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The Club PUBlication  04/27/2020

4/27/2020

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​U.S. sent millions of face masks to              China early this year 
ignoring pandemic warning signs U.S. government reversed course in April after previously encouraging shipments. 


By Juliet Eilperin , Jeff Stein , Desmond Butler and Tom Hamburger, 
Washington Post​
APRIL 18, 2020 — 10:45PM
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Masks on a rack at Regions Hospital where 3M N95 masks will be sterilized by a Xenex robot utilizing ultraviolet light at Regions Hospital Wednesday, April 15 2020, in St. Paul, MN. When the process is up and running next week 200 masks
U.S. manufacturers shipped millions of dollars of face masks and other protective medical equipment to China in January and February with encouragement from the federal government, a Washington Post review of economic data and internal government documents has found. The move underscores the Trump administration’s failure to recognize and prepare for the growing pandemic threat.

In those two months, the value of protective masks and related items exported from the United States to China grew more than 1,000 percent compared with the same time last year — from $1.4 million to about $17.6 million, according to a Post analysis of customs categories which, according to research by Public Citizen, contain key PPE. Similarly, shipments of ventilators and protective garments jumped by triple digits.

“Instead of taking steps to prepare, they ignored the advice of one expert after another,” said Rep. Lloyd Doggett, D-Texas. “People right now, as we speak, are dying because there have been inadequate supplies of PPE.”

While the percentage increase of exports to China was steep, they represent a small fraction of the overall U.S. need. Throughout the country, the shortage has forced hospitals, nursing homes and first responders to ration masks and other protective gear as they treat infected and high-risk patients, creating a secondary health crisis among first line providers.

In the early days of the COVID-19’s exponential march across the globe, when it was still mostly contained in China, there was no widespread sense of crisis in the White House. But by the end of January, briefings to White House national security staff made clear that the danger of a major pandemic was real. By then seven Americans had fallen ill, and experts said the need for an adequate supply of protective gear should have been apparent.
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Nonetheless, on Jan. 30, Commerce Secretary Wilbur Ross said on Fox Business that the outbreak could “accelerate the return of jobs to North America” because companies would move factories away from impacted areas.

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Kristen Davis, LPN, left, undergoes fit-testing for an N95 mask by Rebekka Haney, LPN, at a training session presented by the Virginia Department of Health's Medical Reserve Corps in Fredericksburg, Va. on Tuesday, April 14, 2020. Volunteers trained health care providers how to perform the tests so they in turn can fit their colleagues.
On Feb. 26 — when total deaths had reached 2,770, nearly all in China — the Commerce Department published a flier titled “CS China COVID Procurement Service,” guiding American firms on how to sell “critical medical products” to China and Hong Kong through Beijing’s fast-tracked sales process. Doggett obtained the flier and other Commerce communications.
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On March 3, a commercial officer in the U.S. Embassy in Beijing notified colleagues about the “new service” Commerce was offering, according to an e-mail.
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“The CS China healthcare team has been busy working with Chinese government procurement agents and U.S. companies to address local healthcare needs. We created the China and Hong Kong COVID Procurement Service — please find the flier attached. We welcome you to send this flier to relevant U.S. manufacturers and suppliers.”

A senior Commerce official, speaking on the condition of anonymity due to the sensitivity of the matter, said senior leaders at the department’s International Trade Administration shut the program down on March 4, shortly after the flier was distributed.

“Department of Commerce senior leadership is aware of this issue and is investigating,” the official said, adding that the ITA has helped 100 groups and 47 states distribute protective equipment since the outbreak began and continues to work in 25 countries to identify sources of medical supplies.

Still, Doggett was incredulous that masks desperately sought today by U.S. medical providers were provided to China by U.S. companies in large numbers through February.

“This is one of multiple failures that have contributed to a significant loss of life in the United States,” Doggett said. “At the very time that Trump is having his first news conference with his coronavirus team, his administration is hawking the vital medical supplies under the title, ‘Covid-19 to China.’ “

Preliminary data from the Centers for Disease Control show that 9,282 U.S. health-care workers have been diagnosed with the virus through April 2. Through April 9, at least 723 had been hospitalized, including 184 in the ICU. Twenty-seven had died from a COVID-19 infection.

A leading producer of masks — 3M, the St. Paul, Minnesota-based manufacturing giant — made a share of this equipment at factories in the United States as well as in plants located in China.

