Stockpile

Finally seeing relatively positive trends on Portugal's big COVID-19 dashboard. It's not the end of things, but it is at least a good sign.

However, from the US, three mind-boggling stories concerning the Strategic National Stockpile (SNS) ...

First, is a story from the New York Times about how medical device companies undercut the nation's plan to create a fleet of ventilators. Super-frustrating to learn that thirteen years ago, the US government established BARDA, and one of its first projects was an effort to add seventy thousand new, cheaper ventilators to the SNS. But that program was unable to deliver due to mergers and market forces. After the first contract was finally abandoned, another contract was signed in 2014, but no new ventilators have been built. It sounds like the 16,600 ventilators that are (were) in the SNS are older units, and reports from hospitals receiving those devices indicate that they are in need of some specialized repair.

So – ventilators. We planned to build new devices thirteen years ago, and should have a substantial reserve, except company A bought company B, and company B, who already manufactured a more expensive ventilator, asked for and got more money, then later said they couldn't fulfill the contract, so company C was contracted for even more money five years ago, and we're still waiting on them. Thirteen years.

Next is a story, reported on CNN, about the US sending almost eighteen tons of medical supplies, including personal protective equipment, to China in early February. In the story, there is a link to State Department press release indicating the shipment included exactly the kinds of materials that are in critical supply now:

This week the State Department has facilitated the transportation of nearly 17.8 tons of donated medical supplies to the Chinese people, including masks, gowns, gauze, respirators, and other vital materials.

This was almost three weeks after the first cases of COVID-19 were identified in Washington state, and two days after several senators requested emergency funding. Concerned about the implications, Senator Chris Murphy (D-CT) tweeted:

Just left the Administration briefing on Coronavirus. Bottom line: they aren't taking this seriously enough. 

Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now. 

During a briefing on Sunday, Trump claimed cases would peak by Easter, Jim Watson/AFP, Getty Images

In response, the Trump Administration launched a campaign to label this effort by the Democratic legislators as a 'hoax' being used to discredit him during an election year. We had literally tons of PPE but spent hundreds of millions of dollars sending a large part of our SNS to China in early February. Soon after, President Trump then turned around and labelled the SAR-CoV-2 a 'Chinese virus'. But last Friday, Trump had a phone call with President Xi, and now we're best friends again.

Today, in another 'whiplash' move, and after a bizarre weekend news conference in which he seemed to accuse health care workers of stealing PPE, the US extended social-distancing guidelines to the end of April.

Finally, Greg Burel, who retired in January as the Director of the SNS said something staggering with a throw-away line in this interview on CBS This Morning:

 [I]n response to the 2009 H1N1 pandemic, the stockpile deployed nearly twenty million pieces of personal protective equipment and eighty-five million N95 masks.

'We didn't receive funds to replace those masks, protective gear, and the anti-virals that we used for H1N1.'

So – PPE. Three weeks after the US reported its first confirmed case on January 20, we shipped eighteen tons worth of the material from the SNS overseas. Eighteen tons.

And a decade ago, after we were hit by the 'swine flu pandemic', we never re-stocked the SNS. A decade.

President Trump claims that he's 'not a shipping clerk', but that's exactly what the nation needs right now. It's a lesson in logistics that is so heartbreakingly obvious, and that we should have learned years ago. Kafka himself could not have written a more wretched existential fiction.

How did we arrive here?

I started this on a positive note; I'll try to end on one, too. I just finished reading This Is Chance!, by John Mooallem, which is featured in the 99-Percent Invisible podcast. It's the story of radio-broadcaster Genie Chance, and her determined conduct during the 1964 Alaska Earthquake. Mooallem describes how the quake struck on Good Friday, nine point two on the Richter scale, and how Ms. Chance broadcast for fifty-nine hours over Easter weekend to steady her shattered city. It's a lesson in logistics during a time of immense chaos. While we're social distancing, it's great to hear these words from the author:

What is safety, anyway? Genie seemed to be conceding that there is only randomness, only chance, and if everything beyond us is chance, maybe the only force we have to survive a world like that is connection. By then, it must’ve seemed so obvious to her. It’s a good idea to hold on to each other.

I'll go ahead and cast Reese Witherspoon in my movie adaptation.

