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by **admin** » Sun Apr 26, 2020 3:48 am

National Nurses United Response To COVID-19
by National Nurses United
Accessed: 4/25/20
https://www.nationalnursesunited.org/covid-19

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

About the Novel Coronavirus (COVID-19) Outbreak

In December 2019, a newly identified coronavirus, known as COVID-19, emerged in Wuhan, Hubei Province, China causing illness in humans. Multiple clusters of COVID-19 have since been reported across China and in more than 70 other countries including Italy, Iran, Japan, South Korea, and the United States.

The U.S. Department of Health and Human Services declared the virus to be a nationwide health emergency following the World Health Organization’s (WHO) declaration of a public health emergency of international concern on January 30, 2020.

On January 21, 2020, China announced for the first time that health care workers have been infected- at least fourteen by recent counts. In recent days, dozens of U.S. health care workers have been exposed due to their employer’s lack of protections.

Health care workers need your help in the fight against COVID-19.
Click below to call for safer facilities, more PPE, and thank nurses for all that they do.

TAKE ACTION

About COVID-19

While much has been learned about COVID-19 in a few weeks, there is still a lot we don’t know:

About the Virus

What is known: It is a coronavirus, which is a large family of viruses that can infect animals and/or humans. COVID-19 is similar to the viruses that cause SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

Symptoms

What is known: Several published reports have established a basic picture of clinical symptoms and outcomes for those infected with COVID-19. These symptoms can include fever, cough, muscle soreness, weakness, diarrhea, headache, and other symptoms. While some symptoms appear to be common, there is also diversity in how COVID-19 manifests (Table 1).

Several additional reports underline the potential seriousness of a COVID-19 infection, including damage to lung tissue that has become characteristic to COVID-19. Shi et al. (Feb 24, 2020) describe this damage:

The Chinese Centers for Disease Control and Prevention (Chinese CDC) reported recently that approximately 20% of COVID-19 cases are classified as severe or critical.[5] COVID-19 infections may result in life-threatening conditions including acute respiratory distress syndrome, acute kidney injury, cardiac injury, and liver dysfunction (Table 2) and may require hospitalization, intensive care, intubation, or other significant life-saving interventions. In some cases COVID-19 may lead to death; the Chinese CDC reported that 2.3% of confirmed COVID-19 cases died.[6] The World Health Organization’s reports indicate that 3.4% of reported cases have died.[7] There is currently no cure, only supportive treatment, and no vaccine.

Transmission

What is known:

The virus is spread through human to human transmission. Asymptomatic cases are occurring and can be infectious. Two studies indicate that the most infectious period may actually be the first four days or so after exposure. Researchers found very high levels of the virus in upper respiratory tract samples before clinical symptoms occurred.[1,2]

What is unknown:

All modes of transmission for COVID-19 have yet to be established.

However, current epidemiological evidence supports aerosol transmission of COVID-19. Aerosols, particles suspended in air, can be transmitted by an infected person through breathing, talking, coughing, and sneezing.[3] They can also be generated during medical procedures such as intubation and bronchoscopy. Particles vary in size; larger aerosol particles can remain suspended in the air for several minutes, while smaller or lighter ones can linger in the air for hours and travel through the room and ventilation systems. Perfume spray demonstrates the extent of aerosol distribution as it can be smelled from a distance for quite some time as the particles disperse throughout the room.

Similar to SARS (severe acute respiratory syndrome), researchers have found that SARS-CoV-2, the virus that causes COVID-19, can survive and stay infectious in aerosols for at least 3 hours.[4] SARS-CoV-2 can also survive on surfaces for an extended period of time. For example, genetic material from SARS-CoV-2 was detected on a number of surfaces in the Diamond Princess cruise cabins of both symptomatic and asymptomatic infected passengers 17 days after they vacated.[5] Asymptomatic virus shedding and viability in the air and on surfaces may explain the rapid person-to-person transmission. As such, all contact and airborne precautions must be maintained to protect healthcare workers.

[1] Woelfel, Roman et al. Clinical Presentation and Virological Assessment of Hospitalized Cases Of Coronavirus Disease 2019 In A Travel-Associated Transmission Cluster. MedRxiv, Cold Spring Harbor Laboratory Press, 2020. https://doi.org/10.1101/2020.03.05.20030502

[2] Nishiura, Hiroshi, et al. Serial Interval of Novel Coronavirus (COVID-19) Infections. International Journal of Infectious Diseases, Elsevier, 2020. https://doi.org/10.1016/j.ijid.2020.02.060

[3] Jones, R.M. and L.M. Brosseau, Aerosol transmission of infectious disease. Journal of Occupational and Environmental Medicine, 2015. 57(5): p. 501-8.

[4] N van Doremalen, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. The New England Journal of Medicine, 2020. DOI: 10.1056/NEJMc2004973.

[5] Moriarty, et al. Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3

Additional Resources

The situation is evolving rapidly. Please see the links below for the most up-to-date information.

World Health Organization (WHO)’s Dashboard
https://experience.arcgis.com/experienc ... ee1b9125cd

Bibliography

Airborne precautions are needed for COVID-19.

Bourouiba, Lydia, “Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19,” JAMA, March 26, 2020, https://jamanetwork.com/journals/jama/f ... le/2763852.

Summary:

• This paper reported on what is known about disease transmission via respiratory droplets created by human exhalations, sneezes, and coughs.
• Droplet transmission was originally defined in 1897, large and small droplets defined in 1930s. This model of infectious disease transmission hasn’t been updated since. And yet, the CDC and WHO maintain use of this paradigm despite more recent research.
• More recent research over the past few decades performed with instrumentation that better measures particle sizes and movement has determined that human exhalations, coughs, and sneezes (the things that supposedly create large droplets under old model) are actually made of multiphase turbulent gas clouds (a puff) that entrains ambient air and traps and carries clusters of particles of a wide range of sizes.
• This includes viral particles in people who are sick.
• Pathogen-carrying gas clouds emitted when people breath, cough, and sneeze can travel up to 23-27 feet.

Patients infected with SARS-CoV-2 produce viral particles that can be aerosolized when they breath, cough, sneeze, etc.

Wolfel, Roman, et al., “Virological assessment of hospitalized patients with COVID-2019,” Nature, April 1, 2020, published online at https://www.nature.com/articles/s41586-020-2196-x.

Summary:

• This study examined viral loads and isolates for patients hospitalized with COVID-19. The majority of patients in this study presented with upper respiratory tract symptoms. Viral loads from upper respiratory tract samples were extremely high (more than 1000 times higher than SARS). Live virus was isolated from upper respiratory tract tissues.
• Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said, “The findings [of this study] confirm that COVID-19 is spread simply through breathing, even without coughing… They also challenge the idea that contact with contaminated surfaces is a primary means of spread,” (emphasis added). http://www.cidrap.umn.edu/news-perspect ... 19-viruses.

Leung, Nancy H. L. et al. “ Respiratory virus shedding in exhaled breath and efficacy of face masks,” Nature Medicine, April 3, 2020, https://www.nature.com/articles/s41591-020-0843-2

Summary:

This study examined viral presence and load in exhaled breath of patients with lab-confirmed influenza, seasonal coronaviruses, or rhinovirus.
• Found viral presence in exhaled breath, even without cough, for all types of viruses in both droplet (>5 micron) and aerosol (<5 micron) particles.

SARS-CoV-2 virus can survive in the environment, including in the air.

Doremalen et al., “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1,” New England Journal of Medicine, April 16, 2020, https://www.nejm.org/doi/full/10.1056/N ... tured_home.

Summary:

• This study examined how long SARS-CoV-2 can survive in aerosols suspended in the air and on surfaces of different types (metal, plastic, cardboard).
• They found that SARS-CoV-2 can survive up to three hours in aerosols, four hours on copper, 24 hours on cardboard, 2-3 days on plastic and stainless steel.
• The authors conclude, “Our results indicate that aerosol and fomite transmission of [SARs-CoV-2] is plausible, as the virus can remain viable in aerosols for multiple hours and on surfaces up to days.” This study was conducted by NIH and CDC scientists in addition to UCLA and Princeton.

Chin, Alex W H et al. “Stability of SARS-CoV-2 in different environmental conditions,” The Lancet Microbe, April 2, 2020, https://www.sciencedirect.com/science/a ... via%3Dihub.

