Although our case numbers are comparable to those of Italy, the numbers of dead here are less than 1/6th of Italy. Sounds like our case numbers reflect increased testing rather than growth in actual infections.
Gosh, I’m worried about Florida and the lack of action there. >500 new cases in one day.
This might be of interest to a few people:
“The US Army has reached out to retired medical personnel to possibly volunteer to support the coronavirus response effort.
In an email obtained by CNN, the Army called upon retired personnel on Wednesday looking for “voluntary recall of retired soldiers” with specific medical specialties.
“We need to hear from you STAT!” the Army said.”
This is blowing up in military medicine groups. Many, many comments ago I posted links to articles regarding the DOD plans to CUT the active duty military corps by 18,000 personnel, to transfer all non-direct combat support medicine to civilian providers. (Links to a few articles about this below.)
On the one hand 18,000 medical personnel are being cut. On the other hand, the Army is asking for more help.
“ With the renewed focus on readiness, the military services also are cutting roughly 18,000 uniformed medical billets — but exactly what types and who will be affected is not known because the Defense Department has not yet released a report due on that effort.”
“ The military health system reforms represent a systemic shift. Historically, the MTFs have provided in-house care for all beneficiaries located near military treatment facilities. Under the new reforms, however, the MTFs would focus on serving military personnel and concentrating on medical training on-base while pushing non-uniformed beneficiaries — such as active-duty families, retirees and their family members — to rely more on civilian providers and the Tricare program for care.”
https://www.health.mil/News/Articles/2020/02/25/DHA-Director-discusses-progress-vision-for-future
On Rachel Maddow right now: Surgical residents at USC all volunteered to learn nursing skills so they can work as nurses in ICUs.
A new twist:
Trump team failed to follow NSC’s pandemic playbook
The 69-page document, finished in 2016, provided a step by step list of priorities – which were then ignored by the administration.
President Donald Trump’s administration was briefed on the playbook’s existence in 2017, said four former officials.
By DAN DIAMOND and NAHAL TOOSI
https://www.politico.com/news/2020/03/25/trump-coronavirus-national-security-council-149285
The Trump administration, state officials and even individual hospital workers are now racing against each other to get the necessary masks, gloves and other safety equipment to fight coronavirus — a scramble that hospitals and doctors say has come too late and left them at risk. But according to a previously unrevealed White House playbook, the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago.
“Is there sufficient personal protective equipment for healthcare workers who are providing medical care?” the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. “If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?”
The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics, which POLITICO is detailing for the first time. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.
“Each section of this playbook includes specific questions that should be asked and decisions that should be made at multiple levels” within the national security apparatus, the playbook urges, repeatedly advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity and check on the U.S. stockpile of emergency resources.
Pandemic playbook
The playbook also stresses the significant responsibility facing the White House to contain risks of potential pandemics, a stark contrast with the Trump administration’s delays in deploying an all-of-government response and President Donald Trump’s recent signals that he might roll back public health recommendations.
“The U.S. government will use all powers at its disposal to prevent, slow or mitigate the spread of an emerging infectious disease threat,” according to the playbook’s built-in “assumptions” about fighting future threats. “The American public will look to the U.S. government for action when multi-state or other significant events occur.”
The guide further calls for a “unified message” on the federal response, in order to best manage the American public’s questions and concerns. “Early coordination of risk communications through a single federal spokesperson is critical,” the playbook urges. However, the U.S. response to coronavirus has featured a rotating cast of spokespeople and conflicting messages; Trump already is discussing loosening government recommendations on coronavirus in order to “open” the economy by Easter, despite the objections of public health advisers.
The NSC devised the guide — officially called the Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents, but known colloquially as “the pandemic playbook” — across 2016. The project was driven by career civil servants as well as political appointees, aware that global leaders had initially fumbled their response to the 2014-2015 spread of Ebola and wanting to be sure that the next response to an epidemic was better handled.