“We were not aware of any discouragement from anyone during those very early days of the crisis, including from the U.S. government, to export from outside of China into China,” said 3M spokeswoman Jennifer Ehrlich. On the contrary, through February some administration officials were calling attention to China’s plight and encouraging assistance from the United States.

Today, China’s imports of masks and other PPE from around the world is seen by some White House officials as part of a deliberate attempt by China to corner the market as it concealed and downplayed the danger posed by the outbreak.

“While China was silent on the seriousness of the crisis, they were quietly buying up a large portion of the world’s global supply for masks and other PPE,” said Peter Navarro, who directs trade policy at the White House.

Navarro was among the U.S. officials who raised early alarms, writing memos early in the year that the outbreak could imperil millions of Americans and required increased supplies of protective equipment.

Desperate officials in Illinois reported last week that N95 masks, which typically cost $1.75 apiece, are being sold for as much as $12 each as states frantically bid against one another.

On April 2, the U.S. government reversed course completely when President Donald Trump announced his administration would invoke the Defense Production Act in a way that could have prevented 3M from selling masks to foreign customers, requiring the company to provide them to U.S. customers first. “We hit 3m hard today after seeing what they were doing with their masks,” Trump tweeted, as he announced plans to invoke the Defense Production Act “against 3m.”

The president’s push encountered immediate resistance from Canada, other U.S. allies, and 3M, whose CEO called Trump’s complaint “absurd” and warned of “consequences on a humanitarian level” if the company did not fulfill orders to other countries.

Upset that the president was antagonizing trading partners in a way that could hamper supplies of critical equipment coming to the United States, foreign leaders and U.S. companies used a White House back channel, appealing to members of a task force reporting to Trump’s son-in-law and senior adviser Jared Kushner. The backdoor approach was successful: Trump reversed course three days later and announced an “amicable” agreement: 3M could continue providing masks to foreign customers, while ramping up domestic production. Despite the president’s caustic remarks about 3M, a senior White House official had praise for that company and another U.S. manufacturer of masks — Honeywell — for quickly agreeing to step up domestic mask production and distribution.

N95 masks derive their name from the fact that they filter at least 95 percent of airborne particles. Known as respirators, the N95 masks used in hospital settings differ from those used at industrial sites, and are subject to different federal regulatory requirements. It took weeks for the administration to clear the use of the industrial masks for health care purposes, and then additional delay occurred when the industry demanded Congress approve legislation shielding it from liability lawsuits.

Health and Human Services Assistant Secretary Robert Kadlec testified in February that the U.S. would need 3.5 billion N95s in a serious pandemic.
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Early in the outbreak response, according to the Department of Health and Human Services, the Strategic National Stockpile had approximately 13 million N95 respirators available to distribute to U.S. health care workers, and they have now given away 90 percent of them.

Nicole Lurie, who served as Assistant Secretary of HHS for preparedness and response in the Obama administration, said the White House “could have acted much earlier to alleviate the mask shortage by completing work on a high-speed mask production line and placing orders early to manufacturers to surge production.”

Data from both the U.S. and China capture the scope of the influx of protective face masks to the world’s most populous country during January and February. In those two months, China’s trade data show imports of a category of goods which includes surgical and N95 masks jumped nearly 2,200 percent over a year earlier.
China produces about half of the world’s masks, but in those two months, the country transformed from a minor mask buyer to the world’s single biggest importer. While it did not report separate January and February totals this year, other countries’ data obtained via Trade Data Monitor shows they exported far more mask-related equipment to China in February, when deaths and cases in that country peaked. Among its biggest suppliers were South Korea, Japan and the United States.

The Chinese government’s customs arm estimates it cleared nearly 2.5 billion pieces of epidemic-related equipment between Jan. 24 and Feb. 29, including just over a billion masks and more than 25 million protective suits. On Feb. 24 alone, Chinese customs cleared nearly 43 million face masks. A separate analysis by Public Citizen, a left leaning, group, also found a spike in U.S. exports of protective gear to China.

America now faces acute and deadly shortages of proper medical equipment. A recent survey found nearly 90 percent of American mayors say they do not have enough test kits or face masks, while 85 percent say they do not have enough ventilators. The Office of the Inspector General at HHS found “severe shortages” of testing kits and personal protective equipment. Numerous hospitals and states have reported that nurses and doctors are forced to resort to makeshift gear that increases the odds of exposure.

