Coronavirus in the US

Ventilators, PPE, testing, and drugs/vaccines should be a national priority. Corporations will benefit in the long run if they can provide these essential things.

As a nurse who no longer works in acute care, my thoughts are that some kind of mask that can be re-used after sterilizing would be of prime importance. When brilliant people focus on stuff like this, results happen. Our brilliant scientists, biologists, etc. should be taking on the role of the Ph.Ds in Apollo 13 when they were given the task of creating a solution with only the components the astronauts had on hand in the spacecraft.

Someone upthread posted that a CA TJMaxx store was open under the ‘guise’ of being a food provider (my word). As of today, all TJX stores (brick and mortar as well as online) are closed for 2 weeks. Workers will be paid during the two week period. (Reasonable guess that it’ll be longer than 2 weeks, of course; hope they’re able to continue paying their employees.)

https://www.tjx.com/docs/default-source/default-document-library/a-message-from-the-tjx-companies-inc.pdf

@TatinG Totally disagree. You can order what you can’t get. The manufacturers allocate on historical orders from their customers. This way they don’t make to much and have warehouses full of unused stock. That is a loss of money for any business. Hospitals/doctor offices really only have so much space to put stock. It’s not endless . Again orders are on real time demand not expected pandemics. Even if the 3 largest states hospital systems put in “extra” orders just in case (which they most likely did) this would stretch the manufacturers resources. But then there was a shut down in China (companies rely on them making masks also ) plus now every hospital system asking for more gear and now the factories are going 24/7. A good friend of mine works for 3m and she tried to explain this to me. Kinda hard to make product when your shut down and trying to play catch up. They can only produce so much product per hour/day even going 24/7.

This was posted in a military medicine group, Points 2,4,5 and 6 are what I found most interesting. Those points are being discussed and implemented in larger medical centers as well, since appointments are being cancelled/handled via telephone whenever possible, and elective surgeries are also being cancelled.

“Lessons from the front, for family med clinics

  1. The virus is at least one step ahead of you. Whatever your next step is, take it now
  2. Figure out what your true minimal manning is. Write it down. Then cut that in half. Now figure out what you can do with that
  3. Don’t underestimate sporting events and packed meeting rooms. They absolutely breed infection and create clusters.
  4. Divide your treatment teams in half. Send half home for two weeks. They can do a lot from home. Swap out teams in two weeks time
  5. Divide your pharmacists into small teams that do not mix. Keep them away from others. You want at least 3 of those teams.
  6. Same goes for your lab people
  7. Break down your tasks into discrete jobs. That way when you get manpower from shuttered sections you can put them to work easily
  8. Figure out how you are going to keep acute respiratory patients out of the clinic. They need their own waiting room and their own treatment rooms.
  9. Keep acute respiratory patients out of the pharmacy waiting room. We send them outside and have a runner get their meds for them.
  10. STOP scheduling patients. They are just going to get cancelled anyway. 11,. Do all you can via the phone. Then walk in the rest as needed.
  11. This is not normal. Don’t pretend you can do normal things.
  12. Walk through your clinic and look for easy wins like clustered waiting room seats.
  13. Mistakes will be made. Don’t fall into the trap of blaming. It’s counterproductive. Move on and solve the next puzzle.”

Probably not. Today he went in to harvest sperm, so it should be available if they can’t keep the mice.

@eastcoascrazy I’m not allowed to click both Like and Helpful but would if I could.

AT one point can we sustain ourselves with nothing but grocery stores open. 2 weeks, 4 weeks, longer? We want to flatten the curve, but once we are allowed out again cases will go up again. Can we really stop everything for months and months? Is this even working in Italy? i am doing what I am suppose to do, but worry that we cant just stop life for months and months. So many people will be out of work, companies will be out of business. It will be a worldwide depression. Is the Netherlands still thinking Herd mentality? We need to protect the immune compromised, but reading that so many are asymptomatic. without everyone being able to test, how do we do this without every one locked in for months and months. I dont have answers. Do we wait to find out if once you have it, if you are at least temporarily immune? or any of the meds were are looking at to work? Why havent the cases in Italy start to even go down after they went into lockdown? Just so many questions. and i know , no answers.

