Given shortages on testing, there have been just a few populations exposed to coronavirus in the US that have all been tested. Among the first cruise ships to be tested, up to 19% of those on board tested positive. 660 members of the crew of the USS Teddy Roosevelt have tested positive, about 13% of the crew. At the Kirkland Life Care Center, 67% of residents tested positive by March 27.

In Marion Prison in Ohio, two months into this crisis, an astounding 1828 — around 73% — of prisoners have tested positive, per Ohio’s official numbers.

I have no reason to believe that Ohio’s Governor Mike DeWine conducted this experiment intentionally — or even considers it an experiment at all. This is data the state needs to understand how to deal with COVID. His medical officer, Amy Acton, has been first rate. I assume that as Ohio considered the areas where their aggressive response hasn’t succeeded in stopping the spread of COVID, the prisons in the state were one of the most obvious failures (the federal prison at Elkton, Ohio has an official count of 50 inmates who have tested positive, with 6 who have died, though federal prisons aren’t testing everyone). And so the state decided to test everyone at three different institutions.

*DRC has taken an aggressive and unique approach to testing, which includes mass testing of all staff and inmates at the Marion Correctional Institution, the Pickaway Correctional Institution, and the Franklin Medical Center (which is Ohio’s medical facility for inmates). Because we are testing everyone – including those who are not showing symptoms – we are getting positive test results on individuals who otherwise would have never been tested because they were asymptomatic. The total tested and total pending are part of the large mass testing currently underway. Pickaway staff testing will begin the week of April 19, 2020. Once all of those results are received, these columns will be filled. Positive and negative results are still being reported and are current as of this posting.

Thus far, the positive rates in the other two facilities are lower than at Marion. While I’m not convinced all the Marion prison cases get included in the Ohio count right away, as of now, almost 16% of the Ohio’s cases are in Marion prison.

Whether intentionally or not, Ohio will soon begin to understand what happens when COVID spreads in an enclosed space with a younger population and — in the weeks ahead, what percentage of those men will weather the exposure without deathly symptoms, and then, what percentage of those men have antibodies that suggest they might be able to leave in a prison rampant with the virus with some kind of immunity.

At a minimum, the Marion prison experience shows that — even with two months of warning — without testing, spread of the disease inside closed quarters, will outrun any attempt to generate herd immunity, presumably because the lag between getting the disease, exhibiting symptoms, and developing immunity is too long.

Ohio is collecting necessary data. Better to collect it and identify all the people that might need medical treatment, then pretending the problem is not as bad as it is, which is what virtually all other prisons are doing. The data will help Ohio understand what’s happening at all of its prisons and make informed decisions as a result. One reason DeWine’s response in Ohio has been so good is that he has followed the data.

But having it will create ethically fraught policy questions, particularly in places where those making policy decisions have already shown an inclination to put economic decisions over health considerations.

It poses some pretty troubling policy considerations. While 109 guards at Marion have also tested positive (244 guards in state prisons across Ohio, as well as 38 at Elkton), it’s not yet clear whether the guards have contributed to clusters in surrounding communities — though that’s another thing Ohio will learn as it tests all the Marion population. No prisoner at Marion has yet died (one staffer has). Effectively — again, I’m not saying that this was at all intentional — Ohio is testing whether it’s possible for certain, younger enclosed populations to just weather this illness.

The thing is, I suspect something similar may be happening in other clusters where entire populations will be tested, one where ethical considerations won’t be aired publicly. Will meatpackers, for example, decide that their workers are so expendable that losing ten or so, but then reopening a plant with an immune workforce, is worth the human cost? if they do, we’re unlikely to find out they’ve made that decision anytime soon.

Given the disproportionate impact of this disease on the poor and those who live or work in confined spaces, especially people of color in both populations, given the political stakes Republicans are placing on proceeding as if a pandemic doesn’t change ordinary politics, as more populations like the one in Marion do tests of the entire population, will present ethical questions that our society is in no way prepared to handle.

The language of mountains and mountain climbing is all over the COVID-19 coverage, from the talk of “reaching the peak” of infections to the euphoria of those who proclaim that in various areas, we are “hitting the plateau.” But as a mountain-climbing friend once told me “Climbing the mountain is the easy part — it’s the descent that’ll kill you.”

This is not just a cliche, or a (non-)urban legend, but backed up by the experience of those who know the mountains best:

Kami Rita Sherpa knows Mount Everest better than anyone else: He’s summited the world’s tallest peak 24 times, more than any person in history. . . .

Sherpa said problems arise not from those lines [of climbers waiting at altitude to pass along single-file sections of the climb], but when people accidentally push past what their body can support. Some research suggests that Everest climbers can develop a kind of “summit fever,” racing to the top to prove they can, even when their bodies are showing signs of giving out.

“At that altitude, it takes everything to put one foot in front of the other,” Everest climber and exercise psychologist Shaunna Burke recently told Business Insider. “If you haven’t judged how much gas you have left in the tank, then you can’t make it down. That’s why some climbers sit down and don’t get back up.”

Sherpa echoed this.

“When returning, their body is out of energy, and many people die due to this cause,” he said.

It’s not just one or two climbers’ opinion, either. In 2006, Paul Firth and his colleagues published “Mortality on Mount Everest, 1921-2006: descriptive study” in the British Medical Journal, which looked at every documented death on Mount Everest and sought to understand what commonalities might be found among the fatalities. They first distinguished between deaths below 8000 meters as climbers and their guides traversed areas prone to avalanches, crevasses, and other features of the mountain, and the deaths that took place above 8000 meters, where the mountain is generally more stable but fatigue and altitude sickness are the greatest dangers. On the lower part of the mountain, guides were more likely to be the ones who died, which the authors surmise is because the guides make multiple trips up and down the climbing route, setting ropes and bringing supplies up to the higher camp, before they guide the climbers along the route they found and made more safe. When it came to the deaths above 8000 meters, however, things reversed, and they noticed some shocking numbers:

Table 3 presents data on the mountaineers who died after reaching 8000 m. Fifty three (56%) died during the descent, 16 (17%) after turning back below the summit, and nine (10%) during the ascent. The stage of the summit bid was unknown for 12 mountaineers (13%), and four (5%) died before leaving the final camp.