The Trump administration was briefed on the playbook’s existence in 2017, said four former officials, but two cautioned that it never went through a full, National Security Council-led interagency process to be approved as Trump administration strategy. Tom Bossert, who was then Trump’s homeland security adviser, expressed enthusiasm about its potential as part of the administration’s broader strategy to fight pandemics, two former officials said.
Bossert declined to comment on any particular document, but told POLITICO that “I engaged actively with my outgoing counterpart and took seriously their transition materials and recommendations on pandemic preparedness.”
The playbook was designed “so there wasn’t piecemeal thinking when trying to fight the next public health battle,” said one former official who contributed to the playbook, warning that “the fog of war” can lead to gaps in strategies.
“These are recommended discussions to be having on all levels, to ensure that there’s a structure to make decisions in real-time,” said a second former official.
An NSC official confirmed the existence of the playbook but dismissed its value. “We are aware of the document, although it’s quite dated and has been superseded by strategic and operational biodefense policies published since,” the official said. “The plan we are executing now is a better fit, more detailed, and applies the relevant lessons learned from the playbook and the most recent Ebola epidemic in the [Democratic Republic of the Congo] to COVID-19.”
A health department spokesperson also said that the NSC playbook was not part of the current coronavirus strategy. “The HHS COVID-19 response was informed by more recent plans such as the foundation of the National Biodefense Strategy (2018), Biological Incident Annex (2017),and panCAP (2018) among other key plans provided by the CDC, White House Task Force, FEMA, and other key federal departments and agencies,” the spokesperson said.
Trump has claimed that his administration could not have foreseen the coronavirus pandemic, which has spread to all 50 states and more than 180 nations, sickening more than 460,000 people around the world. “Nobody ever expected a thing like this,” Trump said in a Fox News interview on Tuesday.
But Trump’s aides were told to expect a potential pandemic, ranging from a tabletop exercise that the outgoing Obama administration prepared for the president’s incoming aides to a “Crimson Contagion” scenario that health officials undertook just last year and modeled out potential risks of a global infectious disease threat. Trump’s deputies also have said that their coronavirus response relies on a federal playbook, specifically referring to a strategy laid out by the Centers for Disease Control.
It is not clear if the administration’s failure to follow the NSC playbook was the result of an oversight or a deliberate decision to follow a different course.
The document rested with NSC officials who dealt with medical preparedness and biodefense in the global health security directorate, which the Trump administration disbanded in 2018, four former officials said. The document was originally overseen by Beth Cameron, a former civil servant who led the directorate before leaving the White House in March 2017. Cameron confirmed to POLITICO that the directorate created a playbook for NSC staff intended to help officials confront a range of potential biological threats.
But under the Trump administration, “it just sat as a document that people worked on that was thrown onto a shelf,” said one former U.S. official, who served in both the Obama and Trump administrations. “It’s hard to tell how much senior leaders at agencies were even aware that this existed” or thought it was just another layer of unnecessary bureaucracy.
Part 1
Part 2
The NSC playbook would have been especially useful in helping to drive the administration’s response to coronavirus, given that it was intended to guide urgent decisions and coordinate the all-of-government approach that Trump so far has struggled to muster, said people familiar with the document.
The color-coded playbook contains different sections based on the relative risk — green for normal operations, yellow for elevated threat, orange for credible threat and red once a public health emergency is declared — and details the potential roles of dozens of departments and agencies, from key players like the Health and Human Services department to the Department of Transportation and the FBI. It also includes sample documents intended to be used at coordinating meetings.
“While each emerging infectious disease threat will present itself in a unique way, a consistent, capabilities-based approach to addressing these threats will allow for faster decisions with more targeted expert subject matter input from federal departments and agencies,” the playbook reads.
The playbook lays out different strategies for policymakers based on the severity of the crisis and shares lessons gleaned from past outbreaks. For instance, one section is devoted to addressing 34 “key questions” and 21 “key decisions” as soon as there is a “credible threat” — which in the case of coronavirus would have been early-to-mid January, as it raged in China and as the first U.S. case was detected on Jan. 20 — and calls on officials to move quickly.
