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  1. #3106

    Re: covid-19 Virus Updates and Discussion

    Trump administration recommends the National Guard as an option to help hospitals report coronavirus data
    Move eliminates the CDC as a data recipient, raising concerns among public health experts

    By
    Lena H. Sun and
    Amy Goldstein
    July 14, 2020 at 6:40 p.m. EDT

    The Trump administration is asking governors to consider sending the National Guard to hospitals to help improve data collection about novel coronavirus patients, supplies and capacity, according to a letter, internal emails and officials familiar with the plans.

    The move is part of a new data reporting protocol for hospitals that eliminates the Centers for Disease Control and Prevention as a recipient of that information — a decision that is sparking controversy about whether or not the data is reliable.

    In a letter to the nation’s governors that says the National Guard could help improve hospitals’ data flow, HHS Secretary Alex Azar and Deborah Birx, the White House’s Coronavirus Task Force response coordinator, say they ordered the changes because some hospitals have failed to report the information daily or completely. That portrayal, and the involvement of the National Guard, have infuriated hospital industry leaders, who say any data collection problems lie primarily with HHS and repeatedly shifting federal instructions.

    The new protocol, to begin Wednesday, leaves health-care institutions to report information daily about covid-19, the disease caused by the novel virus, to a federal contractor or to their state, which would coordinate the federal reporting.

    Public health experts say bypassing the CDC could harm the quality of data and the federal response to the coronavirus pandemic.

    Under the reporting system that is ending, about 3,000 hospitals — or the health systems that own them — send detailed information about covid-19 patients and other metrics to the CDC’s long-standing hospital network, the National Healthcare Safety Network, or NHSN. CDC staff analyze the data and provide tailored reports to every state twice a week and multiple federal agencies every day, according to a federal health official who spoke on the condition of anonymity to discuss policy deliberations. These data are used by local health officials and policymakers to identify coronavirus trends in hospitals in their communities, the official said.

    Some experts said the move could further marginalize the CDC, the government’s premier public health agency, at a time when the pandemic is worsening in most of the country, with records falling day by day of new infections.

    “I worry greatly about cutting CDC out of these reporting efforts,” said Jennifer Nuzzo, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security. “I see little benefit from separating reporting of hospitalizations from reporting of cases, which CDC currently coordinates.”

    The letter from Azar and Birx to the governors, which was sent out late Monday night or early Tuesday, backs away from earlier drafts that had as recently as late last week directed state leaders to deploy the National Guard to help hospitals with daily data submissions. It now includes the National Guard among states’ options for improving the data flow, according to copies of the letter obtained by The Washington Post from two individuals.

    The idea of bringing in the Guard was first broached at a late June meeting with hospital industry leaders by Birx, according to two industry officials who attended and spoke on the condition of anonymity to describe private discussions.


    “Given our track record of being cooperative to evolving data requests, it’s perplexing that the possibility of using the National Guard has been suggested,” said Rick Pollack, president of the American Hospital Association. “It makes no sense. Certainly the expertise of the National Guard can be used in a more productive way.”

    At meetings Monday and Tuesday between HHS officials and hospital representatives and state health officers to discuss the new protocol, posted as an FAQ on the department’s website, there was no mention of the National Guard, according to a senior hospital industry official and other individuals present.

    According to one senior administration official, speaking on the condition of anonymity about private conversations, the draft of the letter that had directed governors to deploy the National Guard was revised over the weekend.

    The final version tells governors that the data submitted by hospitals and health officials “is not always complete or timely enough to be effective … We ask that you demand this of all of your hospitals, especially those that have failed to report daily or complete. Please insist that every hospital leader assign this reporting responsibility as a mission-critical assignment. If need be, you could consider prioritizing National Guard duties, in coordination with state health officers and emergency managers, to serve reporting needs for hospitals in the red zones."

    The letter also says, “[I]t is critical that we receive complete, accurate, daily hospital-level date in order to ensure that critical items such as therapeutics, testing supplies, and PPE are distributed efficiently and effectively across the country.” It says that, starting later this week, the daily data will be used to guide the following week’s federal distribution of remdesivir, an antiviral medication that is the only approved treatment for covid-19 patients.

