New Orleans Is Drowning. Again.

August 29 will mark 15 years since Hurricane Katrina struck New Orleans. The next day the country watched in horror as the levees broke and thousands of residents who could have been evacuated but were neglected by many levels of government and public safety officials, were forced onto rooftops to await rescue. Many of the rescues were not by government agencies but by fellow citizens with boats in what became the Cajun Navy. For days, people pleaded for rescue. Many did get moved to safety. Many did not. The “official” death toll states that 1577 died in Louisiana. That figure is widely believed to be a large underestimate, as many of the dead and missing came from the neglected fringes of society.

I often return to Mary Gauthier’s poetic description of the the losses and displacement suffered by those affected by the flooding, with many of them evacuated as far away as Houston with no means to return and nothing left in New Orleans to return to after their homes were destroyed.

Although there were too many to count, one of the most tragic developments during the flood was at Memorial Medical Center. The hospital was not evacuated before the storm. It appears that there were at least 45 deaths at the hospital during the time that it was marooned and without electricity, supplies or rescuers. The choices the marooned staff faced were stark and ugly. From a New York Times description in 2009:

Within days, the grisly tableau became the focus of an investigation into what happened when the floodwaters of Hurricane Katrina marooned Memorial Medical Center in Uptown New Orleans. The hurricane knocked out power and running water and sent the temperatures inside above 100 degrees. Still, investigators were surprised at the number of bodies in the makeshift morgue and were stunned when health care workers charged that a well-regarded doctor and two respected nurses had hastened the deaths of some patients by injecting them with lethal doses of drugs. Mortuary workers eventually carried 45 corpses from Memorial, more than from any comparable-size hospital in the drowned city.

Charges were filed by the state in 2006 against the doctor and two nurses. The Times continues:

The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view.

In the four years since Katrina, Pou has helped write and pass three laws in Louisiana that offer immunity to health care professionals from most civil lawsuits — though not in cases of willful misconduct — for their work in future disasters, from hurricanes to terrorist attacks to pandemic influenza.

I don’t want to go into details of what might have led Pou and the nurses to hasten death for these patients or even if they did. Instead, let’s just focus on the fact that in such a situation, the health care workers are faced with helping those they can help while knowing that there are some who are destined to die no matter what they do. Further, with such limited resources, effort spent on those destined to die runs the risk of harming those who have a shot at recovery.

Doesn’t that sound familiar? Right now, various hospitals are drawing up their priority lists for allocating life-saving resources when the COVID-19 outbreak overwhelms staff, space and equipment. Note that even in this 2009 article, Pau mentions how the Katrina situation will not be unique and that a pandemic could lead to the very same scenario.

And with that, we come to the NOLA.com story from which the feature image of this post is derived:

A woman who identifies herself an Ochsner Medical Center nurse has published a gut-wrenching post on social media, going into detail about how she has seen coronavirus overwhelm a patient and pleading with the public to say inside “as if your life depended on it.”

Claudia Griffith’s 416-word Facebook post explains how the disease can take over a person’s lungs and kidneys. And “if it makes it to your kidneys, you’re lucky to be alive because your liver is next,” Griffith explains.

The story continues:

“As a nurse you cry at the window knowing there’s nothing you can do,” she writes.

/snip/

“You spend hours in your (patient’s) room gowned up head to toe sweating and not able to breathe. Then you realize…this is it. I can’t save this patient anymore. You sit there and say your goodbyes while they pass without family or loved ones because nobody is allowed in the hospital for everyone’s safety. You are their only contact and hope. You sit and watch as the (heart rate) and (blood pressure) can’t read anymore. You lost your patient to COVID19. You don’t even know how this virus works but you watch as it kills your patient,” she says.

In a very real sense, those patients she is describing are drowning as the pneumonia from COVID-19 relentlessly fills their lungs just as relentlessly as the Katrina floodwaters rose.

The best I can tell, Ochsner Medical Center in Jefferson and Memorial Medical Center in New Orleans are only four miles from one another. It is such a tragedy that they find themselves in the same dilemma just shy of 15 years apart.

Note that Louisiana doesn’t even make it into the list in the Washington Post article detailing huge disparities in how the Trump Administration is allocating emergency reserves of supplies and ventilators. And you can read here about the dire situation Louisiana hospitals are facing, with maximum capacity likely to be reached by this time next week. The people of New Orleans and all of Louisiana desperately need help, but I fear that we as a country can’t find the way.

Rural Roulette: The Three-Day Church Event

CNBC posted a list of the highest COVID rates per 10,000. In general, it includes two kinds of places: metro areas (NYC and environs, New Orleans, and Detroit), and ski resorts (the counties where Sun Valley, Crested Butte, Park City, Vail and Beaver Creek, and Aspen are).

There are two exceptions to that rule (though I expect Otsego County, MI may soon be on the list, based on a cluster I don’t yet understand): Dougherty County, GA, which I noted in this thread. That’s an outbreak tied to two funerals, especially that of Andrew Mitchell.

The service was for 64-year-old Andrew J. Mitchell, an Albany native who worked in custodial services and who died from what his family believes was heart failure. Mitchell came from a large family, and on Feb. 28 as many as 100 people came by the funeral home for visitation. The next day, seven of his siblings attended the funeral, along with dozens of his nieces, nephews, cousins and their own families. Some guests traveled in from as far away as Louisiana, Washington, D.C., and Hawaii. They greeted each other with tight handshakes, long embraces and kisses.

“The minister, he was shaking pretty much everybody’s hand, just giving the family comfort and condolences,” Mitchell’s niece Chiquita Coleman said. “The funeral home officiants, they were kind of doing the same thing. That’s kind of their job, to give comfort. So there was a lot of touching and hugging and hand-shaking.”

Afterward, chapel workers at the exit handed out memory cards. Later, there was a repast at Mitchell’s house and a gathering at the home of a sister.

In the days and weeks following, at least two dozen Mitchell family members fell sick with flu-like symptoms.

The other is Cleburne County, Arkansas, a county of just 25,000 people. That cluster is tied to a 3-day event at a local church.

Nearly three dozen cases of covid-19 have been diagnosed in people who share a connection to a church in Cleburne County, while others at the approximately 80-member congregation have been tested and are awaiting results.

