Failing Grades for US Response in COVID19 Crisis: D-

On March 3, 2020, 500+ medical and legal experts in public health, law and human rights, with experience in previous pandemic responses wrote a letter to Vice President Pence, the newly designated Trump Administration Czar of the White House Coronavirus Task Force (Task Force). 

The White House Task Force “coordinates and oversees the Administration’s efforts to monitor, prevent, contain, and mitigate the spread” of the coronavirus disease (COVID-19). The Task Force was established on January 29, 2020 but people were not appointed until February 26th. The Task Force is chaired by Vice President Mike Pence and Dr. Deborah Birx is the response coordinator.

As of 3/29/2020, we have 139,745 Cases, 4,435 people have recovered and 2,448 People have died.

The US has surpassed China, and is now #1 in the number of confirmed cases. As of March 29th, the US is #5 in the number of deaths worldwide and we expect the number of deaths to exponentially increase.

Check out this video by the World Health Organization, animated by Worldwide Engineering:


We decided to grade the US performance so far against the four main performance metrics and detailed strategies/tactics that the medical and legal experts laid out earlier this month –and — the grades are not good: 

Adequate Funding and Support for the Response must be Provided. = Grade C-

Surging Healthcare demand must be Managed and Patients and Healthcare Workers Protected. = Grade D-

Clear, Evidence-Based Communication is Critical to Manage Public Fear.  = Grade F

Support and Resources Must be Provided for Fair and Effective Infection Control.  = Grade C and TBD

Their March 3rd letter puts the COVID-19 public health crisis response into perspective:

“We write as experts in public health, law, and human rights, with experience in previous pandemic responses, set forth principles and practices that should guide the efforts against COVID-19 in the US. It is essential that all institutions, public and private, address the following critical concerns through new legislation, institutional policies, leadership and spending.”

“The COVID-19 outbreak is unprecedented in recent American history, and there is no playbook for an epidemiological event of this scope and magnitude. To mitigate its impact, you must act swiftly, fairly, and effectively. We urge you to take these recommendations seriously and act urgently so that we are best protected from the damage of this unprecedented microbial threat and the possible harms of an uninformed or poorly conceived response.”

Let’s check in now 25 days later to grade the US’ government’s performance on these strategies/tactics to see what we need to change to save lives:

1. Adequate Funding and Support for the Response must be Provided. = Grade C-

Federal, state and local governments should act immediately to allocate funds to ensure that necessary measures can be carried out and that basic human needs continue to be met as  the epidemic unfolds. Mitigating COVID-19 is costly. The uneven distribution of resources will lead to unnecessary suffering and death. On Feb 26, 2020, Trump identified Vice President Trump to be in charge of the White House Coronavirus Task Force. Recall how poorly then Governor Pence handled HIV and AIDS.

Congress took action on March 27th = eight weeks AFTER the initial COVID-19 case was reported in the US by the CDC on January 21st. The $2.2 Trillion Dollar Coronavirus Relief Act, CARES Act, which passed includes $2 Trillion for Corporations and only $250 Billion for human beings – $1,200 each person. 

NO dollars have been distributed YET the rent is due April 1. Last week 3.3 million Americans filed for unemployment. Commerce Secretary Mnuchin controls a $500 billion dollar bail out fund for corporations and $350 billion loans for small businesses. 

WHAT’s MISSING: Need guarantee that people cannot be evicted or foreclosed upon!  It does not do enough to protect local governments, hospitals or community health centers. A one time minimum-wage check of $1200 does not allow 80% of Americans to survive. 

The federal government and federal, local, and state agencies must minimize disruption to government activities throughout the epidemic to continue providing public services to those who need them.​ The exact opposite is happening and the federal government is increasing disruption by reducing public services to those who need them . The U.S. Department of Homeland Security (DHS) has listed which industries and workers are “essential” to fighting the pandemic. The list of essential employees—which is advisory, but is not a federal directive—was made as the U.S. has more than 25,000 confirmed cases of the virus, according to the Johns Hopkins University coronavirus tracker on Friday March 20th. 

March Social Security Checks were issued.

The Environmental Protection Agency, EPA issued a sweeping suspension of its enforcement of environmental laws Thursday, telling companies they would not need to meet environmental standards during the coronavirus outbreak.

The Agriculture Department said that it would appeal a judge’s ruling that it would be “arbitrary and capricious” to move forward during a global health crisis with food stamp changes that could force hundreds of thousands of people from the program. Federal Judge Beryl Howell, in a ruling late last week, stopped a set of changes that would have taken effect on April 1. On Wednesday, an Agriculture Department spokesperson responded to an Associated Press query with a terse email saying only that “USDA disagrees with the court’s reasoning and will appeal its decision.”  