Look at those top three figures again: 10% died while making the push for the summit, and 73% died while descending. For every death going up, there were 7 going down.

Maybe these climbers who died on the way back down pushed too hard going up, and had nothing left for the descent. Maybe they became disoriented because of lack of oxygen and quit thinking clearly. Maybe they were so excited at having made it to the top that they got sloppy as they turned around and headed down the mountain.

Whatever the cause, the study was clear: descending from the peak is more deadly that making the climb up. As our veteran climber cited above put it:

Burke said that although all climbers want to reach the summit, that objective alone can be a problematic.

“The summit is only halfway,” she said. “Your ultimate goal should be to make it back to camp alive.”

I look at the images of the folks protesting the “stay-at-home” orders issued to fight the COVID-19 epidemic, and their cheers of things like “We made it! We stopped the disease! Now let’s open things up again and get back to work!” I read the tweets to “liberate” this or that state, cheering on those who think the task is done. Then I think of the mountain climbers cheering at having reached the top of the mountain, who don’t realize how dangerous things can be on the way back down. That’s what worries me about all the talk of opening back up right now.

Yes, some places may have reached the peak of new infections, the peak of ICU bed usage, and the peak number of intubated patients. But here’s the thing: we are still on the mountain. Getting to the top is great, but the goal is to make it back to camp alive.

I don’t want to minimize the accomplishment of the climb, whether speaking of those who scale mountains or those who have been struggling to keep ahead of the increasing numbers of those hit by COVID-19. But relatively speaking, climbing the mountain is the easy part. It’s the descent that’s much more likely to kill. Face it, people: This journey has a long way to go, with plenty of opportunities for negligence and for misplaced cheering which will give life to a virus that deals out death.

This is no time for getting complacent or sloppy. Stay home, stay safe, save lives.

There has been a lot of attention to the COVID cluster in the Smithfield plant in Sioux Falls, SD, which shut down after hundreds of workers became ill with COVID-19. One worker in the factory died.

But there’s another meatpacking plant that has had four deaths: a Tyson’s Food plant in Camilla, GA.

Four employees of a major poultry producer’s operations in rural southwest Georgia have died after becoming infected with the coronavirus, a company spokesman said Friday.

Tyson Foods spokesman Gary Mickelson said three of the employees worked at the company’s chicken processing plant in Camilla, while the fourth person worked in a supporting job outside the plant. He declined to say how many workers there have tested positive for COVID-19, the disease caused by the new virus.

[snip]

The Retail, Wholesale and Department Store Union, which represents 2,000 workers at the Georgia chicken plant, identified the three plant employees who died as women who had worked there for 13 to 35 years. A statement from the union said many plant employees are “sick or in quarantine.”

This factory is commuting distance — 30 miles — from Albany, GA, where a funeral on February 29 led to a significant cluster. It’s in Mitchell County, GA, which has a population of around 22,000, of whom about half are black. Camilla itself is about 5,600 people, of whom 66% are black. The poultry plant is the largest employer.

Coronavirus has spread to the next largest employer in town: Autry State Prison, which employs 500 people and houses 1,700 prisoners. 4 staffers and 6 prisoners have tested positive, according to official numbers. (And a County jail has 3 cases.)

While Tyson Foods has implemented some measures to slow the spread — including making masks mandatory — it still isn’t providing sick pay.

Gonzalez said the company has improved safety measures at the Camilla plant by checking employees’ temperatures, requiring workers to wear face coverings, installing dividers at work stations and providing more space in break rooms. He said the company in March had “relaxed our attendance policy to encourage workers to stay at home when they’re sick.”

[snip]

The union has called on poultry processors to require employees to quarantine themselves for 14 days, and pay them sick leave, when they’re exposed to co-workers testing positive for the virus. It also wants individual departments to be shut down for 72 hours and cleaned after a worker tests positive.

The CEO of Tyson Foods, Dean Banks, is one of the CEOs Trump claims to be consulting on how to reopen the country. Yet his plants are responsible for two clusters of COVID.

148 of the workers in a Tyson pork plant in Columbus Junction, IA have tested positive, and two have died. 47% of the population in Columbus Junction are Hispanic and 12% Asian.

Tyson’s workers account for 89% of the cases in rural Louisa County. This story includes an anonymous family member of someone who works at the plant claiming that Tyson’s public comments about preventative measures at the plant are not true.

The relative of one plant worker, however, disputed that, telling Starting Line the company did not provide face masks to workers, still had people working in close proximity to each other, allowed workers to eat together in the break room, and that workers weren’t told of the infections until the day the plant shut down. Not wanting to disclose their name, they also noted the only changes made at the plant were taking employees’ temperatures as they came in, encouraging people to wash their hands, and displaying posters with information about the virus in multiple languages.

Trump and Tyson Foods seem to think these workers are expendable. But if food plants continue to cause clusters like this, it’ll not only shut down key parts of the food supply, but create clusters of COVID-19 in rural areas that are far less equipped to deal with it.

Update: Deleted a comment about Hispanic population in Columbus Junction per Peterr’s comment.

According to multiple reports yesterday, Michael Cohen will soon be released to serve out the remainder of his prison sentence in home confinement.

The federal Bureau of Prisons has notified Michael Cohen, President Donald Trump’s former personal attorney, that he will be released early from prison due to the coronavirus pandemic, according to people familiar with the matter and his lawyer.

Cohen is serving a three-year sentence at the federal prison camp in Otisville, NY, where 14 inmates and seven staff members at the complex have tested positive for the virus.

Cohen was scheduled for release in November 2021, but he will be allowed to serve the remainder of his sentence from home confinement, the people said. He will have to undergo a 14-day quarantine at the prison camp before he is released.

