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CNN: CDC director says some coronavirus-related deaths have been found posthumously
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NYT: Before Virus Outbreak, a Cascade of Warnings Went Unheeded
Government exercises, including one last year, made clear that the U.S. was not ready for a pandemic like the coronavirus. But little was done.
By David E. Sanger, Eric Lipton, Eileen Sullivan and Michael Crowley
March 19, 2020
Source:https://www.nytimes.com/2020/03/19/us/politics/trump-coronavirus-outbreak.html?action=click&module=Top Stories&pgtype=Homepage
WASHINGTON — The outbreak of the respiratory virus began in China and was quickly spread around the world by air travelers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later, the World Health Organization declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalized and 586,000 dead.
That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.
The simulation’s sobering results — contained in a draft report dated October 2019 that has not previously been reported — drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.
The draft report, marked “not to be disclosed,” laid out in stark detail repeated cases of “confusion” in the exercise. Federal agencies jockeyed over who was in charge. State officials and hospitals struggled to figure out what kind of equipment was stockpiled or available. Cities and states went their own ways on school closings.
Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation’s leaders. Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.
In 2016, the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017, outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.
The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement on Monday that he had known all along that a pandemic was on the way.
What the scenario makes clear, however, is that his own administration had already modeled a similar pandemic and understood its potential trajectory.
The White House defended its record, saying it responded to the 2019 exercise with an executive order to improve the availability and quality of flu vaccines, and that it moved early this year to increase funding for the Department of Health and Human Services’ program that focuses on global pandemic threats.
“Any suggestion that President Trump did not take the threat of COVID-19 seriously is false,” said Judd Deere, a White House spokesman.
But officials have declined to say why the administration was so slow to roll out broad testing or to move faster, as the simulations all indicated it should, to urge social distancing and school closings.
Asked at his news briefing on Thursday about the government’s preparedness, Mr. Trump responded: “Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.”
The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Mr. Trump is now scrambling belatedly to address.
Crimson Contagion, the exercise conducted last year in Washington and 12 states including New York and Illinois, showed that federal agencies under Mr. Trump continued the Obama-era effort to think ahead about a pandemic.
But the planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress, leaving the nation with funding shortfalls, equipment shortages and disorganization within and among various branches and levels of government.
The October 2019 report in particular documents that officials at the Departments of Homeland Security and Health and Human Services, and even at the White House’s National Security Council, were aware of the potential for a respiratory virus outbreak originating in China to spread quickly to the United States and overwhelm the nation.
“Nobody ever thought of numbers like this,’’ Mr. Trump said on Wednesday, at a news conference.
In fact, they had.
From Ebola, Lessons Learned
As early as the George W. Bush administration, homeland security and health officials focused on big gaps in the American response to a biological attacks and the growing risk of pandemics. The first test came in April 2009, just a few months after the start of President Barack Obama’s first term. A 10-year-old California girl was diagnosed with a contagious disease that would be called swine flu or H1N1, the first flu pandemic in more than 40 years.
The Centers for Disease Control and Prevention estimates that ultimately there were about 60.8 million cases in the United States, along with 274,304 hospitalizations and 12,469 deaths associated with H1N1.
The virus turned out to be less deadly than first expected. But it was a warning shot that officials in the Obama administration said they took seriously, kicking off a planning effort that escalated in early 2014, with the outbreak of Ebola in West Africa and ensuing fear that it could spread to the United States.
Ebola was less contagious than the flu, but far more deadly. It killed 11,000 people in Africa. But it could have been far worse. The United States sent nearly 3,000 troops to Africa to help keep the disease from spreading. While the containment effort was considered a success, inside the White House, officials sensed that the United States had gotten lucky — and that the response had revealed gaps in preparedness.
Christopher Kirchhoff, a national security aide who moved from the Pentagon to the White House to deal with the Ebola crisis, was given the job of putting together a “lessons learned” report, with input from across the government.
The weaknesses Mr. Kirchhoff identified were early warning signals of what has unfolded in the past three months.
His report concluded that the United States assumed more ability on the part of the World Health Organization than the agency actually had.
The United States had its own issues. There was no airplane in the U.S. fleet capable of evacuating an American doctor who was infected while treating patients in Liberia. The Pentagon was largely unprepared for the intervention that Mr. Obama ordered.
While the United States rapidly developed a way to screen air passengers coming into the country — borrowing from intelligence tools developed after the Sept. 11, 2001, attacks to track possible terrorists — Mr. Kirchhoff found deficiencies in even measuring how fast the virus was spreading.
On the plus side, the Obama White House had created an Ebola Task Force, run by Ron Klain, Vice President Joseph R. Biden Jr.’s former chief of staff, before a single case emerged in the United States. Congress allocated $5.4 billion in emergency funding to pay for Ebola treatment and prevention efforts in the United States and West Africa.
