Saturday, April 04, 2020
"In states with many uninsured citizens, few hospitals and leaders who have not required citizens to stay home, a disaster is looming.
NASHVILLE — On March 22, when Nashville’s mayor John Cooper closed nonessential businesses here, it was a terrible blow to companies and shops still reeling from the tornado that tore through Middle Tennessee on Super Tuesday. Small businesses struggle in the best of times, and a one-two punch like that — a natural disaster followed by a lethal pandemic — will almost certainly force some of them to close for good.
But it had to be done. Nashville’s courts and schools were already closed, but the crowds on Lower Broadway, the heart of Nashville’s tourist district, showed no sign of dissipating. “Downtown Nashville is undefeated,” tweeted a visitor posting a video of music fans crowded onto a dance floor. Even after the Nashville Board of Health voted unanimously to shut the honky-tonks down, several bar owners said they would not comply unless ordered to do so by the governor of Tennessee.
Such orders have been slow in coming here, and in nearly every other state in the American South. Tennessee governor Bill Lee was slow to end the legislative session and send members of the Tennessee General Assembly home to their districts, slow to close public schools, slow to suspend church services, slow to shutter restaurants and gyms.
Many city charters in Tennessee prevent local leaders from issuing their own orders, and mayors begging for a statewide directive got none. Chaz Molder, mayor of Columbia, Tenn., urgently called on Mr. Lee to issue a statewide stay-at-home order: “One state, one response,” he wrote on Twitter. But in a conference call on March 16, Mr. Lee told local leaders around the state that mandates weren’t necessary to enforce social-distancing guidelines: “We’re not issuing orders, we’re issuing guidance and strong suggestions,” Mr. Lee said. “We don’t have to mandate people not do certain behavior because Tennesseans follow suggestions.”
As it turns out, they don’t. Last week I arrived to pick up a to-go order I’d paid for on the phone and that the owner had promised to put directly into the trunk of my car. But where I expected to find a deserted parking lot, it was business as usual on a sunny spring Saturday. Nashville has received hundreds of reports of similar violations.
Joelle Herr, owner of The Bookshop in East Nashville, which closed more than two weeks ago, wrote on Facebook about her “fury, despair and helplessness” at watching other businesses carry on as if nothing had changed. “It’s frustrating when you feel like you’re one of only a few doing the right thing (and at a great cost to my small business!) and those doing the wrong thing are the ones with the greater impact — an impact that is going to be devastating.”
On March 30, when Mr. Lee issued an executive order shutting down nonessential businesses, he stopped short of requiring Tennesseans to stay home. “It is deeply important that we protect personal liberties,” he said, ignoring tens of thousands of health professionals who argued that nothing less than a stay-at-home order would save this state from disaster. And not just this state.
Out of fear of what Tennessee’s delays might mean for their own populations, Fort Campbell, a U.S. Army base that straddles the Tennessee-Kentucky border, restricted travel to Nashville. And Andy Beshear, the Democratic governor of Kentucky, urged his citizens not to enter Tennessee: “We have taken very aggressive steps to try to stop or limit the spread of the coronavirus to try to protect our people,” Mr. Beshear said. “But our neighbors from the south, in many instances, are not. If you ultimately go down over that border and go to a restaurant or something that’s not open in Kentucky, what you do is you bring the coronavirus back here.”
Kentucky, which not only elected a Democratic governor but also expanded Medicaid under the Affordable Care Act, is an outlier in the South. Most Southern states, like Tennessee, did not expand Medicaid, and in those states a perfect storm has gathered force. What does it mean to live though a pandemic in a place with a high number of uninsured citizens, where many counties don’t have a single hospital, and where the governor delayed requiring folks to stay home? Across the South, we are about to find out.
Finally, on April 2, Mr. Lee acknowledged epidemiological reality and issued a stay-at-home order. The rest of the red-state governors will also capitulate to reality before this is all over. But the time for decisive action has long since passed, and their delays, like the president’s, will end up costing thousands of lives.