“We recommend early budget and financial analysis of various response scenarios and an early decision to request supplemental funding from Congress, if needed,” the guide urges. But the Trump administration waited more than a month to ask for emergency funding after the timeline laid out in the playbook.
The playbook also repeatedly urges officials to question official numbers about the viral spread. “What is our level of confidence on the case detection rate?” reads one question. “Is diagnostic capacity keeping up?” But across January and much of February, Trump administration officials publicly insisted that their diagnostic efforts were sufficient to detect coronavirus. Officials now privately concede that the administration’s well-documented testing problems have contributed to the outbreak’s silent spread across the United States, and health experts say that diagnostic capacity is only now in late March catching up to the need.
In a subsequent section, the playbook details steps to take if there’s evidence that the virus is spreading among humans, which the World Health Organization concluded by Jan. 22, or the U.S. government declared a public health emergency, which HHS Secretary Alex Azar did on Jan. 31.
Under that timeline, the federal government by late January should have been taking a lead role in “coordination of workforce protection activities including… [personal protective equipment] determination, procurement and deployment.” Those efforts are only now getting underway, health workers and doctors say.
@rosered55 , having watched the care my husband got in a teaching hospital’s icu several years ago, I think ALL residents should be required to serve a stint in frontline care. It was very obvious that they were uncomfortable dealing with the patients and families.
Top health official says coronavirus pandemic is accelerating in the US
From CNN Health’s Jen Christensen
The coronavirus pandemic is “accelerating” in the United States and “there are other parts of the country which we need to get a better feel for what is going on,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN Wednesday night.
“The way we do that is by increasing testing and identifying people who are infected, isolating them getting out of circulation, and then do contact tracing,” Fauci said.
“New York City is dominating the situation in the United States. About 60% of the infections are in the New York City metropolitan area, and 56% of the new infections are coming from the New York City metropolitan area."
Fauci added: "I mean, I have spoken to the political officials in New Orleans and in the state of Louisiana. They are now shutting things down in a very vigorous way. It is likely that that should have been done a little bit sooner — not blaming anyone on that but you get caught unaware because the nature of this outbreak.”
LA mayor warns there may be “a second or third explosion” of cases in the fall
Los Angeles Mayor Eric Garcetti warned today that the pandemic may not be over quickly, and that “we may see a second or third explosion of (coronavirus) as we do in the flu season.”
The new surge of coronavirus cases could come as early as October or November, Garcetti said.
He also added that the stay-at-home orders are showing great results so far. Los Angeles County residents have moved the least out of anyone in Southern California, he said.
“When we move less, it’s like winning the gold medal,” Garcetti said. “Everybody is safer at home."
[ Fauci also commented today in the press briefing that given the nature of the spread in South America and Africa it is likely that this virus will not abate in the warmer weather but will stick around, coming back in the fall in the US. ]
Two different Boston hospitals each have more than 40 employees that tested positive
From CNN’s Ellie Kaufman
Two different Boston hospitals tell CNN that they now each have more than 40 employees who have tested positive for the coronavirus.
Brigham and Women’s Hospital has 45 employees that have tested positive, Brigham Health Media Relations Associate Serena Bronda told CNN.
“Employees who have tested positive are not working until after they have been cleared by Occupational Health Services,” Bronda said.
Massachusetts General Hospital has 41 employees who have tested positive, but most are believed to have contracted the virus somewhere other than the hospital, said Senior Public Affairs Officer Terri Ogan.
“Based on hospital data, our broad implementation of CDC-guided infection control procedures throughout the hospital, and the extent of community spread now ongoing in Massachusetts, it’s believed that the vast majority of these individuals did not contract the virus at work,” Ogan said in an email.
Japan reports its biggest one-day jump in cases
Japan reported 98 new cases of the coronavirus and two more deaths on Wednesday, marking the country’s largest single-day jump in new infections since the outbreak began.
Some 41 of the new cases come from Tokyo. The capital’s governor urged continued vigilance in a news conference yesterday, telling citizens not to make unnecessary trips outside this coming weekend.