The money helped fund a little-known agency inside the Department of Health and Human Services in charge of preparing for future contagious disease outbreaks, the same office that in 2019 ran the Crimson Contagion exercise and other similar events in the years since.
After a man named Thomas Duncan, a Liberian citizen, became the first person given a diagnosis of Ebola on American territory in September 2014, errors resulted in the infection of two nurses and fear of a wider spread in the United States. (Mr. Duncan died, but the two nurses recovered.)
What is striking in reading Mr. Kirchhoff’s account today, however, is how few of the major faults he found in the American response resulted in action — even though the report was filled with department-by-department recommendations.
There were deficiencies “in personal protective equipment use, disinfection” and “social services for those placed under quarantine.”
There was confusion over travel restrictions, and the need “for a smoother sliding scale of escalation of government response, from local authorities acting on their own to local authorities acting with some federal assistance” to the full activation of the federal government.
The report concluded that “a minimum planning benchmark might be an epidemic an order of magnitude or two more difficult than that presented by the outbreak of Ebola in West Africa, with much more significant domestic spread.”
But one big change did come out of the study: The creation of a dedicated office at the National Security Council to coordinate responses and raise the alarm early.
“What I learned most is that we had to stand up a global biosecurity and health directorate, and get it enshrined for the next administration,” said Lisa Monaco, Mr. Obama’s homeland security adviser.
Getting the Trump Team’s Attention
After Mr. Trump’s election, Ms. Monaco arranged an extensive exercise for high-level incoming officials — including Rex W. Tillerson, the nominee for secretary of state; John F. Kelly, designated to become homeland security secretary; and Rick Perry, who would become energy secretary — gaming out the response to a deadly flu outbreak.
She asked Tom Bossert, who was preparing to come in as Mr. Trump’s homeland security adviser, to run the event alongside her.
“We modeled a new strain of flu in the exercise precisely because it’s so communicable,” Ms. Monaco said. “There is no vaccine, and you would get issues like nursing homes being particularly vulnerable, shortages of ventilators.”
Ms. Monaco was impressed by how seriously Mr. Bossert, her successor, appeared to take the threat, as did many of the 30 or so Trump team members who participated in the exercise, details of which were reported by Politico.
But by the time the current crisis hit, almost all of the leaders at the table — Mr. Tillerson, Mr. Kelly and Mr. Perry among them — had been fired or moved on.
In 2018, Mr. Trump’s national security adviser at the time, John R. Bolton, ousted Mr. Bossert and eliminated the National Security Council directorate, folding it into an office dedicated to weapons of mass destruction in what Trump officials called a logical consolidation.
Asked about that shift on March 13, Mr. Trump told a reporter that it was “a nasty question,” before adding: “I don’t know anything about it.” Writing on Twitter the next day, Mr. Bolton lashed out at critics who said the shift had reflected disinterest in pandemic threats.
“Claims that streamlining NSC structures impaired our nation’s bio defense are false,” Mr. Bolton tweeted. “Global health remained a top NSC priority.”
In a statement, the National Security Council said it “has directors and staff whose full-time job it is to monitor, plan for, and respond to pandemics, including an infectious disease epidemiologist and a virologist.”
But in testimony to Congress last week, Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, suggested that ending the stand-alone directorate was ill-advised. “It would be nice if the office was still there,” he said.
On Feb. 10, nearly three weeks after the first coronavirus case was diagnosed in the United States, Mr. Trump submitted a 2021 budget proposal that called for a $693.3 million reduction in funding for the C.D.C., or about 9 percent, although there was a modest increase for the division that combats global pandemics.
‘Crimson Contagion’
The Crimson Contagion planning exercise run last year by the Department of Health and Human Services involved officials from 12 states and at least a dozen federal agencies. They included the Pentagon, the Department of Veterans Affairs and the National Security Council. Groups like the American Red Cross and American Nurses Association were invited to join, as were health insurance companies and major hospitals like the Mayo Clinic.
The war game-like exercise was overseen by Robert P. Kadlec, a former Air Force physician who has spent decades focused on biodefense issues. After stints on the Bush administration’s Homeland Security Council and the staff of the Senate Intelligence Committee, he was appointed assistant secretary of Health and Human Services for Preparedness and Response.
“He recognized early that we have a big problem and we needed much bigger budgets to prepare,” said Richard Danzig, the secretary of the Navy in the Clinton administration, who had worked with Mr. Kadlec.
The exercise played out in four separate stages, starting in January 2019.
The events were supposedly unspooling in real time — with the worst-case scenario underway as of Aug. 13, 2019 — when, according to the script, 12,100 cases had already been reported in the United States, with the largest number in Chicago, which had 1,400.