Viruses are not partisan. Science itself is not partisan. Nevertheless, Covid-19 has become a partisan issue here in the South because our governors have followed the lead of both the president, who spent crucial early weeks denying the severity of the crisis, and Fox News, which downplayed concerns about the pandemic as Democratic hysteria. That’s why every governor who has issued a deeply belated shelter-in-place order is a Republican.
In that March 16 conference call with mayors and county leaders around Tennessee, Mr. Lee offered some advice: “I want to encourage you to pray. I want you to pray for your citizens that are affected by economic downturns, by the sickness sweeping through the state. I want you to know that you’re being prayed for as leaders in your community that you will have wisdom and discernment.”
I, too, pray for my fellow Tennesseans. I pray for the success of researchers racing for a vaccine. I pray for the safety of every medical team working to save lives. But I also pray for our leaders to lead, to put the safety of their citizens far, far above partisan pandering. And when the entire medical community — people who are putting their very lives on the line for us — are begging for help, the answer isn’t prayer alone. It’s also action."
Opinion | In the American South, a Perfect Storm Is Gathering - The New York Times
To help stop coronavirus, everyone should be wearing face masks. The science is clear | Jeremy Howard | Opinion | The Guardian
To help stop coronavirus, everyone should be wearing face masks. The science is clear
A woman wearing a face mask stands on the Charles Bridge in Prague. Mask use went from 0% to nearly 100% in three days after a social media and influencer campaign. Photograph: Michal Čížek/AFP via Getty Images
You might walk into stores over the next few days and sicken dozens without knowing it. Some might die. Others will think they are dying before they recover.
The list of presidential failures is long and varied. But when it comes to failure in the face of an external force — a natural disaster or an economic meltdown — it is difficult to find anything as catastrophic as President Trump’s handling of the coronavirus outbreak, even at this early stage of the crisis.
There are moments that come close. There was President James Buchanan’s indifference to the secession crisis of 1860. Other than to give a speech — clarifying his view that secession was an extra-constitutional action — the outgoing president did little but watch as most of the South left the Union in the wake of Abraham Lincoln’s election.
There was President Herbert Hoover’s response to the 1929 stock market crash and subsequent Great Depression. He urged calm — “The fundamental business of the country, that is production and distribution of commodities is on a sound and prosperous basis” — encouraged volunteer action and pressured employers to keep wages up. But he wasn’t intellectually or politically equipped to go further — “We cannot legislate ourselves out of a world economic depression, we can and will work ourselves out” — and the country suffered as a result.
I would also include President George W. Bush’s response to Hurricane Katrina and his handling of the subsequent crisis in New Orleans. His management of the situation — from his initial lack of interest to the abject failure of his disaster response team — produced devastation for thousands of people and marked the effective end of his presidency.
Trump hasn’t just failed to anticipate the way Buchanan did or failed to respond like Hoover or failed to prepare like Bush — he’s done all three. He inherited everything he needed to respond to a pandemic: explicit guidance from the previous administration and a team of experienced experts and intelligence agencies attuned to the threat posed by the quick spread of deadly disease. He even had some sensible advisers who, far from ignoring or making light of the virus, urged him to take it seriously.
The federal government may not have been able to stop coronavirus from reaching the United States — that was impossible to avoid in a globalized, highly-mobile world — but it was well equipped to deal with the problem once it reached our shores.
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But as the world knows, Trump ignored, downplayed and dismissed the problem until it became one of the worst crises in our nation’s history.
It was just over a month ago, for example, that Trump told Americans that the virus would vanish of its own accord. “Because of all we’ve done, the risk to the American people remains very low,” he said during a news conference at the White House on Feb. 26. He emphasized the small number of cases at the time (“We have a total of 15”) and added that “the fifteen within a couple of days is going to be down to close to zero.”