2. Surging Healthcare demand must be Managed and Patients and Healthcare Workers Protected. = Grade D-

Our healthcare system will face severe burdens under all plausible scenarios. Hospitals must receive direct funding and adequate resources for enhanced surge capacity in order to handle the front-line response. Particular attention and funding must also be directed to primary care facilities and community health centers — The front lines of healthcare provision are the gatekeepers to prevent the overburden of our hospital systems. Only $150 billion of the CARE Act goes to hospitals. US hospitals lack beds, ICU units, personal protective equipment (PPE) and ventilators. The USNS Mercy is being deployed to Los Angeles  The USNS Comfort is being deployed to New York City. An Army Field hospital is being built in Seattle and will be staffed by 300 medically trained soldiers and have 50 ICU beds. WHAT’s MISSING:  No requirement for insurance companies to fully cover and reimburse hospital costs for treatment of patients with COVID-19.

Healthcare workers and other first responders will be critical to the response. We must ensure their safety and give them fair working conditions. –Healthcare workers must be given PPE and be provided normal respite. Healthcare workers do NOT have the necessary PPE to protect themselves, they are under stress since there is a lack of tests and long-turn around time for tests, are working long hours, do not have childcare and are risking their lives for us – everyday! 

Kelley Cabrera, a registered nurse and president of the New York State Nurses Association’s labor bargaining unit at New York’s Jacobi Medical Center, said staff members at New York City hospitals have to reuse the same N95 mask — particle-filtering respirator masks — for five days. N95 masks are intended for one-time use, and are not to be used on multiple patients, according to Cabrera.

Dr. Ming Lin in a Washington State hospital was terminated for speaking out for not protecting his staff and patients at Peace Health Hospital in Bellingham, WA. Mutual Aid (MN COVIDsitter) and some cities are providing childcare for healthcare workers and first responders.

More than 1,200 health care workers have used a private online document to share their stories of fighting the coronavirus pandemic on the front lines. They say the outbreak has turned American hospitals into “war zones.” They talk about being scared to go to work and anxious that they will become infected. They describe managers who seem to not care about their plight.

Let’s have a plan: Without a federal plan to secure and distribute critical PPE and ventilators, states are bidding against each other for medical supplies and according to Michigan Governor Gretchen Whitmer, this is ‘creating a lot more problems for us all’ .

Healthcare facilities must be immigration enforcement-free zones so that immigration status does not prevent a person from seeking care. The COVID-19 response should not be linked to immigration enforcement in any manner. –Similar enforcement free zones are set up during hurricanes and other emergencies, including the September 11 attacks. Individual and collective health depend on whether individuals feel safe to utilize care. However these must be articulated by federal, state and local governments. 

Policymakers must work directly with insurance companies to allow all insured individuals to adhere to public health recommendations. It will be critical for policymakers to ensure comprehensive and affordable access to testing, including for the uninsured. People are less likely to seek appropriate diagnosis or treatment due to large out of pocket costs or co-pays. Out of network cannot be allowed to disrupt local triage and patient plans. As of March 23, 11 states have re-opened their Affordable Care Act enrollment to allow uninsured coverage

Testing: Widespread testing for COVID-19 is NOT available in America. Congress recently passed a new law, the Families First Coronavirus Response Act, that will require most private health plans to cover testing for the coronavirus with no cost sharing during the emergency period. Some states have adopted similar requirements for insurers they regulate, and many private insurance companies will voluntarily expand coverage for testing.

Treatment:  However hospitalizations and ICU beds are required for many patients to recover from COVID-19. Many medical officials have raised concerns about whether insurers will pay the costs of COVID-19 treatment, whether individuals can afford large co-pays and deductibles and how much insurers will discount the life-saving services that hospitals are providing patients. 

If therapeutics or vaccines are developed, policymakers must assure that they are affordable and available to all. Americans have been denied access to COVID-19 test kits for two months. This allowed Jared Kuschner time to create a new LLC so that the Trump family could make a profit on all of the future COVID-19 test kits. More COVID-19 diagnoses are made in each of the 50 states every day, an indication both of the virus’ spread and of expanded testing capacity. And with the expanded testing capacity the Trump family makes money when Americans are ill. 

People residing in close living quarters are especially vulnerable to COVID-19 and will need special attention both to minimize transmission risk and address their healthcare needs in the context of an outbreak.​  Three populations are especially vulnerable and need special attention which they are not getting: (1) people experiencing homelessness living on the streets or in shelters, (2) incarcerated populations in prisons, jails and holding cells and (3) immigrants and refugees in detention centers. 