The fictional outbreak involved a pandemic flu, which the Department of Health and Human Services says was “very different than the novel coronavirus.” The staged outbreak had started when a group of 35 tourists visiting China were infected and then flew home to Australia, Kuwait, Malaysia, Thailand, Britain and Spain, as well as to the United States, with some developing respiratory symptoms and fevers en route.
A 52-year-old man from Chicago, who was on the tour, had “low energy and a dry cough” upon his return home. His 17-year-old son on that same day went out to a large public event in Chicago, and the chain of illnesses in the United States started.
Many of the moments during the tabletop exercise are now chillingly familiar.
In the fictional pandemic, as the virus spread quickly across the United States, the C.D.C. issued guidelines for social distancing, and many employees were told to work from home.
But federal and state officials struggled to identify which employees were essential and what equipment was needed to effectively work from home.
There also was confusion over how to handle school children. The C.D.C. recommended that states delay school openings — the exercise took place toward the end of the summer. But some school districts decided to go ahead with the start of school while others followed the federal advice, causing the same types of confusion and discrepancies that have marked the response to the coronavirus.
The exercise from last year then went on to predict how the situation on the ground in the United States would worsen as the weeks passed.
Confusion emerged as state governments began to turn in large numbers to Washington for help to address shortages of antiviral medications, personal protective equipment and ventilators. Then states started to submit requests to different branches of the federal government, leading to bureaucratic chaos.
Friction also emerged between the Federal Emergency Management Agency, which is traditionally in charge of disaster response, and the Department of Health and Human Services, another scenario playing out now.
But the problems were larger than bureaucratic snags. The United States, the organizers realized, did not have the means to quickly manufacture more essential medical equipment, supplies or medicines, including antiviral medications, needles, syringes, N95 respirators and ventilators, the agency concluded.
Congress was briefed in December on some of these findings, including the inability to quickly replenish certain medical supplies, given that much of the product comes from overseas.
These concerns turned more urgent at a hearing last Thursday on Capitol Hill, as lawmakers peppered officials with the Department of Health and Human Services with questions that sounded almost as if they had read the script from the fictional exercise, reflecting the shortage of respirators and protective gear.
Senator Mitt Romney, Republican of Utah, said last week that he blamed Congress and prior administrations for not increasing stockpiles of this type of equipment.
“That is an area we ought to consider making an investment in,” he added, making a point, apparently unknown to him, that the administration’s own simulation had made clear five months earlier.
Government exercises, including one last year, made clear that the U.S. was not ready for a pandemic like the coronavirus. But little was done.
By David E. Sanger, Eric Lipton, Eileen Sullivan and Michael Crowley
March 19, 2020
Source:https://www.nytimes.com/2020/03/19/us/politics/trump-coronavirus-outbreak.html?action=click&module=Top Stories&pgtype=Homepage
WASHINGTON — The outbreak of the respiratory virus began in China and was quickly spread around the world by air travelers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later, the World Health Organization declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalized and 586,000 dead.
That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.
The simulation’s sobering results — contained in a draft report dated October 2019 that has not previously been reported — drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.
The draft report, marked “not to be disclosed,” laid out in stark detail repeated cases of “confusion” in the exercise. Federal agencies jockeyed over who was in charge. State officials and hospitals struggled to figure out what kind of equipment was stockpiled or available. Cities and states went their own ways on school closings.
Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation’s leaders. Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.
In 2016, the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017, outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.
The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement on Monday that he had known all along that a pandemic was on the way.
What the scenario makes clear, however, is that his own administration had already modeled a similar pandemic and understood its potential trajectory.
The White House defended its record, saying it responded to the 2019 exercise with an executive order to improve the availability and quality of flu vaccines, and that it moved early this year to increase funding for the Department of Health and Human Services’ program that focuses on global pandemic threats.
“Any suggestion that President Trump did not take the threat of COVID-19 seriously is false,” said Judd Deere, a White House spokesman.
But officials have declined to say why the administration was so slow to roll out broad testing or to move faster, as the simulations all indicated it should, to urge social distancing and school closings.
Asked at his news briefing on Thursday about the government’s preparedness, Mr. Trump responded: “Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.”
The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Mr. Trump is now scrambling belatedly to address.
Crimson Contagion, the exercise conducted last year in Washington and 12 states including New York and Illinois, showed that federal agencies under Mr. Trump continued the Obama-era effort to think ahead about a pandemic.
But the planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress, leaving the nation with funding shortfalls, equipment shortages and disorganization within and among various branches and levels of government.