Today, the world is nearing a three quarters of a million cases of COVID-19, with over thirty-five thousand deaths. The US reports almost one hundred and fifty thousand cases, and over a twenty-five hundred deaths. Portugal reports over sixty-four hundred cases and one hundred and forty deaths.

cases: 737,670 global • 144,060 USA • 6,408 Portugal

deaths: 35,071 global • 2,573 USA • 140 Portugal

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UPDATE: File under 'Could Be Raining', this story just gets worse –  Taxpayers Paid Millions to Design a Low-Cost Ventilator for a Pandemic. Instead, the Company Is Selling Versions of It Overseas.

Worse Than the Disease

WH Coronavirus Task Force Briefing, March 20, NBC News

During the weekend President Trump tweets, in all-caps:

WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!

Throughout the course of this pandemic, the White House’s 'tone' shifts back and forth. The tweet launches another shift and a campaign, presaged and echoed by right-wing media and politicians, to plant the idea that the country must quickly 're-open' again to prevent further economic damage:

Easter’s a very special day for me. Wouldn’t it be great to have all the churches full? You’ll have packed churches all over our country … I think it’ll be a beautiful time.

So, is the cure worse than the disease? Let's hear from a patient – Kat Powers:

Here’s a weird side effect you may notice, between the headaches and the sore throat. Your pee will smell disgusting. Like you drank sewage or something. The rest of you might start to smell too, but soon enough you won’t care. Or you'll lose all smell. 

I’ve been watching my super-healthy kids deal with this. All 5’11 of one of my kids curled up in a ball from the body aches and wracked with coughs. No one could watch that and think “meh, it’s like the flu.”

So that’s the mild form of the disease: she did not go to the hospital, she was not placed on a ventilator, she did not even got tested. The descriptions remind me of reading The Hot Zone; they turn me inside out.

Let's hear from ER doctors – at Elmhurst Hospital, Queens (embedded 'guerilla' video by Dr. Colleen Smith):

Today is kind of getting worse and worse. We had to get a refrigerated truck to store the bodies of patients who are dying. We are right now scrambling to try to get a few additional ventilators or even CPAP machines. If we could get CPAP machines we could free up ventilators for patients who need them.

Leaders in various offices from the President to the Head of Health and Hospitals saying things like 'we're going to be fine, everything's fine.' And from our perspective, everything is not fine. I don't have the support that I need, and even just the materials that I need physically to take care of my patients. And it's America. And we're supposed supposed to be a first world country.

The refrigerated truck got me – devastating and sobering.

Last year, the Global Health Security Index published a report ranking the US at the top of a list of one hundred and ninety-five countries, with a score of 83.5 out of 100. President Trump cited this report in a press conference in February. And yet, nurses in New York city are wearing garbage bags after running out of disposable gowns. If we have this amazing score, and we are so prepared, why's it all going pear-shaped?

Here in Portugal, the government is extending the state of emergency past Easter, to April 16th.

Today, the world is nearing a half million cases of COVID-19, with well over twenty thousand deaths. The US reports almost seventy thousand cases and over a thousand deaths. Portugal reports over thirty-five hundred cases and sixty deaths.

cases: 491,276 global • 69,219 USA • 3,544 Portugal

deaths: 22,165 global • 1,054 USA • 60 Portugal

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UPDATE [10:30PM GMT]: The US passes China and Italy and now has the most total confirmed cases of COVID-19 in the world (82,547 vs 81,285 vs 80,589); the world total passes half a million (509,427). Things seem to be really accelerating now.

An excellent essay describing how COVID-19 may be affecting the political situation in the Monongahela Valley, near where I grew up.

Legacy

President's Trump briefing notes, March 19; "Corona Virus" changed to "Chinese Virus", Jabin Botsford, Washington Post

I am having a nightmare: I am taking care of a large, old house, and there is a water leak. The house is slightly reminiscent of a house my parents owned years ago, but it's as big as a hangar. Water is pouring down throughout the ceiling of the bathroom, and I really have to go. There are two maintenance workers helping me. They keep joking and chatting away, but they are trying to find the source of the leak while keeping the water inside tiled floor with towels. I run upstairs to the bathroom above the one being flooded, the toilet there is running; it's constantly flushing. The room is shockingly bright. As I approach the toilet, I am yelling down to the workers about what I've found. I really have to go. I move to open the tank, and suddenly, there are small, round, hairy, grey bugs all over my hands. I try to squash them, but they spring right back to life. They aren't doing anything, just crawling around my hands. I look down, and there is a white mouse on its back, a dead lab mouse covered with the same bugs. I wake.