Ehrlich, the 3M spokesperson, said her firm adjusted its supply chain earlier this year based on what it had learned from prior virus outbreaks.

“Nearly all of the respirators 3M produces in China are for the China market. Given the severe humanitarian need there, however, and as a company with a global supply chain, we also directed some additional production into China,” she said.

Chinese officials undertook several measures to ensure that the protective equipment stayed within the country, Ehrlich added. The municipal government of Shanghai informed 3M in late January it “was requiring additional supervision and control of certain 3M facilities in China” to help control the spread of the coronavirus there, she said.

“As a result of that action, the Municipal Government of Shanghai authorities assumed responsibility for order handling and product delivery of 3M respirators in Shanghai at this time,” Ehrlich said. “This impacted 3M China’s ability to respond to product orders in the normal course.”

Navarro said the major factor restraining the U.S. response was the fact that the Chinese government had not permitted American scientists into Wuhan, and the World Health Organization had delayed labeling the crisis a pandemic.

“America and the world lost a full six weeks of preparation to the CCP’s deadly silence, a time during which the Wuhan virus might well have been put quickly back into its lethal bottle,” he said, referring to the Chinese Communist Party.

In a March 31 media conference, China’s director of the Foreign Ministry Information Department Hua Chunying rejected the idea that her country was hoarding protective equipment.

“China’s fight against COVID-19 isn’t over yet,” she said. “We are under heavy pressure to guard against imported cases and a rebound in indigenous cases, and so there is a huge demand for medical supplies. It is the government’s top priority to prevent and control the epidemic at home and safeguard people’s health.”

Hua added that China has provided 120 countries and four international organizations with surgical masks and other forms of equipment.

The Chinese Foreign Ministry declined to answer questions about its mask production and distribution, instead referring to its previous public remarks.

With local governments and hospitals appealing to members of Congress for help securing protective equipment, Congress authorized a special commission last month that will review the international supply chain and its effect on domestic health security.
​

“This is now on the top of our list of concerns,” said Rep. Lauren Underwood, D-Ill., a nurse and public health expert, who co-sponsored the legislation. In an interview this week, she described fielding calls about a lack of protective equipments. “We cannot accept a situation that effectively makes our health professionals expendable,” she said. “It is unacceptable.”
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The Club PUBlication  04/27/2020