    The Washington Post also obtained two earlier drafts. One said the data being reported to federal health officials overseeing the response is “not always complete or timely, and we understand that staff are stretched and hospital systems are also stretched.” It was sent Sunday to dozens of federal health officials from a senior HHS official, Coast Guard Vice Adm. Daniel B. Abel, part of the HHS team overseeing the federal response to the pandemic, according to a federal health official who shared the document with The Post.

    The senior administration official said the letter “changed significantly,” so governors will now be given a choice of ways they can bolster hospitals’ data reporting if that is necessary.

    The earlier draft said: “We have been in dialogue with your health officials, hospital associations and hospitals over the past few months and working incrementally to improve the availability of key data but given the urgency in your state and hospitals, we are asking you to deploy the National Guard to these hospitals for these limited daily data collection.”

    In an email exchange last Wednesday between Abel and HHS general counsel Robert P. Charrow, Abel said about 3,000 hospitals “do not report sufficient data at the frequency required to work COVID preventative measures,” according to copies of the emails shared by the federal health official. “One idea being discussed is to employ National Guard troops to be stationed in the hospitals with laptops/ipads to gather this data,” Abel added.

    Charrow was asked whether this course of action was legally viable, and he replied that the Cares Act, a coronavirus relief package adopted by Congress early in the spring, may be “broad enough to permit us to request this information from each hospital on a daily basis,” he wrote. But he questioned whether this was a good idea.

    “As a practical matter, I cannot imagine how the National Guard would be able to collect data at the hospital itself nor the number of Guards who would be exposed to COVID-19 in the process,” he wrote in one email. In another email earlier that day, he said, “I believe that using National Guard troops to gather these data would be counter-productive.”

    According to one of the senior hospital industry officials, the possibility of bringing in the National Guard was broached at meetings June 26 and July 8 between Trump administration officials and hospital industry leaders — initially by Birx. “We just ignored it and said it’s silly,” said the hospital industry official, who spoke on the condition of anonymity to describe private conversations.

    “It was an offhand threat,” the industry official said. The official said Birx and representatives of HHS were expressing “undue frustration” at hospitals, mistakenly asserting that hospitals were not properly reporting data when, in reality, all but a few hospitals have been doing so. It was the HHS system on the receiving end that was flawed, the industry official said.


    A coalition of hospital groups protested in a letter to Birx, saying that the industry has been complying with the data requests and that almost all hospitals have been submitting the required information.

    Four previous CDC directors, who have worked in both Republican and Democratic administrations, said in an op-ed in Tuesday’s Post that the White House’s efforts to countermand the agency’s school-opening guidelines are an example of the administration’s disregard of scientific expertise.

    Josh Dawsey and Ovetta Wiggins contributed to this report.


    https://www.washingtonpost.com/healt...ge%2Fstory-ans
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.




  2. #3107

    Re: covid-19 Virus Updates and Discussion

    Seth Abramson
    @SethAbramson
    Remember, this is the guy who in mid-March bragged about taking his family out to a "packed" restaurant and through his communications staff proudly told the media and all Oklahomans that he would continue to do so
    https://apnews.com/b7f0791859d371ed8e8bb6bbe2173d87

    Oklahoma’s governor says he has tested positive for COVID-19
    By SEAN MURPHY

    OKLAHOMA CITY (AP) — Oklahoma Gov. Kevin Stitt announced Wednesday that he’s the first governor in the United States to test positive for the coronavirus and that he is isolating at home.

    Stitt, 48, said he mostly feels fine, although he started feeling “a little achy” on Tuesday and sought a test. He said his wife and children were also tested Tuesday and that none of them have tested positive.

    Stitt has backed one of the country’s most aggressive reopening plans, resisted any statewide mandate on masks and rarely wears one himself.

    “We respect people’s rights ... to not wear a mask,” Stitt said during Wednesday’s news conference, which was held virtually. “You just open up a big can of worms.

    “A lot of businesses are requiring it, and that’s fine. I’m just hesitant to mandate something that I think is problematic to enforce,” he said.

    Stitt attended President Donald Trump’s rally in Tulsa last month, which health experts have said likely contributed to a surge in coronavirus cases there.

