{"id":8405,"date":"2020-04-06T21:24:14","date_gmt":"2020-04-06T21:24:14","guid":{"rendered":"https:\/\/adhc.lib.ua.edu\/pandemicbook\/?page_id=8405"},"modified":"2022-02-23T20:32:00","modified_gmt":"2022-02-23T20:32:00","slug":"02-27-2","status":"publish","type":"page","link":"https:\/\/adhc.lib.ua.edu\/pandemicbook\/02-27-2\/","title":{"rendered":"04-06"},"content":{"rendered":"\t\t
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Monday, April 6<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tUS Cases 382,787
US Deaths 14,553<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Apr 6: The acting secretary of the Navy, Thomas Modly, tells sailors that Capt. Brett Crozier, the former commander of the aircraft carrier USS Theodore Roosevelt who was ousted for criticizing his superiors for not reacting adequately to curb a coronavirus outbreak on board, was either “too naive or too stupid to command a ship<\/a><\/span>.” He later apologizes. Domestic abuse hotlines<\/a><\/span> around the world receive a surge in calls since stay-at-home orders have been imposed. *<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\tFrom the Cutting Room Floor...\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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HHS conducted phone surveys of 323 hospitals across 46 states plus Puerto Rico last week to determine how things were working so far in this outbreak, how that HHS money is being spent.[1]<\/a><\/span><\/p>\n

The hospitals\u2019 responses are shocking. And while they do not include statistical measures, the anecdotes included in the report make it sound like we are talking about not the touted American healthcare system, but local clinics in some impoverished nation run by grifters.<\/span><\/p>\n\n\n\n
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\u201cSome hospitals noted that at the time of our interview they had not received supplies <\/span>from the Strategic National Stockpile, or that the supplies that they had received were not sufficient in quantity or quality. One administrator stated that getting supplies from the stockpile was a major challenge, saying that the supplies the hospital received \u201cwon’t even last a day. We need gloves, we need masks with fluid shields on\u2014N95 masks\u2014and we need gowns. It\u2019s the number one challenge all across the system.\u201d One health system reported that it received 1,000 masks from the Federal and State governments, but it had been expecting a larger resupply. Further, 500 of the masks were for children and therefore unusable for the health system\u2019s adult staff. One hospital reported receiving a shipment of 2,300 N95 masks from a State strategic reserve, but the masks were not useable because the elastic bands had dry-rotted. Another hospital reported that the last two shipments it had received from a Federal agency contained PPE that expired in 2010. The shipment contained construction masks that looked different than traditional masks and did not contain a true N95 seal.\u201d<\/span>[2]<\/a><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Even when the hospitals go on the market to make up for the lack of supplies they\u2019re receiving from government, they find themselves priced out.<\/span><\/p>\n

[read_more id=”1″ more=”Read more” less=”Read less”]<\/p>\n\n\n\n
\u201cOne administrator noted that masks that originally cost 50 cents now cost $6 apiece. Other hospitals reported concerns about vendors buying up supplies and selling them to the hospital at a higher cost. As one hospital administrator noted, \u2018We are all competing for the same items and there are only so many people on the other end of the supply chain.\u2019 Another administrator reported being concerned about poor quality products despite high-prices and \u2018…wonder[ing] if you get what you paid for.\u2019\u201d[3]<\/a><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Around 100 of the 323 hospitals surveyed are located in rural areas or small towns. In that context, it makes more sense that supplies in a pandemic might not be readily at hand. However, 34 were either major teaching hospitals associated with the nation\u2019s top universities or special pathogen centers specialized in treating infectious disease. The report suggests that even these hospitals are understaffed, under-resourced, and generally not at the level they should be to face a pandemic. Hospitals complain the wait to receive a definitive answer on a test is a week or more. Patients either occupy hospital beds, waiting, or are sent home, potentially spreading the virus more.<\/span><\/p>\n

New York Governor Cuomo put it succinctly. He wrote in a tweet, “Our single greatest challenge is ventilators. We need 30,000 ventilators. We have 11,000.”<\/span><\/p>\n

Strangely, Cuomo\u2019s pleas triggered the president to lash out at Cuomo\u2019s cited shortage. His deal with GM to produce ventilators has fallen through and he is refusing to enforce the Defense Production Act in order to strong-arm manufacturers into producing the needed supplies.[4]<\/a><\/span><\/p>\n

Having failed to secure more ventilators, he then attacked the whole notion of New York needing ventilators.[5]<\/a> In one of his nightly task force briefings, and again on Sean Hannity\u2019s show, the president said he didn\u2019t believe there needed to be so many ventilators.[6]<\/a> He says that thousands of ventilators have been delivered and are sitting in a warehouse in Edison, New Jersey.\u201d[7]<\/a> He doesn\u2019t understand that Cuomo is saying they are going to need 33,000 ventilators in the future. Right now, they have 11,000, which is not enough to manage the expected number of cases in the next two weeks.[8]<\/a><\/span><\/p>\n

This ventilator wrangling and the tantalizing dust-up between the president and the press only serves to distract from two deeper issues. First, the ventilators used to be there, stockpiled, gathering dust. Eventually the cost of retaining ventilators for a future pandemic became too much of a drain. Economic shortfalls, some of which were caused by the lack of federal preparedness funds, led to New York selling the emergency ventilators it did have in storage.[9]<\/a><\/span><\/p>\n

