You may have heard talk of eventually redeploying the resources mobilized to fight the pandemic to tackle carbon emissions. It’s not a misplaced sentiment exactly, though I do think the parallels are generally inapt. But then TPM Reader FL wrote in a few days ago and framed it up in a way that felt more on point than other discussions I’ve seen. I yield the floor:
As you know, we’ve been focusing heavily on the ‘excess mortality’ question in the COVID19 pandemic across the world. Excess mortality is the number of deaths in a given region over a particular period of time which is in excess of the average number of deaths in previous years. We’ve looked closely at analyses from Italy and Spain which show dramatic discrepancies between the reported number of COVID19 fatalities and actual amount of excess mortality during the periods in question. In many cases, when this full excess mortality is calculated the number is two, three or even four times higher than the official COVID19 death toll.
What remains unknown in these other cases is how many of these additional deaths were ‘hidden’ COVID19 fatalities versus people who died as a result of the overall crisis but not the disease itself. This can range from an overwhelmed hospital system which creates a degraded level of care, to stress imposed by the totality of the crisis to people who do not seek medical attention for health crises they could have survived.
Sometimes we adopt a metaphor for a big societal question that, even though we know it’s a metaphor, still significantly distorts our thinking about what we’re talking about. I’m thinking here of when we “reopen the economy”. At least in its more antic forms, President Trump himself seems to be the big driver of this catchphrase. So that may explain the confusion behind it. The economy isn’t closed and we’re not going to reopen it. Not any time soon.
A small but notable collection of data was published yesterday in The New Journal of Medicine. One major New York City hospital evaluated and tested every expectant mother who was admitted to the hospital for childbirth. Almost 14% were COVID positive and almost all of lacked any symptoms. This is an early and still very small window into the kind of universal and/or random sample testing that will be necessary to get an accurate understanding of the prevalence of COVID19 in the population at large.
His impeachment acquittal may have left him with the impression that he holds the keys to an unbound presidency. And he may be stoking secret pipe dreams that the pandemic will delay the presidential election. But President Trump is clearly getting increasingly fed up with the fact that he is leading a democratic nation and not something more totalitarian.
Wisconsin Republicans took the unconscionable step of forcing an in-person election during a deadly pandemic last week because they were sure a low turnout election would ensure victory for the conservative candidate in a state Supreme Court race. But in a stunning development, the conservative lost. Jill Karofsky, the liberal candidate in a technically non-partisan race, is the winner.
As Congress is consumed by how best to confront and combat the spread of the novel coronavirus, Senate Republicans have been forced to toss their efforts — to confirm a string of conservative judges while Republicans still hold the majority in the upper chamber — to the backseat.
I wanted to flag your attention to this oped in the Times, now a couple weeks old. It notes that other countries in Europe are not seeing the scale of job loss that we are in the US, even though they’re shutting down their economies just as much. It’s from March 30th. So it’s from eons ago in COVID terms. But it holds up pretty well. There are two points I want to focus on.
On Friday I noted news reports that claimed US military intelligence was warning as far back as late November of a possible new virus in China with a possible global impact. The problem is that these US intelligence reports would predate by weeks our earliest understanding of when the first cases emerged and well before the Chinese themselves knew they had a new disease on their hands. That chronology of the outbreak comes from news reports from major dailies in the United States and Hong Kong. But there’s another body of evidence which points to a similar and more definitive timeline. That’s hidden in the COVID-19 genome itself.
All month we’ve been talking about Project Air Bridge, the federal government organized airlift of medical supplies which are then handed over to private sector distributors to distribute around the country. A few media reports have suggested, often on the basis of unnamed sources, that there is a 50-50 deal. The distributors agree to route 50% of the supplies to hotspots as defined by FEMA while the other 50% they can sell on an ordinary commercial basis. But we don’t have to rely on these reports. An April 8th FEMA bulletin, flagged to me by TPM Reader GG, lays it all out pretty clearly. There’s even a handy graphic.
To quote the April 8th bulletin: “Per agreements with distributors, 50 percent of supplies on each plane are for customers within the hotspot areas with most critical needs. The remaining 50 percent is fed into distributors’ normal supply chain to their customers in other areas nationwide. HHS and FEMA determine hotspot areas based on CDC data.”
The Washington Post has a new story out about the chaotic and overlapping efforts to acquire and distribute medical supplies across the country. We get yet more evidence that FEMA is routinely jumping into private transactions, either at the front end of overruling a purchase or seizing it when it’s being transported to whatever hospital or state purchased it. As my hospital system board member source told me a couple days ago this isn’t just happening it’s pervasive.
Here is a true sign of the times story. In late March the Service Employees International Union-United Healthcare Workers West (part of SEIU) announced that they’d discovered a stockpile of 39 million n95 masks. They proceeded to arrange for different hospitals in the region to purchase allotments from the cache. There were viral pressure campaigns launched against hospitals who didn’t rush forward to purchase. There were even bogus claims that the union had been caught ‘hoarding’ the masks.