Eli Lilly indicates otherwise. Hoping that what they indicate is true. Of note is that this press release was written on March 3 and Europe is now having significant disruption which they were not having when this was written.

https://www.lilly.com/news/stories/coronavirus-covid19-global-response

"March 3, 2020
Manufacturing and Medicine Supply Chains

Lilly does not anticipate shortages for any of our products, including all forms of insulin. Since the initial outbreak, Lilly has been closely monitoring our supply chain for potential impact to the supply of our medicines around the world.

We do not source active pharmaceutical ingredients (API) for any of our approved medicines from China, and our insulin manufacturing sites in the United State and Europe have not been impacted by coronavirus. Lilly insulin and other medicines are available, as normal, in U.S. pharmacies. Pharmacies that don’t have certain medicines in stock can order them from wholesalers, with delivery in one to two days.

Globally, our manufacturing network is fully operation and taking steps to prevent impact. We’re in close communication with key suppliers to ensure appropriate supplies of raw materials. As the global situation evolves, we will continue to take the steps necessary to safeguard the reliable supply of our medicine."

In New Orleans, the mayor broadcast her “stay home mandate” from the roof of city hall, with everyone standing a safe distance apart. It looked odd at first but reassuring that they are taking their own health seriously. So different from those crowded stages we see on TV with the task force.

The drive through testing for first responders and health care providers started this morning. It is being run by the National Guard. (Thank you, National Guard!) There were already some drive through testing places run by area hospitals.

A major hospital chain here had been sending their tests to the Mayo Clinic. The backlog meant it took 3 days to get results, and then 7 days. So they are opening their own testing facility onsite. That is the kind of thing that we need to do everywhere.

Of course the United States can reposition and produce needed medical supplies and increase hospital capacity. By the middle of WW2, for instance, each coast of the United States was producing and shipping more war materiel than Germany and Japan combined. Within about 6 months of entering WW1, the US was producing more artillery shells than every other combatant country, again combined. (It is worth noting that no fighting at all took place on German Empire soil during WW1, so it was not like production capacity had been destroyed.) The US can absolutely do it, of that I have no doubt.

But it takes time, and no amount of bleating and pleading will change that. In the meantime, people will get angry that the system is being overwhelmed and some will demand even further measures to enforce social distancing measures and flatten. But of course, to the extent that extreme social distancing and curfews are enforced or observed, production will take longer than it otherwise would. In the end you need a functioning economy to produce anything. There are always going to be tradeoffs.

Not sure Lilly manufactures aspirin; nearly all of the North American-sourced product is made in China.

It’s good to hear that their insulin supply is unaffected.

U.S. intelligence reports from January and February warned about a likely pandemic
President Trump attends the coronavirus response daily briefing at the White House on March 20.

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

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

Taken together, the reports and warnings painted an early picture of a virus that showed the characteristics of a globe-encircling pandemic that could require governments to take swift actions to contain it. But despite that constant flow of reporting, Trump continued publicly and privately to play down the threat the virus posed to Americans. Lawmakers, too, did not grapple with the virus in earnest until this month, as officials scrambled to keep citizens in their homes and hospitals braced for a surge in patients suffering from covid-19, the disease caused by the coronavirus.

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

Coronavirus cases rose as Trump said they were under control
At least seven times over the past two months, President Trump said the number of coronavirus cases in the U.S. were falling or contained even as they rose. (Video: JM Rieger/Photo: Jabin Botsford/The Washington Post)

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

Shut in and stir-crazy: Grappling with a new reality

Spokespeople for the CIA and the Office of the Director of National Intelligence declined to comment, and a White House spokesman rebutted criticism of Trump’s response.

