Yesterday I noted an emerging debate within the critical care community of whether at least some critical COVID-19 cases are significantly different from standard Acute Respiratory Distress Syndrome (ARDS) and require a different treatment protocol. Since posting that piece I’ve found more evidence that this is a rapidly emerging discussion among critical care doctors and perhaps even some emerging consensus about how critical COVID-19 cases are different from ARDS.

First here’s an update from TPM Reader WC (not their actual initials), a critical care doctor on the West Coast who our team has been in touch with since early in the crisis …

Newly minted White House chief of staff Mark Meadows was behind the decision to replace the White House press secretary with one of President Trump’s most ardent defenders on his reelection campaign.

And he’s not stopping there.

We’ve now seen the common pattern. A certain region or jurisdiction reports X number of COVID-19 fatalities over a given period. But when the average number of deaths for all causes is compared to these COVID-19 death tolls they are still dramatically higher than the COVID-19 numbers alone can account for. So we see a large number of unexplained deaths that are almost certainly due to the COVID-19 crisis, whether that is people dying of COVID-19 or dying from other causes at higher rates because of the social and medical care disruptions brought in its wake.

This morning TPM Reader SH sent me this article (in English) from the Spanish daily El Pais which shows another example from the Madrid region of Spain. (An earlier example came from the autonomous community (something like a US state) of Castile and Leon.)

Here is a fascinating new bit of information. It’s not new per se. But either I hadn’t heard about it or perhaps it’s simply been overrun in the furious last month of news. As recently as the end of February, the US Commerce Department was encouraging US companies to take advantage of newly relaxed Chinese import regulations to export masks, ventilators and other COVID-relevant medical supplies to China.

This appears potentially quite important. Since it has to do with technical clinical details and treatment protocols I’ll try to be both as precise and general as possible. Yesterday I noticed this grainy youtube video posted on March 31st by a New York City emergency and critical care physician, Cameron Kyle-Sidell. Kyle-Sidell said that he thought the treatment protocol and basic understanding of acute COVID-19-induced respiratory distress were both wrong. He said that what he is seeing in his ICU does not look like pneumonia but rather oxygen deprivation (hypoxia). Thus the treatment shouldn’t be focused on high pressure for someone whose lungs aren’t able to function but rather more effective ways of delivering additional oxygen. Critically, he argued that the high pressure ventilation might be damaging the lungs. He also said his impressions were based both on his ICU work over the previous two weeks and conversations with other clinicians around the country.

In our on-going efforts to form a clearer picture of the true scale of mortality in the COVID-19 crisis yesterday I referenced a tweet by the New York City Council’s health committee which noted a 10 fold run up in the number of deaths that are being reported in homes across New York City. Here’s a great piece of reporting from WNYC/Gothamist filling out the details of what is happening.

I want to thank you and again encourage you to keep sending in the emails. They are providing a huge assist to our understanding of the crisis and thus what we are able to report to the larger TPM community. Some is showing up in reports you’ve already seen. More we’re still in the process of reporting out. For confidential tips about information you know, for guidance based on your general knowledge of key aspects of the story (epidemiological, clinical career, transport logistics, et al.) and just for links to new press reports. These are all hugely helpful. Keep them coming. We cannot always respond but all of these emails are being looked at closely.

My routine as a kid was pretty simple. I’d wake up, grab the Cleveland Plain Dealer (or The News-Herald, published in the neighboring county) sports section, read every single story and then try as best I could to memorize every box score, statistic and name for every sport. I loved (and love) sports. I also loved the Plain Dealer, but sadly the Plain Dealer is being murdered.

We are still in a space where we’re just getting hints and clues about just how this COVID-19 Crisis response is being handled, who’s doing what and just how much private companies are involved – and if so whether they are being allowed to extract windfall profits. Here’s a snippet from yesterday’s Morning Joe where The Washington Post’s Robert Costa reported that Jared Kushner’s role in the taskforce is largely to liaise with GOP donors and the White House’s corporate allies. I think that speaks for itself.

Robert Costa on Kushner's role in White House COVID response: "Jared Kushner is there and he's really being a liaison to different donors and corporate allies of this administration, which has created confusion about the chain of command." pic.twitter.com/S8avc0UPIM

— Josh Marshall (@joshtpm) April 7, 2020

White House press secretary Stephanie Grisham is returning to the first lady’s team as chief-of-staff, leaving behind a likely calculated legacy of not once holding a press briefing.