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Saturday, 21 March 2020

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Great article, Mike, as ever.
I'm angry too. And shocked!

And senators taking advantage of security briefings to dump stock, while publicly denying the problem.

I don't know where you're getting your news from, Mike, but virtually everyone I am watching on the news is talking about the lack of PPE for healthcare workers. This is even more important than ventilators right now (though ventilators are important).

Just to put things into perspective, all of these "issues" were predicted in 2019.

HHS actually modeled a pandemic in a project called "Crimson Contagion" for most of 2019 that elucidated and predicted exactly the same challenges that are being encountered now with COVID-19.

https://www.nytimes.com/2020/03/19/u...-outbreak.html

Here are some key findings from the Crimson Contagion After Action Report:

1) Currently, there are insufficient funding sources designated for the federal government to use in response to a severe influenza pandemic.

2) It was unclear if and how states could repurpose HHS and the Centers for Disease Control and Prevention(CDC) grants, as well as other federal dollars to support the response to an influenza pandemic.

3) Exercise participants lacked clarity on federal interagency partners' roles and responsibilities during an influenza pandemic response.

4) At times, HHS' Operating Divisions and Staff Divisions provided inconsistent an inaccurate response guidance and actions to health care and public health private sector partners.

Full report is here: http://bit.ly/3b6bUBe

It’s also worth noting that a particular problem that the USA is going to face is lack of respiratory therapists (RT’s), a medical specialty that doesn’t really exist in other parts of the world. More here: https://www.reddit.com/r/CoronavirusUS/comments/fiwle9/lack_of_respiratory_therapists_will_be_a_north/

It's a gobsmacking observation, especially considering that the USA has the highest per capita spending on healthcare in the world.

I would suggest that anger won't help anyone stay healthy, so take a chill pill and keep a cool head. I think it's way too early to play the "how could it go so wrong game". Put your trust in karma. For now.

A positive thing that you could do is push the government to maintain a permanent reserve of PPE and respirators, just as it keeps strategic oil reserves.

...The more I researched this yesterday, the angrier I got...I don't know what we as private citizens can do...

There's not much, other than staying at home and social distancing, that we can do in the short term.

In the medium term, don't get angry. Vote!

Here in So Cal, the ICUs are already almost full even before the virus has really hit. Hospitals have been merging and closing, costs are astronomical. In America, we don't have healthcare, we have a "for-profit medical system" that charges more than twice the average in the rest of the world.
During the recent campaigns, we heard "America can't afford healthcare for all." Will we be able to afford the aftermath of this debacle when so many people are uninsured and have no coverage or for-profit hospitals are unable to cope with real emergencies?
BTW, the LA Times reports that the for-profit surgical centers here in LA are still doing elective surgery - facelifts, no problem! Bet they have plenty of PPE.

Sad and inexcusable situation - particularly disappointing when you have heroes getting sick and dying on the front line and bozo's partying on Bondi beach.

Bandanna Republic? No, that's Banana Republic, and that is where we are rapidly descending under the debilitating and incompetent non-leadership in Washington. But we do not need any of that PPE stuff. After all, we were told for two months by the talking heads on a certain TV channel and by the administration that this virus stuff was a hoax and we barely needed to be concerned. Looks like they might have changed their tune when the stock market tanked......

Here is a good thread about this issue on Twitter from Tom Inglesby, Director, Johns Hopkins School of Public Health, Center for Health Security:

https://twitter.com/T_Inglesby/status/1240825539818127360

Excerpt:

"The agency best suited for the massive logistics and supply chain operation now needed across the country may be the Defense Logistics Agency."

My wife is a nurse here in Australia and while she is not on the front line she is involved very closely with the ongoing efforts to stem the tide of infection.

She told me yesterday that 10% of the people on ventilators in Italian hospitals are nurses. I fear the US and possibly here at home the same situation will soon be unfolding.

The PPE that is being provided to medical staff if proving to be ineffective at preventing the spread of this virus and the complete lack of that equipment, or the continued reuse of one time use only items like masks, is only going to hasten the spread of this disease amongst those tasked with fighting it effects.