    Stitt said he’s confident he didn’t contract the virus at the rally.

    “As far as where he became infected, it’s really unknown,” Oklahoma Health Commissioner Lance Frye said. “It wasn’t so far back as the rally,” which took place nearly a month ago.

    Stitt’s announcement came as Oklahoma reported a second consecutive day of record-high numbers of confirmed virus cases, with 1,075 new cases, bringing the statewide total to more than 22,000. The previous daily high was 993 confirmed cases on Tuesday. Health officials also confirmed four additional COVID-19 deaths on Wednesday, bringing the statewide death toll to 432.

    Coronavirus-related hospitalizations also are surging in Oklahoma, increasing from 458 last week to 561 on Wednesday, although Frye said there is still plenty of hospital capacity.

    Stitt came under fire early in the pandemic after he tweeted a photo of himself and his children eating at a crowded restaurant.

    One of Stitt’s cabinet members, David Ostrowe, tested positive for the coronavirus in March.
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.




  3. #3108

    Re: covid-19 Virus Updates and Discussion

    I guess he didn't see the bus coming either.


    White House distances itself from extraordinary Navarro op-ed criticizing Fauci

    By
    John Wagner and
    Meryl Kornfield
    July 15, 2020 at 12:00 p.m. EDT

    The White House on Wednesday moved to distance itself from an extraordinary op-ed in USA Today in which Peter Navarro, President Trump’s trade adviser, heavily criticized Anthony S. Fauci, the nation’s top infectious-disease official, over his handling of the coronavirus crisis.

    “The Peter Navarro op-ed didn’t go through normal White House clearance processes and is the opinion of Peter alone,” White House spokeswoman Alyssa Farah said in a tweet, adding: “@realDonaldTrump values the expertise of the medical professionals advising his Administration.”

    In the USA Today piece — with the headline “Anthony Fauci has been wrong about everything I have interacted with him on” — Navarro cited several instances when he had disagreed with the director of the National Institute of Allergy and Infectious Diseases, who has been a key player in the administration’s response to the pandemic.


    “So when you ask me whether I listen to Dr. Fauci’s advice, my answer is: only with skepticism and caution,” Navarro wrote.

    Asked Wednesday about the op-ed, Trump told reporters at a White House event, “I get along very well with Dr. Fauci.”

    “That’s Peter Navarro, but I have a very good relationship with Dr. Fauci,” Trump said when pressed again on his thoughts about the piece.

    Despite the White House’s posture on Wednesday, Navarro’s op-ed in some way echoed Trump’s comments during a Fox News interview Thursday with Sean Hannity, when he said Fauci “is a nice man, but he’s made a lot of mistakes.”

    Fauci hasn’t spoken with Trump since June, The Washington Post has reported.

    While White House officials have undermined Fauci before, the article by Navarro marks one of the most public attacks by a high-ranking official. Navarro has also worked on the administration’s response to the pandemic, particularly on supply chain issues.

    White House aides previously circulated talking points questioning statements Fauci has made about the novel coronavirus, which Navarro repeated in the article.

    Among the criticisms listed by the White House officials and Navarro is that Fauci didn’t urge caution when the cases were first reported in China in January, that he gave varied advice on face masks and that he has said that he didn’t believe there was concrete scientific evidence to support that hydroxychloroquine is an effective treatment against the coronavirus.

    Dan Scavino, the White House social media director and deputy chief of staff for communications, late Sunday shared a cartoon on his Facebook page mocking Fauci. It depicted Fauci as a faucet spewing cold water on the economy, with phrases written alongside, including “schools stay closed this fall,” “indefinite lockdown” and “no NFL season.”


    A White House official said Wednesday that Navarro “went rogue” by writing the op-ed.

    “The White House does not stand by these unauthorized opinions,” said the official, who spoke on the condition of anonymity to discuss internal White House dynamics.

    https://www.washingtonpost.com/polit...ge%2Fstory-ans
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.