“We have it so well under control,” he continued, “I mean, we really have done a very good job.”
Now, of course, the message is quite different. The White House expects a six-figure death toll — 100,000 to 240,000 deaths, provided most Americans follow federal guidelines for social distancing. This, Trump says, would be a victory, since it could be much worse. “So you’re talking about 2.2 million deaths, 2.2 million people from this. And so if we could hold that down, as we’re saying, to 100,000. It’s a horrible number, maybe even less — but to 100,000. So we have between 100 and 200,000, and we altogether have done a very good job.” These numbers, it should be said, come from several different projections that use several different models for the disease. The death toll could be lower, or it could be much, much higher.
We should put this death toll in context. At the low end, Covid-19 will have killed roughly as many Americans as died in the Korean War, the Vietnam War, Desert Storm and the wars in Iraq and Afghanistan combined. At the high end, it’s that number plus all American deaths in the Spanish-American War and the First World War. The difference is that deaths from Covid-19 will occur in a matter of months versus a number of years. And at that scale, this won’t just afflict the old and infirm — many of the dead will have been in the prime of their lives. And all of this as the economy collapses on itself — as of Thursday, nearly 10 million Americans had filed for unemployment benefits, compressing the job losses of the 18-month Great Recession in 2008-9 (and then some) into a two-week period.
Trump is very likely, over the next several months, to preside over the deaths of at least a hundred thousand Americans in a crisis he chose to ignore until there was no choice but to act. He’ll try to say — is already trying to say — that this was the best he could do, but that will be a lie. He’ll make excuses or cite mitigating factors. But Trump wasn’t distracted by an impeachment trial or focused on any other area of concern. In February, as the crisis deepened, he was holding rallies for voters and parties for supporters, as well as golfing at his private club.
It’s true that Trump imposed some travel restrictions on foreign nationals coming from China as the virus came into public view. But he had the time, energy and responsibility to do far more. He didn’t. Instead, he said things like this — “I think the numbers are going to get progressively better as we go along” — and continued to do everything he could to minimize the threat.
It was only after action from states, colleges and other institutions that the White House began to take this seriously. And by then, it was too late to move off the path to disaster.
As we enter the second full month of the pandemic in the United States, the cost of the president’s indifference is clear: thousands dead and thousands who will die because their government didn’t care to protect them."
Opinion | The Coronavirus Test Is Too Hard for Trump - The New York Times
Local officials left to ‘copy and paste’ Kemp’s order
Friday, April 03, 2020
Navy relieves captain who raised alarm about coronavirus outbreak on aircraft carrier. Outrageous, they questioned his judgment? Their judgment was poor by not addressing the problem on the ship.
Thursday, April 02, 2020
Wednesday, April 01, 2020
Neighborhood pharmacists and government intervention were the secret weapons.
By E. Tammy Kim
The coronavirus erupted in South Korea in late January, six months into Yoo Yoon-sook’s new job. She had just moved from Seoul, where she spent three decades working in the same pharmacy, to open the Hankyeol (“Steadfast”) Pharmacy in the city of Incheon, near the international airport. Ms. Yoo hadn’t really gotten a sense of the neighborhood around her new pharmacy “before this all happened,” she told me. It became all coronavirus, all the time.
Incheon’s 1,100 pharmacies, including Ms. Yoo’s, began to sell out of KF-94 face masks, the equivalent of the American N95. So did corner stores and large retail chains like E-Mart. As Koreans learned of the scale and aggressiveness of Covid-19, first from Chinese reports, then from a surge of cases at home, the mask with the weave and construction that proved most effective against the virus could not be found, except at exorbitant prices online. Customers grew angry waiting outside stores. One Incheon pharmacy posted a sign saying, “Regarding masks: Threats, physical violence and insults against employees are punishable under criminal law.”