Cohen was notified on Thursday of his pending release, and his lawyer, Roger Adler, confirmed it to CNN.

As Josh Gerstein has described, sometimes these promises don’t work out.

The spouse of an inmate at one of the hardest-hit federal prisons, in Elkton, Ohio, described a puzzling transfer of prisoners into pre-release quarantine and then out again.

Tammy Hartman said her husband Pete, who’s due out of prison in August of next year, was one of 56 inmates whose names were called on Saturday to report for quarantine so they could be sent on home confinement.

“They were all told: you’re going home,” she said. But on Wednesday, 54 of the men were sent back to their cells. “They told them, sorry, you’re not going anywhere, because they’d approved only two of them to leave.”

“I actually thought he was coming home,” Hartman said of her 59-year-old husband who — like other prisoners mentioned in this story — is serving time on drug charges. “I canceled all his subscriptions to magazines because I thought he’d be home in 14 days… I’m trying to hold it together.”

Which is, I guess, why Cohen’s lawyers promptly made this public — to make it harder for BOP to renege.

Otisville prison is one of the federal prisons with a growing cluster — currently, officially, with 14 prisoners and 7 guards testing positive. So it is an appropriate places for BOP to attempt to move older, non-violent prisoners. That said, Cohen is not actually that old (just 53) and as far as is public, his health is fine.

A far better case might be made that Paul Manafort should be sent to home confinement. He’s 71 and wasn’t all that healthy when he first went to jail almost two years ago, and he has continued to have health problems since then. His attorney, Kevin Downing, cited those health problems in a letter to BOP asking for his release. Curiously, Downing appears to be thinking exclusively in terms of internal appeals, rather than appealing to a judge, which suggests he thinks his client stands a better chance if someone working for Bill Barr makes the decision (which certainly worked to keep him out of Rikers when he was arraigned in New York). Perhaps that’s because the prison he’s in, Loretto, has had no reported cases yet. Manafort has been quarantining since the end of March, so can be sent home if there are cases there.

Paul Manafort is a shithole who sold out the candidate he worked for and his own country. He got fabulously wealthy fronting for dictators and other sleazebags, and stiffed the American taxpayers on the blood money he got in exchange.

But BOP should seriously consider moving him to home confinement for as long as the COVID outbreak lasts. Manafort was not nor should he have been sentenced to a death for his crimes. And if you can’t support that move for his miserable humanity, then do it for others he might infect, like the far poorer guards who tend to him.

Cohen and Manafort are not the only Trump criminals who may dodge full prison terms because of this virus. As bmaz noted, yesterday Amy Berman Jackson rejected Roger Stone’s bid for a new trial. While BOP doesn’t assign spots to people all that quickly in any case, for new non-violent prisoners, BOP is not rushing people into incarceration. And Stone, at 67, is also old enough to be considered a higher risk.

So rather than starting rebellions against stay-at-home orders in Michigan, Minnesota, and Virginia, Trump should encourage Bill Barr to liberate his criminal co-conspirators, along with the similarly situated men of color incarcerated with them.

But the only reason to remove Paul Manafort from an environment where he’d be more likely to contract the virus is if there’s a shut-down. So if Trump wants his criminals liberated — or wants Stone to remain out of prison long enough for the post-election pardon — then he should be rooting for a continued shut-down.

[Check the byline, thanks! /~Rayne]

On March 25 I published a post in which I counted out the anticipated time required from a surge of new COVID-19 exposures to the date when the exposed persons would likely be recovered, dead, or free of SARS-CoV-2 virus.

At that time the last big public event at which people would have gathered closely and ignored social distancing was St. Patrick’s Day on March 17. Several states issued shelter-in-place/Stay Home orders after the last of the green beer was served, among them Michigan on March 23.

See Marcy’s post for a list of other states’ lockdown orders.

Of course Trump’s malignant narcissism, megalomania, and oppositional defiant disorder kicked in several times during his near-daily coronavirus briefing cum re-election campaign rally. He has champed at restraints on business, in part because Trump organization businesses have been shut down and cut into whatever their revenue streams may be, and in part because his good-old-boy network has been prodding him about the market and their businesses’ lack of revenue.

Which in turn has been used by the right-wing and white nationalists to foment unease and dissension among the Tea Party-ish types.

Like these embarrassments to my state.

While the DeVos family denies having any ties to the Michigan Freedom Fund and the Michigan Conservative Coalition which organized the “Operation Gridlock” protest for this Wednesday in Lansing, somebody surely funded the groups behind these racist feckwits.

And somebody organized these mouthbreathing zombies in Ohio so they would protest in Ohio’s capital city Columbus at the same time.

And somebody organized these sheep-dip-for-brains in Kentucky as well, also protesting in Kentucky’s capital city.

Sure feels like Tea Party 2.0, just missing the tea bags.

But it’s possible there’s some other entity behind this neatly coordinated multi-state tantrum. Let’s not forget that in 2016 a foreign influence operation persuaded Floridians to hold rally-like pro-Trump events via Facebook.

Somebody knows exactly who the easily motivated Trumpists are who would jump in their car on relatively short notice. It’s just not clear yet whether this was homegrown or if there was help from abroad. Such effort could explain the number of Trump flags and other pro-Trump paraphernalia present at these protests. It would also explain the presence of the far right Proud Boys.

Whatever the case, these whiny morons protesting the lockdowns in their respective states as incursions against their freedoms have likely spread COVID-19 amongst themselves due to their lack of adequate social distancing.

That photo of the mouthbreathers in Columbus fogging up the glass is a perfect example of the aerosolized exhalation humans give off and other humans breath in when there is poor air circulation and a lack of distance between humans. It’s highly possible this photo captured the moment of exposure between individuals. I do hope some well-masked journalist asked these people their names so they could follow up with them:

— in 5 days time when infection has likely set in and earliest symptoms begin;
— in 10-14 days when mild cases will have symptoms and severe to critical cases will seek medical treatment or hospitalization; and again
— in 21-28 days when the exposed have been hospitalized, treated, begun to recover, or died leaving their loved ones behind to answer questions.