At what number of deaths are US authorities going to sit up and take notice? Ten thousand, a hundred thousand, a million? Sadly, it seems it’s already too late to avert the worst of the spread which happened while your leaders downplayed the seriousness of the virus. Whether this was through ignorance, incompetence or greed is yet to be determined but imagine when a full accounting of this pandemic is conducted in the future few of the current leadership will come out smelling of roses.

My son, a potter (https://www.stevetheberge.com), is collecting N95 masks, gloves and other PPE used by himself and other artisans and craftspeople to donate to a local hospital. Perhaps readers of this blog could suggest that to their artisan/craftspeople friends.

I have a brother who is an RN and my response to this PPE scandal has been to take stock of my meager supplies and let him know what I have on hand. I have a ten pack of latex gloves from the dollar store that I use when dealing with strong cleaners or chemicals and I have protective eye wear (face shield/glasses/goggles) that I use with power tools. I also have a handful of cheapo dust masks for working in the yard when pollen is high. I have no idea if my inexpensive Harbor Freight protective eye wear can hold up to sterilization procedures but I’m doing/offering what I can. I’m also hoping other locals can chip in as well when crunch time arrives.

We need to have a public “official” make a televised appeal to the hoarders and profiteers to deliver needed PPE supplies to their local hospital.

Another better publicized scandal is how badly we have fallen down in regard to testing. Without testing we can’t engage in suppression. We need to test many, many, many people, even those without symptoms, so we can isolate the infected and prevent them from infecting others. If each infected person could in turn infect only one other person we would be much better off than we are now. Our current testing infrastructure is so bad we can’t even test everyone who is sick.

Mike wrote, "As a former manufacturing powerhouse, it's pathetic that the USA now can't even supply doctors and nurses with enough N95 masks."

More companies are trying to get into the mask-making business, as hospitals and public officials scrounge for protective gear for medical workers confronting the corona-virus pandemic.
[ ... ]
However, the new entrants are facing the same problem as established mask makers: shortages of key supplies and equipment.
[ ... ]
Mask-making machines sit idle at Strong Manufacturers’ facility in Charlotte, N.C., because the company can’t find enough raw materials.

https://www.wsj.com/articles/new-manufacturers-jump-into-mask-making-as-coronavirus-spreads-11584792003?

Chinese officials are buying up medical masks in the virus-wracked country from factories that typically supply hospitals around the world, forcing manufacturers to boost output globally and hospitals to ration supplies.
[ ... ]
Officials in India and Taiwan have banned exports of medical masks.
[ ... ] 3M said the Shanghai municipal government is requiring additional “supervision and control” of some of its facilities in China as a result of the outbreak.
[ ... ]
Direct Relief, a nonprofit based in Santa Barbara, Calif., that provides medical supplies during disasters, is sending air shipments of more than 300,000 masks to hospitals in China.

https://www.wsj.com/articles/coronavirus-outbreak-strains-global-medical-mask-market-11580985003?

https://youtu.be/Gq4UguMMtaI

If you want a nurse’s perspective on this madness. But about 15 minutes in I mention the T word. It’s not political. It’s life and death.

Well said, Mike. Very well said.

Be well,
Dan

“Why is this not being treated as a matter of the highest possible urgency?” Let’s start with this: the Surgeon General saying “Everything”s fine,” on Feb 5.

https://www.usatoday.com/story/news/health/2020/02/05/coronavirus-vs-flu-us-surgeon-general-says-flu-bigger-risk/4667797002/

That man is the head of our health care system.

A government official who perhaps would have treated this as a matter of urgency was Rear Adm. Tim Ziemer, a member of the National Security Council until May 2018, when his position was eliminated by John Bolton.

https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/

Just google: Kakistocracy. If you didn’t know, now you know.

I have a garage shop with a few machine tools. Phoenix is usually too hot for me to use it much, but I still regularly visit this website: https://bbs.homeshopmachinist.net/forum/general/1862857-anyone-tooling-up-to-make-ventilators#post1863095. The call has gone out to see if they can help in making ventilators.