“President Trump has taken historic, aggressive measures to protect the health, wealth and safety of the American people — and did so, while the media and Democrats chose to only focus on the stupid politics of a sham illegitimate impeachment,” Hogan Gidley said in a statement. “It’s more than disgusting, despicable and disgraceful for cowardly unnamed sources to attempt to rewrite history — it’s a clear threat to this great country.”

Public health experts have criticized China for being slow to respond to the coronavirus outbreak, which originated in Wuhan, and have said precious time was lost in the effort to slow the spread. At a White House briefing Friday, Health and Human Services Secretary Alex Azar said officials had been alerted to the initial reports of the virus by discussions that the director of the Centers for Disease Control and Prevention had with Chinese colleagues on Jan. 3.

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

The surge in warnings coincided with a move by Sen. Richard Burr (R-N.C.) to sell dozens of stocks worth between $628,033 and $1.72 million. As chairman of the Senate Intelligence Committee, Burr was privy to virtually all of the highly classified reporting on the coronavirus. Burr issued a statement Friday defending his sell-off, saying he did so based entirely on publicly available information, and he called for the Senate Ethics Committee to investigate.

A key task for analysts during disease outbreaks is to determine whether foreign officials are trying to minimize the effects of an outbreak or take steps to hide a public health crisis, according to current and former officials familiar with the process.

At the State Department, personnel had been nervously tracking early reports about the virus. One official noted that it was discussed at a meeting in the third week of January, around the time that cable traffic showed that U.S. diplomats in Wuhan were being brought home on chartered planes — a sign that the public health risk was significant. A colleague at the White House mentioned how concerned he was about the transmissibility of the virus.

“In January, there was obviously a lot of chatter,” the official said.

Inside the White House, Trump’s advisers struggled to get him to take the virus seriously, according to multiple officials with knowledge of meetings among those advisers and with the president.

Azar couldn’t get through to Trump to speak with him about the virus until Jan. 18, according to two senior administration officials. When he reached Trump by phone, the president interjected to ask about vaping and when flavored vaping products would be back on the market, the senior administration officials said.

On Jan. 27, White House aides huddled with then-acting chief of staff Mick Mulvaney in his office, trying to get senior officials to pay more attention to the virus, according to people briefed on the meeting. Joe Grogan, the head of the White House Domestic Policy Council, argued that the administration needed to take the virus seriously or it could cost the president his reelection, and that dealing with the virus was likely to dominate life in the United States for many months.

Mulvaney then began convening more regular meetings. In early briefings, however, officials said Trump was dismissive because he did not believe that the virus had spread widely throughout the United States.

By early February, Grogan and others worried that there weren’t enough tests to determine the rate of infection, according to people who spoke directly to Grogan. Other officials, including Matthew Pottinger, the president’s deputy national security adviser, began calling for a more forceful response, according to people briefed on White House meetings.

But Trump resisted and continued to assure Americans that the coronavirus would never run rampant as it had in other countries.

“I think it’s going to work out fine,” Trump said on Feb. 19. “I think when we get into April, in the warmer weather, that has a very negative effect on that and that type of a virus.”

“The Coronavirus is very much under control in the USA,” Trump tweeted five days later. “Stock Market starting to look very good to me!”

But earlier that month, a senior official in the Department of Health and Human Services delivered a starkly different message to the Senate Intelligence Committee, in a classified briefing that four U.S. officials said covered the coronavirus and its global health implications.

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

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

Part 1

Part 2

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

Some of Trump’s advisers told him that Beijing was not providing accurate numbers of people who were infected or who had died, according to administration officials. Rather than press China to be more forthcoming, Trump publicly praised its response.

“China has been working very hard to contain the Coronavirus,” Trump tweeted Jan. 24. “The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!”

Some of Trump’s advisers encouraged him to be tougher on China over its decision not to allow teams from the CDC into the country, administration officials said.