We’ll be watching the calendar for the wave of new cases which will likely start this weekend.

Thanks to these thoughtless morons demanding their freedom to buy lawn fertilizer and visit their hair colorist right the fuck now, the rest of us could be looking at lockdown extended to Memorial Day.

Yes, it will be nearly the end of May until the secondary exposures and infections die out after the primary wave of new exposures recover or fade.

It was bad enough that we will likely have a small wave of new cases because of resistance from evangelical and fundamentalist Christian churches which insisted on holding services for Easter. Those exposures would result in new cases from a primary exposure requiring recovery through the first week of May.

Freedom for the rest of us is sadly dependent on waiting out the illness and death of the persuadable and stupid.

This is an open thread.

Trump’s new spox, Kayleigh McEnany, got hired because she’s willing to say any thing, regardless of how stupid.

Consider her claim that Trump is doing a great job because the US has now conducted 3.3 million coronavirus tests.

Ignore for a second what would be the appropriate amount of testing for a country of 320 million people that didn’t catch the outbreak before it spread widely (per person, we’ve done half of what Germany has done).

Back on March 6, which was over a month ago, Alex Azar said that the government would roll out 4 million tests by the following week (which would be March 13, which is also over a month ago). By my math, a month later, they’re still 700K tests off their promise, 17.5%.

In other words, McEnany is bragging that the Trump Administration still hasn’t met the promises they made a month ago.

Update: According to NBC, 41 days after making a promise on testing they still haven’t delivered, Trump is “close” to announcing a plan to do what should have been the priority two months ago.

A senior administration official said the White House is “close” to making an announcement on a plan.

But that plan still doesn’t include the single most thing Trump could do to restart the economy.

Another idea that’s been discussed would use the Defense Production Act to rapidly scale up testing, according to one person familiar with the discussions, though officials played down the idea given that Trump has been resistant to more consistently deploying that presidential power since he would rather use the law as leverage to get companies to take such steps.

As Politico reported yesterday, in a bid to marginalize Alex Azar (who has been largely silenced in the middle of a pandemic since Rod Rosenstein’s sister Nancy Messonier told the truth in public), Trump has made Michael Caputo the spokesperson at Department of Health and Human Services.

The move is interesting for several reasons. It suggests the White House believes the way to control a Senate-confirmed cabinet member is to hire a spokesperson for that person, not to replace him or work out problems with him.

The move is designed to assert more White House control over Health and Human Services Secretary Alex Azar, whom officials believe has been behind recent critical reports about President Donald Trump’s handling of the coronavirus pandemic, according to two officials with knowledge of the move.

That, in turn, suggests that in the middle of a pandemic, Trump’s White House is treating HHS as a PR shop, not a functional agency.

But the far more interesting aspect of this hire is that, as recently as February 3, Bill Barr’s DOJ claimed in FOIA exemptions on Caputo’s FBI interview report that it was conducting an ongoing investigation into something Caputo did during the 2016 election — possibly with Roger Stone — called Project Rasputin. What Project Rasputin was is redacted in the 302. But whatever it was is closely enough connected with his and Stone’s willingness to take a meeting with a Russian selling dirt on Hillary Clinton that Caputo told Mueller’s team that, “‘Project Rasputin’ was mutually exclusive from anything having to do with” the guy selling that dirt.

Of course, on precisely the same day that Bill Barr’s DOJ released materials indicating it was still investigating something called Project Rasputin that Caputo had been involved in, Barr replaced then DC US Attorney Jesse Liu, who had permitted the Roger Stone investigation and prosecution to proceed unmolested by the kind of unprecedented interference that Barr would engage in just days later. Which raises questions about whether Trump doesn’t care that his own DOJ was still investigating something Caputo did in 2016, or whether Barr saw to it that investigation ended, making Caputo hirable for the first time in Trump’s Administration.

When I asked Caputo what Project Rasputin was, he simply responded by tweeting a picture of the charlatan advisor to a czar, a picture he has since deleted (along with a bunch of other Tweets he purged before taking this position).

Ah well. I’m glad that Trump’s desperation to stop Azar from telling the truth about how the President ignored sound medical advice in favor of conspiracy theories will provide yet another pressing reason to ask Reggie Walton to fully declassify the 302s describing this project.

I guess, if the WaPo is going to continue to treat President Trump’s “plan” to restart the economy as a real policy effort, they’ll end up reporting all the evidence that it’s just a Potemkin show for their benefit and that of Trump’s followers. Yesterday, they described that the Great American Economic Revival Industry Groups that he had rolled out just a day earlier involved, to a significant extent, simply putting a bunch of names on a list and then having a conference call that the White House assumed they would call into.

Some of the groups involved in the calls were notified in advance of Trump’s announcement, while others heard their names for the first time during the Rose Garden event Tuesday night.

“We got a note about a conference call, like you’d get an invite to a Zoom thing, a few lines in an email, and that was it. Then our CEO heard his name in the Rose Garden? What the [expletive]?” said one prominent Washington lobbyist for a leading global corporation, who spoke on the condition of anonymity to discuss the sensitive matter. “My company is furious. How do you go from ‘Join us on a call’ to, ‘Well, you’re on our team?’”

[snip]

One member of a group that participated in the calls, the AFL-CIO, was told in advance of being named to the outside advisory council. But a spokeswoman for the AFL-CIO said its leader, Richard Trumka, was not asked — rather, Trump just announced that the coalition of labor unions would be a part of the council, she said.

And the list of businesses invited looks like something Jorge Luis Borges would invent to demonstrate the addled mind of someone who doesn’t understand the American economy. It includes casinos, foreign-owned cruise lines,  Trump’s buddies who own sports teams, and top Reality TV chefs like Wolfgang Puck, Thomas Keller, and Daniel Boulud (h/t DJ for the Top Chef insight). While it includes some businesses that are part of critical supply chains, there are big gaps that we should expect to be the ones that will crash once the economy does reopen more broadly. And large populations of workers and small business owners are barely represented.