Thank you for your sentiments, Mike.
I've been a physician for 42 years. I only heard of the term "PPE" a few weeks ago.
The problem that Italy had is the same one that the US had: politicians at the highest levels of government who denied to the public that there was an emerging pandemic threat, and who avoided taking drastic but necessary steps early to prevent a crisis that would occur only a few weeks later. This was a failure of imagination coupled with greedy politics. They didn't understand that they could not wish the problem away. Ethically, the worse cases were the two senators who knew of the evolving disaster and, instead of sounding a warning to the public, kept quiet and sold off stock for their own financial benefit.
I also take great offense to a president who chides health care workers for being wasteful by not reusing protective masks which, when properly used, are single use only. This is an attempt to blame health care workers, who are risking their lives to help others, for the shortage of critical supplies that is the responsibility of this president and his administration.

The G7, controlled by investment banks and lobbyists for fortune 500 companies entered into a pact with the devil. With supply chain and manufacturing ceded to China in order to maximize shareholder value a giant sink hole was created. Which we, none voting consumers, just fell into. There is no way anyone except the 1% could afford to pay for goods manufactured in the USA within the current wage structure of the average blue collar worker. The tables have been tipped and not in the 99%'s favour. Good luck getting manufacturing back into the USA!

A thing I have noticed when examining my own reactions to similar issues in the past is that our righteous anger toward any particular situation is in reality feed and propelled by your own fears and insecurities. We feel vulnerable and expect that someone else is going to fix it for us ... put us back in a bubble safety. Never works as envisioned.

In 2016, American voters chose a "disruptor" over a technocrat.

For they have sown the wind, and they shall reap the whirlwind.

It's much the same in the UK. I have just read that the government is asking vets to donate ventilators normally used for animals! In addition various high tech aerospace and automotive companies are racing to design and build ventilators, as none are manufactured here. 3d printing wil be a crucial technology for that.

It is worrying how much the American government has underestimated this problem; yesterday (Saturday) in Italy we had nearly eight hundred deaths, companies are closed, people (those with common sense) remain closed at home, doctors and nurses risk their lives every day (my country, despite having an excellent national health service, has suffered from economic cuts in recent years). All of this is surreal. I hope that the future and destiny reserve a better treatment for America than it did in Italy.

Just a piece of advice: stay home.

Mike, here in Portugal it is the same. Many governments cose to bury their heads in the sand, when it was clear that surprise surprise, viruses can travel by plane, car, boat and train.

I too had to Google PPE. I wondered why doctors needed an Oxford University degree in Philosophy, Politics, and Economics.

This is too long for publication and incomplete but I thought you'd be interested.

In a recent Joe Rogan podcast interview with Michael Osterholm, he pointed out there is a mask (not sure which model) and 95% of the world's supply came from one company in Puerto Rico. When a Cat 5 hurricane hit, there was an almost immediate worldwide shortage of them. Hospitals use 'just in time' inventory management now because, you know, that's the efficient way to do it. 'Just in time' works just fine until it doesn't.

Sam Harris' podcast No. 191 with Dr Amesh Adalja is a must listen about the virus. It's good to listen to people who know what they're talking about.

It's a perpetual dilemma, isn't it. If you let government make masks, we'd be screwed because government is terrible at that. If you let private industry make masks, they'll make them in a way that suits them, which is not always aligned with the public interest.

So why aren't we mature enough to understand that this dilemma exists and to find methods and procedures to counteract the bad tendencies that arise. Instead, we have endless shouting matches about ideology as if the doctrines were more important than the outcomes. Ego is a terrible thing sometimes.

The lack of PPE is a disgrace.
I recently returned from east Africa to Australia, and am now self-isolating as per our government’s rules. The contrast between the west and Africa is startling. We were screened at airports, land borders and on a major road. All officials had face masks, infra-red thermometers and hand sanitiser was everywhere - as were hand wash facilities. This is because they are used to dealing with serious infectious diseases such as Ebola, and where prevention is the only solution as the health system could not cope with something like coronavirus.
In the west, we have become complacent, and are being badly caught out.

