday.com/story/opin...e-scenario-president-trump-column/5070422002/

 

[Leifer]

Dr. Drew Pinsky has publicly apologized. He now admits he was wrong about minimizing the seriousness of Covid-19, and wrong about comparing it to the Flu.
Many of his recent 2-4 week-old videos and podcasts have been removed (by himself I assume).....where he downplayed the virus' seriousness.
Today:

Source: https://www.youtube.com/watch?v=KkYeoLBmw2Y

 

[Agent K]

Dr. Drew Pinsky has publicly apologized. He now admits he was wrong about minimizing the seriousness of Covid-19, and wrong about comparing it to the Flu.

Good of him to apologize. I was wondering if he would. He says he had a lot of different numbers in his head and that he shouldn't have been comparing this outbreak to the flu, but the problem was that he got the numbers wrong. As I pointed out at the time, rather than underestimating the infection fatality rate (IFR) of COVID-19, he overestimated the IFR of seasonal flu to be 0.7%, which is inflated by a factor of seven. He also didn't account for differences in the attack rate.

 

[Mendel]

While it is still not clear which communities are receiving more or less federal support — or how distribution decisions are made — the Post article suggests, anecdotally, that federal allocation of medical resources do not seem to target density of need, but rather the political makeup of affected communities.

According to the Post, the Office of Management and Budget (OMB) requested $2 billion for emergency medical equipment in early February, but received just $500 million weeks later. Now, under strain, that federal stockpile — comprised of ventilators, masks, drugs, and other medical equipment — is insufficient to meet the needs of hospitals who feel underresourced due to the spread of the novel coronavirus.

Communities have been begging, sometimes literally, for increased access to medical equipment, including ventilators and respirators, and basic personal protective equipment (PPE), like masks, gloves, and gowns, for weeks.

But distribution from the federal government has appeared to be uneven. In Massachusetts, where there are major outbreaks around Boston and in the state's western Berkshire County, only 17 percent of requested resources have been shipped out. Maine has received about 5 percent of what it has requested, and Colorado has received about a day's worth of supplies, according to the Post.

On Sunday, Michigan's Gov. Gretchen Whitmer appeared on Meet the Press to say that her state received 112,000 masks from the national stockpile Saturday, but that even with that number, "We're going to be in dire straits again in a matter of days."

President Donald Trump has been critical of Whitmer's requests for aid, and her criticism of his administration's response, referring to her as "the woman in Michigan." By contrast, he has praised Gov. Ron DeSantis of Florida, where Trump resides, and that state has received multiple shipments of everything it has requested, and is awaiting another, according to FEMA data.

It is not clear why this disparity exists, or what protocol FEMA, which recently took over control of the stockpile, uses to administer resources.

https://www.vox.com/policy-and-poli...id-19-supplies-fema-states-federal-government

Is that a comspiracy theory, or is it really happening? That federal supplies are being disbursed according to partisan politics, political favoritism or with a view to elections, with states hopeful to swing for the president receiving more aid?
Or did Florida just ask for less, and the states whose requests were denied asked for much more?

As an outsider, I don't understand this at all (same source):

At a press briefing on March 19, Trump expressed resentment about being asked for medical supplies, saying that the federal government is "not a shipping clerk." He also suggested that governors needed to take care of their own states, acquiring necessary medical materials themselves on the open market.

Governors "are supposed to be doing a lot of this work" of obtaining supplies, Trump said at the time.

That was two weeks ago, has that changed in the meantime?

Contrast with Germany, March 19:
https://www.ft.com/content/c5fb1f72-6920-11ea-800d-da70cff6e4d3

The defence ministry also became the main government procurement agency for emergency equipment such as protective suits, goggles and respirator masks, which it then distributed to hospitals nationwide. It has procured kit to the tune of €241m.

Basically, logistics is one of the military's core competencies, and they've been buying supplies all over the world and are distributing them to the states. Doing this fairly is a challenge, Germany initially had export restrictions in place which are now lifted, and we're complaining about not getting supplies we've ordered in the US.

 

[Mendel]

I looked at Thurday's White House press briefing, and I'm still not completely sure what is going on, but this is relevant:
https://www.whitehouse.gov/briefing...ers-coronavirus-task-force-press-briefing-17/

[Mr. Kushner:] What we've been finding is that people have a lot of these requests based on the models. And what we've been trying to do over at FEMA is say to the states, "Well, if you would like ventilators, we need to see — first, look in your states." Right? So, for example, in northern Jersey, they're going down to southern Jersey and they're finding ventilators and trying to relocate them to where they have their hotspots.