Summary:

• This study examined the ability of SARS-CoV-2 to survive outside the human body in different environmental conditions.
• They found that SARS-CoV-2 can survive outside the human body for up to 14 days at 39 degrees Fahrenheit, 7 days at 72 degrees Fahrenheit and remains infectious in both situations.
• They found that SARS-CoV-2 can survive on different surfaces:
o Printing and tissue papers- up to 3 hours
o Wood and cloth- up to 2 days
o Glass and banknote- up to 4 days
o Stainless steel and plastic- up to 7 days
o Surgical mask- detectable level of infectious virus found after 7 days on outer layer of mask
• They also tested the impact of different disinfectants, used at working concentrations, to successfully inactivate SARS-CoV-2:
o Household bleach (1:49)
o Household bleach (1:99)
o Ethanol (70%)
o Povidone-iodine (7.5%)
o Chloroxylenol (0.05%)
o Chlorhexidine (0.05%)
o Benzalkonium chloride (0.1%)

Fears, Alyssa C. et al. “Comparative dynamic aerosol efficiencies of three emergent coronaviruses and the unusual persistence of SARS-CoV-2 in aerosol suspensions,” medxRiv, April 18, 2020, https://www.medrxiv.org/content/10.1101 ... 20063784v1

Summary:

• This study looked at the viability of SARS-CoV-2 in suspended aerosols and found that SARS-CoV-2 remained infectious after 16 hours suspended in aerosols. This further reinforces airborne/aerosol transmission of SARS-2.
• The authors state: “Our approach of quantitative measurement of infectivity of viral airborne efficiency complemented by qualitative assessment of virion morphology leads us to conclude that SARS-CoV-2 is viable as an airborne pathogen.”

Environmental contamination

Guo, Zhen-Dong et al., “Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020,” Emerging Infectious Diseases, April 10, https://wwwnc.cdc.gov/eid/article/26/7/20-0885_article.

Summary:

• This study looked at environmental contamination in an ICU and a general ward in hospital in China where patients with COVID-19 were placed.
• They found SARS-CoV-2 on many surfaces in patient rooms and on units, including doorknobs, bedrails, patient masks, computer mouse, keyboards, etc.
• Many positive results on floors not just in patient room but throughout the unit. 50% of the samples from the soles of healthcare workers’ shoes were positive.
• They also measured SARS-CoV-2 in air samples and found several air samples positive in addition to finding that the samples from the air outlets were positive for virus.
• Underlines nurses’ need for PPE!

Santarpia, Joshua L et al., “Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center,” medRxiv (pre-print), March 26, 2020, https://www.medrxiv.org/content/10.1101 ... 20039446v2.

Summary:

• This study looked at the presence of virus in air samples taken in patient rooms in addition to environmental samples.
• SARS-CoV-2 was found in a majority of air samples taken at greater than 6 ft from patient.
• SARS-CoV-2 was found in a majority of hallway air samples.
• SARS-CoV-2 was found in the air samplers worn by sampling personnel even when the patients did not cough.

Chia, Po Ying et al. “ Detection of Air and Surface Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Hospital Rooms of Infected Patients” medRxiv April 9, 2020, https://www.medrxiv.org/content/10.1101 ... 1.full.pdf

Summary:

• This study examined surface and air contamination in airborne infection isolation rooms of patients with confirmed COVID-19 infections in Singapore.
• They found that 56.7% of the rooms had at least one environmental surface contaminated, with 18.5% of the toilet seats and toilet flush button being contaminated.
• High touch surface contamination was shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.010).
• Air sampling of two COVID-19 patients (both day 5 of symptoms) detected SARS-CoV-2 PCR positive particles of sizes >4 µm and 1-4 µm. In a single subject at day 9 of symptoms, no SARS-CoV-2 PCR-positive particles were detected.

Protective PPE, including at minimum N95 respirators, gowns/coveralls, eye protection, and gloves, is important to protect nurses and other healthcare workers from exposure to SARS-CoV-2.

Cheng, C.C. et al., (March 5, 2020), “Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong.” Infection Control and Hospital Epidemiology, March 2020, p 1-24 https://www.cambridge.org/core/journals ... DC747EB6EC

Summary:

• Hong Kong has more effectively contained the outbreak of COVID-19 than many other countries. This study reports a description of infection control measures adopted during response to COVID-19 in Hong Kong.
• 42 of 1275 patients evaluated were identified as having COVID-19 in first 42 days of the outbreak.
• 11 of 413 (2.7%) healthcare workers caring for these patients had unprotected exposure requiring a 14-day quarantine.
• No healthcare workers were infected, no nosocomial transmission observed. Environmental surveillance of viral particles conducted- in breathing zone of patient, wipe samples from surfaces in patient rooms.
• Infection control measures implemented include:
o 36 patients immediately isolated upon admission in AIIRs, 6 in non-AIIR
o Standard, contact, droplets, and airborne precautions for suspected or confirmed cases
o Stepped up use of PPE during aerosol generating procedures
o Surgical masks worn by all HCWs, patients, and visitors in clinical areas implemented since day 5
o Promotion of hand hygiene by HCWs and patients

Wang, Xinghuan et al. “Association between 2019-nCoV transmission and N95 respirator use” J Hospital Infection, March 3, 2020, https://www.journalofhospitalinfection. ... 95-6701(20)30097-9/fulltext

Summary:

• This study examined the infection rate in two groups of departments.
o Three departments were in the “mask group” because they utilized N95 respirators and also frequently performed hand hygiene (respiratory, ICU, and Infectious Disease).
o Three departments were in the “non-mask group” because early in the outbreak they hadn’t implemented precautions- staff did not wear masks and disinfected and cleaned hands “occasionally.”
• There were significantly more confirmed or probable COVID-19 patients cared for in the departments in the “mask group,” meaning workers in those units had significantly more exposure than the “non-mask group.”
• “Mask group” reported statistically significantly fewer infections than the “non-mask group.”
o 0 out of 278 staff in “mask group” were infected
o 10 out of 213 staff in “no mask group” were infected
o Difference was found to be statistically significant
• Found similar results in two other hospitals- staff wearing N95s and frequently conducting hand hygiene were not infected

Chen, Weiyun et al “ To Protect Healthcare Workers Better, To Save More Lives,” Anesthesia & Analgesia, March 30, 2020, https://journals.lww.com/anesthesia-ana ... 95724.aspx.

Summary:

• This study reported on healthcare worker protections implemented in China during three phases.
• First stage- this was an unknown disease and healthcare workers were not protected. At this time, the infection rate ranged from 3.5% to 29% among healthcare workers in different hospitals in the epicenter of Wuhan according to previous reports, when the initial source of the novel coronavirus still remained unknown.
• Second stage- inadequate protection for healthcare workers due to supply shortages. During this period of time, the number of confirmed cases in China was still increasing rapidly. By February 11, 2020, a total of 1,716 health care workers were confirmed with COVID-19, including five deaths.
• Third stage- disease severity acknowledged and full protection of healthcare workers. “The highest level of precaution, so called “full precaution,” is mandatory for high-risk exposure, a disposable surgical cap, test-fit N95 masks or respirators, gloves, goggles or face shield, gown and fluid-resistant shoe covers. We would like to point out that the key element of full precaution is the complete coverage of the head and facial skin…” No healthcare worker infections reported in this third period.

Employers Must Prepare to Keep You Safe

In situations like this one where knowledge is lacking about a health threat, there is often debate about what actions to take and when. Too often healthcare employers prioritize saving money over safe care and wait to act— this is unacceptable.

Hospitals and other healthcare employers have the duty and responsibility to prepare ahead of time to protect staff and patients. And in situations like the current outbreak, to follow the precautionary principle. The precautionary principle states that we should not wait until we know for sure that something is harmful before we take action to protect people’s health. Full precautions mean anticipatory or protective action must be taken to prevent possible or further harm.

Following the precautionary principle is necessary to protecting nurses and other healthcare workers from the hazard posed by an emerging infectious disease like COVID-19. Nurses and other healthcare workers have a fundamental right to a safe and healthful workplace and infectious diseases should be no exception. Full protection of healthcare workers is a fundamental and necessary part of limiting the spread of viruses.

Of employers, NNU is asking the following:

1. Employers shall implement plans and protocols in response to COVID-19 based on the precautionary principle, which holds that lacking scientific consensus that a proposed action, policy, or act is not harmful – particularly if that harm has the potential to be catastrophic – such action, policy, or act should not be implemented and the maximum safeguards should be pursued.
2. Employers shall clearly communicate with all RNs/health care workers, including notifying nurses when there is a possible or confirmed COVID-19 case.
3. Employers shall provide education and training for all RNs/health care workers, including on protective gear, donning and doffing, and all other protocols relating to COVID-19.
4. Employers shall provide the highest level of protection, including functioning negative pressure rooms and personal protective equipment for nurses providing care to possible and confirmed COVID-19 cases. Employers must ensure negative pressure rooms remain functional at all times during use. Highest level of PPE must include PAPR (powered air-purifying respirator), coveralls meeting ASTM (American Standard for Testing and Materials) standard, gloves, temporary scrubs, and other protections.
5. Employers shall plan for surge of patients with possible or confirmed COVID-19, including plans to isolate, cohort, and to provide safe staffing.
6. Employers shall conduct a thorough investigation after a COVID patient is identified to ensure all staff and individuals who were exposed are identified and notified. Any nurse/health care worker who is exposed to COVID-19 will be placed on precautionary leave for at least 14 days and will maintain pay and other benefits during the full length of that leave.