The October 2019 report in particular documents that officials at the Departments of Homeland Security and Health and Human Services, and even at the White House’s National Security Council, were aware of the potential for a respiratory virus outbreak originating in China to spread quickly to the United States and overwhelm the nation.
“Nobody ever thought of numbers like this,’’ Mr. Trump said on Wednesday, at a news conference.
In fact, they had.
From Ebola, Lessons Learned
As early as the George W. Bush administration, homeland security and health officials focused on big gaps in the American response to a biological attacks and the growing risk of pandemics. The first test came in April 2009, just a few months after the start of President Barack Obama’s first term. A 10-year-old California girl was diagnosed with a contagious disease that would be called swine flu or H1N1, the first flu pandemic in more than 40 years.
The Centers for Disease Control and Prevention estimates that ultimately there were about 60.8 million cases in the United States, along with 274,304 hospitalizations and 12,469 deaths associated with H1N1.
The virus turned out to be less deadly than first expected. But it was a warning shot that officials in the Obama administration said they took seriously, kicking off a planning effort that escalated in early 2014, with the outbreak of Ebola in West Africa and ensuing fear that it could spread to the United States.
Ebola was less contagious than the flu, but far more deadly. It killed 11,000 people in Africa. But it could have been far worse. The United States sent nearly 3,000 troops to Africa to help keep the disease from spreading. While the containment effort was considered a success, inside the White House, officials sensed that the United States had gotten lucky — and that the response had revealed gaps in preparedness.
Christopher Kirchhoff, a national security aide who moved from the Pentagon to the White House to deal with the Ebola crisis, was given the job of putting together a “lessons learned” report, with input from across the government.
The weaknesses Mr. Kirchhoff identified were early warning signals of what has unfolded in the past three months.
His report concluded that the United States assumed more ability on the part of the World Health Organization than the agency actually had.
The United States had its own issues. There was no airplane in the U.S. fleet capable of evacuating an American doctor who was infected while treating patients in Liberia. The Pentagon was largely unprepared for the intervention that Mr. Obama ordered.
While the United States rapidly developed a way to screen air passengers coming into the country — borrowing from intelligence tools developed after the Sept. 11, 2001, attacks to track possible terrorists — Mr. Kirchhoff found deficiencies in even measuring how fast the virus was spreading.
On the plus side, the Obama White House had created an Ebola Task Force, run by Ron Klain, Vice President Joseph R. Biden Jr.’s former chief of staff, before a single case emerged in the United States. Congress allocated $5.4 billion in emergency funding to pay for Ebola treatment and prevention efforts in the United States and West Africa.
The money helped fund a little-known agency inside the Department of Health and Human Services in charge of preparing for future contagious disease outbreaks, the same office that in 2019 ran the Crimson Contagion exercise and other similar events in the years since.
After a man named Thomas Duncan, a Liberian citizen, became the first person given a diagnosis of Ebola on American territory in September 2014, errors resulted in the infection of two nurses and fear of a wider spread in the United States. (Mr. Duncan died, but the two nurses recovered.)
What is striking in reading Mr. Kirchhoff’s account today, however, is how few of the major faults he found in the American response resulted in action — even though the report was filled with department-by-department recommendations.
There were deficiencies “in personal protective equipment use, disinfection” and “social services for those placed under quarantine.”
There was confusion over travel restrictions, and the need “for a smoother sliding scale of escalation of government response, from local authorities acting on their own to local authorities acting with some federal assistance” to the full activation of the federal government.
The report concluded that “a minimum planning benchmark might be an epidemic an order of magnitude or two more difficult than that presented by the outbreak of Ebola in West Africa, with much more significant domestic spread.”
But one big change did come out of the study: The creation of a dedicated office at the National Security Council to coordinate responses and raise the alarm early.
“What I learned most is that we had to stand up a global biosecurity and health directorate, and get it enshrined for the next administration,” said Lisa Monaco, Mr. Obama’s homeland security adviser.
Getting the Trump Team’s Attention
After Mr. Trump’s election, Ms. Monaco arranged an extensive exercise for high-level incoming officials — including Rex W. Tillerson, the nominee for secretary of state; John F. Kelly, designated to become homeland security secretary; and Rick Perry, who would become energy secretary — gaming out the response to a deadly flu outbreak.
She asked Tom Bossert, who was preparing to come in as Mr. Trump’s homeland security adviser, to run the event alongside her.
“We modeled a new strain of flu in the exercise precisely because it’s so communicable,” Ms. Monaco said. “There is no vaccine, and you would get issues like nursing homes being particularly vulnerable, shortages of ventilators.”
Ms. Monaco was impressed by how seriously Mr. Bossert, her successor, appeared to take the threat, as did many of the 30 or so Trump team members who participated in the exercise, details of which were reported by Politico.