These 98 new cases bring Japan’s total to 2,003, with 712 from the Diamond Princess cruise ship. The death toll stands at 55.
It is normal that residents feel uncomfortable, they are there to learn how to become comfortable. In reality, residency teaches you how not to be dangerous to patients and to get enough experience in avoiding fatal mistakes. Only after you practice independently for a few years and lose quite a few nights of sleep questioning yourself, only then you get comfortable enough to deal with families. Plus, not everybody is Dr Oz and frankly, if a physician has great skills, I can skip liking him.
Um, no. It means we’ll look like Italy now in 3 weeks. It takes weeks on average for an infected person to die
At the current rate (more than 10,000 per day), we’ll surpass China’s total before this weekend. A very depressing thought.
WA DOH reports that they are experiencing issues with their total number of tested.
“ The state’s notifiable conditions database is currently experiencing a slowdown because of a 10-fold increase in the number of lab reports received. Our IT team is working to correct the issue.”
Number of individuals tested: ??? (old data still showing)
Positive: 2,580
Deaths: 132 (9 new)
All Mormon temples are closing worldwide
All Mormon temples worldwide are closing due to the coronavirus pandemic.
The Church of Jesus Christ of Latter-day Saints, informally known as the Mormon Church, announced the closures in a statement on Wednesday.
“After careful and prayerful consideration, and with a desire to be responsible global citizens, we have decided to suspend all temple activity Churchwide at the end of the day on March 25, 2020. This is a temporary adjustment, and we look forward to the day when the temples will reopen,” the statement said.
“Please be assured of our sincere love and appreciation for your devotion and faith.”
The church is based in the United States, but has 16.3 members worldwide, according to its website.
Japan issues a travel alert for the whole world
By CNN’s Emiko Jozuka and Junko Ogura in Tokyo
Japan’s foreign ministry issued a travel alert for the entire world on Wednesday for the first time as the coronavirus pandemic accelerates.
The ministry raised its travel alert to level 2 on a four-level scale, urging people in Japan to refrain from non-essential overseas trips.
The latest move is aimed at preventing the spread of the virus, as Japan has seen a rise in people testing positive after returning from overseas trips.
Japanese foreign minister Toshimitsu Motegi also warned that people traveling abroad may find their mobility restricted or be unable to find flights home if the country they visit issues a lockdown amid the coronavirus pandemic.
Earlier this week, the foreign ministry also requested that those returning to Japan from the United States self-quarantine for two weeks.
Trump accuses media of wanting to keep economy shut to hurt his reelection
Donald Trump has accused the media of wanting to keep the US economy shuttered during the coronavirus pandemic to undermine his chances of reelection.
The US president has been pushing to reopen swaths of the country by Easter – 12 April – despite warnings from medical experts that measures such as closing businesses and social distancing need more time to work.
“The LameStream Media is the dominant force in trying to get me to keep our Country closed as long as possible in the hope that it will be detrimental to my election success,” he tweeted on Wednesday. “The real people want to get back to work ASAP. ”
At Wednesday’s White House coronavirus task force briefing, Trump followed up with an aggressive denial that the Easter timeline is based on his political interests. “The media would like to see me do poorly in the election,” he said. (Guardian)
As far as unauthorized immigrants go, they are better represented in the workforce in agriculture, construction, and leisure/hospitality (e.g. hotels and restaurants) than in the general labor force. Those working in agriculture will probably see little change, because food production still goes on, and many are upstream of where the supply chain splits food between grocery stores and restaurants. But construction will probably lose jobs generally in an economic downturn, and leisure/hospitality looks to be one of the biggest job losers now. So there could be a lot of unauthorized immigrants leaving after losing jobs in leisure/hospitality or construction.
How often and what kind of errors have you found in E-Verify?
If it has many errors, that would be convenient cover for those industries like agriculture, construction, and leisure/hospitality to avoid it so that they can have plausible deniability that they hired unauthorized immigrants knowingly or negligently.