  4. #3109

    Re: covid-19 Virus Updates and Discussion

    More on Navarro:

    And Novarro.... yea, sterling character. From Wikipedia:

    In six of his books about China, Navarro quotes a "Ron Vara", whom he describes as a China hawk and former Harvard PhD doctoral student in economics, and who says Sinophobic things about China and the Chinese. An investigation by the Chronicle of Higher Education found that no such person existed, and that Ron Vara (an anagram of Navarro) appeared to represent views that Navarro himself held.[106][107] Navarro has admitted to making up the character, an author surrogate, and quoting him in his books. Economist Glenn Hubbard, who co-authored Seeds of Destruction with Navarro,[108] has said he was not aware that Vara was fictional, and that he did not approve of Navarro attributing information to a fictional source.[109] In December 2019, a memo apparently authored by Ron Vara began circulating in Washington DC. The memo highlighted the "Keep Tariff Argument" and the use of tariffs against China a few days before an additional 15% tariff on $160 billion of Chinese made goods was set to be implemented. Navarro later confirmed that he had written the memo.
    https://en.wikipedia.org/wiki/Peter_Navarro
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.




  5. #3110
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    Re: covid-19 Virus Updates and Discussion

    I didn't know he co-authored a book with Glenn Hubbard (looks like published in 2010). Hubbard is a very respected economist who served under both Bushes, was a long-time Dean of Columbia Business School and authored a number of leading economics college textbooks. He has some really bad policy ideas, but, I mean, how can you look at Navarro or hear him speak, and think, "Yeah, I want to put my very respected career on the line to work with this guy!"


    Also, WTH kinda editor doesn't factcheck a "China expert" with an obviously fake name. The book was published by the Financial Times Press


  6. #3111

    Re: covid-19 Virus Updates and Discussion

    The ten worst and the ten least affected US States at the moment. Daily new cases per 100k inhabitants (moving 7 day average). Data Source: Harvard Global Health Institute

    Florida 50.5
    Arizona 43.9
    Louisiana 41.5
    South Carolina 32.6
    Texas 31.4
    Alabama 31.1
    Georgia 28.2
    Tennessee 26.5
    Mississippi 26.0
    Nevada 26.0
    -----
    Michigan 5.6
    Wyoming 5.6
    Massachusetts 3.5
    New York 3.4
    New Jersey 3.1
    Hawaii 2.1
    Connecticut 2.1
    New Hampshire 1.6
    Maine 1.3
    Vermont 1.1


    In comparison: Switzerland 1.1, Italy 0.32, Latvia 0.40
    Roger forever

  7. #3112

    Re: covid-19 Virus Updates and Discussion

    You really have to rake your brain to wonder what do the top ten have in common, don't you?
    And, you take out Nevada and Arizona, and they are all contiguous. Arizona and Nevada share a border.
    Last edited by ponchi101; Today at 02:33 PM.
    Face it. It's the apocalypse.

  8. #3113

    Re: covid-19 Virus Updates and Discussion

    Despite the obvious reasons why this has occurred, it is a bit amazing that ALL 10 of the worst 10 have Republican governors.
    Wow!! GH

  9. #3114
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    Re: covid-19 Virus Updates and Discussion

    Quote Originally Posted by ponchi101 View Post
    You really have to rake your brain to wonder what do the top ten have in common, don't you?
    And, you take out Nevada and Arizona, and they are all contiguous. Arizona and Nevada share a border.
    Quote Originally Posted by GlennHarman View Post
    Despite the obvious reasons why this has occurred, it is a bit amazing that ALL 10 of the worst 10 have Republican governors.
    Wow!! GH
    And guess what party the governor of the state in between, New Mexico, belongs to?


  10. #3115
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    Re: covid-19 Virus Updates and Discussion

    WHO's Situation Report for July 14, 2020. Here's the e-newsletter text in the email.

    ::

    EPI UPDATE The WHO COVID-19 Situation Report for July 14 reports 12.96 million cases (196,775 new) and 570,288 deaths (3,624 new). The Americas region continues to lead in new cases, accounting for 110,549 (56.2%) of new cases and 1,853 (51.1%) of new deaths.

    India continues its trend of increased daily COVID-19 incidence, posting its highest daily total to date with 29,429 new COVID-19 cases. India has seen a continued rise in cases and remains #3 globally in terms of daily incidence behind the United States and Brazil. Pakistan continues to report decreasing incidence since its peak in mid-June, reporting only 2,165 new cases on July 14. The country has lowered its total number of active cases to under 80,000, half of which are within the Sindh Province. Bangladesh has had a recent uptick in daily incidence, reporting over 3,500 new cases for the first time since July 1. As of July 14, Bangladesh’s test positivity rate was at 25%.