But by the time the current crisis hit, almost all of the leaders at the table — Mr. Tillerson, Mr. Kelly and Mr. Perry among them — had been fired or moved on.
In 2018, Mr. Trump’s national security adviser at the time, John R. Bolton, ousted Mr. Bossert and eliminated the National Security Council directorate, folding it into an office dedicated to weapons of mass destruction in what Trump officials called a logical consolidation.
Asked about that shift on March 13, Mr. Trump told a reporter that it was “a nasty question,” before adding: “I don’t know anything about it.” Writing on Twitter the next day, Mr. Bolton lashed out at critics who said the shift had reflected disinterest in pandemic threats.
“Claims that streamlining NSC structures impaired our nation’s bio defense are false,” Mr. Bolton tweeted. “Global health remained a top NSC priority.”
In a statement, the National Security Council said it “has directors and staff whose full-time job it is to monitor, plan for, and respond to pandemics, including an infectious disease epidemiologist and a virologist.”
But in testimony to Congress last week, Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, suggested that ending the stand-alone directorate was ill-advised. “It would be nice if the office was still there,” he said.
On Feb. 10, nearly three weeks after the first coronavirus case was diagnosed in the United States, Mr. Trump submitted a 2021 budget proposal that called for a $693.3 million reduction in funding for the C.D.C., or about 9 percent, although there was a modest increase for the division that combats global pandemics.
‘Crimson Contagion’
The Crimson Contagion planning exercise run last year by the Department of Health and Human Services involved officials from 12 states and at least a dozen federal agencies. They included the Pentagon, the Department of Veterans Affairs and the National Security Council. Groups like the American Red Cross and American Nurses Association were invited to join, as were health insurance companies and major hospitals like the Mayo Clinic.
The war game-like exercise was overseen by Robert P. Kadlec, a former Air Force physician who has spent decades focused on biodefense issues. After stints on the Bush administration’s Homeland Security Council and the staff of the Senate Intelligence Committee, he was appointed assistant secretary of Health and Human Services for Preparedness and Response.
“He recognized early that we have a big problem and we needed much bigger budgets to prepare,” said Richard Danzig, the secretary of the Navy in the Clinton administration, who had worked with Mr. Kadlec.
The exercise played out in four separate stages, starting in January 2019.
The events were supposedly unspooling in real time — with the worst-case scenario underway as of Aug. 13, 2019 — when, according to the script, 12,100 cases had already been reported in the United States, with the largest number in Chicago, which had 1,400.
The fictional outbreak involved a pandemic flu, which the Department of Health and Human Services says was “very different than the novel coronavirus.” The staged outbreak had started when a group of 35 tourists visiting China were infected and then flew home to Australia, Kuwait, Malaysia, Thailand, Britain and Spain, as well as to the United States, with some developing respiratory symptoms and fevers en route.
A 52-year-old man from Chicago, who was on the tour, had “low energy and a dry cough” upon his return home. His 17-year-old son on that same day went out to a large public event in Chicago, and the chain of illnesses in the United States started.
Many of the moments during the tabletop exercise are now chillingly familiar.
In the fictional pandemic, as the virus spread quickly across the United States, the C.D.C. issued guidelines for social distancing, and many employees were told to work from home.
But federal and state officials struggled to identify which employees were essential and what equipment was needed to effectively work from home.
There also was confusion over how to handle school children. The C.D.C. recommended that states delay school openings — the exercise took place toward the end of the summer. But some school districts decided to go ahead with the start of school while others followed the federal advice, causing the same types of confusion and discrepancies that have marked the response to the coronavirus.
The exercise from last year then went on to predict how the situation on the ground in the United States would worsen as the weeks passed.
Confusion emerged as state governments began to turn in large numbers to Washington for help to address shortages of antiviral medications, personal protective equipment and ventilators. Then states started to submit requests to different branches of the federal government, leading to bureaucratic chaos.
Friction also emerged between the Federal Emergency Management Agency, which is traditionally in charge of disaster response, and the Department of Health and Human Services, another scenario playing out now.
But the problems were larger than bureaucratic snags. The United States, the organizers realized, did not have the means to quickly manufacture more essential medical equipment, supplies or medicines, including antiviral medications, needles, syringes, N95 respirators and ventilators, the agency concluded.
Congress was briefed in December on some of these findings, including the inability to quickly replenish certain medical supplies, given that much of the product comes from overseas.
These concerns turned more urgent at a hearing last Thursday on Capitol Hill, as lawmakers peppered officials with the Department of Health and Human Services with questions that sounded almost as if they had read the script from the fictional exercise, reflecting the shortage of respirators and protective gear.
Senator Mitt Romney, Republican of Utah, said last week that he blamed Congress and prior administrations for not increasing stockpiles of this type of equipment.