In one February meeting, the president said that if he struck a tougher tone against Xi, the Chinese would be less willing to give the Americans information about how they were tackling the outbreak.

Trump on Feb. 3 banned foreigners who had been in China in the previous 14 days from entering the United States, a step he often credits for helping to protect Americans against the virus. He has also said publicly that the Chinese weren’t honest about the effects of the virus. But that travel ban wasn’t accompanied by additional significant steps to prepare for when the virus eventually infected people in the United States in great numbers.

As the disease spread beyond China, U.S. spy agencies tracked outbreaks in Iran, South Korea, Taiwan, Italy and elsewhere in Europe, the officials familiar with those reports said. The majority of the information came from public sources, including news reports and official statements, but a significant portion also came from classified intelligence sources. As new cases popped up, the volume of reporting spiked.

As the first cases of infection were confirmed in the United States, Trump continued to insist that the risk to Americans was small.

“I think the virus is going to be — it’s going to be fine,” he said on Feb. 10.

“We have a very small number of people in the country, right now, with it,” he said four days later. “It’s like around 12. Many of them are getting better. Some are fully recovered already. So we’re in very good shape.”

On Feb. 25, Nancy Messonnier, a senior CDC official, sounded perhaps the most significant public alarm to that point, when she told reporters that the coronavirus was likely to spread within communities in the United States and that disruptions to daily life could be “severe.” Trump called Azar on his way back from a trip to India and complained that Messonnier was scaring the stock markets, according to two senior administration officials.

Trump eventually changed his tone after being shown statistical models about the spread of the virus from other countries and hearing directly from Deborah Birx, the coordinator of the White House coronavirus task force, as well as from chief executives last week rattled by a plunge in the stock market, said people familiar with Trump’s conversations.

But by then, the signs pointing to a major outbreak in the United States were everywhere.

https://www.washingtonpost.com/national-security/us-intelligence-reports-from-january-and-february-warned-about-a-likely-pandemic/2020/03/20/299d8cda-6ad5-11ea-b5f1-a5a804158597_story.html

Idk if I missed this, but since REM has been on my mind I found this, a message from Michael Stipe. https://youtu.be/UlRML_eeJJk

Boeing suspends dividend, CEO foregoes pay after virus-related aid request

Boeing will cancel CEO pay, suspend its dividend and extend a pause on share buybacks, the U.S. planemaker said on Friday, as companies eager for government aid to curb fallout from the coronavirus face pressure to cut payouts to investors.

Boeing’s decision echoes similar measures taken by the largest U.S. airlines in an effort to win over taxpayer support for their requests for stimulus packages, as the fast-spreading virus virtually erases air travel demand and hits the global economy.

Washington governor asked Trump to declare ‘major disaster’ in state

Washington state Gov. Jay Inslee sent a 74-page letter to President Donald Trump requesting that he declare a federal major disaster in the state to unlock additional federal assistance, including unemployment assistance and basic food benefits. “The state urgently requires additional supplemental federal emergency assistance in order to save lives, protect public health and safety, and limit further spread of the disease,” Inslee said.

Gary Cohn says the US is in a recession that will cost ‘trillions’ as unemployment ‘skyrockets’

The U.S. is in a recession that will see unemployment soar and cost trillions of dollars to solve, Gary Cohn, former White House economic advisor and Goldman Sachs executive, told CNBC.

With markets in turmoil and companies announcing a stream of layoffs, the former National Economic Council director under President Donald Trump said it was hard to put an optimistic face on what’s happening now.

“We’re in recession, I’m not going to tell you that we’re not in recession right now. You cannot remove the consumer from the U.S. economy … and say that we’re not in recession,” Cohn said on “Closing Bell. “The unemployment number is going to skyrocket.”

Macy’s taps $1.5 billion credit line, suspends earnings outlook and dividends

Macy’s said that it has fully drawn its $1.5 billion revolving credit facility, in the midst of the coronavirus pandemic. The department store chain said it did so as a “proactive measure.”