[snip]

“It appears, from what I know at this time, most of the cases that we have in our county” are related to the Greers Ferry church, said Jerry Holmes, county judge of Cleburne County, who restricted public access to county offices last week and shut off access completely as of Monday.

Cleburne County, population 25,000, had 28 positive tests and 35 negative tests as of 7:35 p.m. Monday, according to the Arkansas Department of Health. Only Pulaski County, population 393,000, had a higher number of positive tests at that time, 62. All five counties bordering Cleburne had at least one positive test, including Faulkner County, which had 10.

Shipp’s count of 34 people is an updated count after reaching out to church members Sunday evening to check on them. Before then, Mark Palenske, the church’s pastor, had said in a Facebook post on the church’s official website Sunday that 26 people linked to the church had tested positive, including himself and his wife, Dena. The Palenskes could not be reached for this article.

Shipp said all but three of the people at the Kids Crusade were members or staff at the church. The three nonmembers who later tested positive for the virus were Thomas and Angela Carpenter, missionaries who had brought the three-day program to the church, and a child.

The Carpenters are listed as missionaries for Word of Grace Assembly of God Church in Hope on its website, and could not be reached at the church Monday.

The county has just one hospital and it has no ICU beds. And Arkansas is one of the states that has done least in response to this crisis, which makes it likely the disease will continue to spread from this one cluster.

Tourists, visiting missionaries, grieving friends and relatives of a long-standing community member. These are the ties that link rural communities across the country to a global network of virus. While many people in these rural towns believe they’re a world away from the outbreak in NYC, and therefore have to take none of the drastic measures to stop the spread, these same rural communities are even less prepared with the aftermath. Not only don’t their local healthcare facilities have the resources to treat this disease, but residents are more likely to be older, in ill health, and lack health insurance.

Update: The same kind of event — a church event — seems to behind a cluster of cases on the Navajo Nation.

A church gathering here earlier this month may be linked to a dozen confirmed cases of coronavirus and at least two deaths.

The participants in the large gathering that congregated March 7 at the Chilchinbeto Church of the Nazarene Zone Rally — a meeting in which pastors deliver messages to their members — may have all been exposed to coronavirus by at least one person who later tested positive for the disease.

Several people who attended the rally or who had family members who did later tested positive for the virus.

Before they could be tested, two people — one in LeChee, Arizona, and one in Chilchinbeto — died of respiratory symptoms, according to local sources.

[snip]

Confirmed cases of COVID-19, the disease caused by the coronavirus, in the Navajo Nation on Tuesday evening rose to 49 from 26 late Saturday. Cases include 30 from Navajo County, seven in Apache County, six in Coconino County, four in McKinley County, and two in New Mexico’s San Juan County.

Most of the 30 coronavirus cases from Navajo County are tied to the zone rally, where one pastor was coughing as he gave a sermon, according to sources.

The rally ran concurrently with a “Day of Prayer” event at the Chilchinbeto Chapter House where chapter officials and some members of the church had a prayer service in response to the coronavirus outbreak. Everyone — pastors and members of all churches — were invited to the prayer service.

The LAT has an article about how poor communication and limited resources (including no running water in some cases) add to the challenges of a poor population with little access to medical care.

Dispatch from the War on COVID-19 [UPDATE-1]

[Check the byline, thanks. Update at the bottom. / ~Rayne]

If you’re a regular here you know I don’t like to share stuff from Fox or affiliates. But local station Fox5NY picked up and republished a video online I haven’t been able to capture elsewhere. It’s extremely important.

She isn’t the only nurse we’ve heard from here in Michigan about the “war zone” in which they now work. I shared a link earlier today in a previous post; I’ll share it as an embed here so you can hear these health care workers back to back.

 

View this post on Instagram

 

Dear Family, Friends and Complete Strangers, Please STAY HOME!! Love, an ER Nurse

A post shared by Mary Macdonald (@marymac019) on

Now, a word to Sen. Lindsey Graham who denigrated nurses because of the possibility they may collect $24 an hour on unemployment.

Senator Graham:

Nurses are degreed professionals who not unlike lawyers must pass a state licensing test and earn continuing education credits on top of their regular job. The ICU nurse has had very specific training as has the ER nurse; both have likely had to add more training to cross over to do the jobs they’ve performed this week.

They are our foot soldiers in the war on COVID-19. We will not have enough of these soldiers because they will get sick from a combination of exposure to high viral loads, especially when they don’t have adequate protection, and from the heightened, sustained stress of this pandemic war.

They do not deserve your disrespect. These professionals will treat every patient as someone worthy of their efforts. They will do their level best to save whomever they can provided they have the resources. The least you can do is treat them with the same respect they’d treat you as a patient. For all you know you will find yourself sick with this virus and you’ll be on the business end of one of these professionals who are in such high demand there won’t be any unemployed nurses in this country for more than a year.

Get over yourself, Graham. And stop taking social cues from that rude, nasty cretin in White House. Your friend McCain would be ashamed of you if he were still alive.

To whoever is bashing Governor Whitmer about her performance, a word:

Just like these health care workers who are pleading for supplies, so has Whitmer pleaded for assistance. Her constituents in the state of Michigan deserve all the services they’ve funded their federal government to provide. They are already getting what the state of Michigan can provide because Whitmer is ensuring this happens.

You cannot hide the fact that the federal reserve for supplies should have been ordering and collecting materials in January after China told WHO that a novel coronavirus posed a pandemic risk. Attacking Whitmer won’t change the fact that it is the federal government, directed ultimately by the president, which was responsible for detecting pandemic risk and responding proactively to it, informing states of the risk as early as possible.

That didn’t happen and now governors like Whitmer are forced to do both the job their states have elected them to do and more, taking responsibilities which belong to federal agencies, while Trump denies states the Honest Services they are entitled to because he has not received some sign of obeisance.

To use an aphorism well-known former Michigander Lee Iacocca enjoyed, “Lead, follow, or get out of the way.” Bashing Governor Whitmer is none of those things. Pick one of the three.