4/27/2020

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Social distancing could last months, White House coronavirus coordinator says​
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By Felicia Sonmez , Paige Winfield Cunningham and Meryl Kornfield 
Washington Post
APRIL 27, 2020 — 5:02AM
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White House coronavirus response coordinator Dr. Deborah Birx, seen on Friday, April 24, said in an interview on Sunday on NBC News’ “Meet the Press” that “social distancing will be with us through the summer.”
WASHINGTON – Some form of social distancing will probably remain in place through the summer, Deborah Birx, the White House’s coronavirus task force coordinator, said Sunday — the same day several governors expressed optimism about the course of the virus and outlined their plans for a piecemeal reopening of their economies.
It was the latest instance of conflicting signals coming not just from state and federal leaders but also from within the Trump administration amid a coronavirus pandemic that so far has claimed the lives of more than 54,000 Americans. Last week, Vice President Mike Pence predicted that “we will largely have this coronavirus epidemic behind us” by Memorial Day weekend in late May.
But on Sunday, Birx said in an interview on NBC News’ “Meet the Press” that “social distancing will be with us through the summer to really ensure that we protect one another as we move through these phases.” She cited the need for further testing to be developed after a potential scientific “breakthrough.”
The mixed messages come as Americans are entering a confusing and uncertain new phase in the coronavirus crisis. After weeks of being told to simply stay home to halt the spread of the virus, individuals and business owners are now facing more complex decisions about how to proceed in the absence of clear guidance from their leaders.
In places where restaurant dining rooms are reopening, is it safe to go? Is it a good idea to return to the hair salon for a much-needed trim? And for business owners facing a litany of new guidelines about how to reopen without endangering their workers or customers, are the risks worth it?
Emily Landon, chief infectious-disease epidemiologist at University of Chicago Medicine, said those calculations are tricky for people in states that are beginning to reopen because of the continued lack of widespread testing and the inability to effectively track people who might have been infected.
“It’s hard for me to know what I’d do” in one of the states where governors have announced that spas and salons are able to reopen, Landon said. “I wouldn’t go. And I wouldn’t recommend that my family went. I would recommend that people stay home.”
Landon said that in her view, it’s still not safe for states to fully reopen — or for Americans to try to resume their lives as they were before the pandemic hit.
“This is a brand-new virus, and we have to do these things in a measured way,” she said. “Without requirements for things like personal protective equipment, social distancing and really thoughtful policies for how to do these openings, it’s not the time to do them.”
In its broad guidelines for states to follow as they begin a phased reopening, the White House earlier this month recommended that a number of criteria, such as increasing capacity for testing and contact tracing, should be met before proceeding.
Across the country, however, some states are already relaxing their social distancing restrictions amid pressure from protesters, business groups and others.
On Sunday, several governors defended their decision to do so, arguing that their states’ closures have successfully achieved their goal of building hospital capacity, acquiring personal protective equipment and reducing the spread of the pandemic’s growth.
“The facts in our state are: March 30, we peaked in hospitalizations, with 560 across the state,” Oklahoma Gov. Kevin Stitt, a Republican, said on “Fox News Sunday.” “Today we have 300 across the state in our hospitals. We think it’s time for a measured reopening.”
Stitt said that more than 55,000 Oklahomans have been tested and that the positive rate was 6.3%. He also noted that no one is obliged to reopen a business.
“I’m giving guidance. If a restaurant doesn’t feel like they’re ready to reopen,” he said, “they don’t have to.”
On CNN’s “State of the Union,” Colorado Gov. Jared Polis, a Democrat, also defended his decision to partially reopen his state, and maintained that he is focused on social distancing measures that are sustainable for the coming weeks and months.
“We’ve really been laser-focused on figuring out how we can endure and sustain these kinds of social distancing measures,” Polis said. “If we can’t succeed in doing that, the stay-at-home was for nothing.”
Polis said an apparent spike in coronavirus cases in Colorado was attributable to previous tests that were just confirmed and added to the total, and does not reflect the present situation.
The debate over reopening in the United States comes as another hard-hit country, Spain, allowed children under 14 to go outside for the first time in six weeks. The country, which has had more than 207,000 coronavirus cases and 23,190 deaths, has been in the midst one of Europe’s strictest lockdowns since last month.
British Prime Minister Boris Johnson, meanwhile, is set to return to work Monday after more than three weeks battling a coronavirus infection. Foreign Secretary Dominic Raab, who has been standing in for Johnson, told Sky News on Sunday that the prime minister is “raring to go.”
In the United States, the steps being taken toward reopening vary by state. In some places, such as Florida, beaches have reopened on a limited basis, with police urging visitors to keep moving and avoid congregating.
In Oklahoma, Stitt gave salons, barbers and pet groomers the green light to resume business late last week, and restaurants will be allowed to reopen their doors Friday.
In New York, Gov. Andrew Cuomo, a Democrat, said Sunday that construction and manufacturing businesses outside of the New York City region might be able to reopen after May 15, when the state’s stay-home order expires.
And in Georgia, businesses including bowling alleys, tattoo parlors, gyms and hair salons have already been allowed to reopen, with movie theaters and dine-in restaurants expected to follow suit Monday.
Georgia Gov. Brian Kemp, a Republican, has come under fire for the speed with which he has rolled back social distancing restrictions, and on Sunday, former Food and Drug Administration commissioner Scott Gottlieb said the state is opening up too early.
“Georgia is certainly jumping the gun, I think here, getting started too early relative to where they are in the epidemic,” Gottlieb said on CBS News’ “Face the Nation.”
Asked whether he thinks states such as Georgia and Oklahoma are reopening too quickly, Maryland Gov. Larry Hogan, chairman of the National Governors Association, said that he was “going to be very cautious” in making decisions about his own state but declined to criticize other governors.
“Certain states are in different points of the curve, and they’ve got different situations on the ground, and I don’t want to second guess my colleagues in different states,” Hogan, a Republican, said on ABC News’ “This Week.”
While Pence and President Donald Trump have in recent weeks voiced optimism about the speed with which they expect the country to be able to reopen, Birx and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have voiced caution.
On “Meet the Press” on Sunday, Birx was asked about Pence’s remark to a Cleveland radio station last week that “if you look at the trends today, that I think by Memorial Day weekend we will largely have this coronavirus epidemic behind us.”
She appeared to contradict Pence’s comment, projecting that social distancing will continue through the summer, and said the country needs to have a “breakthrough” in testing for antigens - molecules or molecular structures that trigger an immune response - to get on track toward normalcy.
After a torrent of criticism sparked by his suggestion at Thursday’s coronavirus task force briefing that injecting disinfectants into the human body might help fight the coronavirus, Trump did not appear in public over the weekend. On Saturday night, he questioned in a tweet whether the task force briefings were worth his time, declaring, “They get record ratings, & the American people get nothing but Fake News.”
On Sunday, his wife, Melania Trump’s 50th birthday, the president continued to tweet angrily about the media, lashing out at reporters who he said “have received Noble Prizes for their work on Russia, Russia, Russia, only to have been proven totally wrong.”
Trump appears to have misspelled the Nobel Prize, though journalists recognized for their coverage of the Russia investigation received a different prize, the Pulitzer.
He later deleted the tweets and then tweeted that he was being sarcastic, writing: “Does anybody get the meaning of what a so-called Noble (not Nobel) Prize is, especially as it pertains to Reporters and Journalists? Noble is defined as, ‘having or showing fine personal qualities or high moral principles and ideals.’ Does sarcasm ever work?”
Despite Trump’s efforts to change the topic, Democrats continued to hammer him for his remarks about disinfectants as a possible cure for the virus.
“You know what they call that? They call that embalming,” House Speaker Nancy Pelosi, D-Calif., said on CNN’s “State of the Union.” “That’s the medical term.”
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The Club PUBlication  04/13/2020