Documents:

• Learn more about NNU's nurse and patient protection recommendations (PDF)
• Download our NNU/National flier on protections at work for COVID-19 (PDF)
• Download our CNA/California flier on protections at work for COVID-19 (PDF)
________________________________________

Nurses' Statements

• March 24, 2020 - Statement by National Nurses United Nurses About Making Homemade Facemasks for Health Care Workers
• March 23, 2020 - Nurses Send Petition to Congress Demanding Immediate Protections During COVID-19 Outbreak
• March 23, 2020 - Union Workers in the Building Trades Donate Masks to Nurses Amidst Government Inaction
• March 21, 2020 - Nurses: California Needs to Do More on Protective Gear
• March 20, 2020 - Updated COVID-19 survey of registered nurses shows little improvement and worsening availability of personal protective equipment
• March 16, 2020 - Nurses: Time to sharply ramp up health care capacity for COVID-19
• March 14, 2020 - Nurses Say Eastern Maine Medical Center Has Addressed Many of Their Concerns Over COVID-19 Safety Preparations
• March 14, 2020 - Veterans Health Administration unions decry management’s failure to involve them in COVID-19 preparations, call to work together
• March 13, 2020 - National Nurses United statement on today’s Trump administration press conference
• March 11, 2020 - Recording of National Nurses United COVID-19 Update Call Available on Website
• March 5, 2020 - Survey of Nation’s Frontline Registered Nurses Shows Hospitals Unprepared For COVID-19
• March 5, 2020 - Statement by a quarantined nurse from a northern California Kaiser facility
• March 2, 2020 - National Nurses United Urges Administration, Congress to Protect Health Care Workers and Fully Fund Coronavirus Response
• March 2, 2020 - General Statement - California Nurses Association/National Nurses United Monitoring Coronavirus
• Feb 28, 2020 - Nation’s hospitals unprepared for COVID-19
________________________________________

Letters to Officials

• April 3, 2020 - Letter to Centers for Disease Control and Prevention on N95 Decontamination as Unsafe Practice
• March 17, 2020 - Petition to Congress for Proper Nurses Protection During COVID-19
• March 11, 2020 - Letter to Sacramento County Department of Health Services on 14 Day Quarantine
• March 11, 2020 - Letter to California Department of Public Health
• March 11, 2020 - Letter to Committee on Homeland Security
• March 6, 2020 - Labor's Response to CDC Incident Manager for Coronavirus
• March 4, 2020 - Letter to CDC Incident Manager for Coronavirus
• March 4, 2020 - Letter to Secretary of Labor and Federal OSHA
• March 2, 2020 - Letter to Office of the Vice-President, Coronavirus Response Coordinator, Members of United States Senate and House of Representatives
• Feb 21, 2020 - Letter to Chief of Cal/OSHA
• Feb 19, 2020 - Letter to National Center for Immunization and Respiratory Disease
• Feb 19, 2020 - Letter to California Department of Public Health
• Jan 30, 2020 - Letter to the World Health Organization

by **admin** » Sun Apr 26, 2020 11:45 pm

COVID-19 Masks

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

(Tianqi Chen)

by **admin** » Wed Apr 29, 2020 5:48 am

Nurses hold White House protest over need for protective equipment in coronavirus fight: “We’re here because our colleagues are dying,” said Erica Jones, a nurse at Washington Hospital Center in Washington, D.C.
'We're feeling like martyrs': Nurses hold White House protest over lack of protection
by Ali Vitali
April 21, 2020, 10:13 AM MST

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

WASHINGTON — Their numbers were small, but their message was powerful.

Nearly two dozen nurses from National Nurses United stood in protest outside the White House Tuesday, demanding more Personal Protective Equipment and a codification of protective standards as healthcare workers across the country find themselves underprepared on the frontlines of the coronavirus crisis.

“We’re here because our colleagues are dying,” Erica Jones, a nurse at Washington Hospital Center in D.C., told NBC News. Jones stood silently Tuesday as the names of 50 nurses who died from COVID-19 were read aloud in the shadow of the White House.

Nurses from National Nurses United protest in front of the White House on Tuesday. The group sought to bring attention to health care workers across the country who have contracted COVID-19 due to a lack of personal protective equipment.Patrick Semansky / AP

“I think that right now, people think of us as heroes. But we're feeling like martyrs, we're feeling like we're being left on the battlefield with nothing,” she said. “And I think that we should be paying more attention to what nurses and doctors and other health care workers are going through right now.”

They're calling on President Donald Trump to utilize the Defense Production Act to ensure healthcare workers have necessary supplies, including critical N95 masks and respirators, face shields and gloves. “We need these things to do our jobs,” Jones said. The NNU is also pushing for the Occupational Safety and Health Administration (OSHA) to establish standards for health care workers during outbreaks of infectious disease.

“Right now what’s happening, in hospitals across this country, nurses are being told to reuse their N95 masks, not only their whole shift but for days or weeks on end. That is not safe,” Amirah Sequeira of National Nurses United said. “That is not protecting them, and it is not protecting their patients. We need an OSHA standards to tell hospitals that the reuse of N95 masks is unacceptable and unsafe.”

The nurses’ protest Tuesday was a different picture of public pressure than has been seen in recent weeks. It comes after several protests across the country, often led and organized by conservative groups, demanding states reopen business and commerce. Those protests have often featured attendees who are not wearing masks and are not abiding by social distancing practices.

By contrast, nurses on Tuesday stood on pre-marked blue tape X's on the ground so that they could be appropriately distanced. They all wore masks. Asked about the juxtaposition, Jones, the nurse protesting for protection on her day off, said, “I don't have a problem with people exercising their right to protest. I understand that the economy is very concerning for some people -- and for all of us really. But we also need to protect lives and protect ourselves.”

Ali Vitali is a political reporter for NBC News, based in Washington.

by **admin** » Thu Apr 30, 2020 1:50 am

U.S. Government COVID-19 Response Plan
March 13, 2020
Unclassified / For Official Use Only / Not for Public Distribution or Release

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

Table of Contents PDF HERE

• Situation
o Purpose
o Background
o Threat
o Risk Assessment
o Facts
o Assumptions
o Critical Considerations
o Authorities
o Guiding Doctrine
• Mission
o Senior Leader Intent
 Purpose and End States
 Strategic Objectives
o Scope
o Roles and Responsibilities
• Execution
o Concept of Operations
 Interagency Coordination Constructs
 Phase Indicators and Triggers
 Lines of Effort
 Key Federal Decisions
 Interagency Support
• Sustainment
o Administration
o Resources
o Funding
• Communications, Coordination,and Oversight
o Communications
o Coordination
o Oversight
• Annex A . Task Organization
• Annex C . Operations
o USG Phasing Constructs
o Transitions Between Phases
o Preparing for Future Epidemic Trends Striking Balance Between Mitigation and
o Containment
o Appendix 1. Surveillance
o Appendix 2 . Communication and Public Outreach
o Appendix 3 . Healthcare Systems Preparedness and Resilience
o Appendix 4 .Medical Countermeasures Development
o Appendix 5. Supply Chain Stabilization
o Appendix 6 . Community Mitigation Measures
o Appendix 7. Continuity of Operations & Essential Services
• Annex D . Logistics
• Annex E. HHS Information Collection Plan
• Annex F. Federal Roles and Responsibilities
• Annex G . Regional Operational Coordination
• Annex X . Execution
• Annex Y . Glossary
o Definitions
o Acronyms

by **admin** » Thu May 07, 2020 8:34 am

Coronavirus detected on particles of air pollution
Exclusive: Scientists examine whether this route enables infections at longer distances
by Damian Carrington, Environment editor @dpcarrington
The Guardian
Fri 24 Apr 2020 09.29 EDTLast modified on Fri 24 Apr 2020 14.10 EDT

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

Coronavirus has been detected on particles of air pollution by scientists investigating whether this could enable it to be carried over longer distances and increase the number of people infected.

The work is preliminary and it is not yet known if the virus remains viable on pollution particles and in sufficient quantity to cause disease.