To everyone else: pay heed to what these health care workers are saying. Overall mortality will go up, not just from COVID-19, because first responders will be overwhelmed by both the demands this virus places on our systems, and by illness and death as their own ranks are infected and sickened. Stay home. Keep your distance. Heighten your hygiene practices to reduce risk of infection. Wash your hands. Help your loved ones, friends, community as best you can.

To health care workers and all other first responders: do the best you can. That’s all we can ask of you. If the best you can do is allow someone you cannot save to die in peace, so be it. We should have done more for you before this war began.

And someone should have told us all when that war started instead of lying to us until it was nearly too late.

UPDATE-1 — 7:00 P.M. ET —

I am suitably chastened by this video by a doctor at Emory:

YOU are the frontline, the foot soldiers. What you do during this period of necessary social distancing makes the difference counted in lives. We may have to be patient longer because we didn’t start early enough, but our loved ones, friends, their futures depend on it.

And the lives of health care workers also rely on us. We’ve lost a number of nurses and doctors, people like these women in these videos. We can’t afford to lose more.

Trump Can’t Turn the Economy Back on Without Overriding Executive Orders of 30 Governors

Update: Between March 30 and April 1, most of the last big states — TX, AZ, MD, VA, and FL — imposed stay at home orders.

Update: I’ve updated this and reposted. At least six states have added stay at home orders since Trump said he wanted to reopen the economy by Easter. This post was originally published on March 24, just before mid-day.

As noted, yesterday Trump signaled that he wants to turn the economy back on, perhaps 15 days after his original Emergency declaration on March 13 (which would mean the emergency would end on Saturday, March 28). As Ron Klain just noted, though, Trump doesn’t have that ability: Governors, not the President, have been the ones to shut things down (along with a number of mayors and corporate executives).

It will be governors, not Trump, who decide when to reopen the economy.

Over the last week, a set of governors (currently 30) have issued stay-at-home orders; another (MA) imposed a suggested stay at home declaration, and a number of cities and counties have similarly shut down. This NYT story has a great map and numbers showing how many people are affected (though without durations or governor party affiliation).

As the list below makes clear, Trump can’t turn the economy back on without finding a way to rescind the executive orders of a bunch of governors, including those of Republicans Eric Holcomb (whose order goes until April 6), Mike DeWine (whose order goes until April 6), and Jim Justice (whose order doesn’t have a termination date).

Update: Trump just said, “I would love to have the country opened up and raring to go by Easter.”

Update: This has been updated through March 27. This is the most comprehensive list of orders I’ve seen, including those closing businesses as opposed to ordering people to stay at home (though as of today it is missing a business closure from AL’s Kay Ivey).

Update, March 30: Maryland’s Larry Hogan and Virginia’s Ralph Northam, whose initial non-essential business shutdowns had stopped short of a stay-at-home order, have both now issued the latter.


Full stay-at-home orders

  1. Alabama (Republican Governor Kay Ivey) Imposed April 3, effective April 4.
  2. Alaska (Republican Governor Mike Dunleavy): Imposed March 27, effective March 28, in effect until April 11.
  3. Arizona (Republican Governor Doug Ducey): Imposed March 30, effective March 31, in effect until April 30. Some city flexibility on order.
  4. California (Democratic Governor Gavin Newsom): Imposed and effective March 19, in effect “until further notice.”
  5. Colorado (Democratic Governor Jared Polis): Imposed March 25, effective March 26, in effect until April 11.
  6. Connecticut (Democratic Governor Ned Lamont): Imposed March 20, effective March 23, effective through April 22. (Order)
  7. Delaware (Democratic Governor John Carney): Imposed March 22, effective March 24, in place until May 15 or public health threat eliminated. (Most recent order)
  8. District of Columbia (Democratic Mayor Muriel Bowser): Imposed March 30, effective April 1.
  9. Florida (Republican Governor Rick DeSantis): Imposed April 1, effective April 3, effective until April 30.
  10. Georgia (Republican Governor Brian Kemp): Imposed April 2, originally effective until April 13; extended on April 8 until April 30.
  11. Hawaii (Democratic Governor David Ige): Imposed March 23, effective March 25, effective through April 30.
  12. Idaho (Republican Governor Brad Little): Imposed and effective March 25, effective 21 days (though April 15).
  13. Illinois (Democratic Governor JB Pritzker): Imposed March 20, effective March 21, effective until April 7. (Order)
  14. Indiana (Republican Governor Eric Holcomb): Imposed March 23, effective March 24, effective until April 6. (Most recent orders)
  15. Kansas (Democratic Governor Laura Kelly): Imposed March 28, effective March 30, effective until April 19.
  16. Louisiana (Democratic Governor John Bel Edwards): Imposed March 22, effective March 23, in place until April 13.
  17. Maryland (Republican Governor Larry Hogan): Imposed and effective March 30.
  18. Michigan (Democratic Governor Gretchen Whitmer): Imposed March 23, effective March 24, in place until April 13. (The state announcement, but not the order itself, states the order will be in place “at least” three weeks.)
  19. Minnesota (Democratic Governor Tim Walz): Imposed March 25, effective March 27, effective until April 10.
  20. Mississippi (Republican Governor Tate Reeves): Imposed April 1, effective April 3, effective until April 20.
  21. Missouri (Republican Governor Mike Parson): Imposed April 3, effective April 6, effective until April 24.
  22. Montana (Democratic Governor Steve Bullock): Imposed March 27, effective March 28, effective until April 10.
  23. Nevada (Democratic Governor Steve Sisolak): Imposed April 1, effective April 1, effective until April 30.
  24. New Hampshire (Republican Governor Chris Sununu): Imposed March 26, effective March 27, effective until May 4.
  25. New Jersey (Democratic Governor Phil Murphy): Imposed and effective March 21, effective until further notice.
  26. New Mexico (Democratic Governor Michelle Lujan Grisham): Imposed March 23, effective March 24, in place until April 10.
  27. New York (Democratic Governor Andrew Cuomo): Imposed March 20, effective March 22, in place until April 19. (Most recent orders available here.)
  28. North Carolina (Democratic Governor Roy Cooper): Imposed March 27, effective March 30, effective for 30 days (until April 29).
  29. Ohio (Republican Governor Mike DeWine): Imposed March 22, effective March 23 in place until April 6.
  30. Oregon (Democratic Governor Kate Brown): Imposed and effective March 23, effective until terminated. (Order)
  31. Pennsylvania (Democratic Governor Tom Wolf): Imposed and effective April 1, effective until April 30.
  32. Rhode Island (Democratic Governor Gina Raimondo): Imposed and effective March 28, effective until April 13.
  33. South Carolina (Republican Governor Henry McMaster): Imposed April 6, effective April 7.
  34. Vermont (Republican Governor Phil Scott): Imposed March 24, effective March 25, effective until April 15.
  35. Virginia (Democratic Governor Northam): Imposed and effective March 30, effective until June 10.
  36. Washington (Democratic Governor Jay Inslee): Imposed March 23, effective March 26, effective until April 8.
  37. West Virginia (Republican Governor Jim Justice): Imposed March 23, effective March 24, effective until terminated. (Order)
  38. Wisconsin (Democratic Governor Tony Evers): Imposed March 23, effective March 25, effective until April 24.