The second issue is even more telling. In 2018, in remembrance of the 100th<\/sup> anniversary of the 1918 H1N1 influenza pandemic, NYC Health + Hospitals ran an executive-level pandemic response workshop. The workshop thrust administrators and healthcare providers into a modernized pandemic influenza scenario and asked them to make strategic decisions. The workshop found some holes in response, which resulted in four main recommendations. First, inefficiencies appeared in the way groups shared data, so a flexible, easy to access record keeping system shared broadly needed to be implemented. Second, decision makers often had narrow training and experience that would benefit from a broader, interdisciplinary \u201cbrain bank.\u201d Third, local preparedness leaned heavily on messages coming out of groups from the WHO, the CDC, FEMA, and state health departments, so the communication there needed to be as clear and targeted as possible. Fourth, and, perhaps most surprising, pandemics in the modern era disrupt the hospital as a commercial venture. Without big-money bailouts, cancelations of elective surgeries would sink even a robust hospital system like New York City\u2019s.<\/span><\/p>\n

They published some recommendations just a few weeks ago, in Disaster Medicine and Public Health Preparedness<\/em>.[10]<\/a> But no one has implemented these recommendations, even in New York.[11]<\/a><\/span><\/p>


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Notes<\/p>\n

[1]<\/a> HHS Office of Inspector General, \u201cHospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020. OEI-06-20-00300\u201d (Washington, DC: Department of Health and Human Services, April 3, 2020), https:\/\/oig.hhs.gov\/oei\/reports\/oei-06-20-00300.asp.<\/span><\/p>\n

[2]<\/a> HSS OIG, \u201cHospital Experiences.\u201d<\/span><\/p>\n

[3]<\/a> HSS OIG, \u201cHospital Experiences.\u201d<\/span><\/p>\n

[4]<\/a> Yasmeen Abutaleb et al., \u201cThe U.S. Was Beset by Denial and Dysfunction as the Coronavirus Raged,\u201d The<\/em> Washington Post<\/em>, April 4, 2020, https:\/\/www.washingtonpost.com\/national-security\/2020\/04\/04\/coronavirus-government-dysfunction\/<\/a>.<\/span><\/p>\n

[5]<\/a> Geoff Baker, \u201cTrump Administration Backs off a Deal for Bothell\u2019s Ventec and GM to Produce \u2018up to 20,000\u2019 Ventilators a Month amid Coronavirus Crisis,\u201d The Seattle Times, March 26, 2020, https:\/\/www.seattletimes.com\/business\/local-business\/ventec-and-gm-hoping-to-produce-up-to-20000-ventilators-a-month-amid-coronavirus-crisis\/<\/a>.<\/span><\/p>\n

[6]<\/a> Quint Forgey and Matthew Choi, \u201cTrump Downplays Need for Ventilators as New York Begs to Differ,\u201d POLITICO, March 26, 2020, https:\/\/www.politico.com\/news\/2020\/03\/26\/trump-ventilators-coronavirus-151311<\/a>.<\/span><\/p>\n

[7]<\/a> Trump Berates Reporter for \u201cthreatening\u201d Question during Briefing<\/em> (CNN, 2020), https:\/\/www.youtube.com\/watch?v=1uWT_L58MGc<\/a>.<\/span><\/p>\n

[8]<\/a> \u201cAmid Ongoing COVID-19 Pandemic, Governor Cuomo Announces NYS on Pause Functions Extended for Additional Two Weeks,\u201d Governor Andrew M. Cuomo, April 6, 2020, https:\/\/www.governor.ny.gov\/news\/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-nys-pause-functions-extended-additional<\/a>.<\/span><\/p>\n

[9]<\/a> Justin Elliott, Annie Waldman, and Joshua Kaplan, \u201cHow New York City\u2019s Emergency Ventilator Stockpile Ended Up on the Auction Block,\u201d ProPublica, April 6, 2020, https:\/\/www.propublica.org\/article\/how-new-york-city-emergency-ventilator-stockpile-ended-up-on-the-auction-block?token=sYBNO6t1202JOb6ILFkA_eTWzPmpol3N<\/a>.<\/span><\/p>\n

[10]<\/a> Syra Madad et al., \u201cReady or Not, Patients Will Present: Improving Urban Pandemic Preparedness,\u201d Disaster Medicine and Public Health Preparedness<\/em>, March 16, 2020, 1\u20134, https:\/\/doi.org\/10.1017\/dmp.2020.7<\/a>.<\/span><\/p>\n

[11]<\/a> Brian M. Rosenthal, Jennifer Pinkowski, and Joseph Goldstein, \u201c\u2018The Other Option Is Death\u2019: New York Starts Sharing of Ventilators,\u201d The New York Times<\/em>, March 26, 2020, https:\/\/www.nytimes.com\/2020\/03\/26\/health\/coronavirus-ventilator-sharing.html<\/a>.<\/span><\/p>\n

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tAnthony S. Fauci, left, director of the National Institute for Allergy and Infectious Diseases, attends a White House briefing with Trump on April 1. He is one of the core members of the administration\u2019s coronavirus task force. (Jabin Botsford\/The Washington Post)\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tAt White House Q&A, POTUS cuts off Alcindor's question and calls it 'threatening.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tCuomo Tweet\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tApril 6, 2020\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tWaterson, Jim, and Alex Hern. \u201cAt Least 20 UK Phone Masts Vandalised over False 5G Coronavirus Claims.\u201d The Guardian, April 6, 2020, sec. Technology. \n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\thttps:\/\/www.theguardian.com\/technology\/2020\/apr\/06\/at-least-20-uk-phone-masts-vandalised-over-false-5g-coronavirus-claims.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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