Had Trump done even the least little bit of staff work before putting a slew of executives on the phone with the President, someone in the White House would have known that they would have undermined his claims to be ready to reopen with the same point epidemiologists, journalists, and others have been making: we can’t reopen until we have way more testing.

Many of the chief executives urged the White House to focus more on mass testing, according to several participants on the calls. Public health experts have argued that widespread testing is a key prerequisite to reopening the economy because it would determine who is infected and needs to be isolated, giving Americans greater confidence that they can safely return to work and public life.

[snip]

On one of the morning calls, the point most emphasized by the chief executives was the need for massive testing, which they said would be necessary to create the psychological circumstances for the nation to feel comfortable returning to offices, restaurants and recreation, according to a person familiar with the call.

It’s hard to read about the circumstances of these calls — who was on the list, how the calls were set up, and Trump’s lack of preparation — and take anything away except that this is all just a show, a way to give Trump a big announcement on May 1, maybe even a ribbon cutting ceremony, with absolutely none of the work to move us towards reopening the economy.

Which is, in turn, testament to the fact that four months into this crisis, Trump still believes it is not real.

Update: Politico’s bankster sources described the call as a shit show.

There was a small problem with the Wall Street call. Actually several problems.

Many of the bankers said they knew nothing about the call until late Tuesday night. Several had quarterly earnings calls this morning that directly conflicted with the timing of the White House summons.

Goldman Sachs CEO David Solomon couldn’t be on the call because of earnings. Neither could JPMorgan CEO Jamie Dimon, though not because of earnings. Bank of America CEO Brian Moynihan was able to dial in right after his earnings call ended. Another senior executive from JPMorgan attempted to get on the call in Dimon’s place, two people briefed on the call told POLITICO, but couldn’t get through for 20 minutes and finally gave up.

One top executive described the call as a “shit show” that produced little of substance.

Jim here.

Long time readers of the blog know that whenever I hear something about Battelle, my spidey senses go on full alert. Suffice it to say that the Battelle facility in West Jefferson, Ohio  is one of only a few facilities on the planet that has both the expertise and the equipment to produce something like, say, a fully weaponized anthrax powder. So I’ve been going on alert the last few days as word has come out on Battelle’s process for sterilizing used N95 masks for re-use. West Jefferson is just outside Columbus, so I had a false alarm on Marcy’s post earlier today about the Washington Post needing to go to Columbus, but she wasn’t discussing Battelle.

Don’t get me wrong. I am fully in favor of anything that can be done to provide safe PPE to those on the front lines of the COVID-19 pandemic response. Finding safe ways to re-use these masks has to be one of the many approaches we must rely on while the masks are in such short supply. But when I finally started digging deeper into what is going on with the contract that the Defense Logistics Agency awarded to Battelle for this process, I was staggered by the total cost compared to what looks, on the surface, to be a straightforward, inexpensive already proven approach.

On April 13, the Department of Defense announced a $415 million contract to Battelle for N95 mask sterilization:

The Department of Defense’s Defense Logistics Agency, on behalf of the Department of Health & Human Services (HHS), has awarded a $415 million contract for 60 Battelle Memorial Institute Critical Care Decontamination Systems (CCDS), that can decontaminate up to 80,000 used N95 respirators per system per day, enabling mask reuse up to 20 times.

Spearheaded by the Department’s Joint Acquisition Task Force, six units have already been delivered to locations including two to New York, and one each to Columbus, Ohio, Boston, Chicago and Tacoma, providing the ability to sterilize 3.4 million masks a week, reducing the need for new masks by the same number.

All 60 systems will be available by early May for prioritization and distribution by FEMA and HHS. Once all are delivered, these 60 units will allow 4.8 million masks to be sterilized per day, almost 34 million per week.

‘I remain extremely proud of the selfless efforts of Department of Defense personnel who continue to do everything they can to help provide medical masks, test kits, medicine and meals to support America’s military, medical, emergency services and law enforcement professionals who are on the front lines and need them most,’ said Under Secretary of Defense Ellen Lord.

This procurement includes a service contract to cover operations and maintenance.

A couple of days earlier, on April 11, the New York Times visited Battelle and provided a photoessay on the Battelle process for sterilization. Here is a Times photo of masks hanging in one of the decontamination units. This photo is also the featured image for the post:

One thing that jumps out immediately is to notice that standard food/medical grade shelving is used in the unit. So at least that part isn’t very expensive. I am disturbed, though, by the “extra” rods between shelves that have masks hanging in a way that we can see multiple pairs of them closely nested, raising concern about circulation of the vapor used in the sterilization process. Just below the photo, the Times notes that workers take “care to avoid overlapping”. Okay, then, but I’m still nervous about those that look nested.

The sterilization process itself is carried out by hydrogen peroxide vapor (HPV). Of course, safety dictates that the chamber in which the masks are exposed to the vapor is perfectly sealed as vapors escaping would be toxic to the staff working around the chamber. Technology to inactivate the peroxide in the exhaust stream from the chamber is known, off the shelf technology and would be a part of the air handling for the chamber. Hydrogen peroxide itself is very inexpensive and is produced in bulk by the chemical industry.

Battelle already validated the process under a contract from FDA, with the final report issued in July of 2016 (thanks, Obama!). Here’s a partial screengrab from the report with a photo of the simple machine used to generate the HPV (gratuitous anthrax mention included for grins):

Sure enough, the Times found a very similar machine when they were at Battelle:

This is not a very complicated piece of machinery. I’m not sure of the full retail price, but I found a used “as is” listing for $4500. I’d be surprised if these are costing Battelle more than $20,000 per unit.

And the “chambers”? They’re shipping containers. Again, from the Times photos:

Also visible in this photo is very standard-looking air handling equipment.

So, making 60 units out of shipping containers, outfitting them with an HPV generator and air handling equipment doesn’t look very expensive to me at all when compared to the total value of the contract. It’s very hard to estimate more than $10-15 million in materials costs for 60 units.