Non-essential business closures

  1. Alabama (Republican Governor Kay Ivey)
  2. Kentucky (Democratic Governor Andy Beshear)
  3. Maine (Democratic Governor Janet Mills)
  4. Oklahoma (Republican Governor Kevin Stitt)
  5. Tennessee (Republican Governor Bill Lee)
  6. Texas (Republican Governor Greg Abbott)

Trump Threatens to Withhold Disaster Declaration for Michigan because Gretchen Whitmer Was Mean to Him

Update: According to NBC’s Geoff Bennett, Trump has now approved the request.

Last night, Donald Trump suggested that he might withhold a disaster declaration for Michigan requested by Governor Whitmer on March 26 because he doesn’t like Governor Whitmer’s public comments about the Federal government’s failures.

“We’ve had a big problem with the young — a woman governor. You know who I’m talking about — from Michigan. We don’t like to see the complaints,” President Trump told Sean Hannity during a FOX News interview on Thursday.

Gov. Whitmer has been openly critical of the federal response to the coronavirus outbreak, voicing her frustration with not having enough COVID-19 test kits and a lack of “clear and concise guidance from the federal government.”

The comments from President Trump come on the same day Gov. Whitmer requested a major disaster declaration for Michigan over the coronavirus outbreak.

“She doesn’t get it done, and we send her a lot. Now, she wants a declaration of emergency, and, you know, we’ll have to make a decision on that,” President Trump continued. “I don’t know if she knows what’s going on, but all she does is sit there and blame the federal government.”

Here are the states for which Trump has declared an emergency with the number of positive cases on the date Trump made that declaration and the party of their governor.

As of yesterday, Michigan has had 2,856 people test positive for COVID-19. Dr. Deborah Birx pointed to SE Michigan’s Wayne County (which includes Detroit and the mostly working class suburbs), along with Cook County, IL, as the alarming hotspots in the country.

And yet Trump doesn’t want to approve a disaster declaration because a girl was mean to him.

Trump’s Death Panel Comes for Detroit [UPDATE-1]

[Update at bottom of post, thanks. /~Rayne]

Ordinarily I wouldn’t step on Marcy’s posts by putting another one up so soon and one so short, but I am both FURIOUS and scared sick about this.

Since last night, Detroit Free Press confirmed yesterday’s rumors about the number of ventilators at one chain of Detroit hospitals — that area hospitals had run out of ventilators and patients were notified on arrival they may not have access to a ventilator if needed.

Without ventilators, those suffering from acute respiratory distress syndrome in critical need may die.

Trump decided to kill Detroiters by withholding essential equipment. He’s chosen not to act in a timely fashion and interfered with the state’s ability to obtain equipment, while trash talking about Michigan’s governor in the process.

Welcome to Trump’s death panel.

Michigan’s Governor Whitmer couldn’t make it any more plain how urgent the situation was, just as Governor Cuomo has.

Trump’s gross negligence isn’t hurting just black Detroiters, either — yeah, I went there, you know damned well Trump doesn’t care about the woman who is our governor or the black people who are the majority in Detroit.

Trump is hurting rural white Michiganders in areas that voted for him in 2016.

If this is how he’s setting out to win swing states, I hate to see what more harm he’ll cause to solidly blue states.

UPDATE — 1:10 P.M. ET —

You need to watch this video produced by an ER nurse in Oakland County, Michigan. The county straddles four congressional districts, two of which recently flipped blue. This is where white flight settled pre-2000, leaving Detroit behind.

They don’t even have acetaminophen to give patients when they put the ventilator tube down their throats — assuming they still have ventilators right now.

Trump’s death panel won’t just kill you. It will make sure you suffer along the way.

 

Trump Fighting for Floating Petri Dishes but Not Life-Saving Ventilators

Trump’s response to learning that the cruise industry — which is almost entirely flagged overseas, in part to avoid US taxes — would not be eligible to tap the $500 billion slush fund for large businesses was to work to find a “legislative fix” so these floating petri dishes could survive a pandemic exacerbated by their industry.

Sr. admin official says bipartisan Senate grp working to ensure they can access one of the facilities–or else will seek a legislative fix in the next package.

He proposed adopting Josh Hawley’s offer, which is that if they registered here they could qualify for this loan package.

Meanwhile, on the same day Trump went out of his way to think creatively about how to fund an industry that has almost no societal value that isn’t already being addressed with extended unemployment benefits, outlets reported that the Trump Administration was balking on a plan — which both Trump and Mike Pence had already celebrated — to back a joint venture between General Motors and ventilator manufacturer Ventec Life Systems to produce up to 80,000 ventilators in Kokomo, IN. The problem: $1 billion was too much to spend to address the acute shortage of ventilators in the country.

The decision to cancel the announcement, government officials say, came after the Federal Emergency Management Agency said it needed more time to assess whether the estimated cost was prohibitive. That price tag was more than $1 billion, with several hundred million dollars to be paid upfront to General Motors to retool a car parts plant in Kokomo, Ind., where the ventilators would be made with Ventec’s technology.

By the end of the day, both Trump and Dr. Deborah Birx questioned the number of ventilators New York Governor Andrew Cuomo has consistently said his state will need.