4/13/2020

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​Returning to normal is too dangerous to contemplate It's clear premature re-openings could be a historic mistake resulting in an explosion of infections, hospitalizations and deaths. 

By Nicholas Kristof and Stuart A. Thompson
MARCH 27, 2020 — 5:55PM

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Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, listens to President Donald Trump speak about the coronavirus during a news conference March 26.

​President Donald Trump says he wants the United States “raring to go” in 2 ½ weeks, on Easter, with “packed churches all over our country.” He and many other political conservatives suggest that we are responding to something like the flu with remedies that may be more devastating than the disease.

We created a model with epidemiologists to show that returning to normal quickly could be a historic mistake that would lead to an explosion of infections, hospitalizations and deaths.

Instead, health experts advise giving current business closures and social distancing a month to slow the pandemic, buying time to roll out mass testing and equip doctors with protective equipment. Then, depending on where we are, we can think about easing up — while prepared for a new burst of infections that will then require a new clampdown.

“Anyone advising the end of social distancing now needs to fully understand what the country will look like if we do that,” cautioned Dr. Tom Inglesby, a health security expert at Johns Hopkins University. “COVID would spread widely, rapidly, terribly, and could kill potentially millions in the year ahead, with huge social and economic impact.”

Social distancing may delay an outbreak more than prevent it, but it is beneficial in two ways.

First, we can use the time to buttress hospitals and test treatments. Second, interventions can flatten the curve and spread infections over a longer time so that the health care system does not become overwhelmed.

Whatever we do, the pain of both disease and business and school closures may be enormous. During the Great Depression, the jobless rate reached 25%; today, the president of the Federal Reserve Bank of St. Louis, James Bullard, warns that it might reach 30%. People may lose their jobs, savings and homes; they will go without parties, weddings, funerals and graduations that give life connectedness and meaning.

But we know quite a bit about how to ease economic pain: We can send out checks to individuals, and we can incentivize companies to keep workers on the payrolls. Both steps are part of legislation passed this week in Washington.

Some prominent conservatives have suggested that it is worth sacrificing some elderly people to keep the economy moving. “I’d rather die than kill the country,” Glenn Beck told viewers.

But that view reflects two fallacies. First, the fundamental force damaging the economy is not the rule book on social distancing but rather an out-of-control virus, and the best way to protect the economy is to rein in the pandemic. Second, while these critics speak nobly about sacrificing themselves, the policies they advocate would more likely lead to the deaths of many other people who are older and in poorer shape.

It is a false choice to say that we must accept the deaths of senior citizens to keep small businesses going. And any easing of social distancing should be based on data.