Such was the extent of the “mask crisis” when the central government decided to intervene in production and distribution. At the end of February, it announced that it would purchase 50 percent of KF-94 masks from the nation’s 130 or so manufacturers. The government began to ship these masks, at a discounted price of 1,500 won each (about $1.23), to some 23,000 pharmacies, in cooperation with the Korean Pharmaceutical Association.
Pharmacies would earn no more than a few dozen cents on each sale — a few even reported losing money because of credit-card fees — but they embraced their role in the epidemic response. Licensed pharmacists were ideally placed to answer questions about Covid-19, give instructions on social distancing and proper use of masks, and refer sick people to field testing stations and hospitals. (In rural areas of South Korea, where there are fewer pharmacies, agricultural cooperative offices and post offices sell the face masks.)
At Hankyeol Pharmacy, Ms. Yoo posted a sign on the door, telling customers that the sale of KF-94s would begin at 9 a.m. every morning. It was impossible to fill prescriptions or sell anything else during the mask rush. “All of us local pharmacists posted the various times of sale on our door and a map of all the nearby locations,” she told me. Popular mapping apps from Kakao and Naver also showed information on pharmacies and real-time numbers of available masks.
Ms. Yoo was initially allotted 50 masks per day, six days a week, but this wasn’t nearly enough. As South Korea’s infection and fatality numbers grew, people felt desperate for protection. Across the country, pharmacists continued to face long lines and insults when masks sold out.
On March 5, the government increased its share of mask purchases to 80 percent of national production. The following day, Ms. Yoo received a text message from President Moon Jae-in, addressed to “the pharmacists of Korea.” In addition to expanding mask manufacturing, the government was about to start a new rationing system.
“Starting today, 70 percent of all masks acquired through the public distribution system will be sold at pharmacies,” Mr. Moon wrote. “Pharmacies are the primary on-the-ground node in our public health system.” All citizens and registered noncitizens could buy two masks per week on an assigned weekday, depending on their year of birth — a system similar to one used in Taiwan since early February.
The Incheon Pharmaceutical Association encouraged its members to stay open on Sundays, to receive as many daily shipments as possible, so Ms. Yoo began working seven days a week. Her daily shipment went from 50 to 400 masks, with more on the weekends.
This week, the Centers for Disease Control and Prevention is weighing whether to recommend that everyone — not just health care workers and people infected with the coronavirus — wear masks. If this advice is issued, Americans may finally embrace wearing face masks, something that has long been common in East Asia, not only during disease outbreaks, but also during cold season and whenever air pollution levels rise.
Such guidance could also worsen the already dire shortage of N95 face masks and other personal protective equipment. 3M has promised to make more than a billion N95 masks by the end of the year. But without a vast expansion of complementary manufacturing or imports, supplies will be inadequate.
South Korea and Taiwan responded to their mask crises with significant market interventions. America needs to do the same. The U.S. government, and state and municipal bodies, should immediately enter into large-scale contracts to produce masks that can be sold at an affordable, standard price.
These masks (and other personal protective equipment) should go first to health providers and hospitals, then to essential workers in sanitation, warehouses, transportation, food service, child-care centers, and people in prisons and detention facilities. A distribution plan along the lines of those in East Asia could then get masks to the public, perhaps through pharmacies, corner stores and post offices. Some of those masks should also be allocated, free of charge, to people who are homeless or living below the federal poverty level.
For most of us, an N95 mask is not strictly necessary. Last weekend, I used a free online pattern to sew masks for myself and family members, using old handkerchiefs, shirts and elastic hair ties. I wore my homemade mask, reinforced with a large gauze bandage, to the grocery store and bodega, while trying to stay six feet away from fellow shoppers.
To survive this pandemic, we Americans must stop viewing masks as a sign of disease, and see them instead as a social kindness, a courtesy as common as “please” and “thank you.” As Choi Gwi-ok, a pharmacist in northern Seoul, told me, “Koreans wear masks to protect themselves from infections, but, even more important, to show consideration for others in public.”