The Times article provides an accessible description of the sterilization process. Here’s what happens in the chamber:

A contraption known as a vapor phase hydrogen peroxide generator, which looks like a washing machine with two hoses, is then used to circulate the colorless gas into and out of the room. During the first four hours, workers increase the humidity inside the chamber, causing the hydrogen peroxide to collect as condensation on the masks, neutralizing the coronavirus and other contaminants.

Over the next four hours, the gas is flushed out of the room. The teams then re-enter the chamber to inspect the masks and conduct spot tests for harmful levels of residual hydrogen peroxide. They then confirm that chemical indicator cards placed throughout the chamber have changed color — the sign of a successful decontamination.

The process itself is very labor intensive, although the masks are inside the chamber for what looks like 8 hours in between bouts of activity. The masks have to be handled and inspected both before and after the sterilization procedure.

Is the labor the reason the contract costs so much? A key missing piece of information is just how long the contract lasts. Recall that the DOD press release indicates that Battelle is providing the labor for the process along with maintenance of the chambers.

After a bit of digging, I found a few more details. Here is information from a Defense News post that is dated April 13 in its URL:

Battelle has already set up two machines in the New York City area, as well as one each in Chicago, Illinois; Tacoma, Washington; Columbus, Ohio; and in the suburbs of Boston, Massachusetts. A solicitation on the organization’s website, found by the Boston Globe, says the group anticipates a need of at least 2,300 workers for 100 sites — or 23 staff per site, which is expected to run 24 hours a day. The $20 per hour job is expected to last at least four weeks.

“We are anticipating a surge over the next two months,” the solicitation read.

Let’s be generous here and extend that two month surge to a full year. If there are 2300 workers each making $20 an hour for a year, I calculate a little under $96 million in direct costs. Being generous again, travel expenses (Battelle in their solicitation mentioned the employees may need to move among sites), benefits, and overtime may bring total personnel costs close to $200 million.

My gut feeling here is that Battelle stands to make quite a bit of money off this contract, even if they run full-out with these chambers for a full year.

But rest easy, citizens.  Battelle plans to provide the sterilization service free of charge for those submitting masks and other equipment for processing.

[Check the byline, thanks! /~Rayne]

Funny enough, this COVID-19 post originally came about because of one of my family members.

They sent me a link to an op-ed from the Detroit News — the more conservative of the two major Detroit-based papers in this state — in which the author took Michigan’s Gov. Gretchen Whitmer to task because the state’s Department of Licensing and Regulatory Affairs clamped down on off-label prescriptions of an antimalarial drug.

“Any thoughts on the mandate against hydroxychloroquine?” they asked along with the link.

“Oh no,” I replied, “the author is going to regret writing that op-ed.”

They really had no idea what they were writing about. But then Trump doesn’t either.

~ ~ ~

We’re desperate. Trump and his minions don’t want to admit it, carrying on with Trump’s daily self-fluffing at the podium in front of his narcissistic supply, I mean, select White House press pool as if everything is under control.

We the public know it’s not. On Wednesday March 25, actor and activist George Takei pointed out a person died of COVID-19 in New York City every six minutes the previous day. The numbers have only grown worse.

We are that measurably desperate.

We’re grabbing at any kind of research, peer-reviewed and not, to find a way to shut down this fire hose of death because the other realistic alternative is at least 18 months of alternating levels of social distancing until a vaccine for COVID-19 has made it through multiple trials.

In a previous post I did homework and laid out some of the off-label approaches which have been taken in other equally desperate countries — like the antiviral remdesivir and the rheumatoid arthritis medication tocilizumab. These are in studies and haven’t been approved for use against COVID-19. We can only hope that other countries’ desperate, compassionate use of drugs off-label will add to the body of knowledge we have about effective treatments between now and the vaccine to come.

Our desperation makes us sloppy. We forget that what looks too good to be true often is just that.

Like the combined drug cocktail hydroxychloroquine and azithromycin.

~ ~ ~

Back on March 13 while writing about drug therapies in research, I wrote:

A number of existing drugs have been revisited for repurposing against COVID-19 instead of their original intended purpose. Antiviral remdesivir and antimalarial chloroquine are among them.

Chinese researchers posted a paper about in vitro results, not peer reviewed (at least I didn’t see that it was).

There’s a paper about chloroquine alone; in vitro studies suggest it may work against COVID-19. Chinese researchers have a number of in vivo studies in progress, but no data has been released.

Chloroquine by itself as an effective therapy would be a miracle in that it’s an old drug now off patent and available as a generic, super cheap to produce. Can’t imagine Big Pharma would like this. But we won’t even face this conflict if we don’t get data from in vivo studies.

Data. We needed data from peer-reviewed in vivo studies before any pronouncement could be made about the antimalarial medication as a therapy for COVID-19.

Published March 2 in Science Direct, a commentary by researchers at Aix Marseille University said essentially the same thing after examining an announcement by Chinese researchers that chloroquine phosphate was better than a control in treating SARS-CoV-2 (COVID-19) pneumonia — an announcement which had no supporting data:

In conclusion, the option of using chloroquine in the treatment of SARS-CoV-2 should be examined with attention in light of the recent promising announcements, but also of the potential detrimental effect of the drug observed in previous attempts to treat acute viral diseases. We urge Chinese scientists to report the interim trial results currently running in China as soon as they are available. This should be preferentially done in a peer-reviewed publication with detailed information to allow the international scientific community to analyse the results, to confirm in prospective trials the efficacy of the proposed treatment and to guide future clinical practice.

(Emphasis mine.)

These researchers are literally begging the Chinese researchers to provide data as soon as possible, after noting that while hydroxychloroquine’s precursor chloroquine appeared effective as an antiviral in vitro against different viruses, it has shown no benefit in animal models. (They also noted in a study of its efficacy against chikungunya virus, chloroquine actual “enhanced” viral replication in animal models. Not good.)

