CORONA Main Coronavirus thread
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Ragnarok
On and On, South of Heaven
Ragnarok
On and On, South of Heaven
Up yer arse...
Ragnarok
On and On, South of Heaven
A lot of mortgage companies are about to go bankrupt if they can't figure out it is a new world and they have to find ways to work with their customers
marsh
On TB every waking moment
7:02 min
Country preparing for the worst in handling coronavirus cases | WNT
•Mar 25, 2020
ABC News
Teams set up a makeshift morgue outside New York’s Bellevue Hospital, something they did during 9/11 and Hurricane Sandy.
Ragnarok
On and On, South of Heaven
I think anyone that gives themselves the equivalent of General Eisenhower and George Marshall is a narcissist...
PanBear
Veteran Member
marsh
On TB every waking moment
9:38 min
UK Junior ER Doc Vlogging his experiences (prior Vlogs previously posted)Dr Hope's Sick Notes
Second night shift this week and seeing more patients with Covid-19.
Ragnarok
On and On, South of Heaven
LA County Sheriff's Effort to Close Gun Stores Gets Shut Down
Los Angeles County Sheriff Alex Villanueva's efforts to close all gun stores in the county have been suspended.www.breitbart.com
LA County Sheriff’s Effort to Close Gun Stores Gets Shut Down
Josh Lefkowitz/Getty ImagesAWR HAWKINS25 Mar 2020237
Los Angeles County Sheriff Alex Villanueva’s efforts to close all gun stores in the county have been suspended pending Gov. Gavin Newsom’s (D) reconsideration of what constitutes an “essential business.”
On March 24, 2020, Fox 11 reported Villanueva’s order to close gun stores.
The sheriff attempted to justify the store closures by intimating that all the first-time gun buyers emerging amid the coronavirus crisis create a perilous situation: “I’m a supporter of the 2nd amendment, I’m a gun owner myself, but now you have the mixture of people that are not formerly gun owners and you have a lot more people at home and anytime you introduce a firearm in a home, from what I understand from CDC studies, it increases fourfold the chance that someone is gonna get shot.”
On March 25, 2020, the Los Angles Times reported that Villanueva’s effort to close gun stores was halted by news that Newsom would be rethinking whether such stores fell under the “essential business” protections.
Breitbart News reported on Villanueva’s gun store closure order, pointing to the Fox 11 report showing that the sheriff’s effort coincided with his release of 1,700 inmates.
Those Five stars weren't all that important were they, douchebag???
marsh
On TB every waking moment
1:52 min
Hospitals in the South overwhelmed by spike of coronavirus cases
•Mar 25, 2020
CBS Evening News
The pandemic is spreading rapidly in the South and hospitals are becoming overwhelmed. Louisiana, Florida and Georgia are seeing an alarming rise in those infected by COVID-19. Health officials say large public events like spring break and Mardi Gras are partly to blame. Omar Vilafranca reports.
marsh
On TB every waking moment
58:46 min
War Room: Pandemic EP…72
•3/25/2020 Steve Bannon
Citizens of the American Republic
marsh
On TB every waking moment
10:54 min
Coronavirus: Deputy CMO updates on COVID-19 | Nine News Australia
•Mar 25, 2020
Nine News Australia
March 26, 2020: Deputy Chief Medical Officer Dr Paul Kelly provides an update on the latest COVID-19 cases across Australia
marsh
On TB every waking moment
4:01 min
Los Angeles may see the same number of COVID-19 cases as New York City
•Mar 25, 2020
ABC News
Los Angeles Mayor Eric Garcetti talks about the uptick in cases, compliance with stay at home order, the death of the 18 y/o, and whether L.A. will be back to work by Easter . (Hint - no, at least 2 more months)
marsh
On TB every waking moment
9:53 min
NYC doctors describe being on the frontlines in US's coronavirus epicenter | Nightline
•Mar 24, 2020
ABC News
With more COVID-19 cases in New York City than anywhere else in the U.S., medical professionals are being redirected to ICUs as the state tries to boost its health care system.