    Brazil reported 41,875 new cases, continuing a recent trend of highly variable daily incidence. The past two weeks saw a flattening of newly reported COVID-19 cases in Brazil, each ending with around 260,000. Brazil remains #2 globally in terms of daily incidence, however the most recent data suggests that Brazil and India may be nearing similar daily incidence rates. Mexico reported 7,051 new cases, after 2 days of reporting daily incidence less than 5,000. Similarly to Brazil, Mexico has reported fluctuating daily incidence rates likely due to the county’s reporting and surveillance systems.

    Israel reported 1,728 new COVID-19 cases. Since the beginning of the month, Israel has had a daily incidence of over 1,000 on all but one day, and in total, has continued to see an upward trend. It has been noted in past update letters that the Eastern Mediterranean Region remains a global hotspot in terms of per capita incidence, including 5 of the top 10 countries (Oman, Bahrain, Israel, Qatar, and Kuwait).

    South Africa remains among the top countries globally in terms of both per capita (currently #4) and total daily incidence (currently #4). South Africa reported 11,369 new cases on July 15, joining the US, India and Brazil as the only countries reporting over 10,000 new cases.

    The US CDC reported 3.35 million total cases (58,858 new) and 135,235 deaths (351 new). The 7-day average for daily incidence has risen steadily since it’s plateau in early June, and now sits at 58,619, its highest total since the pandemic began. In total, 24 states (increase of 2) and New York City have reported more than 40,000 total cases, including California with almost 330,000 cases; Florida and Texas with more than 250,000 cases; and 6 additional states and New York City with more than 100,000. The Johns Hopkins CSSE dashboard reported 3.45 million US cases and 136,807 deaths as of 1:00pm on July 15.

    MEDICAL COUNTERMEASURES ADVANCEMENTS A new paper published in the New England Journal of Medicine outlines new results of Moderna’s phase 1 trials for its mRNA SARS-CoV-2 vaccine candidate. The trial enrolled 45 healthy adults ages 18-55 to partake in a dose escalation experiment. Participants were broken into 3 groups, each receiving a different dosage of the vaccine candidate. Participants received 2 doses of the vaccine candidate 28 days apart, and were tested for resulting antibody response throughout the study period. The results showed a promising level of immune response after the second vaccine in each dosage group. The study noted several adverse outcomes amongst participants, but none of serious safety concern. There is no expert consensus on this study’s results, but many acknowledge that it is a positive step toward vaccine development. According to a post on clinicaltrials.gov, Moderna has plans to start a 30,000 person phase 3 trial later this month.

    Two new papers published earlier this week outlined the potential use of tocilizumab, a drug typically used forrheumatoid arthritis, to treat severe COVID-19 patients. The first paper, published in the Journal of Infection, examined the safety and efficacy of tocilizumab in severe and critical COVID-19 patients. The paper provided a retrospective analysis of patients from a singular hospital who were given tocilizumab treatment when diagnosed with severe COVID-19 disease. In total, 74 patients were given such treatment and subsequently compared to 148 matched controls. The paper found that these patients were more likely to survive their illness than matched controls, but that adverse events resulted in longer hospitalization time. The second paper, published in Clinical Infectious Diseases, looked at the effectiveness of tocilizumab treatment in patients suffering from COVID-19 that required mechanical ventilation. The paper compared 78 patients who received tocilizumab and 76 that did not, and found that the treatment was associated with a 45% decrease in patient mortality. While these papers present only initial findings, it opens the door for future research in this area.

    A systematic review of the current landscape of clinical trials for COVID-19 therapeutics in the United States was published in JAMA Network Open on Monday - “Characteristics of the Multiplicity of Randomized Clinical Trials for Coronavirus Disease 2019 Launched During the Pandemic.” Of the 674 trials yielded from the search, 83.4% were randomized multigroup studies and only 71.1% of studies included a validated control group such as standard of care or a placebo group. The most commonly tested interventions involved chloroquines (143 trials). The research letter findings also discusses issues regarding multiplicity where many clinical trials are being conducted to test the same therapeutic. Authors note that practice could increase the likelihood of finding a positive result based on chance and lead to complications in trial management, including competition for recruitment, that could lower statistical relevance.