Dr. Larry Brilliant, an epidemiologist who is a veteran of the eradication of smallpox and now chairman of an organization called Ending Pandemics, warned that if Trump sends everyone back to work by Easter, “I think history would judge it an error of epic proportions.”

Brilliant said that the entire country probably does not need to be shut down but that we need widespread testing to determine which areas are at risk and which are not. We also desperately need blood testing to determine who has had the disease and is now immune.

If COVID-19 is as fearsome as some believe, our model suggests a grim possibility: It may be that the only way to control it sustainably is with an economic pause too long to be politically sustainable. In that case, we may be headed for a year of alternating periods of easing and tightening economic activity, with the pandemic rising whenever we ease and subsiding whenever we tighten.

Dr. David Fisman, a University of Toronto epidemiologist who helped us build this model, suggests that for the next year we may have to tighten social distancing whenever intensive care unit capacity is stretched, and then loosen it when the situation improves. “This gives the economy and the population ‘breaks’ so that people can breathe and businesses can operate,” Fisman said.

There are some hopeful signs that social distancing and business closures can turn the tide, and not just in South Korea and Singapore. In Italy, confirmed new cases have started to drop. And the number of positive test results conducted by the University of Washington, in hard-hit Seattle has stabilized.

Trump seems to be pushing for a relaxation of restrictions partly based on his repeated comparisons of COVID-19 to the flu, warning that “we cannot let the cure be worse than the problem itself.” Meanwhile, Fox News medical correspondent Dr. Marc Siegel scoffed this month about the coronavirus: “Worst-case scenario, it could be the flu.”

Modeling the virus underscores why epidemiologists emphasize that this is not the flu and why we should not expect a return to normal within weeks.

One gauge of a virus is how contagious it is. The flu has an infectiousness measure (or R0) of only about 1.5, meaning that each sick person infects on average 1.5 others. In contrast, COVID-19 without social distancing appears to have an R0 of perhaps 2.5.

A second gauge of a virus is how often infected people must be hospitalized. With the seasonal flu that’s roughly 1%; with the coronavirus, estimates range from 5% to 20%.

A higher R0 and higher hospitalization rate conspire to wreak havoc. A single person with the flu can result in the infections of 386 other people over two months, and a handful would be hospitalized. But in that same period one COVID-19 patient could lead to the infections of 99,000 people, of whom nearly 20,000 might need to be hospitalized.

A third measure is lethality, the “case fatality rate,” or percentage of people who contract an illness who eventually die of it. For the flu, this is about 0.1%. For COVID-19, there are enormous uncertainties but even in optimal circumstances it may be 10 times greater, roughly 1% — although it has been much higher than that in countries like Italy with older populations and overburdened hospitals.

We asked Dr. Tara Smith, an epidemiologist at Kent State University, what she would advise a bride and groom whose long-planned wedding is imminent, especially if they can’t afford to reschedule. “They should think about putting other people at risk,” she said, “and what would they think if there was an outbreak because of something happy like a wedding.”

These are not questions we wrestle with each flu season.

We’re living through an extraordinary time, forced to make difficult trade-offs with uncertain information — and one lesson of past pandemics is that early “knowledge” of diseases is often wrong. Yet another lesson of history is the value of responding to pandemics early and firmly. In the 1918 flu pandemic, cities like St. Louis that acted decisively saved many lives. In this crisis, parts of the world like South Korea and Taiwan that acted resolutely have managed far better than those that were more relaxed, like Italy, Iran and the United States.

That’s why epidemiologists and public health experts warn against relaxing too soon. Dr. Peter Hotez, a global health expert at Baylor College of Medicine, calls for maintaining controls for at least another month and then reassessing.
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Life is about making difficult decisions in the context of uncertainty, and we hope our model will help you appreciate the trade-offs — and the significance of sustained efforts for social distancing not only by the president but also by each of us in our own lives.
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The Club PUBlication  04/06/2020

4/6/2020

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By Cynthia Weiss
​How does COVID-19 affect the heart?

April 3, 2020
MAYO CLINIC
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​2 main cardiac issues

According to Dr. Cooper, there are two dominant cardiac issues related to COVID-19: heart failure, when the heart muscle doesn't pump blood as well as it should, and arrhythmias, or abnormal heart rhythms, that can be related to the infection or to the effect of medications used to treat the virus.