The Italian scientists used standard techniques to collect outdoor air pollution samples at one urban and one industrial site in Bergamo province and identified a gene highly specific to Covid-19 in multiple samples. The detection was confirmed by blind testing at an independent laboratory.

Leonardo Setti at the University of Bologna in Italy, who led the work, said it was important to investigate if the virus could be carried more widely by air pollution.

“I am a scientist and I am worried when I don’t know,” he said. “If we know, we can find a solution. But if we don’t know, we can only suffer the consequences.”

Two other research groups have suggested air pollution particles could help coronavirus travel further in the air.

A statistical analysis by Setti’s team suggests higher levels of particle pollution could explain higher rates of infection in parts of northern Italy before a lockdown was imposed, an idea supported by another preliminary analysis. The region is one of the most polluted in Europe.

Neither of the studies by Setti’s team have been peer-reviewed and therefore have not been endorsed by independent scientists. But experts agree their proposal is plausible and requires investigation.

Previous studies have shown that air pollution particles do harbour microbes and that pollution is likely to have carried the viruses causing bird flu, measles and foot-and-mouth disease over considerable distances.

The potential role of air pollution particles is linked to the broader question of how the coronavirus is transmitted. Large virus-laden droplets from infected people’s coughs and sneezes fall to the ground within a metre or two. But much smaller droplets, less than 5 microns in diameter, can remain in the air for minutes to hours and travel further.

Experts are not sure whether these tiny airborne droplets can cause coronavirus infections, though they know the 2003 Sars coronavirus was spread in the air and that the new virus can remain viable for hours in tiny droplets.

But researchers say the importance of potential airborne transmission, and the possible boosting role of pollution particles, mean it must not be ruled out without evidence.

Prof Jonathan Reid at Bristol University in the UK is researching airborne transmission of coronavirus. “It is perhaps not surprising that while suspended in air, the small droplets could combine with background urban particles and be carried around.”

He said the virus had been detected in tiny droplets collected indoors in China.

Setti said tiny droplets between 0.1 and 1 micron may travel further when coalesced with pollution particles up to 10 microns than on their own. This is because the combined particle is larger and less dense than the droplet and can remain buoyed by the air for longer.

“The pollution particle is like a micro-airplane and the passengers are the droplets,” said Sett. Reid is more cautious: “I think the very small change in the size of the [combined] particles is unlikely to play much of a role.”

Prof Frank Kelly at Imperial College London said the idea of pollution particles carrying the virus further afield was an interesting one. “It is possible, but I would like to see this work repeated by two or three groups.”

Another expert, Prof John Sodeau at University College Cork, in the Republic of Ireland, said: “The work seems plausible. But that is the bottom line at the moment, and plausible [particle] interactions are not always biologically viable and may have no effect in the atmosphere.” He said the normal course of scientific research might take two or three years to confirm such findings.

Other research has indicated correlations between increased Covid-19 deaths and higher levels of air pollution before the pandemic. Long-term exposure to dirty air is known to damage lung health, which could make people more vulnerable to Covid-19.

by **admin** » Tue May 12, 2020 4:25 am

RALPH NADER RADIO HOUR EP 321 TRANSCRIPT
Dr. Michael Osterholm on Covid-19
May 2, 2020

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

Steve Skrovan: It's the Ralph Nader Radio Hour.

Steve Skrovan: Welcome to the Ralph Nader Radio Hour. My name is Steve Skrovan, along with my co-host, David Feldman. Hello there, David.

David Feldman: Hello there, Steve.

Steve Skrovan: And the man of the hour, Ralph Nader. Hello, Ralph.

Ralph Nader: Hello. Please listen carefully to this one, listeners.

Steve Skrovan: That's right. This week, some states have ended their lockdowns and some are easing restrictions. President Trump has suggested that some schools could reopen before the end of this school year. Just this week, he also said that COVID-19 will not return after this, or if it does, it will be small and contained. This is not what the experts are saying, and it should be disregarded, just like his suggestion last week that ingesting disinfectants might kill the virus. To be clear, do not ever drink bleach. First up, we welcome Dr. Michael Osterholm, one of the foremost experts in infectious diseases. He wrote a book in 2017 called Deadliest Enemy: Our War Against Killer Germs, in which he predicted a global pandemic. We first spoke with Dr. Osterholm more than two years ago after he wrote what is turning out to be a scarily prescient op ed for the New York Times entitled “We're Not Ready for a Flu Pandemic”. That warning was ignored by the Trump administration and Congress, and everything Dr. Osterholm wrote in January of 2018, 100 years after the so-called Spanish Flu Pandemic, and two years before COVID-19, has unfortunately come true.

Now, he predicts that the second peak of COVID-19 will be bigger than the first. We'll hear about what he means by that and how he thinks the country can reopen by "threading the rope through the needle", as he calls it, which means finding a balance between resuming some parts of life and keeping people safe.

That's the first part of the show. The second part of the show, we're going to talk about schools, because the future of schools is uncertain. Schools have switched to online learning with no end in sight. The inequalities already present in our education system have become even more apparent. 17% of students in the United States don't have a computer at home. These differences put low-income students at a disadvantage compared to their wealthier peers.

Our second guest, Naila Bolus, is the president and CEO of Jumpstart. Jumpstart is a national early-education organization that provides language, literacy, and social- emotional programming for preschoolers from underserved communities, and she's here to talk about educational inequality and Jumpstart's role in addressing it. As always, somewhere in between, we'll take a short break and check in with our corporate crime reporter, Russell Mokhiber, and if we have some time left over, we'll try to answer some listener questions. First, let's start by talking about what our new normal in the age of COVID might look like. David?

David Feldman: Dr. Michael Osterholm is a professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He is the author of the 2017 book, Deadliest Enemy: Our War Against Killer Germs. From 2018 through May of 2019, Dr. Osterholm served as a science envoy for health security on behalf of the U.S. Department of State. Welcome back to the Ralph Nader Radio Hour, Dr. Michael Osterholm.

Dr. Michael Osterholm: Thank you. It's great to be with you. I appreciate it. Ralph Nader: Mike, I'm going to ask you a question that a lot of people who have been asking you questions probably haven't. You've been very prophetic in warning the country year after year after year about the probability of these epidemics and pandemics coming from various places of the world quite apart from in this country. What would you suggest that this country should have done--let's go back, in its relations with China, its collaboration with specialists, epidemiologists, its treaties with countries--in order to have prevented this, detected it early, in this case, China, and prevented it? What kind of system should our country have put in place years ago, and what kind of resources should have been allocated. Because, this is going to happen again and again. This is not the last virus that's going to come from somewhere else.

Dr. Michael Osterholm: That's absolutely correct, and I think the best way for me to summarize this is in the book, Deadliest Enemies, that I wrote in 2017 [where] I laid out a battle plan, actually, for what we need to do, and it's extensive. But, the bottom line is that we can't prevent many of these infectious diseases from entering into the human race. It's going to happen. What we can do, though, however to stop them quickly, or at least more quickly than we have, and when we do stop them, we can then, also, for those individuals who will be at future risk, prevent that from happening again. What I mean by that is, for example, the tools we have; when we look at what we invest in military defense, what we invest in public health pales in comparison. Vaccine development, the idea that we knew that coronaviruses were going to be a problem again. In my 2017 book, the chapter on coronaviruses was entitled “SARS and MERS, a harbinger of things to come”. If we'd had creative imagination and said we need to invest heavily in platforms for the types of vaccines that could be used against coronaviruses, we would have been much further along in this situation.

We need to have a much more capable system for responding for testing so that we could pick up, very early, this virus and how can we elevate, quickly, the testing capability that we need to have, rather than almost piecemeal on a global basis. How do we communicate information? We do have a challenge today where countries, governments don't want bad news out, because it'll adversely impact them. What can we do to incentivize actually getting information out quickly? Stopping news is not just about being a good citizen, but you won't be punished financially.

There's a number of things I think that we can do for these acute big events. On the other hand, we have ones, and Ralph, you and I have talked about this before about antibiotic resistance, the idea that we're losing the gift that we've had for the last century of antibiotics because, as we use them, the bacteria, the viruses even, and the parasites mutate in a way that the antibiotic no longer kills them the way it once did. We're investing very little in that, yet we are very quickly sliding back into, almost, what I call a post-antibiotic era, much like the pre-antibiotic era.

I think part of it is the lack of creative imagination. People with the book that I wrote in 2017 would tell you I was a scare-mongerer, that I basically just did that as a horror movie. Now, hopefully, this event will be a wake-up call for modern public health, modern medicine, and modern world affairs to say, No, this is important, in many ways, as defense itself as we think about it from a military standpoint. The investments have to increase and we have to be able to have the tools that we need to respond quickly. Imagine if we were fighting a war today and we had Civil War muskets. Unfortunately, far too often, that's what we have in public health today.