The second thing that we've done asked them to survey for alternative ventilators. Dr. Birx spoke before about the anesthesia machines and the ability to — to convert them to be ventilators. So we're asking people to be resourceful inside their states before they come to the federal government.

The third thing we've been asking states to do is to provide what their daily utilization rates are. So everyone is asking for everything. One congressman got a call from his local hospital saying, "I need 250 ventilators." And he said, "Well, you don't have a COVID patient within four counties, why do you want 250 ventilators?" And he says, "Well, we just want to be safe. We're very nervous right now."

So what you have all over the country is a lot of people are asking for things that they don't necessarily need at the moment. And the job of FEMA and Admiral Polowczyk has been to try to make sure that we're getting the real data from the cities, from the states, so that we can make real-time allocation decisions based on the data.

And right now, what's happening is a lot of the different cities and states are providing FEMA that — that information. We're talking to them daily. They're updating that information daily. And that's enabling the federal government to make much more informed decisions on where they position ventilators.

You also have a situation where, in some states, FEMA allocated ventilators to the states. And you have instances where, in cities, they're running out, but the state still has a stockpile. And the notion of the federal stockpile was it's supposed to be our stockpile; it's not supposed to be state stockpiles that they then use. So we're encouraging the states to make sure that they're assessing the needs, they're getting the data from their local — local situations, and then trying to fill it with the supplies that we've given them.

The one thing that did for me is put the "stockpile" quote in context. They don't want to move supplies to the states until they see a need; they don't want to stock state warehouses. Naturally, that makes it hard for states to plan.

The briefing was quite interesting in total; Admiral Polowzcyk mentioned that the governement is flying supplies in from other countries that are then sold through private distributors. He also expicitly said "allocate", so it seems they are using that DPA power now.

And Dr. Birx talks about the "logarithmic curve" and how the test rates, how many percent test positive, determine where the hotspots are.

So I just wanted to say one other thing about testing, just to give you the bottom-line data of what we're seeing. We appreciate the groups who are reporting; not everyone is reporting yet. And this is part of us trying to understand at a very granular level.

We do have two states that do have 35 percent positives, and that's New York and New Jersey. So that confirms very clearly that that's a very clear and important hot zone.

Louisiana, though, has 26 percent of their tests are positive. Michigan, Connecticut, Indiana, Georgia, Illinois — so that should tell you where the next hotspots are coming — are at 15 percent test positive. And then Colorado, D.C., Rhode Island, and Massachusetts are at 13 percent.

There's a significant number of states still under 10 percent: everyone that I didn't discuss. California and Washington remain steady at an 8 percent rate.

So what we're seeing finally is testing improving — more testing being done; still a high level of negatives — in states without hotspots, allowing them to do more of the surveillance and containment.

I don't really understand how test coverage is an indicator of how severe the epidemic is. If do 20000 tests per day and have 6% positive and then double the capacity to 40000 tests and 4% of the tests come back positive, the situation hasn't become better, it has become worse, except in the sense that the health authorities are now better able to track and isolate high-risk contacts.

 

[deirdre]

As an outsider, I don't understand this at all (same source):

the United States is 4 times bigger than Germany. It doesn't matter how much money the Fed has, if there are no ventilators to buy.
To me, the analogy would be more like if the EU was the shipping clerk and Germany etc expected the EU committee to ship them everything they asked for the minute they asked for it.

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, confirmed Sunday the federal government's emergency stockpile of medical supplies contains nearly
13,000
ventilators. To access those, hospitals are required to ask their state and local governments, which then ask the
federal government to release supplies.

https://www.washingtonpost.com/health/2020/03/18/ventilator-shortage-hospital-icu-coronavirus/

New York/Cuomo said he needed 30,000. The fed doesn't have 30,000.
New York(pop. 8.5 million) got 4000 ventilators already, Connecticut got 50. (pop 3.6 million)

as far as masks and gowns (note:media reporting so im not verifying accuracy).