Heart failure can develop due to a systemic inflammatory response to the infection, high lung pressures from lung damage, or occur from heart inflammation known as myocarditis.

"For many people who present with heart failure in the context of COVID-19 infection, we don't know if the heart failure is related to myocarditis or to a response to systemic inflammation from COVID-19," says Dr. Cooper. 
​
For older patients, with existing coronary artery disease or hypertension, it is likely heart failure resulting from the increased demand placed on the heart and the body’s already decreased cardiac reserve capacity, he says. In younger patients, it's likely primary myocarditis caused by the virus. 


Watch: Dr. Cooper discusses how COVID-19 can affect the heart.

Medication concerns 
There has been some debate as to whether medications used to support blood pressure may increase a person's risk for heart failure. 

“It is unclear if medicines used to support blood pressure are actually leading to some of the deterioration in heart function,” says Dr. Cooper. “But right now, there is no evidence that the commonly used medications for any cardiovascular disorders in the United States will put you at heightened risk of contracting COVID19 or the consequences of infection.”

Dr. Cooper advises people to continue their medications, unless their physician has directed them otherwise.

Long-term heart health issues
Since COVID-19 is new, there is little data available regarding long-term cardiovascular issues as a result of the virus. Research has already begun at Mayo Clinic, says Dr. Cooper. 
"We need to determine the long-term effects of COVID-19 at both a population health level and individual level," says Dr. Cooper, adding funding from the American Heart Association and National Institutes of Health is spearheading research related to COVID-19's cardiovascular impact.


Staying heart-healthy
"We know this is a stressful time for everyone because of the economic and social impact of this disease, even if you don't have it yourself," says Dr. Cooper. "And that can put people at heightened risk for all sorts of stress-related illnesses." 

For those with known heart issues – whether high blood pressure or other disease – stay focused on good heart health practices. "Taking care of yourself, being vigilant with hand hygiene, trying to maintain an exercise regimen if you had been before, eating well, are key to maintaining health," he says. 

He adds that while we're also being instructed to avoid large group gatherings and maintain social distancing, build in time to stay connected – which will keep your heart emotionally healthy. "Maintaining social contact through the internet or through the telephone is really important so we don't lose contact and become depressed or otherwise isolated." 

Be mindful of emergencies
"Shortness of breath is very common, and only a minority of people today will actually have COVID-19 infection who develop shortness of breath," says Dr. Cooper. "Now, as before, if people develop chest pain or shortness of breath, they should seek medical attention by calling their health care provider or, if it's severe, 911 for assistance."
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The Club PUBlication  04/03/2020  (Coronavirus - 4)

4/3/2020

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What to do to prevent getting sick / if you suspect you are / if you are

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Q: What should I do if I suspect COVID-19? 

A: According to reports from nearly 56,000 confirmed cases in China, people develop such symptoms as a dry cough, shortness of breath, sore throat, fever, body aches and extreme fatigue — symptoms that can overlap with those of the flu, cold or allergies.  Also, some people who have the coronavirus show no symptoms.
 Dr. Jeff Dichter,critical care physician at M Health Fairview, said if someone is experiencing shortness of breath, they should be seen because the virus can severely affect the lungs. Doctors say dehydration from vomiting or diarrhea, a severe headache and progressively worsening symptoms also are warning signs. The CDC and doctors also suggest extra caution for people with a chronic health problem, including those with heart disease, lung disease, diabetes, cancer or who are immune-compromised. One suggestion is to call your clinic to get advice on how to proceed.

Q: What should I do if I get sick?

A: The general advice is rest and drink plenty of fluids. Most people with mild cases get better in about two weeks. Severe cases may take three to six weeks to resolve. Doctors can give only supportive care, and there are no approved treatments.

Q: Should I be wearing a mask?

A: Infectious disease doctors, epidemiologists and officials from the Centers for Disease Control and Prevention are in agreement: If you are not sick, there is no reason to wear a mask. Common surgical masks won’t block the coronavirus, which is about 900 times smaller than the width of a human hair, once it is in the air. But they can block droplets from a sick person. There are specialized masks, such as N95 masks (because they filter out 95% of airborne particles), that are more effective, but they must be fitted and tested.