What did happen is that the news got FEMA interested in seeing if they could seize the mask motherlode for the federal government – yet another part of the still murky confiscated supplies story. But this time things turned out differently. The US Attorney for the Western District of Pennsylvania, Scott Brady, got involved because the broker who had located the masks for the union was based in Pittsburgh. But while Brady’s office and FBI agents were seeing whether they could seize the masks they discovered that the whole thing was a scam.
You likely saw this ABCNews report from Wednesday evening that US military intelligence was sending out alerts as far back as November about a novel disease in Wuhan that could produce “cataclysmic” results for US military troops in Asia and countries around the world. The intelligence report was reportedly from National Center for Medical Intelligence (NCMI), an arm of US defense intelligence. After ABC published its report the Director of the NCMI released a statement in which he said reports of a “product/assessment in November 2019 is not correct. No such NCMI product exists.”
But there is something wrong with this ABC story. The timeline does not make sense. Either that or our understanding of the chronology of the origins of this disease is very flawed.
It would be imprecise to say COVID-19 hit NYC overnight. It was a slowly building menace, spreading though the community. But as these new numbers from FDNY show, the gathering threat hit the fire department like a tsunami at the beginning of the fourth week of March. The fire department was suddenly flooded with cases involving deaths at home or on the streets. Take a look.
In the last couple days the President has started itching again open up the economy again in the near future. So there’s more chatter about setting a date. We’ve also seen continuing bottlenecks and debates about the quality and availability of testing. But both of these discussions miss the reality of the situation we’re in and what we need to focus on right now. So I want to return to some points I made at dinner time last night on Twitter. Put simply, we won’t be able to get back to even a semi-normal social and economic life until we have a system in place that will prevent us from rapidly falling right back into a cycle of more outbreaks, lockdowns, deaths in the tens of thousands and economic shocks.
A robust system of testing is the critical necessary condition for that. But in itself it’s not at all sufficient. We will need a system of mass surveillance testing to give us real time visibility into the current prevalence of the disease and keep numbers low enough to make contact tracing at a vast scale possible. Without this kind of data and early warning system our society will be like a plane flying in a cloud bank with all the instruments on the blink.
With that happy image let’s define a few terms and concepts.
Some of President Trump’s closes allies would like him to stop talking now.
And they’re saying it publicly.
This is very, very strange. As we’ve reported on the seemingly ubiquitous seizures and reroutings of purchases of medical supplies, FEMA has always appeared to be at the heart of it, even though the targeted buyers are seldom given much information about who took their supplies. But now FEMA is denying that it is requisitioning or confiscating supplies anywhere within the United States, except in cases where they suspect criminal activity.
Earlier today we put up a new page at TPM: our coronavirus community resource hub. It gathers together all of our latest coverage, along with some valuable resources that have informed our reporting.
Particularly interesting, for me, is a map showing various emails we’ve received from our readers — across America and around the world. These emails give first-hand accounts of what was happening on the ground as the coronavirus spread — first in China, then in Italy, then in Washington state, and now everywhere. Read More
One of the big questions hovering over this medical supply and PPE shortage story is how much of this is just chaos and mismanagement versus some sort of more organized bad acting. It’s simply not clear. This morning I heard from a board member of a regional private hospital system who said these seizures aren’t just happening. They’re commonplace. Seemingly bordering on routine. To paraphrase this person’s account it’s searching high and low everywhere to find supplies and on those rare occasions when you strike gold the feds are likely to jump in and grab your stuff anyway. Hearing this my sense – not the source’s words – is that it’s almost like FEMA and whatever other agencies are doing this are using these desperate buyers as their involuntary lead generators. Let them find the stuff and when you see a shipping order surface, grab it.
As we work to find out the scope and goals of the White House’s seizure of medical goods across the United States, a simpler pattern is coming into view: the White House seizes goods from public officials and hospitals across the country while doling them out as favors to political allies and favorites, often to great fanfare to boost the popularity of those allies. The Denver Post today editorialized about one of the most egregious examples. Last week, as we reported, a shipment of 500 ventilators to the state of Colorado was intercepted and rerouted by the federal government. Gov. Jared Polis (D) sent a letter pleading for the return of the equipment. Then yesterday President Trump went on Twitter to announce that he was awarding 100 ventilators to Colorado at the behest of Republican Senator Cory Gardner, one of the most endangered Republicans on the ballot this year. As the Post put it, “President Donald Trump is treating life-saving medical equipment as emoluments he can dole out as favors to loyalists. It’s the worst imaginable form of corruption — playing political games with lives.”
I’m very proud that our team has been early on the federal governments seizures of medical supply shipments around the country. We continue to work major leads on this front. If you didn’t read it yet be sure to read Josh Kovensky’s look at the range of powers the federal government can use to seize medical supplies during a public health national emergency. Tonight I wanted to flag your attention to this story published yesterday by The Los Angeles Times on this evolving story.
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.