“I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be,” he said. “I don’t believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’”

New York has become the new epicenter of the coronavirus outbreak in the United States, with hospitals struggling to keep up with larger patient numbers and limited supplies, including masks, gowns and ventilators. In severe cases of Covid-19, the illness caused by coronavirus, ventilators can allow patients to breathe with incapacitated lungs — a common outcome of the disease.

Dr. Deborah Birx, the White House coronavirus response coordinator, said earlier on Thursday she was told that New York had enough ventilators to meet current needs. While there may be shortages in urban areas like New York City, Birx said, there are other parts of the state “that have lots of ventilators and other parts of New York state that don‘t have any infections right now.“

“There is still significant — over a thousand or two thousand ventilators that have not been utilized yet,” Birx said. “Please, for the reassurance of people around the world, to wake up this morning and look at people talking about creating DNR situations — do not resuscitate situations for patients — there is no situation in the United States right now that warrants that kind of discussion.“

Trump’s interest in thinking creatively to fund the cruise industry as compared with his stinginess regarding crucial medical needs is not just malpractice during a pandemic.

But it doesn’t even serve his own stated priorities.

Trump has said he wants the economy to resume as soon as possible — he has been pushing for an Easter restart. Both WA (where Ventec is headquartered), MI, and IN are under state-wide stay-at-home orders, permitting only essential workers in the state to leave their homes to go to work. With some exceptions, the stay-at-home orders in the Midwest have shut down much of the auto industry.

Redeploying a parts plant in IN to produce ventilators would be a way to shift a facility and its workers from the non-essential category to the essential category, potentially getting them working before the stay-at-home orders are lifted.

Indeed, pushing manufacturers to shift production to items deemed essential, via whatever means (in this case, the venture would be supported only by a purchase agreement, but the Defense Production Act could be used to do even more of this). And even if Cuomo is overestimating how many ventilators he’ll need (there’s no reason to believe he is), if there’s a surge in COVID cases in the southern hemisphere as it shifts into fall, there’ll be plenty demand worldwide to pick up the slack.

Even if it led to a glut, one of the best employment policies right now would be to shift as much short- to medium-term production from goods deemed non-essential to goods deemed essential. Even if the US government overpays for those products, it’d be a better jobs program than restarting the cruise industry.

Trump continues to fool himself about where capitalism ends and state support begins. But he’s also adopting a policy that undermines his own hopes to get as many people back to work as he can.

Trump’s Blame the Governors Strategy and Rural Roulette

The other day, I laid out how, even if Trump wants to open the country back up by Easter, at least fifteen governors may prevent him, including OH’s Republican governor Mike DeWine, who in the wake of Trump’s comments tweeted out defending his approach again. The WaPo did a similar piece this morning, confirming that the governors aren’t on board with Trump’s hopes.

That said, it’s clear that Trump plans to pressure governors, not just to do his bidding, but also to demand fealty before he heeds their pleas for help. Ultimately, it may be a bid to blame the upcoming crisis on the governors — disproportionately Democrats — struggling most directly with the crisis.

And that could work.

Though I doubt it, for a number of reasons. As US numbers continue to spike, it’s likely the governors who’ve taken more aggressive stances (with the possible but very notable exception of Andrew Cuomo, largely because of NYC’s density) will be able to show significantly better outcomes than those states that have adopted a hybrid approach, shutting down affected cities but not the entire state, to say nothing of those who were doing nothing (this Politico piece shows what each state has done or, in the case of OK and MS, not done at all).

Right now, almost all the identifiable clusters are in big cities, with both the international travel and density that would lead to early exposure. But some (not all — Detroit is an exception) of those cities actually have relatively low levels of the preexisting conditions that make the population more susceptible to the virus and more likely to have an extreme case if they get it. By contrast, much of America’s more rural areas have a higher instance of those pre-existing conditions. And those rural areas don’t have the hospital beds, much less ICU rooms, to treat seriously ill patients. This map, from an MIT project, shows where current outbreaks are and where particularly vulnerable populations are for the country as a whole.

That means in states where governors have not imposed state-wide stay at home orders, there’s a significant risk that clusters will arise in areas that are less prepared to deal with an outbreak. Effectively, the governors who’ve adopted such an approach are playing “rural roulette,” assuming that a focus on the cities will mitigate the biggest risks, even though the rural areas would be easily overwhelmed even with a smaller number of infections.

And that may have an important dynamic given the election. A number of the key swing states — MN, WI, MI, OH — have instituted full state stay-at-home orders. But many of the rest — PA, FL, NC, CO, GA, TX — have not. And in some of the states where that decision is riskiest — GA, FL, and AZ — there’s a Republican governor adopting those strategies in part to adhere to Trump’s views.

Take Georgia. It has had an outbreak in the more rural southwest part of the state, and municipalities are trying to force Governor Brian Kemp to impose a state-wide shutdown.

But the rest of the state has high incidences of some of the preconditions that make the population particularly susceptible to infection. In other words, while Atlanta has the medical resources (including CDC) to respond to the medical crisis, Georgia is already exhibiting an atypical pattern of rural spread in ways that might make Kemp’s refusal to do a state-wide order particularly costly. (As I was writing this, Kemp announced that schools will remain closed through April 24, which suggests he may be budging on a state-wide approach.)

Then there’s Florida.

Jim here.

As the New York Times notes, the municipalities of Miami and Miami Beach have stay home or shelter in place orders that went into effect this week. Also, Alachua, Leon, Orange and Pinellas Counties have stay home orders. Note that while Orange County holds most of the Orlando metro area, Pinellas is only the St. Petersburg portion of the Tampa Bay region. Tampa is in Hillsborough and the population stays fairly high going north into Pasco and south into Manatee and Sarasota Counties.

A very interesting aspect of the Alachua County stay home order, which went into effect here at 12:01 am Tuesday, is that, as noted in the Gainesville Sun, “Non-medical businesses may only allow one customer inside per 1,000 covered square feet, per an Alachua County emergency order.” Here is the line outside a grocery store Tuesday morning in the Sun’s photo accompanying the article:

As the Tampa Bay Times notes, despite multiple public health authorities pleading for a statewide shutdown, DeSantis has instead been listening almost exclusively to business interests, and their message to him has been exactly the one Fox News and Trump have been flogging:

The Florida Chamber of Commerce have spoken frequently with the governor and his staff, urging him not to take drastic measures that might shut down the state’s economy. The Florida Restaurant and Lodging Association has been asking for ways to help their industries stay afloat.