Kuk Seung-gon, the president of the pharmacists’ association in Gimcheon, near South Korea’s Covid-19 hot spot, told me: “It’s been terrible to see what’s been happening in Europe and America. I really hope that, in the West, people develop a culture of mask wearing. A mask is not just for sick patients.”
By the end of March, the lines for masks outside South Korea’s pharmacies had become manageable. “Now that people are able to buy two masks per week, they feel reassured,” Ms. Yoo told me. “We pharmacists do, too.”
“After three weeks of constant work, the fatigue has built up. I’m very tired,” she said. But she feels a duty to the public, and plans to keep the pharmacy open seven days a week until the crisis is over.“
Tuesday, March 31, 2020
"Hostility toward immigrants is hurting the fight against the pandemic.
The editorial board is a group of opinion journalists whose views are informed by expertise, research, debate and certain longstanding values. It is separate from the newsroom.
Three weeks ago, with much of the United States already gearing up to limit the spread of the coronavirus, the Trump administration’s chief immigration judge sent out a stern order to immigration courts nationwide to take down all public health posters, printed in English and Spanish, on how to deal with the pandemic. “Per our leadership,” the order said, immigration judges did not have the authority to post fliers. “If you see one (attached), please remove it.”
Soon after the order was revealed by The Miami Herald, the Department of Justice, which oversees the immigration courts, reversed course and told the paper that “the signs shouldn’t have been removed.”
A bureaucratic blunder? More like a case in point of how the administration’s obsession with immigrants, undocumented, legal or aspiring, has infected its efforts to control the spread of a pandemic, exacerbating the crisis.
Tough times call for tough measures, to be sure, and the administration’s anticipated order to turn back all asylum seekers and other foreigners trying to cross the southwestern border illegally makes sense in the context of measures already taken to severely restrict movement across other American borders, land and sea.
The immigration system along the southern border is overtaxed, and detention centers across the United States are already bursting with nearly 40,000 people, at enormous risk of contagion. The coronavirus doesn’t discriminate between carriers who are held behind bars and those whose job it is to guard them. The Immigration and Customs Enforcement agency has continued to make arrests and has shown no intention of releasing nonviolent detainees, though judges in some states have ordered some released out of health concerns.
Rounding up undocumented immigrants and shutting down the border is something President Trump has yearned to do since long before the coronavirus began its fateful spread. And his animosity toward undocumented immigrants is affecting the efforts to contain the coronavirus far beyond the border.
As Miriam Jordan of The Times reported, the virus has spread more fear among immigrants, legal and undocumented — the fear that seeking medical or financial help will put them in the cross-hairs of the administration’s repressive immigration policies.
At the beginning of March, more than 700 public health and legal experts addressed a petition to Vice President Mike Pence and other federal, state and local leaders asking, among other things, that medical facilities be declared enforcement-free zones (ICE currently classifies them as “sensitive locations,” where enforcement is avoided but not precluded). The Citizenship and Immigration Service subsequently appeared to signal that it was suspending enforcement of a new “public charge” rule, which makes it harder for immigrants to obtain the green card of a permanent resident if they tap federal benefits, but the suspension has not been publicized.
Those who are not documented are afraid that going to a public health facility will expose them to ICE agents. Immigrants in the country legally and hoping to obtain a green card fear that seeking help will ruin their chances under the public charge rule, which went into effect in February after injunctions blocking it were lifted by the Supreme Court.
These immigrants are particularly at the mercy of the pandemic. They often live in crowded conditions, have little money and no paid sick leave, and so lack the ability to self-quarantine. And according to the Kaiser Family Foundation, 23 percent of noncitizens lawfully in the country and 45 percent of those who are undocumented lack health insurance.