It's dark and dry. I really have to go. I collect myself and realize I have a sore throat, too.

Of course, images of the coronavirus floating in my brain have flooded my dreams. I'm sure they have for many people. It's about five in the morning, and there's no way I'm getting back to sleep. After finishing in the bathroom, and thoroughly washing my hands, I go to the kitchen to gargle with salt water. I move to the living room, grab the iPad, and find this video at the top of my 'Recommended' list – How Inadequate Funding Slowed Coronavirus Vaccine Research:

It's an excerpt from a House hearing of the Committee on Science, Space, and Technology. It's the testimony of this medical researcher from Baylor University, Dr. Peter Hotez. He describes how we had a vaccine for coronavirus in the works, and might have been better prepared for this pandemic if there had been funding for clinical trials:

The bottom line is had we had those investments early on to carry this through to clinical trials years ago. We could've had a vaccine ready to go. So we've got to figure out what the ecosystem is going to be to develop vaccines that are not going to make money.

My mind explodes. And then my heart breaks. I think of doctors and researchers involved in these kinds of communicable diseases – they know. They know that these drugs and vaccines can be developed, but they aren't. That the world could be in a much different place if our heath economy is geared to make medicine and not money. I consider how their hearts must all be breaking, too.

The full hearing video is below for context – Coronaviruses: Understanding the Spread of Infectious Diseases and Mobilizing Innovative Solutions:

Dr. Hotez is, of course, right – it's the ecosystem. 'Eco', in this case, is short for both ecologic and well as economic. The hearing drives home the idea that we can make room in our system for innovation and mobilization, we just don't. This is a pandemic-sized teachable moment. What will we take from it and how will it impact our health system so future generations have better tools?

I think back to my father, a medical researcher focused on motor-neuron diseases like ALS. He was diagnosed with Parkinson's Disease on his sixtieth birthday. As he struggled and lost more and more abilities, he rushed to finish a series of projects that he intended to leave as a legacy. One major project was the translation of a book, from German, of a text by a Japanese doctor, on The Foundation of the Public Health System in Formosa (Taiwan). Its author, Dr. Tomoe Takaki, described how the Japanese intended to create a 'model system' on Formosa as a showcase for the world. Dr. Takaki passed this to a protege, Dr. To So-mei, who passed it to his protege, my father.

Amazingly, that system in Taiwan is now hard at work containing and mitigating the spread of SARS-CoV-2 on Taiwan with startling effect. The reason the video of Dr. Hotez popped into my 'Recommended' list is that I watched this video yesterday – Taiwan's COVID-19 Response Should Be A Model For The World:

We finished the translation of the book on June 18, 2016; that's the date on the PDF file. It was his eighty-sixth birthday. He passed away two years later.

Back in the day, while I was still in high school, I remember helping my father in his lab at West Virginia University. We had white rabbits that we would expose and euthanize. We had to remove the leg muscle, treat the sample, freeze it, slice it, and prep it for the scanning electron microscope. My father landed in West Virginia after he protested Martial Law and helped establish the Taiwan independence movement. He became stateless when he was blacklisted by the Kuomintang. But he was allowed to stay in the US after successfully lobbying Congressman Harley Staggers, who said he was "an important health scientist indispensable to West Virginia". He accepted a position at WVU and established a research lab there.

I think of those memories every time I hear another story with President Trump's race-baiting, calling SARS-CoV-2 a 'Chinese virus'. I wonder what researchers like Dr. David Ho, another Taiwanese-American, and his team at Columbia University think. They are leading the effort to create and test a vaccine to fight this pandemic. Click on this Bloomberg article and you'll see their names: Huang, Iketani, Chavez, Hong.

After a hot cup of coffee and some yogurt and granola for breakfast, my throat is feeling better. I cannot account for the soreness; maybe it's allergies. I realize, while writing, that I feel fine now.

Today, the world is nearing three hundred thousand cases, and twelve thousand deaths. There are over twenty thousand cases of COVID-19 in the US and nearly three hundred deaths. In Portugal there are over one thousand cases and six deaths. On Taiwan, there are over one hundred and fifty cases and two deaths.

cases: 278,472 global • 20,227 USA • 1,020 Portugal • 153 Taiwan

deaths: 11,554 global • 279 USA • 6 Portugal • 2 Taiwan

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Read the story of how the Ebola vaccine was produced.
Read an opinion piece on the sinophobia surrounding COVID-19.