“That is an area we ought to consider making an investment in,” he added, making a point, apparently unknown to him, that the administration’s own simulation had made clear five months earlier.
LKJ86
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The draft report source:
https://int.nyt.com/data/documenthe...after/05bd797500ea55be0724/optimized/full.pdf
LKJ86
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'Every Single Individual Must Stay Home': Italy's Coronavirus Surge Strains Hospitals
March 19, 20201:59 PM ET
Daniela De Rosa, a 43-year-old veterinarian in Italy's southwest Campania region, made a video message over the weekend as she was hospitalized with COVID-19. Her video plea has gathered much attention in Italy, which has just surpassed China in the number of reported deaths from the new coronavirus.
"I've been in isolation in a hospital room for so many days I've lost count," she says. "I have no contact with anyone other than doctors twice a day."
"Very few people understand what's happening. I want people to see I'm suffering," De Rosa continues.
"Every single individual must stay home and not endanger the lives of others," she insists.
Since the video was shared on Facebook last Sunday, it has racked up more than 11 million views.
As of Thursday afternoon, Italy has registered 41,035 diagnoses of the coronavirus and 3,405 deaths. The death toll is now higher than China's known COVID-19 deaths of over 3,200. Earlier this month, Italy became the first Western country to launch a nationwide lockdown to contain the outbreak, but despite strict measures, the number of cases continues to rise.
Italy has a universal health care system. But now, its hospitals and medical staff are overwhelmed, prompting anguished debate.
The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has issued guidelines for what it calls a "catastrophe medicine"-like scenario. The college put it starkly: Given the serious shortage of health resources, patients with the "best chance of success and hope of life" should have access to intensive care, the organization says.
"If you have an 99-year-old male or a female patient, that's a patient with a lot of diseases. And you have [a] young kid that need to be intubated and you only have one ventilator, I mean, you're not going to ... toss the coin," says Carlo Vitelli, a surgeon and oncologist in Rome.
He's speaking just a few hours after operating on a perforated appendix of a young man who had been in contact with a person from northern Italy, where the virus has hit the hardest in the country. It was "an emergency operation done on somebody who was in quarantine," Dr. Vitelli says, "don't know if he's going to develop. I don't think so. But, you never know."
Italy is treating the coronavirus pandemic like a wartime emergency. Health officials are scrambling to set up more beds. In Milan, the old fairgrounds is being turned into an emergency COVID-19 hospital with 500 new beds; across the country, hospitals are setting up inflatable tents outdoors for triage.
Other countries can learn important lessons from Italy, says Dr. Giuseppe Remuzzi, co-author of a recent paper in The Lancet about the country's dire situation. The takeaways include how to swiftly convert a general hospital into a coronavirus care unit with specially trained doctors and nurses.
"We had dermatologists, eye doctors, pathologists, learning how to assist a person with a ventilator," Remuzzi says.
Some question why Italy was caught off guard when the virus outbreak was revealed on Feb. 21.
Remuzzi says he is now hearing information about it from general practitioners. "They remember having seen very strange pneumonia, very severe, particularly in old people in December and even November," he says. "This means that the virus was circulating, at least in [the northern region of] Lombardy and before we were aware of this outbreak occurring in China."
He says it was impossible to combat something you didn't know existed.
March 19, 20201:59 PM ET
Daniela De Rosa, a 43-year-old veterinarian in Italy's southwest Campania region, made a video message over the weekend as she was hospitalized with COVID-19. Her video plea has gathered much attention in Italy, which has just surpassed China in the number of reported deaths from the new coronavirus.
"I've been in isolation in a hospital room for so many days I've lost count," she says. "I have no contact with anyone other than doctors twice a day."
"Very few people understand what's happening. I want people to see I'm suffering," De Rosa continues.
"Every single individual must stay home and not endanger the lives of others," she insists.
Since the video was shared on Facebook last Sunday, it has racked up more than 11 million views.
As of Thursday afternoon, Italy has registered 41,035 diagnoses of the coronavirus and 3,405 deaths. The death toll is now higher than China's known COVID-19 deaths of over 3,200. Earlier this month, Italy became the first Western country to launch a nationwide lockdown to contain the outbreak, but despite strict measures, the number of cases continues to rise.
Italy has a universal health care system. But now, its hospitals and medical staff are overwhelmed, prompting anguished debate.
The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has issued guidelines for what it calls a "catastrophe medicine"-like scenario. The college put it starkly: Given the serious shortage of health resources, patients with the "best chance of success and hope of life" should have access to intensive care, the organization says.
"If you have an 99-year-old male or a female patient, that's a patient with a lot of diseases. And you have [a] young kid that need to be intubated and you only have one ventilator, I mean, you're not going to ... toss the coin," says Carlo Vitelli, a surgeon and oncologist in Rome.