Macy’s has also withdrawn its 2020 sales and earnings outlook, and it is not offering an updated forecast at this time.

The retailer is further suspending its quarterly cash dividend, starting in the fiscal second quarter. It said its previously announced dividend payment, set for April 1, will not be impacted. The company said that shareholders of record as of March 13 will receive a first-quarter dividend payment, as scheduled.

Novartis to donate malaria drug in the fight against COVID-19
Novartis will donate enough doses of malaria drug hydroxychloroquine to treat several million patients in the fight against the coronavirus, if it wins approval, the Swiss company said.

There are no vaccines or treatments approved for the disease, but there is currently a 1,500-person trial, led by the University of Minnesota, to see whether hydroxychloroquine can prevent or reduce the severity of COVID-19. Two other trials are studying blood pressure drug losartan as a possible treatment.

Novartis makes the malaria drug, which is also used to treat lupus and rheumatoid arthritis, at its Sandoz unit in the United States. It plans to donate 130 million doses of the drug and is in talks with U.S. Food and Drug Administration regulators over expanding its use for coronavirus.

CNBC

CEOs say food supply chains are so far holding up during outbreak shopping rush

Food supply chains have so far held up despite the coronavirus bringing swaths of the American economy to a halt, CEOs from across the industry told CNBC.

“As of right now, the supply chain remains strong. It remains healthy,” Chipotle CEO Brian Niccol said on “Power Lunch.” “We’re fortunate that we’ve got such great partners getting us the Chipotle food we need to run our business.”

Niccol’s comments come as the food industry across the U.S. experiences upheaval due to the coronavirus pandemic. State and local governments are mandating the closure of restaurants and bars, except for takeout and delivery food, while grocery stores face increased demand as consumers stockpile goods.

New York City is the new coronavirus epicenter with one-third of all US cases, Mayor de Blasio says
New York City accounts for roughly a third of all the coronavirus cases in the nation with 5,151 confirmed infections as of 10 a.m., Mayor Bill de Blasio said.

“We are now the epicenter of this crisis,” he said at a press conference, adding that 29 residents have died. Some 52 New York City police are among those infected, city officials said.

Hospitals set up coronavirus tents, seek emergency credit and $100 billion in US aid
U.S. hospitals are setting up coronavirus wards and tents, seeking emergency credit lines and lobbying Washington for a $100 billion stabilization fund to help meet an expected onslaught of patients as the pandemic sweeps the nation.

“We believe hospitals and health systems should be top priority number one for the Congress, at this moment,” said Robyn Bash, vice president for government relations at the American Hospital Association.

Global auto production could fall by 1.4 million vehicles this year
As the coronavirus spreads across the globe, shuttered auto plants in Europe, North America and Latin America could reduce global production this year by more than 1.4 million vehicles, according to new research from IHS Markit.

Auto plants across the globe have announced plans to temporarily suspend production in order to sanitize facilities and prevent the spread of COVID-19. The hiatus, which could last for nearly three weeks in some cases, would create an immediate cash crunch to automakers through lost vehicle production.

CNBC

Thanks, not a WA resident but happy to help.

Side note in case someone has to fly for an emergency, children leaving a college campus or is health care worker needed elsewhere (examples of why to fly not requirements) -

I was told by someone at work that JetBlue has $18 round trip Boston to Orlando. $89 round trip Boston to LA.

A hospital system in Washington State is calling on volunteers to make masks for health-care workers. I can’t find information on how useful these would be; anyone know?
https://www.providence.org/lp/100m-masks

From the link:

“How to make our face masks
This video tutorial is intended for volunteers who have been selected to help us make masks. Our product uses medical grade material that is not available commercially. We are supplying volunteers with this specific material. Masks created with alternative materials may not have the same effectiveness. Watch here>> “