Ralph Nader: Let's take what you just recommended to a level of international treaties. We have arms control treaties in the nuclear area; we have economic treaties, like the World Trade Organization. We even have some environmental treaties. Don't you think that we need to develop an international cooperative treaty system where we can provide adequate funds for what you're saying, the various nations? We can have interchange of epidemiologists. For example, more FDA inspectors in China. What would you favor here? Because, I think if we have different policy recommendations, the mechanism has to be some sort of international regime, international treaty in order to put all these parts in place, and so it isn't just a desperate catch-up when the outbreak occurs. Have you given any proposal to that, anybody in the public health area taken it to that level? Because, that's what usually gets more budgets, you see.

Dr. Michael Osterholm: You raise a very important point, and we do have the public health laws, in a sense, as through the World Health Organization, and how we are, as a world, supposed to act. A challenge we have is whether it's a treaty, or it's laws, or whatever, people can violate them if there are disincentives for them to comply. I think the challenge we have today is that we don't want to see a country penalized for discovering, uncovering, and disclosing a challenge that says, this could be everywhere around the world tomorrow. And that has been a major incentive for countries not to quickly identify something. The fact that the kitchen's on fire; I don't want the neighbors to know I have smoke in my house, so I'll just wait until the whole house is now on fire. I think that that is the issue. I'm not sure, as much, and I surely wouldn't minimize the treaty issue or that, but I think it's how do we, basically, protect countries who disclose, quickly, these problems, and allow for world resources to come in and help? I think it's a combination of all that.

Ralph Nader: Let's look at the World Health Organization [WHO]. I don't think many people realize how small its budget is compared to its responsibilities all over the world. It has a budget of about 4 to 5 billion dollars, which is basically what two large hospitals get in revenue in this country. And they have a focus, for example, on terrible epidemics in Africa. The Ebola epidemic was one; there was more than one. Then, there was a variant on a cholera epidemic that was even more lethal, and they actually worked with local efforts to head those off. But now they don't seem to be given the kind of resources, much less the authority that's needed. What's your view [on] Donald Trump has attacking the WHO, after he pushed for a cut in the U.S. contribution to the WHO? It does seem that you have The CDC has a budget, until recently, of $7 billion, and the WHO has this budget, 4 to 6 billion, and the Pentagon budget is $2 billion a day throughout the year. What kind of resources, and we want to focus on Congress getting back to work here because the money has to come from congressional appropriations. Before we get into the details of the present pandemic, what kind of overview would you have on this to head it off? Isn't it true that if China owned up to it publicly and, immediately, international cooperation kicked in, we probably would only have a fraction of this pandemic. Is that accurate?

Dr. Michael Osterholm: I'm not sure. I think that once a virus like this emerges, it's like a bullet being fired from the gun. Once the trigger has been pulled and executed, it's hard to stop it. At the same time, what we could have done is picked it up much quicker, and we could have had a much more comprehensive response. Even if we couldn't control it out of China, meaning it was eventually going to leak out, somehow, somewhere, our international opportunity to get vaccines out quickly and to protect people would have been substantially different if we'd had the tools you talked about. I think in your opening to this question, you made the case, as well as any person could, about the resource issue and how little we invest in this area and what we could do. Let me also say I have my challenges with the WHO. Our group came out and said on January 20th that this was going to be a coronavirus pandemic, and WHO didn't come out for weeks later to say that. While I have those challenges, I actually believe WHO is essential; it's critical. We need to have a strong international presence where when these events like this happen; we need to go back and reconstruct what happened, what could have been done better, and how does WHO need to change to be a modern international public health agency in the world. We need their air traffic control. If you look, the United States supplies a great deal of expertise to the WHO, as do other countries from around the world. You need to have that place where it's like an INTERPOL, almost, for infectious diseases where all this expertise can come together. I think it's a very short-sighted mistake to pull out of the WHO financially. I think it would be a real public health disaster if WHO was not strengthened as opposed to being weakened, and I think that there's just a lot more that we could do with the tool. I don't want to make this sound like it's a boondoggle, because everybody, at a time of a crisis, want to step up and get resources. I think, in this case, this is illustrating all the holes that we do have in the current system and what we could do to fix them, and this needs to be an international priority as we deal with this pandemic.

Ralph Nader: When we don't have this priority, trillions of dollars of economic activity crash in the United States, so it's easy to do a cost benefit analysis here. People who observe the WHO know that it is wary of offending foreign governments because it has to have entry. That's where it's wary, for example, of criticizing early China's belated publicity on what happened in Wuhan province. Do you believe that they have controlled it the way they have? If they had, it's quite an epidemiological success. The latest report is there is only one hospitalization for the Coronavirus in Wuhan city of 11 million. Do you believe that they have controlled it to that extent?

Dr. Michael Osterholm: I think they've done a remarkable job of driving this virus down, but they've not eliminated it. I would have to say that one of the things I'm concerned about right now is that we have full transparency with China. I will tell you right now, I think it's a problem. They have done through what, for lack of better term, we call the most draconian population limitation efforts any modern government has ever done for public health reasons. People were literally in their homes in the Wuhan area for weeks and weeks and weeks without being able to leave. They have facial recognition everywhere so they can track you, and if you turn up positive, they know every step you took in many locations in China. At the same time, we also, as you pointed, have very little activity recognizing the Wuhan area, but we see it in the other provinces right now, and we cannot understand how they can report 100 "asymptomatic infections" every day and then only one or two clinical cases. That makes no sense whatsoever. I think there is more going on there, but more importantly, when this virus decides to do what it's going to do, humans can only have some impact on that. Remember in 1918, and this is just an example, we had spring waves that adversely affected Chicago and New York in a big way, lots of illnesses and doubts. Hardly impacted Boston, Philadelphia, Baltimore, Washington D.C., or even here in the Midwest, Detroit and Minneapolis, very little activity; then it disappeared. Where did it go? It didn't go away because of human activity. It went away because whatever it does, it does, and then it came back with a vengeance in the fall of 1918, and we don't know where it was, why it came back and did what it did, and then communities that had no activity in the spring suddenly, were in very dire trouble in the fall. Even now, in China, I don't know how much of this is due to what the Chinese did and how much of it is due to what Mother Nature herself is doing. It also means if it goes away, it surely can come back, and we talked about this before. Until we get 60 to 70 percent of U.S. population infected and develop some sense of immunity, or we get a vaccine that accomplishes that same kind of herd immunity protection, this is like gravity; it's going to keep happening. We're going to see virus transmission, whether it's in China. Look at Singapore, another example of a country that was touted as having the ideal kind of control measures; now they're in a national state of emergency because of transmission. I think it's too early to say that they have successfully handled it in China, but what they did do to reduce Wuhan clearly was a remarkable effort that I'm not sure could be done in many countries of the world.

Ralph Nader: Let's talk about vaccine. There's a report in the New York Times that Oxford University is ahead of the pack in trying to develop a vaccine, and they may be ready in early fall, which is about a year earlier than predictions. Tell us about the probability of a vaccine working and safe. And also are there intermediate remedies short of a vaccine that can diminish the severity of this virus that patients are afflicted?

Dr. Michael Osterholm: Obviously, vaccine is the Holy Grail. That's what we need and want. That would be ideal, but what do we want in that vaccine? We want it to be effective, and by effective we mean it surely keeps us from getting infected and also it protects us for a long period of time. And we want it to be safe. The challenge we have right now with these vaccines is that, with coronaviruses in general, we've not had good luck in finding vaccines that induce long-term immunity. And this is just from our work with MERS and SARS, and other coronavirus infections like that. So while we surely may be able to induce short-term immunity, which I think is obvious from clinical disease, you recover. Also, there's several studies using macaque monkeys where animals were challenged with the virus, then allowed to recover, and then challenged again, and they were protected, meaning the previous infection of the macaques protected them. There's one study, in fact, using a vaccine that was administered from Oxford here in the study in the United States in monkeys that suggested, again, it provided an immunity shortly after the vaccination took place. The problem is we don't know how long this lasts, and we don't know how good it is. There's this one like influenza where, while it's a different mechanism, you'd have to get vaccinated every year for this kind of situation. We just don't know; so that's the number one thing. I think we can find a vaccine that will give us short-term protection. The challenge will be long term. The second thing is safety, and I do think we have some challenges here yet in the work that was done with SARS. There was a condition called antibody- dependent enhancement. ADE is a situation where if you make a little bit of antibody from the vaccine, it's not enough to be protective. When you do get infected, the virus and the antibody interact in such ways, it causes the cascade in your immune system that goes out of control and actually is very damaging to the human to the point of actually killing them. This is what we had happen with the dengue vaccine several years ago in the Philippines where it was withdrawn from the market because people who had been vaccinated started developing this ADE position. We're going to have to study this. We need to know this, but we don't have an option here to study it for years and years and years. We're on virus time right now, and what we need to have has been what we have in the next 16 to 18 months. I think, from that standpoint, we'll probably not have all the data we want for safety. We will have data on short-term protection. We won't have data on long-term protection, and we'll put those vaccines into play, I think, if possible, and I think the Oxford one is surely one of the candidates. I still don't believe that it'll happen though, however, anytime soon, meaning that we're still 16 months earliest before we could get vaccine out there, 18 months maybe where you have it studied, you have it approved, you have it manufactured, you have it distributed, and you have it going into people. I think we're a ways from that yet.