Most immigration courts, meanwhile, were still working at full steam long after state and federal courts across the country sharply scaled back their activities. On Monday, several groups representing lawyers who work with immigrant clients sued the administration to stop in-person immigration hearings during the pandemic. It was only last week that the Executive Office for Immigration Review, the Justice Department agency that oversees immigration courts, closed down some courts and suspended hearings for immigrants not in custody.
The coronavirus does not care which passport its human hosts may carry or tongue they speak. Nor does it serve global public health for only American citizens to wash their hands and practice social distancing. Those are best practices that should transcend borders and walls and help us acknowledge our common plight, and humanity."
Opinion | The Wall That Didn’t Stop the Coronavirus - The New York Times
The coronavirus studies that appear to have convinced President Trump to prolong disruptive social distancing in the United States paint a grim picture of a pandemic that is likely to ravage the country over the next several months, killing close to 100,000 Americans and infecting millions more.
White House officials have not specifically said which of several epidemiological models by researchers around the world they used to persuade Mr. Trump to extend federal guidelines that call for people to remain in their homes, limit travel, work from home and refrain from gathering in groups of 10 or more. But the administration’s leading scientists — including Dr. Anthony S. Fauci and Dr. Deborah Birx, who is coordinating the coronavirus response — have said that several of the publicly available studies generally match their own conclusions about the deadly impact of the virus.
“We’ve reviewed 12 different models. And then we went back to the drawing board over the last week or two, and worked from the ground up, utilizing actual reporting of cases,” Dr. Birx told reporters during a briefing in the White House Rose Garden on Sunday. She said the evidence collected by the government experts “ended up at the same numbers.”
Dr. Birx and Dr. Fauci are expected to provide a detailed presentation about their conclusions during a briefing from the White House Tuesday evening. A senior administration official declined to reveal any information about those studies in advance. But the publicly available research suggests that even with the isolation efforts already underway to limit the spread of the virus, infections are almost certain to soar, straining the ability of hospitals to care for infected patients and leading to a growing number of deaths.
One of those models, created by scientists at the University of Washington’s Institute for Health Metrics and Evaluation, predicts that deaths from the virus in the United States will rise rapidly during the month of April, from about 4,000 to almost 60,000, even with the many restrictions on movement now in place. The study suggests that the pace of deaths will eventually slow down, reaching a total of about 84,000 by the beginning of August.
The model assumes that social distancing measures will be broadly effective across the country and uses the severe lockdown in Wuhan, China, to calibrate how the outbreak might play out in the United States. That approach has some critics because control measures imposed in the United States have generally been less stringent than those in Wuhan. While officials have told more than 250 million people to stay at home, some parts of the country, especially in the South, have resisted or delayed similar measures for fear of the economic consequences.
A second study, released on March 17 by the epidemic modeling group at Imperial College London and authored by 30 scientists on its coronavirus response team, predicted that if the United States had done nothing to prevent the spread of the virus, 2.2 million people could have died. If, however, the government tried to isolate people suspected of having the virus and people they were in contact with, the number of deaths could be cut in half, the researchers said.
They concluded that only a suppression effort across the entire country — an expanded version of efforts now underway across wide swaths of the country — might significantly further reduce the death toll. But they warned that such efforts might have to be maintained for long periods of time in order to ensure that the threat is over.
“The major challenge of suppression,” the British scientists concluded, is the length of time that intensive interventions would be needed, given that “we predict that transmission will quickly rebound if interventions are relaxed.”
Mr. Trump appears to have been affected by the grim statistics. During his appearance in the Rose Garden on Sunday, the president repeatedly mentioned the worst-case scenario from the Imperial College study, saying that hundreds of thousands of lives would be saved by making the decision to continue social distancing.
“Think of the number: 2.2 — potentially 2.2 million people if we did nothing. If we didn’t do the distancing, if we didn’t do all of the things that we’re doing,” Mr. Trump told reporters. He acknowledged that even 100,000 would be a “horrible number,” but that bringing the deaths down from possible millions would show “we all, together, have done a very good job.”