A study was published around the March 24 but reports said it was unfavorable for the antimalarial. (I haven’t been able to get my hands on the study; the link from each news source citing it has failed.) The size of the group studied was very small — only 30 patients with a control group of 15.

And yet sandwiched in time between the first Chinese study and this most recent one was another one submitted for publication on March 17:

Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of
COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of
Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949
https://www.mediterranee-infection.com/wp content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

The researchers from Aix Marseille University made no mention of this study though it must have been underway in their own backyard, so to speak.

No one noticed this — the dog that didn’t bark.

Meanwhile, on March 19, Trump talked about hydroxychloroquine from the podium during a briefing before a White House press pool. He not only mentioned it in glowing terms but he tweeted about it. Mike Pence also promoted the antimalarial two days later.

On March 24 an Arizona man died and his wife was hospitalized after taking hydroxychloroquine’s precursor, chloroquine — used to maintain their fish tank — having heard Trump talk about it so positively. The couple poisoned themselves; Trump scored two casualties with his misinformation.

~ ~ ~

A critical threat to U.S. health security is its monoculture — specifically, its complete investment in English excluding other languages. Back when we worried about Zika virus posing a threat to Americans traveling to South America and when Zika arrived in Florida, we were combing through research from other countries. The Chinese fortunately published much of their work in both Mandarin and English, but Brazil had a considerable amount in Portuguese. Their work was ignored in favor of less credible work which appeared in English.

This same dynamic is at work with regard to potential drug therapies — hydroxychloroquine in particular.

The study Gautret et al. (2020) was published in French and English, you’ll note. Many people picked up on it because it was so accessible.

What wasn’t picked up readily was the problems with an affiliated researcher. Many reported problems have been documented online where the world can read them, in of all places, Wikipedia.

But that’s Wikipedia France — a different address than we use in the U.S., published in French.

See: https://fr.wikipedia.org/wiki/Didier_Raoult

Use Google Translate and read the section on COVID-19. The translation isn’t entirely smooth but it does well enough for the average English speaker to figure out Raoult is a character.

He also has a history of sexual harassment and possible abuse according to a number of accusers, also documented in this Wikipedia entry.

(I’ve scraped that entry and translated it out of concerns it might change over time. You can read the portion of the French Wikipedia entry on Raoult and COVID-19 at this link. You can compare it against the Wikipedia page’s editing history though you’ll need to reverse translate it.)

It could be said in the MeToo age that many accused abusers are competent at their professions and are simply jerks when it comes to managing their attitude toward co-workers. But in Raoult’s case the accusations are smoke and where there’s smoke there’s an ethical fire.

It seems Raoult’s research has had a problem with data which looks artificial in at least two other studies, noted during peer review.

He’d previously been banned from publishing in microbiology journals.

Complaints about a hostile work environment in his lab do not offer reassurance about the credibility of his work. Were subordinates pressured for results?

It also seems odd this one study from France has been relied on so heavily by others, when the underlying drug is manufactured by a French manufacturer (though not the only company which does).

None of this passes the smell test.

Gautret et al. also didn’t pass the sniff test with the journal in which it was published though it did not retract the study:

The April 3, 2020, notice, from the International Journal of Antimicrobial Agents, states that the March 20 article, “Hydroxychloroquine and azithromycin as a treatment of Covid-19: results of an open-label non-randomized clinical trial”

does not meet the [International Society of Antimicrobial Chemotherapy’s] expected standard, especially relating to the lack of better explanations of the inclusion criteria and the triage of patients to ensure patient safety.

The notice, which is from the ISAC and not the journal itself, is a bit ambiguous. The society says it “shares the concerns” about the paper, but it doesn’t appear to be taking additional action.

It’s unclear what took the journal nearly a month to make this statement of doubt. Because it hasn’t been retracted references are still made to Gautret et al. (2020).

~ ~ ~

Studies to date on hydroxychloroquine or its precursor chloroquine have been small or flawed; the merits of these antimalarials were thin to begin with.

Zumla, A., Chan, J., Azhar, E. et al. Coronaviruses — drug discovery and therapeutic options. Nat Rev Drug Discov 15, 327–347 (2016).
Published: 12 February 2016
https://doi.org/10.1038/nrd.2015.37
https://rdcu.be/b3uhd

An excerpt from this review of drug therapies notes chloroquine had limited promise against SARS-CoV-1:

…Chloroquine is an anti-malarial drug that sequesters protons into lysosomes to increase the intracellular pH. It has broad-spectrum antiviral activities against numerous CoVs (SARS-CoV, MERS-CoV, HCoV-229E and HCoV-OC43) and other RNA viruses in vitro 123, 210, 211, 212, 213, 214. However, it did not substantially reduce viral replication in SARS-CoV-infected mice, possibly because the cell surface pathway was not simultaneously blocked. …

This study of antiviral remdesivir with antimalarial chloroquine was in vitro, not in vivo:

Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020).
Published: 04 February 2020
https://doi.org/10.1038/s41422-020-0282-0

Remdesivir may act alone as antiviral. Conclusion is that these two drugs “should be assessed in human patients suffering from the novel coronavirus disease.” The drugs were assessed but not employed as a protocol.

This next study is again in vitro, not in vivo:

Liu, J., Cao, R., Xu, M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 6, 16 (2020).
Published: 18 March 2020
https://doi.org/10.1038/s41421-020-0156-0
https://www.nature.com/articles/s41421-020-0156-0

Its conclusion calls for more testing, while implying hydroxychloroquine’s use would be better as an anti-inflammatory during cytokine storm though this study didn’t examine its anti-inflammatory effects:

…HCQ is a safe and successful anti-inflammatory agent that has been used extensively in autoimmune diseases and can significantly decrease the production of cytokines and, in particular, pro-inflammatory factors. … In combination with its anti-inflammatory function, we predict that the drug has a good potential to combat the disease. This possibility awaits confirmation by clinical trials. We need to point out, although HCQ is less toxic than CQ, prolonged and overdose usage can still cause poisoning. And the relatively low SI of HCQ requires careful designing and conducting of clinical trials to achieve efficient and safe control of the SARS-CoV-2 infection.