Texican
Live Free & Die Free.... God Freedom Country....
Good map with infections in counties shown in each state.
Texican....
infection2020.com
Texican....
U.S. County Coronavirus (COVID-19) Interactive Map and Tracker
See the number of infected people in your area and how close they are to you in real-time on our interactive map, and view the historical trend for your county.
marsh
On TB every waking moment
8:02 min
Unemployed struggling as the coronavirus upends the US economy | Nightline
•Mar 25, 2020
ABC News
People across the U.S., including a single mom in Texas and veteran dad in Kansas, are losing jobs and trying to keep their businesses afloat as the federal government works on a stimulus package.
marsh
On TB every waking moment
3:38 min
As the Coronavirus Approaches, Mexico Looks the Other Way | The Dispatch
•Mar 24, 2020
The New York Times
“This is going to be as bad as Italy or worse.” As much of the world shuts down amid the worsening coronavirus pandemic, Mexico City’s streets are bustling and the country’s president insists on calm.
marsh
On TB every waking moment
2:23 min
Berwyn dad describes COVID-19 as 'truly miserable'
•Mar 25, 2020
ABC 7 Chicago
A Berwyn father is currently being treated for persistent fevers, pain and an unbearable cough that he said can only be like drowning above water.
marsh
On TB every waking moment
7:08 min
Intensive care doctor warns of 'tsunami' of UK coronavirus cases - says we 'won't cope' | COVID-19
•Mar 25, 2020
Channel 4 News
‘I have no doubt at all that we will be unable to cope’ – says Professor of Intensive Care Medicine Hugh Montgomery on the COVID-19 coronavirus.
DragonBurrow
Contributing Member
Have you also noticed that the supposed to be shut down hospital is getting busier. The camera has also become much less stable since the new police cameras were installed. It’s all enough to make you go hmmm
marsh
On TB every waking moment
Amazon gives delivery drivers detailed guidance for working amid coronavirus
Amazon provided its contract delivery drivers Wednesday evening with its most detailed guidance. Many of the recommendations hew closely to those made by public health officials for weeks.
www.seattletimes.com
Amazon gives delivery drivers detailed guidance for working amid coronavirus
March 25, 2020 at 8:24 pm Updated March 25, 2020 at 10:18 pm
Contractors working for Amazon’s Flex program load packages into vehicles to deliver to customers in San... (David Paul Morris / Bloomberg) More
By
Benjamin Romano
Seattle Times business reporter
Use your phone to knock on doors. Don’t sneeze on the packages. Ask customers to set their identification on the ground and step away before you check it.
Amazon provided its contract delivery drivers Wednesday evening with its most detailed guidance yet for collecting and distributing packages while maintaining good hygiene and social distance to slow the spread of coronavirus. Many of the recommendations hew closely to those made by public health officials for weeks.
Drivers in the Amazon Flex program had previously reported crowded, sometimes chaotic conditions at overburdened pickup locations, where they load their vehicles with dozens of packages for delivery to customers. They called out a lack of hand sanitizer or easy access to restrooms for washing hands and Amazon’s limited communication on how they should go about their work, which has become essential amid a global pandemic.
Meanwhile, Amazon had not increased the base rate it pays Flex drivers for delivery blocks, and an influx of new drivers has largely eliminated surge rates — financial incentives offered to attract more workers to handle increases in demand. “They are flooded with so many new drivers locally that the block rate never surges,” a Seattle-area driver said Tuesday. Despite that, Amazon has had to tell customers that no delivery windows were available for some of its services.
Working Washington, already in the midst of a campaign to improve conditions for gig economy workers, on Wednesday called for companies to provide hazard pay of an additional $5 per delivery, as well as 14 days of unrestricted paid leave. Amazon has pledged a $25 million fund to help drivers and other contractors, providing grants equal to two weeks of pay for those diagnosed with COVID-19 — the illness caused by the coronavirus — or put in quarantine.
In a Wednesday evening email to Flex drivers that was reviewed by The Seattle Times, Amazon said they must maintain a distance of six feet from others when picking up packages, which the company said will be “strictly enforced.” Amazon has told its warehouse employees — some of whom have ongoing concerns about social distancing and hygiene — they must stay at least three feet apart.