He's speaking just a few hours after operating on a perforated appendix of a young man who had been in contact with a person from northern Italy, where the virus has hit the hardest in the country. It was "an emergency operation done on somebody who was in quarantine," Dr. Vitelli says, "don't know if he's going to develop. I don't think so. But, you never know."
Italy is treating the coronavirus pandemic like a wartime emergency. Health officials are scrambling to set up more beds. In Milan, the old fairgrounds is being turned into an emergency COVID-19 hospital with 500 new beds; across the country, hospitals are setting up inflatable tents outdoors for triage.
Other countries can learn important lessons from Italy, says Dr. Giuseppe Remuzzi, co-author of a recent paper in The Lancet about the country's dire situation. The takeaways include how to swiftly convert a general hospital into a coronavirus care unit with specially trained doctors and nurses.
"We had dermatologists, eye doctors, pathologists, learning how to assist a person with a ventilator," Remuzzi says.
Some question why Italy was caught off guard when the virus outbreak was revealed on Feb. 21.
Remuzzi says he is now hearing information about it from general practitioners. "They remember having seen very strange pneumonia, very severe, particularly in old people in December and even November," he says. "This means that the virus was circulating, at least in [the northern region of] Lombardy and before we were aware of this outbreak occurring in China."
He says it was impossible to combat something you didn't know existed.
LKJ86
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Scott Morrison says now is the right time to close our borders
20/03/2020
ALAN JONES
SCOTT MORRISON
Source:https://www.2gb.com/scott-morrison-says-now-is-the-right-time-to-close-our-borders/
Prime Minister Scott Morrison is confident in his decision to order the close of Australia’s borders.
New border controls will take effect in Australia tonight, with all non-citizens to be banned from entering the country.
The new restriction, in force from 9pm, is the latest measure rolled out to help slow the spread of coronavirus.
Earlier in the week, the government issued a ‘do not travel’ alert for the whole world.
Mr Morrison tells Alan Jones he believes the ban is being implemented at the right time.
“We were able to slow the virus’ start and spread in Australia through these early periods.
“The country which has actually been responsible for a large amount of these [infections] has actually been the United States.”
20/03/2020
ALAN JONES
SCOTT MORRISON
Source:https://www.2gb.com/scott-morrison-says-now-is-the-right-time-to-close-our-borders/
Prime Minister Scott Morrison is confident in his decision to order the close of Australia’s borders.
New border controls will take effect in Australia tonight, with all non-citizens to be banned from entering the country.
The new restriction, in force from 9pm, is the latest measure rolled out to help slow the spread of coronavirus.
Earlier in the week, the government issued a ‘do not travel’ alert for the whole world.
Mr Morrison tells Alan Jones he believes the ban is being implemented at the right time.
“We were able to slow the virus’ start and spread in Australia through these early periods.
“The country which has actually been responsible for a large amount of these [infections] has actually been the United States.”
LKJ86
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LKJ86
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CNN: US is "looking into" why young people are getting coronavirus
From CNN Health's Jacqueline Howard
Source:https://www.cnn.com/world/live-news...0-intl-hnk/h_2fe6383c4ac9154ea1e48cbeafe15a42
US Surgeon General Dr. Jerome Adams said the US is looking into why young people in the country are being diagnosed with the novel coronavirus.
"So far the demography definitely seems to be very different in the United States versus in other countries that saw this hit earlier," US Surgeon General Dr. Jerome Adams said on the "Today" show on Monday morning.
"And we're looking into that," Adams told NBC's Savannah Guthrie.
"There are theories that it could be because we know we have a higher proportion of people in the United States and also in Italy who vape," Adams said. "We don't know if that's the only cause."
In New York state so far, more than half of coronavirus cases — 53% — have been among young people between the ages of 18 and 49, Gov. Andrew Cuomo noted on Sunday.
LKJ86
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CNBC: Death toll rises from mysterious lung illnesses linked to vaping, prompting CDC to sound alarm on e-cigarettes
PUBLISHED FRI, SEP 6 2019 1:08 PM EDTUPDATED FRI, SEP 6 2019 4:04 PM EDT
Source:https://www.cnbc.com/2019/09/06/cdc...-in-vaping-related-lung-disease-outbreak.html
At least three people have died from a mysterious lung illness doctors believe may be caused by vaping — a rising public health worry that has U.S. and state officials perplexed, the Centers for Disease Control and Prevention said Friday.
A new patient in Indiana died, in addition to the previously reported deaths in Illinois and Oregon, Ileana Arias, CDC’s acting deputy director of non-infectious diseases told reporters on a media call. Officials are investigating a fourth death, she said.