Ralph Nader: What about intermediate treatments, short of vaccines? Anything there?

Dr. Michael Osterholm: Actually, there was news breaking today about one of the Gilead drugs, Remdesivir, which was one that has been touted. The NIH has some data today that they'll be releasing later suggesting that there were some benefits from it. On the other hand, another study from China today which was just released said there were none. So, we'll have to wait and see. This is one of the challenges of dealing with a disease like this is that everybody wants the answers right now, and while we're doing a great deal to get them, I must say, this has been an incredible experience in terms of the number of clinical trials that were set up very quickly in a comprehensive manner. And so I'm optimistic we're going to get answers soon. But, again, as I said a moment ago, we're in virus time, not human time, and that makes it really tough to get this work done to have a meaningful impact. If we have a big wave of disease coming in this fall, what we don't have available at that point is what our tools are going to be.

Ralph Nader: You've written quite a bit in the Washington Post, New York Times about testing, and you're quite skeptical in a very meticulous way about the accuracy of these tests, whether they’re serology tests or whether the other more prominent type tests. Could you summarize that for our listeners, because I must say, that provoked a lot of pessimism among people who read it, and they said, "Good heavens, you can't rely on this; there are so many ways that these tests can be inaccurate and misleading, false positives, false negatives." Could you clarify that for our listeners?

Dr. Michael Osterholm: Be happy to. There are actually three aspects to this, and I have an op ed in today's New York Times about this very issue. The first one is we just have a shortage of testing for what we call the PCR test [Polymerase chain reaction]. This is the one that detects the actual virus itself-- finding some of the genetic material in it. Everybody keeps promising all this testing. We hear this almost daily at the news briefings that occur. The challenge has been that we need reagents, chemicals that run the test. That's really important, and if we don't have those, you can't run the test. It's like a car without gasoline. The chemical that we take the swab and put it in, basically, to take the virus out of the swab to open it up, grab the RNA material for the virus if it's there, and then present that to the next level of the catalyst. If you don't have that chemical, you can't do anything. It's a car without gas. What happened was, in December, when Wuhan emerged, clearly, testing went up substantially in China, and the world's resources for these reagents, the manufacturing capacity and supply chains handled it with some difficulty, but they handled it. Once the whole world caught on fire with COVID, everybody wanted the test. Billions of people needed testing done, and we just overran our headlights with regards to reagent capability. What we've needed is, really, a national/international effort, almost a Marshall Plan to figure out how we're going to, with the private sector and public sectors coming together, actually make these reagents in a timely way. What can we do? That hasn't happened yet. What we kind of have happening right now is, again, everybody's out there trying to get the reagents for themselves and there are not nearly enough. So, that's a test that we need to have. We should be testing every person who is clinically ill that may have COVID infection every day on that day. That would help us tremendously. The second problem we have is the FDA in reacting to CDC's failure to get a test on the market that we needed and the outcry that occurred because of that decided, well, one of the ways to respond is we'll just open up the floodgates of anybody and everybody who can test, let's let them test. And there was no major oversight for these tests. It was more for the real-time PCR test, but not nearly enough, and on top of it, for the antibody test, all you had to was basically sign a sheet that says, "I can do this with this test," and with no evidence of how effective they were in terms of how they perform. And so these serology tests, in particular, the antibody tests, are now being used out there, and they're horrible. As described by a senior FDA official themselves last week, "They're crap." This has to change. FDA has to agree to assume its responsible position of, really, oversight, of making sure that any test that's on the market works and that people who are going to use it in the clinical labs, and the healthcare settings know how well it works. The last piece is just when you use a screening test, and this is true for any condition, not just COVID infection that is occurring in a low, low level, the test will give you a number of false positives, meaning that, right now, we estimate that, at best, 5 to 15 percent of the U.S. population has been previously infected with this virus, higher in the New York City Metropolitan Area. In many parts of the country, it's still 5%. If you run an antibody test today, which has a very high level of sensitivity and specificity, meaning that you can pick up true positives and you can pick up true negatives, and that's good; you still have as many people testing positive for this antibody that are not as you do actual people who test positive who are. If I tell you, you're positive, but you have one of two chance it's not real.

Ralph Nader: Given the exponential growth of this virus, people ask me, "Is it true that if what we did in March, lockdown, social distance, etcetera, we did in late January, it would have prevented 90% of the cases?" Is there any truth to that?

Dr. Michael Osterholm: No, I don't think so. We surely can slow it down. Our goal, as a public health community, should be to minimize severe disease and death, first and foremost. Second, just prevent infections, period. We know that there are certain people that are higher risks that are having adverse outcomes, generally speaking, older, underlying health conditions, etcetera. We should be trying to keep them protected. Once this virus is out, it's going to spread. It's a respiratory-transmitted virus that basically transmits through aerosols, these very fine particles that you and I put out just talking. If you were here right now in this room that I've been in talking to you for the last X minutes, you'd see my little aerosols floating all around. Best way to remember what an aerosol looks like, when you think about seeing sunlight come through the window in your house and you see this stuff floating in the light, you think, "Oh, my house is dusty," those are aerosols, and just talking produces them. One of the challenges is this is going to transmit, but we could do a lot more to hold it back by the kind of testing, contact tracing, follow-up that we could have done that we didn't do. And this is where I think some countries surely have done a good job, or a better job, at least. The challenge they have, even if we have a big wave of infection, like say in 1918, it's not clear how much we can really do, except be prepared for its impact. It's like an F5 hurricane. You can't miss it. It's going to be there, but you can do a lot to make your community more resilient when it happens and have prepared it beforehand so that the destruction is limited.

Ralph Nader: Some practical advice. Let's say a family in apartment, family of four or five were in the house and one person comes down with it. What exactly should they do? What equipment should they have? And talk about [pulse] oximeters and face masks. What should that family do to protect the rest of them? Because, in China, they took these people and sent them to like warehouses, and they immediately segregated them. They pulled them right out of their families, the reports say, but what do you recommend that people do and be prepared for?

Dr. Michael Osterholm: Well, first of all, what we have to do is get people tested early to know. If you have any signs and symptoms, be tested, and then isolate yourself from the rest of the family. The problem is, I have to be honest with you and say that may be far too late. We know that you're highly infectious two to three days before you get sick. If you've been with your family for that time period, you probably already exposed them. Then, what you have to do is shelter in place together, meaning that I shouldn't be out in public at all, for sure, and my family members shouldn't be because they, then, may become infected, and you wouldn't pick it up until they became clinically ill. But then they were infectious two days before they got clinically ill. The way to stop this is not just to identify cases and remove them. That's almost too late. That's what makes it such a challenge. It really is about once you have been infected and you've exposed others, they then have to wait out this time period to see if they're going to get clinically ill, and that's how we're going to limit transmission.

Ralph Nader: What about immunity after you get infected and recover?

Dr. Michael Osterholm: At this point, we believe there surely is short-term immunity that occurs. The question is will it be long term, and we don't know that. I think in the short term, I'd be confident that somebody's not going to be reinfected, but I can't say, six months from now, they'll still have that protection.

Ralph Nader: Thank you very much. I know you have a lot of other things on your mind.

Dr. Michael Osterholm: I just appreciate this. Unfortunately, I have. Okay, talk to you later. Thank you.

Ralph Nader: Thank you very much, Mike.

Dr. Michael Osterholm: Have a good one, Ralph. Good bye, guys.

Steve Skrovan: We've been speaking with Dr. Michael Osterholm, who has a weekly podcast, the Osterholm Update, COVID-19. We will link to that at RalphNaderRadioHour.com. Now, we're going to take a short break. When we return, we will talk about what this global pandemic has done to our educational system. First, let's check in with our corporate crime reporter, Russell Mokhiber.

by **admin** » Fri May 15, 2020 4:40 am

Coronavirus may never go away, World Health Organization warns
by bbc.com
14 May 2020

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

There are more than 100 potential vaccines currently in development

The coronavirus "may never go away", the World Health Organization (WHO) has warned.