Amazon told drivers that every delivery site and pickup location is equipped with ways to clean their hands, and Amazon or Whole Foods employees were instructed to assist anyone who couldn’t find the restroom or adequate sanitizing supplies, which remain hard to come by.
“We are working hard to ensure that hand sanitizer and wipes are available for your use at delivery sites and to keep your hands clean when you’re on the road,” the company told the Flex drivers, whose numbers have swelled in recent weeks with demand for delivery from homebound people. “We’ve placed orders for sanitizer and other cleaning supplies and, as soon as we receive these supplies, our first priority will be getting them in your hands.”
Specific instructions varied for pickups at Amazon’s delivery stations for groceries and other merchandise. In general, drivers are told to wait in their cars rather than crowding into staging areas. Amazon said they would be notified when their orders were ready to load. “Please keep your window closed throughout this process,” the instructions said.
When making deliveries, drivers were told to wipe down frequently touched services, including handheld devices, steering wheels, keys and vehicle and door handles.
They were told to wash hands frequently or use hand sanitizer.
Drivers should try not to touch gates and doors with their hands. “Use your phone to touch elevator buttons and to gently knock on doors,” the email said.
For “attended” deliveries, in which the customer must be present for the driver to leave the package, Amazon told drivers to place the package on the doorstep, ring or knock — with the phone — and step back at least six feet. “Greet the customer with a ‘hello,’ and point to the package,” the email said. “No signature is required.”
If an identification check is required, such as for delivery of alcohol, drivers should ask customers to “please place your ID on the ground and step back while I check it, so we maintain distance for your safety and my own.” Drivers are instructed not to touch the customer’s ID, or to do so as little as possible.
Coughs or sneezes should be directed into a tissue or an elbow. “If you are delivering, step 6 feet away from the customer or the packages,” the email said.
Drivers who are feeling ill are instructed to stay home until they have no fever for at least 72 hours without medications, and to inform Amazon Flex support as soon as possible.
marsh
On TB every waking moment
Police struggle to enforce India’s sweeping virus lockdown
NEW DELHI (AP) — Indians struggled to comply with the world's largest coronavirus lockdown on Wednesday as the government began the gargantuan task of keeping 1.3 billion people indoors. Official assurances that essentials wouldn't run out clashed with people's fears...
www.seattletimes.com
Police struggle to enforce India’s sweeping virus lockdown
March 25, 2020 at 3:02 am Updated March 26, 2020 at 12:10 am
ASHOK SHARMA
and
SHEIKH SAALIQ
The Associated Press
NEW DELHI (AP) — Indians struggled to comply with the world’s largest coronavirus lockdown on Wednesday as the government began the gargantuan task of keeping 1.3 billion people indoors.
Official assurances that essentials wouldn’t run out clashed with people’s fears that the disease toll could soon worsen, gutting food and other critical supplies.
In five days, the number of confirmed cases of COVID-19, the disease caused by the coronavirus, has jumped from about 200 to 519, and experts say the real toll is likely to be much higher because of insufficient testing.
On Tuesday, Prime Minister Narendra Modi announced a three-week countrywide lockdown covering nearly one-fifth of the world’s population “to save India and Indians.”
He said the lockdown would be “total,” but officials after his speech released advisories explaining that medical, law enforcement, media and other sectors were exempted and that stores selling food and other essentials would remain open.
Television images from many cities and towns on Wednesday showed shuttered markets and offices. Normally bustling railway stations stood empty. Joggers awkwardly avoided each other to maintain safe distances.
Still, Modi’s speech triggered panic buying as online retailers Amazon and Big Basket, an Indian grocery delivery service, began canceling previously placed orders and said they had no delivery slots available. That spurred people to risk fines and other penalties for violating the lockdown by going out to shop at local stores.
Social distancing was forgotten at a grocery store in the Nizamuddin neighborhood of New Delhi as panicked residents swarmed inside and jostled with each other to get fast-disappearing supplies.
