Josh Marshall

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Possible Developments in the Treatment of Critical COVID-19 #2
Foto Claudio Furlan - LaPresse 03 Aprile 2020 Bergamo (Italia) NewsVideochiamate con i parenti per i pazienti Covid che non possono ricevere visite, in un reparto dell'ospedale Papa Giovanni XXIII di BergamoPhoto Claudio Furlan/Lapresse03 Aprile 2020 Bergamo (Italy)Video calls with relatives for Covid patients who cannot receive visits, in a ward of the Papa Giovanni XXIII hospital in Bergamo

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 …

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Notes on Excess Mortality #1: Spain
A general view a temporary field hospital set at Ifema convention and exhibition of in Madrid, Spain, Thursday, April 2, 2020. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/Manu Fernandez)

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.)

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Trump Admin Still Pushed Mask Exports to China in Late Feb

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.

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Possible Developments in the Treatment of Acute COVID-19

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.

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The True Scale of Excess Mortality in NYC

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.

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Keep Sending the Emails

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.

Hints and Clues

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.

Finally the Bigs Are Taking Notice

Been a long day. So I don’t have time for a full write up. But the airlift program and the shipment seizures are finally getting some big media org attention. The Times put out this article tonight. They were able to name the entity on the West Coast which I alluded to as having a shipment seized but wasn’t at liberty to name: Kaiser Permanente hospital system. They also add more detail on the airlift. The companies can sell half on the open market, half they have to allocate according to need as ascertained by FEMA. The details on seizures raise more questions than they answer. Give it a read. More tomorrow.

More Details on Airlifts and Supply Seizures

Here are a couple more details on shipment seizures and inter-state bidding we’ve been discussing here in recent days. Both are interviews on this evening’s Newshour, flagged to me by TPM Reader KM.

Gov. J.B. Pritzker (D-IL) appeared to confirm one point that remained ambiguous from the press conference last week in which Rear Admiral Polowczyk explained the ‘Airbridge’ flights from China. According to Pritzker, the US military planes airlift the PPE and other medical supplies to the US and then hand them over to the major medical supply distributors the White House taskforce is working with. That part was clear from the discussion April 2nd. What Pritzker confirmed is that the states then have to bid against each other to purchase the supplies from those distributors.

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Comparing Wuhan to Italy and New York
A portion of Park Avenue, between 28th Street and 34th Street closed to motorists to promote 'Social Distancing' amid Coronavirus(Covid-19) Pandemic on March 30, 2020.  (Photo by John Nacion/NurPhoto)

There’s some very tentative information today that New York may be nearing the peak of its outbreak. I want to emphasize very tentative. If we go by the progression in the hardest hit countries in Europe, even if this is at or near the peak we are likely to see more days where numbers spike again. And I will finally say that there has been evidence of some numbers slowing over weekends. With all that, the number of fatalities in New York was lower yesterday and today than it was on Saturday when it hit 630. The number of new hospitalizations has also slowed while discharges have risen. There’s also some evidence of decline in new cases. But, as we’ve discussed, this can simply be an echo of testing constraints. We can finally note that before its revisions yesterday, the IHME COVID-19 model had predicted that New York would hit its peak on April 6th.

If this does turn out to be the plateau of the epidemic in New York I want to share some information about dates and how they compare with the remarkably consistent pattern from China and Italy.

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