Speaking at a briefing on Wednesday, WHO emergencies director Dr Mike Ryan warned against trying to predict when the virus would disappear.

He added that even if a vaccine is found, controlling the virus will require a "massive effort".

Almost 300,000 people worldwide are reported to have died with coronavirus, and more than 4.3m cases recorded.

The UN meanwhile warned the pandemic was causing widespread distress and mental ill health - particularly in countries where there's a lack of investment in mental healthcare.

The UN urged governments to make mental health considerations part of their overall response.

What did WHO say?

"It is important to put this on the table: this virus may become just another endemic virus in our communities, and this virus may never go away," Dr Ryan told the virtual press conference from Geneva.

"HIV has not gone away - but we have come to terms with the virus."

Dr Ryan then said he doesn't believe "anyone can predict when this disease will disappear".

There are currently more than 100 potential vaccines in development - but Dr Ryan noted there are other illnesses, such as measles, that still haven't been eliminated despite there being vaccines for them.

WHO Director-General Tedros Adhanom Ghebreyesus stressed it was still possible to control the virus, with effort.

"The trajectory is in our hands, and it's everybody's business, and we should all contribute to stop this pandemic," he said.

WHO epidemiologist Maria van Kerkhove also told the briefing: "We need to get into the mindset that it is going to take some time to come out of this pandemic."

Their stark remarks come as several countries began to gradually ease lockdown measures, and leaders consider the issue of how and when to reopen their economies.

Dr Tedros warned that there was no guaranteed way of easing restrictions without triggering a second wave of infections.

"Many countries would like to get out of the different measures," the WHO boss said. "But our recommendation is still the alert at any country should be at the highest level possible."

Dr Ryan added: "There is some magical thinking going on that lockdowns work perfectly and that unlocking lockdowns will go great. Both are fraught with dangers."

by **admin** » Mon May 18, 2020 2:39 am

Trump’s covid-19 inaction killed Americans. Here’s a counter that shows how many.
by Eugene Jarecki
5/13/20

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

(This editorial first appeared in The Washington Post.)

The National Debt Clock hangs above New York City’s Avenue of the Americas as a persistent reminder of a clear message: The United States is recklessly living beyond its means, and this will have grave future consequences. In the same symbolic spirit, it is time for the establishment of a national “death clock” to measure the cost in human lives of President Trump and his team’s reckless handling of the coronavirus pandemic.

Reports show that as early as January, the president was advised by both his own experts and the intelligence services of the need for urgent mitigation measures against the spread of the virus. Instead, he engaged in petty political feuds and pollyannish predictions minimizing its significance. Finally, on March 16, he reversed his previously dismissive stance and announced “new guidelines for every American to follow.”

But by then it was too late; The United States was already the world leader in its rate of covid-19 infection and has since become home to one-third of the world’s cases and five times as many as any other country.

Trump Death Clock, Times Square NYC

Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, has stated that, had the guidelines been implemented earlier, a crucial period in the exponential spread of the virus would have been mitigated and American lives saved. Leading epidemiologists have put a finer point on this, estimating that 50 to 80 percent of covid-19 deaths in New York and approximately 90 percent of all American covid-19 deaths can now be attributed to the administration’s delay between March 2 and 16.
This suffering cannot be forgotten. As of today, tens of thousands of Americans have lost their lives as a consequence of the administration’s failure to act sooner, so it’s no wonder the president excoriates reporters who ask him why he waited so long to implement the guidelines. Trump’s fallback when he is under scrutiny is to deflect, attack, and distract. But will this work when his decisions have led to a loss of American lives? How will the President be held responsible?

It’s all in the branding, that stuff Trump himself does so well when he applies derisive nicknames to his rivals or attaches the name of a foreign power to a global pandemic. Accountability needs a brand, and the National Debt Clock is a helpful precedent. It demonstrates how to plant a symbolic flag in the numbers — one that can’t be knocked over by bluster or misleading campaign videos. This pandemic is ongoing, and the lives already unnecessarily lost demand we seek more responsible crisis leadership. Just as the names of fallen soldiers are etched on memorials to remind us of the cost of war, quantifying the lives lost to the president’s delayed coronavirus response would serve a vital public function.

Trump Death Clock, Times Square NYC

Trump’s career is built on finding shortcuts. Against the virus, there are none.

Designing a death clock must be based on mathematical models. Trump and his defenders may wish to assign blame to other countries, individuals, and institutions. His detractors, on the other hand, may wish to assess the consequences of his statements, decisions, and actions earlier than March. But a death clock must not reflect conjecture and needs to exist outside the news cycle, identifying only that portion of deaths which, according to experts, have resulted directly from the president and his team’s delayed response.

Conservatively, according to epidemiologists, had the Trump administration simply implemented mitigation guidelines by March 9, approximately 60 percent of American covid-19 deaths could have been avoided.

To let the numbers speak for themselves, my team and I have constructed an online counter at TrumpDeathClock.com, estimating the toll of the White House’s delayed response. The site displays both the number of people who have died in the country from covid-19 and an estimate of that portion whose lives would have been saved had the president and his administration acted just one week earlier.

What a powerful statement it would be if this clock could be displayed on billboards and projected on buildings in cities and small towns across America. This would begin to honor those who lost their lives and, in their memory, demand more responsive and responsible leadership.

by **admin** » Mon May 18, 2020 2:55 am

Fauci admits earlier Covid-19 mitigation efforts would have saved more American lives
by Devan Cole
CNN
Updated 2:55 PM ET, Sun April 12, 2020

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

Washington (CNN)Dr. Anthony Fauci said Sunday that calls to implement life-saving social distancing measures faced "a lot of pushback" early in the US coronavirus outbreak and that the country is now looking for ways to more effectively respond to the virus should it rebound in the fall.

"I mean, obviously, you could logically say that if you had a process that was ongoing and you started mitigation earlier, you could have saved lives," Fauci, the nation's top infectious disease expert, told CNN's Jake Tapper on "State of the Union" when asked if social distancing and stay-at-home measures could have prevented deaths had they been put in place in February, instead of mid-March.

"Obviously, no one is going to deny that. But what goes into those decisions is complicated," added Fauci, who is a key member of the Trump administration's coronavirus task force. "But you're right, I mean, obviously, if we had right from the very beginning shut everything down, it may have been a little bit different. But there was a lot of pushback about shutting things down back then."

Asked why the President didn't recommend social distancing guidelines until mid-March -- about three weeks after the nation's top health experts recommended they be put in place -- Fauci said, "You know, Jake, as I have said many times, we look at it from a pure health standpoint. We make a recommendation. Often, the recommendation is taken. Sometimes it's not. But we -- it is what it is. We are where we are right now."

The comments from Fauci come a day after a report from The New York Times detailed the Trump administration's missteps in the early days of the pandemic and how President Donald Trump ignored his advisers' warnings of the potentially deadly disease.

An administration official separately confirmed to CNN that the government's top public health experts agreed in the third week of February on the need to begin moving away from a containment strategy and toward a mitigation strategy that would involve strong social distancing measures. The agreement among the health officials came after they held a tabletop exercise to game out the potential for a full-blown pandemic.

According to the Times report, Dr. Robert Kadlec, the top disaster response official at the Department of Health and Human Services, convened the White House coronavirus task force on February 21. During his meeting, the group conducted a mock-up exercise of the pandemic that predicted 110 million infections, 7.7 million hospitalizations and 586,000 deaths.

The group "concluded they would soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation's economy and the daily lives of millions of Americans," but it took more than three weeks for Trump to enact such guidelines on March 16.

Fauci told Tapper that "there is always a possibility, as we get into next fall and the beginning of early winter that we could see a rebound," in the virus, but the lessons learned from the first iteration of it should help the US better respond to a potential new wave.

"Hopefully, hopefully, what we have gone through now and the capability that we have for much, much better testing capability, much, much better surveillance capability, and the ability to respond with countermeasures, with drugs that work, that it will be an entirely different ball game," he said.

'Not going to be a light switch'

With health experts and some elected officials saying the US is starting to see the effectiveness of social distancing measures put in place last month, Americans are wondering when the country can begin to ease up on the guidance.

Fauci said Sunday that the process of returning to normal "is not going to be a light switch that we say, 'OK, it is now June, July' ... click -- the light switch goes back on."

He added: "It's going to be depending where you are in the country, the nature of the outbreak that you have already experienced and the threat of an outbreak that you may not have experienced. So it's going to have to look at the situation in different parts of the country."