Mike—You have written a very timely post concerning the shortage of PPEs available to our medical professionals and in doing so focused attention on a glaring weakness in 21st century America. You even mentioned that the USA was once a manufacturing powerhouse yet it seems that we have lost that vital capacity. Manufacturing in general has been outsourced to other countries whose workers will labor for wages far lower than those acceptable in this country. Walmart always reminds us that our quest in life is always to buy at the lowest possible price. We have become consumers first and workers second. Therefore, the products sold are made in places with low wages. Basic manufacturing has drifted away and will only return when robotics is implemented so that the robots work for even less than the low wage earners in other countries. We have even glorified the outsourcing in TV shows like "Shark Tank." The sharks get excited when presenters tell them that their products have such great margins because they are made so cheaply in China (or someplace else). Glorify the profits of a few at the expense of American workers. The result is our inability to ramp up manufacturing of vital supplies. The Government has protected some industries that supply products to our national defense. Fighter jets are still made in the USA. However, our pharmaceuticals are not. I have read that over 90% of our antibiotics are made in other countries. Sorry for the long rant, but your post touched a nerve....

Hi Mike, I've just peeped in to see if you were still alive. BTW, is it possible to follow this on FB? I have no time to sift through many sites. But now down to the point: I am in Italy, locked down like everybody else. At this monent in time, it does not matter if Trump is incompetent and how many mistakes have all politicians made. What counts, is not to spread the epidemic around, and survive. Eventually, the elections will come and people will judge. Meantime: take this VERY seriously. Most infections come from people with no symptoms and most of them are kids. You also get infested from virus left over on surfaces - it can survive up to 5 days on hard surfaces. General rule is: wear a mask and gloves, if you have no mask, take a piece of cloth, it is for NOT SPREADING anything. Pretend that anybody who comes into your house does the same. Sanitize all your shopping or set it aside for a week before you touch it with bare hands, After you come back from a shop, take off the mask, gloves and shoes OUTSIDE the main dwelling and wash your hands right away. Above all stay home and don't see anybody. Good luck !

Bandana Republic: perfect coinage. We have become a can't do nation. In WW2, converted car factories were spitting out a tank per hour and yet somehow in our modern tech-savvy age we are incapable of producing masks for those on the front lines who are keeping disaster at bay. We knew about this virus and its potential to wreck havoc in January. It is just one of many indicators that there is severe and widespread rot in the American system.

Good thing that this is all a deep state democratic party hoax (DSDPH).

Related, from 'Slate': "America Is a Sham: Policy changes in reaction to the coronavirus reveal how absurd so many of our rules are to begin with." At https://slate.com/news-and-politics/2020/03/coronavirus-tsa-liquid-purell-paid-leave-rules.html

Like this:
From lianafinck: https://www.instagram.com/lianafinck/

Thank you for raising this crucial issue. My wife is a long-term care/rehab nurse with almost 30 years of experience. Replacing her will not be easy in the short term. Yet inexplicably, our healthcare system forgot to back up their pandemic contingency plans with enough PPE. Amazing! I've spoken with my wife about this and she is fairly close-mouthed and, frankly, stoic. She doesn't want to worry us. But I know she's worried. And I am too, since no amount of my and my daughter's social distancing and home quarantining will protect us if she comes home infected. Bandana Republic, indeed!

For whatever reason the United States is unable to provide the necessary protective stuff for doctors and nurses, but also unable to make enough test kits for the entire population should be intensely investigated. That laxity of imagination and thoroughness is a disaster in the making. There may be thousands of people who have COVID-19 but are asymptomatic and as such are not being tested. Yet we are spreading the disease.

Mike,
Here is what an average person with a sewing machine can do, make simple, CDC-compliant surgical masks. Made with cotton cloth, these can be sterilized and reused unlike the disposable ones in use today. Cotton is what they use to use. If you are handy with a sewing machine, these take about 15 minutes to make. JoAnn's Fabrics has launched a national program to make fabric available.
Here is an article about the Deaconess Health System in Indiana and their requests for masks with patterns and a video showing how to make them. They show using elastic, but if you don't have any elastic, you can make cotton ties.
https://www.courierpress.com/story/news/2020/03/18/coronavirus-deaconess-ask-public-provide-medical-face-masks/2865273001/?fbclid=IwAR1LUMI28yZzu5gskaZfyQ_c5O9jWEzGM-agdzFlomxwwh8rdNm6FPpDe0A

As someone posted on facebook, "Rosie the Riveters, it is time to get to work!"