In New Jersey, people detained by ICE have gone on hunger strike, demanding to be released rather than stare down a coronavirus outbreak they see as impending, inevitable. In Italy and Colombia, those fears have turned violent, sparking riots that resulted in dozens of deaths.” -Wired 

Covid-19 Poses a Heightened Threat in Jails and Prisons: An outbreak could seriously harm staff, the incarcerated, and the surrounding community. Releasing inmates could help—if they have somewhere to go. “All states have suspended normal visitation, and 15 have even banned legal visitation to further reduce chances of exposure to the virus.” – Wired

“People across the United States and around the world are restricting their movement and increasing their social distance in an effort to curb the spread of the coronavirus. But for the more than 37,000 people in Immigration and Customs Enforcement (ICE) detention facilities, social distance is not always an option. Detainees include families with children as young as 7, according to Amnesty International, some of whom have been waiting for their asylum hearing for months. Conditions are often cramped, with detainees sharing housing too small to allow for the six feet of social distance.” – Fortune

Tonight we learned that people residing in three homeless shelters operated by Union Gospel Mission in Seattle are now in quarantine because a shelter resident tested positive. – Kiro 7 

Other critical healthcare programs must be maintained during this crisis.  —The exact opposite is happening. Patients have been notified that all non-essential surgeries are cancelled. Providers have notified women patients that preventative tests are cancelled – including dermatology body checks, pap smears, mammograms, etc. Cancellations and postponements of preventative medicine can have disastrous implications for patients. Some cancer patients face delayed surgeries and scaled-back treatments as the coronavirus advances.

3. Clear, Evidence-Based Communication is Critical to Manage Public Fear.  = Grade F

Science needs to guide messaging to the public, and no government official should make misleading or unfounded statements, nor pressure others to do so. — as of March 28th, a headline in the New York Times read: “Medical Expert Who Corrects Trump Is Now a Target of the Far Right.”  Dr. Anthony Fauci is the doctor that Americans trust and who has served under six consecutive US presidents. His absence last weekend during the White House briefings sent a message that his position was threatened. He is also the administration’s most outspoken advocate of emergency virus measures and he now, faces a torrent of false claims that he is mobilizing to undermine the president. 

Quoting NYT: “An analysis by The New York Times found over 70 accounts on Twitter that have promoted the hashtag #FauciFraud, with some tweeting as frequently as 795 times a day. The anti-Fauci sentiment is being reinforced by posts from Tom Fitton, the president of Judicial Watch, a conservative group; Bill Mitchell, host of the far-right online talk show “YourVoice America”; and other outspoken Trump supporters such as Shiva Ayyadurai, who has falsely claimed to be the inventor of email.” 

Government and institutions must also actively prevent discrimination and scapegoating of individuals or groups.​ Trump has called this the “Chinese virus” for weeks and areas with large Chinese American populations, such as Seattle and King County, Washington, are experiencing much stigma and the public health authorities are having to counter this scapegoating.  

Leaders should refrain from offering false assurances and should act aggressively to correct misinformation. — “There seems to be a concerted effort on the part of Trump supporters to spread misinformation about the virus aggressively,” said Carl Bergstrom, a professor of biology at the University of Washington who has studied misinformation.”  – NYT

The campaign against Dr. Fauci stands out because he is one of the world’s leading infectious disease experts and a member of Mr. Trump’s virus task force, and it is unfolding as the government battles a pathogen that is rapidly spreading in the United States.”  – NYT

Still, the President has resisted portraying the virus as the kind of threat described by Dr. Fauci and other public health experts. In his effort to create a positive vision of a future where the virus is less of a danger, critics have accused Mr. Trump of giving false hope. Dr. Fauci and the president have publicly disagreed on how long it will take for a coronavirus vaccine to become available and whether an anti-malaria drug, chloroquine, could help those with an acute form of the virus. Dr. Fauci has made clear that he does not think the drug necessarily holds the potential that Mr. Trump says it does.”  – NYT

4. Support and Resources Must be Provided for Fair and Effective Infection Control.  = Grade C and TBD

The highest priority needs to be placed on allowing people to voluntarily cooperate with public health advice about prevention, by providing robust social and economic support and clear education. — To enable people to cooperate with social distancing, policymakers must ensure people are protected from job loss, economic hardship and under burden. Hong Kong agreed to give $1200 cash to residents. The US Congress agreed to give one-time cash gifts of $1200 to adult citizens and $500 to children citizens. How did Congress arrive at $1200 per person? Federal minimum wage $7.25/hr. X 40h x 4 = $1160 rounded up to $1200. This is not a livable wage.  For low-wage, gig-economy and non-salaried workers, staying home from work has especially critical implications which I previously outlined.