Asked by Tapper when he thought that process could start, Fauci said he thinks "it could probably start at least in some ways maybe next month," but noted that it's "difficult" to make those types of predictions and officials are trying to open the country "appropriately."

Trump said Saturday night that he hopes to make a decision "fairly soon" on when to reopen the country amid the coronavirus pandemic, telling Fox News' Jeanine Pirro, "We have to bring our country back. So, I'll be making a decision reasonably soon, we're setting up a council now of some of the most distinguished leaders in virtually every field -- including politics, and business and medical -- and we'll be making that decision fairly soon."

But as Trump leans in to his desire to reopen the nation's economy by May 1, America's governors and mayors, who hold the power to enforce closures and who have often taken a far more aggressive posture on protecting public health, stand in his way.

An ominous warning

The director of the Institute for Health Metrics and Evaluation said Sunday that if the social distancing measures and closures were relaxed on May 1, the country would see a rebound of coronavirus cases.

"We don't think the capability in the states exists yet to deal with that volume of cases and so by July or August we could be back in the same situation we are in now" if there was premature opening of the country, Dr. Christopher Murray said on CBS, adding that West Coast states that are further along in the pandemic will still need "weeks of closures" beyond the peak for the opportunity to conduct proper testing and contact tracing.

Relaxing closures and social distancing measures on a rolling basis, he said, poses a new set of questions that have not been addressed.

"Of course there's a big issue of states are on different timings of their epidemics, which we know is the case. How are they going to control importation from other states into their state?" Murray said.

The inconsistent state mitigation policies have also been a problem for the modeling of the pandemic, according to Murray, who said that "incomplete implementation of social distancing closures in many states (is) adding a degree of uncertainty."

The World Health Organization special envoy, Dr. David Nabarro, went a step further in an interview with NBC on Sunday, issuing an ominous warning about coronavirus, which has already infected more than 1,827,000 people worldwide.

"We're not so sure that it will come in waves in the way that influenza does," he said. "We think it's going to be a virus that stalks the human race for quite a long time to come until we can all have a vaccine that will protect us and that there will be small outbreaks that will emerge sporadically and they will break through our defenses."

Nabarro said it will be "key" for countries to "pick up cases as soon as they appear, isolate them and stop outbreaks from developing."

There are more than 530,000 confirmed cases of coronavirus in the US, and more than 20,600 Americans have died, according to a tally from Johns Hopkins University.

This story has been updated with additional developments Sunday.

CNN's Kevin Bohn, Maeve Reston, Maegan Vazquez, Jason Hoffman, Kristen Holmes, Jeremy Diamond and Wes Bruer contributed to this report.

by **admin** » Mon May 18, 2020 3:15 am

He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus: An examination reveals the president was warned about the potential for a pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response.
by Eric Lipton, David E. Sanger, Maggie Haberman, Michael D. Shear, Mark Mazzetti and Julian E. Barnes
New York Times
Published April 11, 2020
Updated May 4, 2020

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

WASHINGTON — “Any way you cut it, this is going to be bad,” a senior medical adviser at the Department of Veterans Affairs, Dr. Carter Mecher, wrote on the night of Jan. 28, in an email to a group of public health experts scattered around the government and universities. “The projected size of the outbreak already seems hard to believe.”

A week after the first coronavirus case had been identified in the United States, and six long weeks before President Trump finally took aggressive action to confront the danger the nation was facing — a pandemic that is now forecast to take tens of thousands of American lives — Dr. Mecher was urging the upper ranks of the nation’s public health bureaucracy to wake up and prepare for the possibility of far more drastic action.

“You guys made fun of me screaming to close the schools,” he wrote to the group, which called itself “Red Dawn,” an inside joke based on the 1984 movie about a band of Americans trying to save the country after a foreign invasion. “Now I’m screaming, close the colleges and universities.”

His was hardly a lone voice. Throughout January, as Mr. Trump repeatedly played down the seriousness of the virus and focused on other issues, an array of figures inside his government — from top White House advisers to experts deep in the cabinet departments and intelligence agencies — identified the threat, sounded alarms and made clear the need for aggressive action.

The president, though, was slow to absorb the scale of the risk and to act accordingly, focusing instead on controlling the message, protecting gains in the economy and batting away warnings from senior officials. It was a problem, he said, that had come out of nowhere and could not have been foreseen.

Even after Mr. Trump took his first concrete action at the end of January — limiting travel from China — public health often had to compete with economic and political considerations in internal debates, slowing the path toward belated decisions to seek more money from Congress, obtain necessary supplies, address shortfalls in testing and ultimately move to keep much of the nation at home.

Unfolding as it did in the wake of his impeachment by the House and in the midst of his Senate trial, Mr. Trump’s response was colored by his suspicion of and disdain for what he viewed as the “Deep State” — the very people in his government whose expertise and long experience might have guided him more quickly toward steps that would slow the virus, and likely save lives.

Decision-making was also complicated by a long-running dispute inside the administration over how to deal with China. The virus at first took a back seat to a desire not to upset Beijing during trade talks, but later the impulse to score points against Beijing left the world’s two leading powers further divided as they confronted one of the first truly global threats of the 21st century.

The shortcomings of Mr. Trump’s performance have played out with remarkable transparency as part of his daily effort to dominate television screens and the national conversation.

But dozens of interviews with current and former officials and a review of emails and other records revealed many previously unreported details and a fuller picture of the roots and extent of his halting response as the deadly virus spread:

The National Security Council office responsible for tracking pandemics received intelligence reports in early January predicting the spread of the virus to the United States, and within weeks was raising options like keeping Americans home from work and shutting down cities the size of Chicago. Mr. Trump would avoid such steps until March.

Despite Mr. Trump’s denial weeks later, he was told at the time about a Jan. 29 memo produced by his trade adviser, Peter Navarro, laying out in striking detail the potential risks of a coronavirus pandemic: as many as half a million deaths and trillions of dollars in economic losses.

The health and human services secretary, Alex M. Azar II, directly warned Mr. Trump of the possibility of a pandemic during a call on Jan. 30, the second warning he delivered to the president about the virus in two weeks. The president, who was on Air Force One while traveling for appearances in the Midwest, responded that Mr. Azar was being alarmist.

Mr. Azar publicly announced in February that the government was establishing a “surveillance” system in five American cities to measure the spread of the virus and enable experts to project the next hot spots. It was delayed for weeks. The slow start of that plan, on top of the well-documented failures to develop the nation’s testing capacity, left administration officials with almost no insight into how rapidly the virus was spreading. “We were flying the plane with no instruments,” one official said.

By the third week in February, the administration’s top public health experts concluded they should recommend to Mr. Trump a new approach that would include warning the American people of the risks and urging steps like social distancing and staying home from work. But the White House focused instead on messaging and crucial additional weeks went by before their views were reluctantly accepted by the president — time when the virus spread largely unimpeded.

When Mr. Trump finally agreed in mid-March to recommend social distancing across the country, effectively bringing much of the economy to a halt, he seemed shellshocked and deflated to some of his closest associates. One described him as “subdued” and “baffled” by how the crisis had played out. An economy that he had wagered his re-election on was suddenly in shambles.

He only regained his swagger, the associate said, from conducting his daily White House briefings, at which he often seeks to rewrite the history of the past several months. He declared at one point that he “felt it was a pandemic long before it was called a pandemic,” and insisted at another that he had to be a “cheerleader for the country,” as if that explained why he failed to prepare the public for what was coming.

Mr. Trump’s allies and some administration officials say the criticism has been unfair. The Chinese government misled other governments, they say. And they insist that the president was either not getting proper information, or the people around him weren’t conveying the urgency of the threat. In some cases, they argue, the specific officials he was hearing from had been discredited in his eyes, but once the right information got to him through other channels, he made the right calls.

“While the media and Democrats refused to seriously acknowledge this virus in January and February, President Trump took bold action to protect Americans and unleash the full power of the federal government to curb the spread of the virus, expand testing capacities and expedite vaccine development even when we had no true idea the level of transmission or asymptomatic spread,” said Judd Deere, a White House spokesman.

There were key turning points along the way, opportunities for Mr. Trump to get ahead of the virus rather than just chase it. There were internal debates that presented him with stark choices, and moments when he could have chosen to ask deeper questions and learn more. How he handled them may shape his re-election campaign. They will certainly shape his legacy.

The Containment Illusion

By the last week of February, it was clear to the administration’s public health team that schools and businesses in hot spots would have to close. But in the turbulence of the Trump White House, it took three more weeks to persuade the president that failure to act quickly to control the spread of the virus would have dire consequences.

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