This virus is a manifestation of The Day the World Changed.

It moves us from the twentieth century to the twenty first century in a similar way WW1 and influenza closed the nineteenth century. Those born in the mid-twentieth and earlier just ceded authority to new generations.

Politics and social policy will follow but where that will lead is unclear at least to me.

Unconscionable. We in America lost two months of response time from the point of the first warnings, which among other things, led directly to the lack of adequate PPE you describe. VOTE!!

One thing ordinary people can do is stop buying those masks when they go on sale. They do f**k all to protect you from coronavirus while you're wandering around on the streets, and take them away from the health care workers who need that protection while working up close and personal with patients.

On Saturday, one of the local Target stores put a shipment of N95 masks on sale. Governor Inslee's office was on them like a pack of wild dogs, and arranged to have Target donate the lot to health care workers, who are running out/have run out, depending on the facility.

You want to get more outraged? Take a look at this. Guess who wants to suspend "parts" of the Constitution? Really don't expect you to publish this as some may get upset with it. This has been reported from multiple sources by the way; https://www.rollingstone.com/politics/politics-news/doj-suspend-constitutional-rights-coronavirus-970935/

It's the same here in Germany. They spent four weeks reassuring us that they're all prepared (they seem to be doing okay with testing and tracing to be fair) but hospitals are saying they have two days supplies of PPE!! I suspect bureaucracy and group think is to blame: "not our job" NOJ; "no one else seems to think it's a problem" NOESTTIAP (going overboard here). Otherwise the communication has been terrible. If you want to see an example of a politician communicating clearly to her people, check out Jacinda Ardern, Prime Minister of New Zealand: https://www.youtube.com/watch?v=AvRuYrH5rjs

At this very moment, stockpiles of masks, hand sanitizer, and other supplies are sitting in warehouses waiting for FDA inspectors to get around to them. Where other nations are expediting these deliveries, trusting proven suppliers in their deliveries, the FDA has resorted to its favorite fetish: bureaucratic lethargy.
https://www.washingtonexaminer.com/opinion/fda-inspections-craziness-preventing-coronavirus-response

On the news down here in the NYC area, they showed health workers in a hospital using black trash, garbage bags in place of protective clothing. Yet the president refuses to order manufacturers to start making needed masks, scrubs, protective outer clothing, and especially badly needed respirators.
We truly are living in a BANdANA REPUBLIC.
Stay safe.

"The PPE thing is shocking. Given plausible trajectories of the disease (if you have not read the Imperial paper from Monday then you should [I'm sorry, I could not find what he's talking about to link to it —Ed.])"

Here you go: https://www.nytimes.com/2020/03/17/world/europe/coronavirus-imperial-college-johnson.html

Correction: I confused myself. It was an IV bag that was manufactured in Puerto Rico not masks. Sorry, I was careless when I wrote that note to you and didn't proofread. My apologies.

My point was about supply chains but I should have re-read what I write.

While we are concentrating on the physical task of getting masks and respirators made some amazing things have been happening in the digital world to help us cope ...

Extreme physical dis-connectivity requires extreme virtual connectivity. The speed of the virtual scale-up has been impressive. Teachers have adroitly shifted to meet with 30 million school children online. Colleges the same. Zoom video conferencing has spread faster than the virus, and Microsoft Teams added 12 million users in just one week, growing by more than a third to 44 million. Communities are leveraging social networks to support neighbors in a crunch. The government is (finally!) allowing doctors and patients to use FaceTime and Skype for remote video check-ups. The American internet infrastructure has handled increased demand admirably, with internet service providers and mobile carriers adding capacity and suspending data usage limits.

And the future ... ?

We can launch a new era in radically decentralized personal medicine — for better individual health, an explosion in physician productivity, a research renaissance into new therapies, and far better public health surveillance.

In the future, massive data will detect outbreaks and smash them early, and most of the world economy can go on while risk zones are isolated and treated.

https://www.aei.org/technology-and-innovation/information-will-be-key-to-defeating-covid-19/

Perhaps digital information technology will be the next penicillin.

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