Their message: don’t let the cure be worse than the disease.

But this is ignored:

Public health experts say that a three-week limit on public movement is required to stop the spread of the virus, and they point to a statistical model that shows that Florida may have only one week to act before hospitals become overwhelmed.

Instead, he hears a Republican telling him just how responsible he is to ignore the public health requests:

Sen. Tom Lee, R-Thonotosassa, said DeSantis was under “a tremendous amount of pressure,” but the idea he’s making decisions based on politics — and not public health — was “irresponsible.”

“He’s hearing from a lot of self-interested actors right now who are acting out of self-preservation,” Lee said. “With every executive order, there’s another industry being impacted. Those people are pretty aggressive and pretty vocal, and I think he’s done a pretty good job of ignoring all that.”

What could go wrong?

/Jim

In Florida, on top of the vacation traffic that DeSantis only belatedly shut down, it has significant numbers of seniors and its rural, more vulnerable communities do not have the beds to treat patients in if an outbreak happens (the gray circles here are senior facilities).

To make things worse, DeSantis is not sharing information about which senior facilities have had positive cases, which is likely to lead to clusters outside of locked down areas that lead to community infection. So on top of the rural/urban mix, DeSantis has the likelihood of a breakout at senior facilities.

It’s not just Republican governors who’ve adopted a hybrid strategy though: Pennsylvania Governor Tom Wolf  locked down PA’s major counties without imposing stay at home in their more rural areas. PA is going to experience the community spread of the Eastern Seaboard; it’s a real question what happens as the virus spreads west from the Philadelphia metro area. Plus, it also has a concentration of senior facilities (the family member I’m most worried about now is stuck in one until April 1 fighting several other preexisting conditions).

In bmaz’s Arizona, something that has the possibility of being worse is happening: Republican Governor Doug Ducey is using his authority to prevent cities from imposing more stringent stay at home orders. Thus far, this order strives only to impose a state-wide standard for what amounts to essential businesses (something that has led to confusion even in states with full state-wide orders). Most of his businesses match those adopted by state-wide orders. His order specifically includes golf courses (but not their restaurant facilities) as essential businesses, which I this is reasonable, in AZ, in the name of exercise; bmaz says that the crowds on urban hiking trails, which are also exempted, are far worse. Ducey’s order could override school closures.

Or, the order as a whole could suggest he’s being pushed closer to where other states are, full stay at home orders.

Arizona faces a particular rural challenge, but one Ducey can’t manage: the Native American reservations, which already have cases and which have a real dearth of health resources. But they’re sovereign.

North Carolina’s Democratic Governor Roy Cooper is another person who is having to be pressured to impose a more stringent state-wide stay at home order.

If states can access adequate testing, it’s still unproven whether state-wide or city-by-city orders will be most effective (though the testing is clearly not there yet).

What is clear, however, is that there will be at least as much political pressure on the states that have incomplete stay at home orders as those with statewide orders. And that just happens to include many of the states where November’s election will be decided.

Update: Trump has just sent a letter to governors suggesting the Feds are going to roll out new standards for identifying high and low risk counties, suggesting he wants to adopt the piecemeal shutdowns of the states discussed here. Such a regime will make orders like Doug Ducey and Mississippi Governor Tate Reeves’ orders standardizing shut-downs at the state level dangerous in a way they aren’t now, because both cite Trump’s guidelines for protective measures.

The Tick-Tock to COVID-19’s Explosion

[Check the byline, thanks! /~Rayne]

When epidemiologists, virologists, and public health officials first began talking about flattening the curve — using social distancing to reduce the number of COVID-19 cases needing hospitalization at any one time to prevent collapse of hospitals and massive mortality — I kept a running mental tick-tock, resetting this clock as data emerged and events unfolded. We learned from Washington state how the virus spread rapidly because of cryptic transmission, but tracking the virus’s dispersion hasn’t been clear to observers let alone elected officials and business leaders. Missing a concrete picture of how the virus emerges and spreads over time to affect our health care systems, officials have been easily badgered to issue delayed and weak containment orders to suppress COVID-19’S contagion.

The Biogen management conference offered a discrete example of how COVID-19 contagion spread and the time from exposure to illness to new infection:

26-27 February — Biogen, a biotech company, held a management conference in Boston at the Marriott Long Wharf hotel [Day 1-2]

01 March — Biogen employee of Chinese heritage who attended the conference developed a cough. [Day 5]

02 March — A Biogen employee from Indiana developed symptoms; they traveled to Biogen’s facility in Research Triangle Park, NC.

03 March — Biogen conference attendees were notified of a potential COVID-19 exposure [7 days after conference began]

06 March — Attendees received confirmation that they were exposed to COVID-19. Four cases were identified in Boston; two had symptoms. The Biogen employee from Indiana drove home. [10 days after conference began]

09 March — At least 32 cases of COVID-19 of 41 total in Massachusetts on this date were associated with the Biogen conference. [13 days after conference began]

11 March — Chinese Biogen employee flew from Boston to Los Angeles with spouse and child.

12 March — Chinese Biogen employee flew from LA to Beijing with spouse and child.

12 March — 82 cases in Massachusetts have both been confirmed and associated with the Biogen conference. The Marriott hotel at which the conference was held closed for disinfection.

13 March — Chinese Biogen employee tested positive for COVID-19 on arrival.

14 March — 104 of 138 total COVID-19 cases in Massachusetts were associated with the Biogen conference. Two new cases related to Biogen appeared in the cities of  Worcester and Malden.

16 March — Spouse of Biogen employee tested positive for COVID-19 in Beijing. [20 days after conference began]

The case of Biogen’s Chinese employee is incredibly important. The woman visited a hospital in Boston repeatedly for her symptoms, potentially infecting multiple people including health care workers, was given an ineffective antiviral (technically off label for COVID-19), and ended up flying to China, exposing other passengers and airline employees to COVID-19 en route because she couldn’t get tested for the virus until she arrived in Beijing.  She risked prosecution by Chinese authorities for failing to disclose her health status in order to get tested.