Q: Does the pneumonia vaccination help fend off pneumonialike symptoms with coronavirus?

A:
 While seniors are encouraged to get that vaccine, it won’t protect against the viral pneumonia associated with COVID-19.

Q: If you get the virus , are you immune? 

A: Researchers are still learning, but “there is some evidence that people can be infected more than once over subsequent years,” said Dr. Susan Kline at M Health Fairview. “But I don’t think we know yet.” 

Q: Can the coronavirus live on surfaces , for example in retail or food settings?


A: It is possible for the coronavirus to be on things that get touched frequently, such as door handles and elevator buttons. But the virus doesn’t last long on objects such as letters or packages, the World Health Organization said. As long as you wash your hands before touching your face, you should be OK, because viral droplets don’t pass through skin. Gary Whittaker, a professor of virology at Cornell University College of Veterinary Medicine, said using a simple disinfectant on a surface can break the delicate envelope that surrounds the tiny microbe, rendering it harmless. If a sick person handles food or it’s a high-traffic buffet, risks cannot be ruled out — but heating or reheating food should kill the virus, he said.

STAFF and WIRE REPORTS


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The Club PUBlication  04/02/2020  Coronavirus - (3)

4/1/2020

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Mayo researchers join quest for unprecedented vaccine

By CHRISTOPHER SNOWBECK 

THE RACE IS ON TO DEVELOP A VACCINE AGAINST THE NOVEL CORONAVIRUS
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Researchers in Seattle have launched a study to evaluate whether an experimental vaccine called mRNA-1273 could induce an immune response against COVID-19 in 45 volunteers. The National Institutes of Health is trying to develop the vaccine in 12 to 18 months, a much faster timeline than typical for vaccines, said Dr. Gregory Poland, chief of the Vaccine Research Group at the Mayo Clinic in Rochester.

​Mayo is among the centers launching studies, he said. “I don’t think it’s likely,” he said, “that one vaccine alone is going to meet all the different needs we have.”
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Massachusetts-based Moderna, Inc., is collaborating with the National Institute of Allergy and Infectious Diseases to develop the vaccine, currently in safety trials.

The technology represents a whole new approach to vaccines, said Marc Jenkins, director of the Center for Immunology at the University of Minnesota and an NIAID council member.

Older vaccines use a weakened or killed form of a virus to stimulate an immune system response that produces antibodies. The experimental vaccine uses viral RNA to prompt host cells to take up the genetic material and translate it into viral proteins, Jenkins said. The hope is that that will prompt a protective immune system response.

The approach is appealing because scientists can make viral RNA quickly, cheaply and with a high degree of purity, Jenkins said. He said some studies in animals have generated promising results.

“This is called an RNA vaccine. As far as I know, this would be the first of its kind,” he said.

Moderna completed its first clinical batch of vaccine in February and it was delivered to the NIH “just 42 days from sequence selection,” the company said.

“Finding a safe and effective vaccine to prevent infection … is an urgent public health priority,” said Dr. Anthony Fauci, director of NIAID . “This Phase 1 study, launched in record speed, is an important first step toward achieving that goal.”
One of the big questions going forward is whether the novel coronavirus can change its genetic material, Jenkins said. If it can, then the virus will be a tougher target for a vaccine to hit — much like the challenge with the flu vaccine, which every year has to match the circulating strain. There is some evidence that the coronavirus has a stable genome.

With other infections, scientists usually had more time to use the other tried-and-true strategies, Jenkins said. He added, “The ability to deliver RNA to people in a way that prevents its degradation and gets it into host cells in a form that can be translated into protein just didn’t exist before.”

Poland said he questioned whether the proposed timeline for developing the vaccine is too fast. The standard pathway is built to be data-informed and reflective, he said so that vaccines are safe and effective.

Vaccine development didn’t have to play out this way, Poland said. After a new coronavirus emerged in 2002 — severe acute respiratory syndrome — experimental vaccines were developed but not fully funded after SARS stopped spreading, he said.

“Humans have limited attention spans,” Poland said. “We were warned in 2002. … We were warned in 2009 with pandemic influenza. We were warned in 2014 with Ebola.”

“These novel viruses have and will continue to emerge. Vaccine research is not a spigot that you can productively turn on and off. When we don’t fund research into these things, look at what it’s costing us as a nation and around the globe.”


Christopher Snowbeck 
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