Pandemic

 

So, what's going on in Lisbon these days? The streets and parks are empty. And, if you do go to the store or post office, the lines are being metered; only a few people inside at a time. The above image is from the Centro Commercial Alvalade, our neighborhood retail center; the queue is for the Pingo Doce, our local grocery. As you can see, there is social distancing at work, as folks stay about a meter apart. Some folks seem to have painters dust masks; another lady is covering her face with a scarf. If folks think this is helpful, maybe it's only to stop them touching their faces; the WHO stays it's not.

I have two texts on my phone from the ProCIV, the Portuguese civil authority. As you can see, I have a text from last September (Friday the 13th) regarding the rural fires, and one from yesterday about COVID-19, after announcing a national alert last week (also, Friday the 13th), and closing schools nation-wide. The text links a web site where the Direção-Geral da Saude (national health authority) keeps a kind of dashboard.

COVID19: Wash hands frequently. Avoid social contact. Prevent contagion. Follow official recommendations. Info http://covid19.min-saude.pt www.prociv.pt ANEPC-DGS

It's reassuring to know the (Portuguese) government is actively and consistently communicating on SARS-CoV-2 pandemic. Plus, I love a good dashboard. Today, the government is meeting to consider a national emergency declaration.

So what are we doing? Staying at home. I'm cleaning the apartment - a lot. Donna is baking. We signed up for our free AppleTV+ subscription as well as britbox. And we're watching YouTube coverage of the pandemic.

We can still take walks in the park, Jardim Mário Soares, across the street, though the restaurant, the fitness center, the boat rental place all appear to be shut. The McDonald's in the park is open, but seems to be offering only drive-through and delivery (a half dozen Glovo and UberEats scooter drivers are always one standby in the turnout). It’s a bad time to introduce the Atlanta Touchdown burger.

Wearing a scarf over your face while shopping in Portugal may seem silly, but it's nowhere near the shocking levels of stupid we've seen on YouTube in the US. Young people flocking to beaches in Florida for Spring Break, putting an aging population at higher risk - filling stores, cafes, ride-shares. The Governor does not shut this down, though some local authorities impose an 11:00pm curfew. WTF. Good luck to you, lady (Tricia Wood) - read the YouTube comments only if your brain can handle it. These people aren't just fiddling while Rome burns, they are spilling gas all over town. And the politicians are asking them if they wouldn’t mind keeping it down.

    

This guy trolling the spring-breakers in a tyvek suit and respirator is my new hero.

Just for being among the sane, I feel like the James Cole character in the Terry Gilliam movie 12 Monkeys suffering the Cassandra Complex:

Cassandra, in Greek legend you'll recall, is condemned to know the future but to be disbelieved when she foretold it. Hence, the agony of foreknowledge combined with the impotence to do anything about it.

The other ironic head-scratcher concerns the Trump Administration's apparent plan to deal with the spread of the virus and its economic impact. After waffling for weeks, the President's team has finally offered a stimulus package that apparently includes sending thousand dollar checks out to US citizens, in addition to last week's promise to work with health insurance companies to eliminate costs for testing and care. Suddenly those two scary, socialist Democratic campaign ideas that Republicans freaked out about, 'Medicare for All' and 'Universal Basic Income', seem awfully useful.

By today, world-wide, there are over two-hundred thousand confirmed cases of COVID-19, and over eight thousand deaths. There are over sixty-five hundred cases in the US with over one hundred deaths; there are over six hundred cases in Portugal, with two deaths. If we were still in Berkeley, we'd be under a shelter-in-place order. In a way, we are doing the same here in Lisbon. In another way, we are so lucky to have retired early last year and moved from the US.

I still receive messages from a listserv for techies serving private schools in the Bay Area, and they are scrambling to remotely support teachers and classes. I keep thinking of the advantages that private schools have over public schools in the US, particularly in terms of preparation, technology, and other resources. And my old school has a program in place to support hybrid and online learning, so they are be in better shape than most private schools. They are throwing these programs together, last-minute, with little training or support, and with parents trying to work from home. Folks are rightly concerned about the health and financial impacts, but the impact in education is also going to be felt for a long time. I'm glad I don't have to deal with it, for sure, but my thoughts are with those who do.

cases: 204,700 global • 6,539 USA • 642 Portugal

deaths: 8,270 global • 116 USA • 2 Portugal

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Read this to understand the nature of the disease and it's treatment.
Read this to understand the costs associated with COVID-19 treatment in the US.