The U.S. literally exported two new cases of COVID-19 to China because Trump has dicked around with testing and lied to us about their availability since he first learned about the virus and risk of pandemic.

~ ~ ~

I’ve made up a calendar — not exactly pretty, mind you, since I didn’t quite know how I wanted to present this when I started. But you’ll see the Biogen-based outbreak, the airport terminal debacle thanks to the Trump EU travel ban, and the last holiday during which people gathered en masse in closed quarters (that’s St. Patrick’s Day).

Four states with the largest populations out of the top 11 most populous states issued shelter-in-place/stay home orders after March 17. You’ll see those effective dates noted on the calendar here as well.

Calender - COVID-19 contagion, Feb-April 2020

Note carefully the weekend of March 14-15 when airports across the U.S. were crammed with people, many of whom were likely exposed to COVID-19. As I said in a previous post, this is a hurricane; the mounting deaths over the last couple of days are only the leading edge of a hurricane-like explosion fomented by Trump’s minions’ ineptitude. Every death is on their heads and hands.

The reason for my mental tick-tock and the calendar is the course of the virus and its contagion: exposed persons are contagious about five days after infection; infected persons may begin to show symptoms from 5 to 14 days after exposure; persons who recover are contagious for at least another seven days.

The total 21 days from exposure to the point where an infected person is  clear of virus is optimistic. The WHO China mission report indicated persons may shed COVID-19 for 4-5 weeks in total.

Which brings me to the ultimate point of this post: In no fucking way is it safe to assume the risk of contagion will have been broken by Easter.

No matter what Trump wants or needs to believe, especially since shelter-in-place/stay home orders have not been given across the entire country and not to a uniform standard since states assumed the responsibility to issue these orders and not the federal government.

Perhaps the contagion will be stemmed by the states which gave shelter-in-place/stay home orders, but COVID-19’s spread could resume as rapidly as a trucker can cross a state line or an airplane land at an airport.

A partial lifting of the shelter-in-place/stay home orders might work if everyone had been screened with an antibody test for exposure, and only those persons with active COVID-19 infections were quarantined for the full 4-5 weeks.

But no — we don’t yet have antibody tests. We still don’t have adequate numbers of tests for COVID-19 infections.

Without testing and uniform shelter-in-place/stay home orders across the country, lifting shelter-in-place/stay home orders by Easter only increases the odds there will be another wave of infections on the heels of the first wave. Hospitals and health care workers would not have a break between these successive waves, further stressing the system.

~ ~ ~

Let’s cut through the bullshit here. If Trump wanted to look like a hero to the American public, he’d listen to virologists, epidemiologists, and public health experts.

He’d make sure the health care system had the resources it needs to protect themselves, to treat those who were ill, and to test everyone so the public, their first responders, and their elected state officials knew the status of the virus and where to direct their attentions most effectively.

He’d make sure every American stayed home and had no reason to leave until the contagion was broken.

But this is exactly what he isn’t doing.

He’s even withholding funds from states which are battling to save Americans’ lives from COVID-19 while containing the virus’s spread.

Why?

Why is Trump not doing what he’s supposed to do to insure domestic Tranquility, provide for the common defense, promote the general Welfare as executive of the United States?

Why has he ignored the hundreds of deaths to date, all of which can be blamed on his ongoing failures?

Why has Trump only been able to maintain kayfabe — the appearance of being a president without actually being one, like professional wrestlers who don’t actually wrestle?

If this was the reality TV show The Apprentice, Trump should have been fired already for dereliction of his duties and escorted off studio property by security personnel for deliberately hurting cast and crew.

~ ~ ~

Finally, two more groups of people need to be asked why they aren’t acting in the best interests of the country, let alone their constituents whether voters, donors, or shareholders.

Republican senators have rejected the math — like that selfish yard-waste-pile Rand Paul who continued to use the Senate pool in spite of his exposure to COVID-19.

Why are they actively refusing to do the right things to save Americans’ lives including their own?

Corporate leaders like Lloyd Blankfein whine about getting American workers back on the job instead of worrying whether there will be an economy left if workers continue to get sick in the workplace and die.

Why can’t a fucking investment banker like Blankfein and other business leaders responsible for P&L figure out the numbers?

Fire them all come November.

A Virus Does Not Care

There’s a right way to deal with a pandemic, and a wrong way to deal with a pandemic

A virus does not care. A virus simply wants to reproduce, and for that it needs a host. A virus does not care about who that host is. A virus just wants a place to live, eat, and reproduce. A virus does not care if it makes the host sick. A virus does not care if it kills the host. This is the First Rule of Viruses: A virus does not care.

In 1918, as WWI was being fought in Europe, a virus emerged at Camp Funston, in the area of Fort Riley, Kansas. This virus did not care about the war. The virus did not care about Our Boys who were preparing to go fight that war. The virus did not care about the farmers in the Kansas fields, who dropped at their plows in the fields when the virus attacked.

A virus does not care.

The soldiers from Fort Riley went to the front lines in Europe with their guns, their ammo, their packs, and their gear, and they took that virus with them. It attacked their comrades in arms, and it attacked their enemies across the trenches.

A virus does not care.

The virus attacked King Alphonso XIII of Spain. Wherever the virus appeared, people began to speak of “the Spanish Flu,” going back to the widely-reported news of the mighty king it brought low. But the virus didn’t care. The virus attacked soldiers. The virus attacked ordinary villagers. Some lived, and some died.

A virus does not care.

The virus spread across the US, just as the war was beginning to come to an end. Bonds were being sold to pay for the war, and soldiers were starting to come home. The virus did not care about the bonds. The virus did not care about the homecoming celebrations being planned.

A virus does not care.

But people care, and they care about lots of things, and that’s where things got worse. People care about their status. People care about their businesses and their livelihoods. People care about parades the celebrate the end of a long and ugly war. People care about gathering in the corner bar with their friends, and playing sports in the local parks. People care about staying safe when danger threatens. People care about singing and dancing and enjoying life. People care about a million and one things, but a virus does not care about any of those things.

A virus does not care.

By 1918, people knew how to deal with a spreading virus in two broad ways: quit interacting so closely with others and practice good hygiene (both individually and as a community). They knew that beating a virus requires that a community care about itself just as much as the virus does not care at all. Give the virus an inch, and it will continue its deadly spread.