CHINA - 67 new cases totaling 81,285 and 6 new deaths totaling 3,287.
ITALY - 5,210 new cases totaling 74,386 and 683 new deaths totaling 7,503.
4th day in a row with daily new cases below the 6557 peak reached on March 21. Protezione Civile Chief Borrelli, the person usually holding the daily press conference, is at home with a fever, while the former chief Bertolaso is now hospitalized in Milan after having tested positive to the virus
**USA - 11,192 new cases totaling 66,048 and 164 new deaths totaling 944.
SPAIN - 7,457 new cases totaling 49,515 and 656 new deaths totaling 3,647.
GERMANY - 4,332 new cases totaling 37,323 and 47 new deaths totaling 206.
IRAN - 2,206 new cases totaling 27,017 and 143 new deaths totaling 2,077.
FRANCE - 2,929 new cases totaling 25,233 and 231 new deaths totaling 1,331.
SWITZERLAND - 1,020 new cases totaling 10,897 and 31 new deaths totaling 153.
UK - 1,452 new cases totaling 9,529 and 43 new deaths totaling 465.
S. KOREA - 104 new cases totaling 9,241 and 5 new deaths totaling 131.
NETHERLANDS - 852 new cases totaling 6,412 and 80 new deaths totaling 356.
AUSTRIA - 305 new cases totaling 5,588 and 2 new deaths totaling 30.
BELGIUM - 668 new cases totaling 4,937 and 56 new deaths totaling 178.
*CANADA - 617 new cases totaling 3,409 and 10 new deaths totaling 36.
NORWAY - 218 new cases totaling 3,084 and 2 new deaths totaling 14.
*PORTUGAL - 633 new cases totaling 2,995 and 10 new deaths totaling 43.
AUSTRALIA - 359 new cases totaling 2,676 and 3 new deaths totaling 11.
BRAZIL - 307 new cases totaling 2,554 and 13 new deaths totaling 59.
*TURKEY - 561 new cases totaling 2,433 and 15 new deaths totaling 59.
*ISRAEL - 439 new cases totaling 2,368 and 2 new deaths totaling 5.
MALAYSIA - 172 new cases totaling 1,796 and 4 new deaths totaling 20.
DENMARK - 133 new cases totaling 1,724 and 2 new deaths totaling 34.
*CZECH REPUBLIC - 260 new cases totaling 1,654 and 3 new deaths totaling 6.
*IRELAND - 235 new cases totaling 1,564 and 2 new deaths totaling 9.
*LUXEMBOURG - 234 new cases totaling 1,333.
JAPAN - 114 new cases totaling 1,307 and 2 new deaths totaling 45.
ECUADOR - 129 new cases totaling 1,211 and 2 new deaths totaling 29.
*CHILE - 220 new cases totaling 1,142 and 1 new death totaling 3.
PAKISTAN - 91 new cases totaling 1,063 and 1 new death totaling 8.
POLAND - 150 new cases totaling 1,051 and 4 new deaths totaling 14.
THAILAND - 107 new cases totaling 934 and no new deaths totaling 4.
ROMANIA - 112new cases totaling 906 and 5 new deaths totaling 17.
SAUDI ARABIA - 133 new cases totaling 900 and 1 new death totaling 2.
INDONESIA - 104 new cases totaling 790 and 3 new deaths totaling 58.
ICELAND - 89 new cases totaling 737 and no new deaths totaling 2.
*SOUTH AFRICA - 155 new cases totaling 709.
*RUSSIA - 163 new cases totaling 658 and 2 new deaths totaling 3.
*INDIA - 121 new cases totaling 657 and 2 new deaths totaling 12.
*PHILIPPINES - 84 new cases totaling 636 and 3 new deaths totaling 38.
SINGAPORE - 73 new cases totaling 631.
*PANAMA - 115 new cases totaling 558 and 2 new deaths totaling 8.
*ARGENTINA - 115 new cases totaling 502 and 2 new deaths totaling 8.