    HIGHLIGHTS FROM THE WHO DIRECTOR-GENERAL BRIEFING On Monday, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus gave his opening remarks during a media briefing regarding the ongoing COVID-19 pandemic. The Director-General noted that countries fall into four categories: those that quelled their COVID-19 outbreak within the first few cases being reported, those that experienced a major outbreak that was brought under control through strong leadership and public health measures, those that overcame their initial peak but are struggling after lessening restrictions and those that are undergoing intense transmission. He noted three steps for future outbreak control: “(1) A focus on reducing mortality and reducing transmission, (2) an empowered, engaged community that takes individual behavior measures in the interest of each other, and (3) strong government leadership and with coordination of comprehensive strategies that are communicated clearly and consistently”.

    US RESPONSE The US continues to see increased COVID-19 activity across the country. States that have seen spikes in cases are now faced with the decision of whether to revert back to more stringent community mitigation measures in an attempt to reduce the spread of the virus. Yesterday, California Governor outlined that California will be asking businesses to alter their operations once again and announced that both Los Angeles and San Diego school districts will start this fall online. Many US businesses and economists have expressed concerns that the resurgence of COVID-19, and the corresponding transition to restricted business activity, will threaten the country’s economic recovery. This comes amidst news that some of the US’ economic buffering plans, including certain unemployment benefits, are lapsing, leaving many unemployed in an economically vulnerable position.

    News broke yesterday that the current Presidential Administration has ordered hospitals to bypass the CDC when sharing COVID-19 data with the US government. The new process would have data sent to a central database within HHS. Officials from the president’s administration have suggested that this move was used to improve information access for the White House coronavirus task force, allowing the group to make decisions around the allocation of supplies including PPE and medical countermeasures. Many experts worry that this transition may limit data access and harm public transparency. The Presidential Administration has also asked governors to consider sending the National Guard to assist in hospital data collection efforts.

    US MASK USAGE CDC leadership, including Dr. Robert Redfield, Dr. Jay Butler and Dr. John Brooks, published a commentary in JAMA on Tuesday to promote the universal use of masks for healthcare workers, patients and in the community. The commentary referenced multiple academic papers that support mask usage to prevent the spread of SARS-CoV-2. Two new articles were also published by CDC’s Morbidity and Mortality Weekly Report yesterday: “Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020” and “Absence of Apparent Transmission of SARS-CoV-2 form Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy - Springfield Missouri, May 2020”. The first article described online surveys conducted in April and May regarding attitudes and behavior regarding mask usage, recent time spent outside the home and demographic characteristics. Findings indicate that rates of face covering usage increased after the White House Coronavirus Task Force and CDC recommended use of a cloth face covering when outside the home. These conclusions support consistent public health messaging promoting the use of face masks. The second article described a case study wherein two hair stylists were found to be SARS-CoV-2 positive but did not transmit to any of their 139 clients. Both the stylists and clients wore face masks due to city ordinance and company policy, which may have protected against onward transmission.

    WHO VACCINE LANDSCAPE Earlier today, the WHO published a draft of landscape documents tracking the current COVID-19 vaccines under development. The document reports the platform basis, type, developer, viruses targeted, and status of clinical and regulatory evaluation for 23 candidates in clinical evaluation and 140 candidates in preclinical evaluation. Of the candidates undergoing clinical trials, there are 10 candidates undergoing only Phase 1 trials and 8 candidates undergoing combined Phase 1/2 trials. Two candidates are in Phase 1 trials and Phase 2 trials separately. Three candidates are undergoing Phase 3 trials: an inactivated candidate by Sinovac, a non-replicating viral vector candidate by University of Oxford and AstraZeneca, and an RNA candidate by Moderna and the National Institute of Allergy and Infectious Diseases.

    https://www.who.int/docs/default-sou...rsn=d01ce263_2
    Winston, a.k.a. Alvena Rae Risley Hiatt (1944-2019), RIP

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