Hydroxychloroquine is toxic and it needs carefully designed clinical trials — this prediction of its “good potential” is happy talk until there’s data to prove its effectiveness for its intended purpose.

A pre-proof study about the two-drug hydroxychloroquine and azithromycin cocktail published on March 30 is small but makes a more declarative statement right in its title:

Molina JM, Delaugerre C, Goff JL, Mela-Lima B, Ponscarme D,
Goldwirt L, de Castro N, No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the
Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19
Infection, Medecine et Maladies Infectieuses (2020),
doi: https://doi.org/10.1016/j.medmal.2020.03.006
https://www.sciencedirect.com/science/article/pii/S0399077X20300858

The summary:

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety.

This study was in vivo, using the same dosing regimen reported by Gautret et
al. study on a cohort of patients similar to the same study. The results were unsatisfactory:

At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination. Mean through blood concentration of hydroxychloroquine was 678 ng/mL (range: 381-891) at days 3-7 after treatment initiation.

Nor had the virus been cleared 5-6 days after treatment began in 8 of 10 surviving patients. The study’s authors made a point to compare their findings against the Gautret et al. study:

These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et al also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination.

Hydroxychloroquine doesn’t work against SARS-CoV-19 even when paired with the antibiotic azithromycin, but a larger, randomized clinical trial with appropriate controls is still necessary to beat it through the heads of people pushing this therapy.

~ ~ ~

But out of desperation, hospitals have been using hydroxychloroquine anyhow, only to discover it doesn’t work against COVID-19 — it may even make patients sick.

That last French study above squelched further use of hydroxychloroquine at the St. Louis Hospital in Paris.

Hospitals in Sweden stopped using it after negative effects (open link in Chrome and use Google Translate to read in English) including impaired vision.

On Sunday, Dr. Sanjum S. Sethi, Vascular Medicine and Interventional Cardiology Columbia University Irving Medical Center, shared that ALL patients treated in the ICU for COVID-19 have received hydroxychloroquine:

6) Every single ICU patient (barring QTc issues) got hydroxychloroquine and it doesn’t seem to have helped. Maybe it helps for prophylaxis or in mild disease, but doesn’t appear to do anything once in ICU. It is NOT a pancea and should not be given indiscriminately. (7/10)

— Sanjum S. Sethi MD, MPH (@sanjum) April 12, 2020

Dr. Sethi doesn’t say how many patients have been treated with the drug so far — there could be as many as 1,000 patients in ICU at one time based on a newsletter by Surgeon-in-Chief Craig R. Smith, MD for NYP/CUIMC — but it didn’t work for severe-to-critical patients in ICU.

Which means the Chinese researchers’ suggestion that hydroxychloroquine’s anti-inflammatory qualities may help with cytokine storms didn’t pan out.

~ ~ ~

Meanwhile, Trump continues to tout hydroxychloroquine, as does his best buddy in Brazil, Jair Bolsonaro.

Brazil, like other tropical countries has ongoing incidence of malaria. It’s endemic along the Amazon River and treated with chloroquine or hydroxychloroquine. The drug has also been used prophylatically.

And yet Brazil is experiencing a growth in COVID-19 cases even along the Amazon River, suggesting hydroxychloroquine or its precursor are not effective in the early stages of the disease, failing to fend off infection and contagious pre-symptomatic progression to mild, severe, and critical cases.

Further assessment is difficult because like Trump, Bolsonaro has undermined reporting and efforts to limit contagion.

Brazil’s Minister of Health Luiz Henrique Mandetta nearly lost his job late last week when he refused to authorize a protocol prescribing hydroxychloroquine for COVID-19 patients. A few doctors continued to press him on this after he survived a heated cabinet meeting in which this pharmaceutical was discussed.

Two days later a small study was published; chloroquine as therapy for COVID-19 patients had been halted early after more than 25% of the subjects died:

Borba M, Almeida Val F, Sousa Sampaio Vanderson, CloroCovid-19 Team, et al. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study)
Published: April 11, 2020
medRxiv 2020.04.07.20056424; doi: https://doi.org/10.1101/2020.04.07.20056424
https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1

~ ~ ~

The bottom line is that we are still without an effective pharmaceutical antiviral therapy, no matter what Trump says.

What he’s said from the podium has only encouraged risk-taking pushing past the limits of ethics guiding the practice of medicine and human experimentation. The Texas City nursing home administration who has dispensed hydroxychloroquine without advanced informed consent is a perfect example of ethics collapsing under Trump’s equally unethical practice of medicine and pharmaceutical lobbying from the presidential podium.

Though we know more now than we did at the beginning of March about hydrochloroquine as a tool for treating COVID-19 — and we know that no study to date has suggested the drug will be effective for a majority of COVID-19 patients — we still do not know why Trump is so invested in this generic medication.

Who told Trump this drug was an effective treatment for COVID-19?

Has someone continued to reinforce this fallacy though Dr. Fauci has yet to reverse his own professional opinion about hydroxychloroquine?

Who likewise sold Bolsonaro on this drug? It likely wasn’t Fox News though the network may have irresponsibly reinforced Trump’s lobbying for hydroxychloroquine.

Why are talking heads on Fox News still promoting this drug with impunity — like Laura Ingraham who is not a medical professional?

laura ingraham, who advised trump personally days ago, calls for firing the cdc director for dismissing hydroxychloroquine on cnn pic.twitter.com/e6RryGkQti

— John Whitehouse (@existentialfish) April 10, 2020

Why are other right-leaning pundits continuing to press for this drug though they do not have medical background, and while other experts continue to express doubts about hydroxychloroquine?

None of this makes sense; we lack information. As I said before, we need data from peer-reviewed in vivo studies before any pronouncement can be made about the antimalarial medication as a therapy for COVID-19.

And we need to know more about Trump’s reasons for promoting this drug while ignoring the risks hydroxychloroquine poses.