The CDC is urging people to avoid using e-cigarettes amid the outbreak.
“Until we have a cause and while this investigation is ongoing, we’re recommending individuals consider not using e-cigarettes,” said Dana Meaney-Delman, who is overseeing the CDC’s response. “As more information comes about and we can narrow down the specific e-cigarette products, we intend to revise that.”
Federal health officials are reviewing 450 possible cases linked to vaping across 33 states, including the 215 cases it has previously reported, Meaney-Delman said. It’s unclear what exactly is causing the disease, officials said Friday. Until they have more information, the CDC is urging consumers not to buy e-cigarette products off the street or add any substances that are not intended by the manufacturer, the agency said.
Many of the patients who became sick said they vaped THC, a marijuana compound that produces a high. Some reported using both THC and e-cigarettes while a smaller group reported using only nicotine, Meaney-Delman said.
New York officials on Thursday said they are narrowing their focus to vitamin E acetate. Federal officials on Friday said it’s too early to pinpoint one substance.
The FDA is analyzing more than 120 samples for the presence of a broad range of substances, including nicotine, THC, other cannabinoids, cutting agents, opioids, toxins and poisons, Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products, said on the call. Lab tests have shown a “mix of results,” and no one substance or compound, including vitamin E acetate, has shown up in all of the samples tested, he said.
Doctors published detailed reports of the cases they’ve treated in the New England Journal of Medicine on Friday in hopes of defining the illness and helping other doctors recognize it.
Patients in many cases experienced gradual symptoms, including breathing difficulty, shortness of breath and chest pain before being hospitalized. Some people reported vomiting and diarrhea or other symptoms such as fevers or fatigue.
X-ray images from the patients typically show shadows similar to the ones seen in patients with viral pneumonia or acute respiratory distress syndrome, said Dr. Dixie Harris, a pulmonologist with Intermountain Healthcare in Salt Lake City, who has worked on 24 cases in Utah.
That led her to perform bronchoscopies on the first few patients. Doctors did not find any infections. Then they considered it might be related to vaping. All of Harris’ patients said they vaped. Some used nicotine. Some used cannabinoids, including THC or CBD. Others used both, making it even more difficult for doctors to pinpoint a culprit.
“My stance is overall, as a lung doctor, I don’t want anybody putting anything into their lungs,” she said. “But I do think there is something going on and there is one common thing making all these lungs react.”
LKJ86
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The early phase of the COVID-19 outbreak in Lombardy, Italy
Cereda D, Tirani M, Rovida F, Demicheli V, Ajelli M, Poletti P, Trentini F, Guzzetta G, Marziano V, Barone A, Magoni M, Deandrea S, Diurno G, Lombardo M, Faccini M, Pan A, Bruno R, Pariani E, Grasselli G, Piatti A, Gramegna M, Baldanti F, Melegaro A, Merler S
(Submitted on 20 Mar 2020)
In the night of February 20, 2020, the first case of novel coronavirus disease (COVID-19) was confirmed in the Lombardy Region, Italy. In the week that followed, Lombardy experienced a very rapid increase in the number of cases. We analyzed the first 5,830 laboratory-confirmed cases to provide the first epidemiological characterization of a COVID-19 outbreak in a Western Country. Epidemiological data were collected through standardized interviews of confirmed cases and their close contacts. We collected demographic backgrounds, dates of symptom onset, clinical features, respiratory tract specimen results, hospitalization, contact tracing. We provide estimates of the reproduction number and serial interval. The epidemic in Italy started much earlier than February 20, 2020. At the time of detection of the first COVID-19 case, the epidemic had already spread in most municipalities of Southern-Lombardy. The median age for of cases is 69 years (range, 1 month to 101 years). 47% of positive subjects were hospitalized. Among these, 18% required intensive care. The mean serial interval is estimated to be 6.6 days (95% CI, 0.7 to 19). We estimate the basic reproduction number at 3.1 (95% CI, 2.9 to 3.2). We estimated a decreasing trend in the net reproduction number starting around February 20, 2020. We did not observe significantly different viral loads in nasal swabs between symptomatic and asymptomatic. The transmission potential of COVID-19 is very high and the number of critical cases may become largely unsustainable for the healthcare system in a very short-time horizon. We observed a slight decrease of the reproduction number, possibly connected with an increased population awareness and early effect of interventions. Aggressive containment strategies are required to control COVID-19 spread and catastrophic outcomes for the healthcare system.
Subjects: Populations and Evolution (q-bio.PE)
Cite as: arXiv:2003.09320 [q-bio.PE]
(or arXiv:2003.09320v1 [q-bio.PE] for this version)
Source:https://arxiv.org/abs/2003.09320
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