The system appears to roughly conform to states' populations, rather than the size of their requests. Florida, a state of 21 million, got all 180,000 N95 masks it wanted. Oregon, a state of 4 million, only received 40,000 of the 400,000 masks it requested, and New Jersey, a state of 9 million, got 85,000 of the 2.9 million masks it feels it needs.

https://ctmirror.org/2020/03/20/her...lies-it-requested-while-other-states-did-not/

 

[deirdre]

I don't really understand how test coverage is an indicator of how severe the epidemic is. If do 20000 tests per day and have 6% positive and then double the capacity to 40000 tests and 4% of the tests come back positive, the situation hasn't become better, it has become worse, except in the sense that the health authorities are now better able to track and isolate high-risk contacts.

you'd have to research more, but my impression from fed, NY and Connecticut press conferences is that states aren't testing to track or isolate at this point. they are really only testing sick people now.

You will need an order from your primary care physician to be tested for COVID-19.
https://www.ctpost.com/news/coronav...can-be-tested-and-where-to-go-in-15173754.php

so I guess statistically the numbers (Connecticut at 15%) is a goodish rough estimate.

 

[Mendel]

The FDA approved an antibody test on April 1st. I'm quoting from the IFU:

https://www.fda.gov/media/136625/download

I have a hard time imagining what the use of this test is going to be. It has a false negative rate of 6.2% and a false positive rate of 4%. The false positive rate rate means if you test 1000 people right now, 40 might test positive, but only 1 actually is, since the overall incidence is still below 1 in 1000. If you think you're immune based on this test, you'd be wrong 98% of the time. Obviously that makes it unsuitable for a population survey. Furthermore, the samples tested came from people with acute infections, and it's unclear if the test is sensitive enough to show antibodies in people who are no longer sick.

The false positive rate drops to under 2% if you disregard results where only one stripe triggers, but then you lose half the true positives.


This test is useful in a setting where you already have a good idea that the patient might have a viral pneumonia, and then a hospital can quickly and inexpensively check if it's Covid-19, but would you really want to rely on it?

 

[Mendel]

the United States is 4 times bigger than Germany. It doesn't matter how much money the Fed has, if there are no ventilators to buy.
To me, the analogy would be more like if the EU was the shipping clerk and Germany etc expected the EU committee to ship them everything they asked for the minute they asked for it.

The EU is not a government, that is not a good analogy.
Germany is a federal republic, like the US, and public health and health care is primarily the responsibility of the individual states, like in the US.

New York/Cuomo said he needed 30,000. The fed doesn't have 30,000.
New York(pop. 8.5 million) got 4000 ventilators already, Connecticut got 50. (pop 3.6 million)

New York has 100000 active cases, Connecticut has 5000. Assuming that NY had 3x the numbers of ventilators to start with that Conecticut had, the shortfall is much greater. E.g. assume 1 ventilator per 10000 inhabitants, and 8% ICU rate, then Connecticut has 400 ICU cases and 360+50 ventilators, while New York State (20 million pop) has 8000 ICU cases and 2000+4000 ventilators. (I don't know the true percentages, this is just an example.)
https://www.worldometers.info/coronavirus/country/us/

 

[Z.W. Wolf]

I was just getting ready to post this story.

https://paloaltoonline.com/news/202...rd-search-for-covid-19-clues-in-blood-samples

Hundreds of volunteers... participants in a Stanford University survey that could help us understand how many people actually have COVID-19 virus, even if they aren't showing symptoms.

The volunteers... submitted to a finger-prick test. Over the weekend, the blood collected during this drive-thru will be analyzed for antibodies, a key indicator of whether a person is – or has been – infected with COVID-19.

Jay Bhattacharya, a professor of medicine at Stanford University who is involved with the project, told the Weekly on Saturday that the research team is taking 2,500 tests at the three sites throughout the county... A similar experiment is also being conducted in southern California...

Stanford is conducting tests over a two-day period on Friday and Saturday, with the goal of analyzing the results by the end of Sunday...

"We need to understand how widespread the disease actually is," Bhattacharya told the Weekly. "To do that, we need to understand how many people are infected. The current test people use to check whether they have the condition... It doesn't check whether you had it and recovered. An antibody test does both.

They must be using the very test you posted about, non?

The study is being done by Jay Bhattacharya who published that controversial WSJ piece on March 24; summarized here:
https://fsi.stanford.edu/news/coronavirus-deadly-they-say

Stanford Health Policy's Eran Bendavid and Jay Bhattacharya write in this Wall Street Journal editorial that current estimates about the COVID-19 fatality rate may be too high by orders of magnitude.

"If it's true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there's little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.

"Fear of Covid-19 is based on its high estimated case fatality rate — 2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, 2 million to 4 million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases."

"The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills 2 million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That's not only plausible but likely based on what we know so far."