Because a virus does not care.

Some communities enacted a wide variety of what epidemiologists today call “nonpharmaceutical interventions” – prohibiting large public gatherings, closing businesses, shutting down churches, suspending schools, and so on. Other communities enacted some of these measures, but not all of them. Some communities took few measures, or decided “We’ll prohibit large gatherings, but not until after the big parade next week.” On the spectrum from “we need to shut everything down” to “we need business as usual,” St. Louis was on one end of the spectrum, and Philadelphia was in the other.

St. Louis:

By late September, Jefferson Barracks [a US military post in St. Louis] went under quarantine as the first soldiers came down with the flu.

In early October, city health commissioner Dr. Max C. Starkloff ordered the closure of schools, movie theaters, saloons, sporting events and other public gathering spots. Churches were told to suspend Sunday services. At the time, with nearly 800,000 residents, St. Louis was among the top 10 largest American cities. . . .

Theater owners, as some of the largest taxpayers at the time, protested the closures. Musicians and entertainers claimed the quarantine threatened their careers. Others were delighted — anti-alcohol leagues that were forming in the runup to Prohibition went on the lookout for taverns that violated the shutdown, [director of library and collections at the Missouri History Museum Chris] Gordon said.

Within two days of the quarantine, eight soldiers at Jefferson Barracks were dead, another eight residents died at St. Louis City Hospital and the number of area flu cases topped 1,150.

Jacob Meeker, a St. Louis congressman, died Oct. 16, six days after touring Jefferson Barracks. He was 40.

With the flu continuing its rampage, Starkloff imposed a stricter quarantine in November, closing down all businesses with few exceptions including banks, newspapers, embalmers and coffin makers, according to Post-Dispatch archives.

The American Red Cross shifted from making bandages to face masks. Volunteers passed around blankets and vats of broth to flu sufferers. An ambulance waited at Union Station to take any sickly train passengers directly to the hospital upon arrival. Police officers and mail carriers wore masks on their daily routes.

And as these measures took hold, it slowed the virus down.

Philadelphia:

In an effort to boost morale for the war and also to sell bonds, the city of Philadelphia threw a parade that drew 200,000 people, despite warnings that the Spanish flu was spreading among the soldiers who were about to head off to World War I and would be in the parade.

That didn’t turn out to be a good idea.

Days later, hospitals in the area were filled with patients suffering or dying from the Spanish flu.

Weeks later, more than 4,500 people in the Philadelphia area died from the virus.

The graph at the top of the post, from a 2007 article in the Proceedings of the National Academy of Sciences, paints the picture of these two approaches in stark, and by now familiar, terms.

Unlike a virus, people get to choose what they care about and how that care will be expressed. In 1918, to borrow from the Grail Knight, the leaders of Philadephia chose . . . poorly, while the leaders in St. Louis chose wisely.

Today, like many places, I and my neighbors in metro Kansas City (on both sides of the state line) are living under a locally-imposed “stay-at-home” order, with school buildings closed, business activity limited to those deemed essential and curtailing large public gatherings completely, including weddings and funerals.

You see, the leaders here know that a virus does not care. Other leaders, however . . .

From an interview on Fox:

Trump: I saw wouldn’t it be great to have all of the churches full—you know the churches aren’t allowed to have much of a congregation there. And most of them, I watched on Sunday online—and it was terrific, by the way—but online is never going to be like being there. So I think Easter Sunday and you’ll have packed churches all over our country—I think it will be a beautiful time. And it’s just about the timeline that I think is right.

A virus does not care about whether churches are full or empty on Easter. A virus doesn’t care if it is beautiful. A virus doesn’t care about your personal faith or lack thereof. In Omaha in 1918, Rev. Siefke S. de Freese, a seemingly healthy 35 year old pastor, led worship on a Sunday, then quickly died days later. A virus does not care.

From yesterday’s coronavirus task force presser:

Q: Mr President, you just reiterated that you hope to have the country reopened by Easter. You said earlier you would like to see churches packed on that day. My question is, you have two doctors on stage with you. Have either of them told you that’s a realistic timeline?

Trump: I think we’re looking at a timeline, we’re discussing it. We had a very good meeting today. If you add it all up. That’s probably nine days plus another two and a half weeks. It’s a period of time that’s longer than the original two weeks, so we’re going to look at it. We’ll only do it if it’s good and maybe we do sections of the country. We do large sections of the country. That could be too, but we’re very much in touch with Tony and with Deborah whenever they [crosstalk].

Q: Who suggested Easter? Who suggested that day?

Trump: I Just thought it was a beautiful time, a beautiful timeline. It’s a great day. . . . I’d love to see it come even sooner, but I just think it would be a beautiful timeline.

A virus does not care if it is a beautiful time. A virus does not care if it is a great day. A virus does not care what you think. A virus does not care what you love.

A virus Does. Not. Care.

We can choose how we respond to an uncaring virus. We can choose like St. Louis did, or we can choose like Philadelphia. And for far too many people, my friends, that is a choice between life and death. And in 1918, even St. Louis didn’t get it completely right:

The quarantine was temporarily lifted Nov. 18 but reinstated when the flu roared back in December. By Dec. 10 the flu peaked in the city with 60 deaths in one day. After illnesses declined sharply, the quarantine was lifted just after Christmas.

Look at that graph again, and you can see the bump at the end of November when the quarantine was prematurely lifted. The virus came back, because a virus does not care.

I’m a pastor. I’d love to see my church packed to the rafters on Easter. I’d love to hear the trumpets leading a 1000 voices in grand hymns of celebration. But that’s not going to happen, because while a virus does not care, I do.

We’re going to be closed this year. Not because we want to be. Not because we lack faith. Not because we don’t care about worship. Not because we’re giving in to the virus. It’s because we care about ourselves and our community so much that we’ll give up this kind of gathering to defeat the virus. Anything less than a full community commitment to a choice like that, and the virus will not be slowed, because the virus does not care.

I pray that more local leaders, state leaders, and national leaders choose wisely, even as Trump seems determined to choose . . . poorly.

I pray this, because I know the First Rule of Viruses: a virus does not care.

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