Policymakers should base decisions on social distancing measures and closures on the best available science. — Homelessness among students enrolled in schools from kindergarten through 12th grade has increased 70 percent over the last decade. Sadly schools were closed one by one school district, county, and state at-a-time. Before closing the schools, no city or state seems to have plans for how children who receive free and reduced breakfast and lunch would be fed, have lesson plans for virtual education, or computers and internet to ensure equitable access to lesson plans.

Special attention must be paid to the needs of people in long-term care or confinement, who are particularly vulnerable.People in nursing homes, long-term care facilities, incarcerated and homeless are at special risk of infection. The Life Care Facility in Kirkland, WA was the original US epicenter of COVID-19 and about ½ of the deaths in Washington State can be traced back to the Life Care facility. Arrest and short-term incarceration can amplify epidemics

Mandatory quarantine, regional lockdowns, and travel bans have been used to address the risk of COVID-19 in the US and abroad. ​B​ut they are difficult to implement, can undermine public trust, have large societal costs and, importantly, disproportionately affect the most vulnerable segments in our communities.— Both the National Lawyers Guild, NLG, and the American Civil Liberties Union, ACLU, have written that mandatory quarantines, regional lockdowns and travel bans must be scientifically sound, be the least restrictive means to protect public health and regularly revisited as the epidemic evolves ACLU

Voluntary self-isolation measures are more likely to induce cooperation and protect public trust than coercive measures, and are more likely to prevent attempts to avoid contact with the healthcare system. Compliance will be determined by the degree of support provided, especially for low-wage workers and other vulnerable communities. While we have been told that public health experts provided data about flattening the curve, I am not certain that the decision-making in Seattle-King County has been open and included legal experts representing the most vulnerable in our communities before orders were announced. – Gov Inslee Stay Home, Stay Healthy Order

Public health officials must provide safe and humane conditions to individuals who are quarantined whether in homes, facilities, or communities. Government must ensure that anyone isolated or quarantined has access to the basic necessities, including food, water, medicine, and sanitation supplies.​ – Quarantine buildings are being built; we have yet to see them become operational in the Greater Seattle.  Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County signed an order and directive on March 28. The order makes it mandatory for people with a positive COVID-19 test to follow isolation protocols at home or at a recovery facility; the directive requires everyone with COVID-19 symptoms (fever, cough, and/or difficulty breathing) who has a test pending to stay quarantined.

Where mandatory measures are used, steps must be taken to ensure that people are protected from job loss, economic hardship, and undue burden. — The wealth gap in King County is large. There has been no financial accommodation for low-wage, gig-economy and non-salaried workers, who may find it impossible to meet their basic needs while staying home and complying with the orders to not spread the disease.

Individuals must be empowered to understand and act upon their rights. — No information has been provided about where and how to appeal the “Stay at Home” Order. There have been no public accommodations for due process including providing individuals access to counsel.

However the day after Washington Governor Inslee order was released further accommodations were made for business owners to argue that their business is essential and can remain open.

Amazon warehouse workers have tested positive in Seattle, Staten Island and other sites. Workers have complained of lack of PPE and claim managers aren’t being transparent about how many people are sick with the virus. Amazon warehouse workers plan strike at the Staten Island warehouse to demand coronavirus protections.

The effectiveness of regional lockdowns and travel bans depends on many variables, and also decreases in the later stages of an outbreak.— The evidence of travel bans for diseases is that they don’t work – Vox 

The conclusion of the experts’ March 3rd letter to the Trump Administration is worth repeating: 

“The COVID-19 outbreak is unprecedented in recent American history, and there is no playbook for an epidemiological event of this scope and magnitude. To mitigate its impact, you must act swiftly, fairly, and effectively. It is essential that all institutions, public and private, address the following critical concerns through new legislation, institutional policies, leadership and spending.

We urge you to take these recommendations seriously and act urgently so that we are best protected from the damage of this unprecedented microbial threat and the possible harms of an uninformed or poorly conceived response.” (emphasis added)

 

So how well do you think the US is doing in protecting its people?

As of 3/29/2020, we have 139,745 Cases, 4,435 people have recovered and 2,448 People have died.

This means the US is now #1 in the number of confirmed cases and #5 in the number of deaths worldwide.

Check out the graphs of the United States data here.

Let’s Have a Plan!

Remember Taiwan – we need a command center.

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