In Argentina, the daily reported cases of coronavirus made a dramatic leap on Wednesday, with 117 new cases, the highest daily increase.Eight deaths have been reported so far, including a seven-year-old girl who died Wednesday after she was hospitalised because of pre-existing conditions in the northern province of Chaco.
In a drastic measure, Argentina Wednesday announced the suspension of repatriation efforts for thousands of Argentinians stranded abroad by the coronavirus pandemic. The harsh decision was apparently in response to repatriated Argentinians who have lied about their health to get on flights home. It is estimated that over 10,000 Argentinians, most of them tourists, are still outside the country, mainly in the US, Europe, the UK and Latin America. Only persons over 65 years of age will be allowed back, President Alberto Fernández announced.
Among those who won’t now be able to return is 62-year-old Martín Echegaray Davies, an Argentinian of Welsh descent who was thwarted from completing his two-and-a-half year walk from Ushuaia, at the southernmost tip of Argentina, to Alaska, when the US border with Canada was closed last week.
PERU - 64 new cases totaling 480 and 2 new deaths totaling 9.
*COLOMBIA - 92 new cases totaling 470 and 1 new death totaling 4.
EGYPT - 54 new cases totaling 456 and 1 new death totaling 21.
CROATIA - 60 new cases totaling 442.
HONG KONG - 23 new cases totaling 410.
MEXICO - 38 new cases totaling 405 and 1 new death totaling 5.
*DOMINICAN REPUBLIC - 80 new cases totaling 392 and 4 new deaths totaling 10.
*SERBIA - 80 new cases totaling 392 and 4 new deaths totaling 10.
IRAQ - 30 new cases totaling 346 and 2 new deaths totaling 29.
*UAE - 85 new cases totaling 333.
ALGERIA - 38 new cases totaling 302 and 2 new deaths totaling 21.
*NEW ZEALAND - 78 new cases totaling 283.
LITHUANIA - 65 new cases totaling 274 and 2 new death totaling 4.
MOROCCO - 55 new cases totaling 225 and 1 new death totaling 6.
TUNISIA - 59 new cases totaling 173 and 1 new death totaling 5.
BURKINA FASO - 32 new cases totaling 146.
UKRAINE - 43 new cases totaling 145 and 2 new deaths totaling 5.
GHANA - 40 new cases totaling 93 and 2 new deaths totaling 4.
HONDURAS - 22 new cases totaling 52.
1st confirmed cases - BVI (2), Guinea-Bissua (2), Mali (2), Saint Kitts & Nevis (2)
Andrew Cuomo
@NYGovCuomo
·
2h
NEW:
@SoftBank
donated 1.4 million critically needed N-95 masks to us.
New York State thanks you.
We are so grateful for this PPE that protects our healthcare workers.
The very first year we used it (think it was 2007 or 2008 when some of our customers with federal contracts needed to show their vendors were also compliant) the error rate - on an admittedly small sample - was around 20%. For example, a person who we knew had been born in the US since his family had been our friends when he was born came back as unverified yet someone who presented with little to no English skills and a social security card that looked “odd” was verified without pause. Speaking with others in our industry, our experience wasn’t unique. It appears to have gotten slightly better over time but it’s still not accurate. It was a big issue and topic of discussion in our industry both around 2008/2009 (when the feds started requiring it on contracts) and in other years when various states started requiring it.
We have very little turnover, so not a large volume of hiring. Unlike restaurants, agriculture, leisure, hospitality, construction where there is large turnover and many small errors can mean a large company headache.
You’re welcome to PM me if you have other questions so we don’t take this thread off topic.
"About 16 percent of Ohio’s coronavirus cases are healthcare workers, Ohio Department of Health Director Dr. Amy Acton said Wednesday.
More healthcare workers are tested for the disease, also known as COVID-19, Acton said. For the first time, at a statehouse news briefing, she released a total number of tests, at 14,764. That gives a 5 percent positive rate for tests statewide."
https://www.cleveland.com/news/2020/03/16-of-ohios-coronavirus-cases-are-healthcare-workers.html