An elderly couple who waited to enter the shop for nearly 30 minutes eventually returned home empty-handed.
Although the lockdown made provisions for people to leave their homes to buy food, TV news and social media showed police striking would-be shoppers in the streets with batons in the southern state of Kerala, the financial hub of Mumbai and New Delhi.
Alok Barman, a servant who works in several well-to-do south Delhi households, said he was beaten up by police when he ventured outside his home in the city’s outskirts.
“Some homes that I work in paid me some money and I thought it was best to get some food in the house. But the police attacked us with sticks and beat us,” he said. “Now we have nothing to eat.”
Tarique Anwar, a former banker, said he went out to buy milk and vegetables at a grocery store in Delhi’s Jamia Nagar neighborhood when he was confronted by a group of policemen who ordered him to go back. He only managed to get vegetables.
A video shot by a passerby showed a policeman using his baton to smash the interior of a meat shop in the capital’s Zakir Nagar neighborhood. The shop’s owner said police also beat him up and told him he shouldn’t have opened his shop.
“They charged inside and started abusing and beating me,” said Parvez, who uses only one name.
New Delhi police spokesman Anil Mittal denied that police were beating people.
Similar scenes occurred in India’s northeast, an eight-state region where only two of the country’s COVID-19 cases have been reported.
Others defied the shutdown order not in order to shop but rather to pray.
Wednesday was the start of the Hindu new year according to an ancient lunar calendar and the beginning of a nine-day holiday in which Hindus normally perform daily rituals called pujas at temples. The lockdown order, however, explicitly religious gatherings and instructs places of worship to close.
Modi acknowledged in a tweet that “The celebrations will not be like they are usually but they will strengthen our resolve to overcome our circumstances.”
“May we all come together to win the important battle that the nation faces against COVID-19,” he said.
DragonBurrow
Contributing Member
For now it’s the 11th. The whole world for some reason thinks Easter weekend will be magic. Even China said the will allow travel in and out of Wuhan then. I don’t understand it.
marsh
On TB every waking moment
New Inslee edict: Most construction work is not authorized during coronavirus shutdown
In a major clarification to the statewide stay-at-home order, Gov. Jay Inslee's office said Wednesday evening that workers on most commercial and residential construction sites should stay home to combat the spread of the novel coronavirus.
www.seattletimes.com
New Inslee edict: Most construction work is not authorized during coronavirus shutdown
March 25, 2020 at 8:09 pm Updated March 26, 2020 at 12:15 am
By
Katherine Khashimova Long
Seattle Times business reporter
In a major clarification to the statewide stay-at-home order, Gov. Jay Inslee’s office said Wednesday evening that workers on most commercial and residential construction sites should stay home to combat the spread of the novel coronavirus.
Nearly all construction is a nonessential activity under the state’s new stay-at-home order, according to a memo issued by the governor’s office.
The clarification is sure to frustrate some construction industry leaders who, since Inslee announced the stay-at-home order Monday evening, have insisted they are essential businesses allowed to continue operating.
“Under the Order ‘construction workers who support … construction sites and construction projects (including housing construction)’ are listed as an ‘essential service,'” the Building Industry Association of Washington wrote in an email to its members Monday. “Based upon this language, homebuilders and remodelers may continue with operations while the stay-at-home order is in effect.”
The clarification rejects that interpretation, exempting only a very few categories of construction from the statewide mandate that all nonessential workers should stay at home.
The exceptions to the stay-at-home rule, which takes effect Wednesday at midnight, are construction related to essential activities like health care, transportation, energy, defense and critical manufacturing; construction “to further a public purpose related to a public entity,” including publicly financed low-income housing; and emergency repairs.
All construction activities allowed to continue must comply with social distancing “and appropriate health and worker protection measures before proceeding,” the memorandum said.
Many construction workers concerned about conditions on their job sites may be gratified by the clarification.
Nearly a dozen construction workers interviewed by The Seattle Times earlier this week said they feared catching COVID-19 at their job sites, where workers are often forced to work in close quarters and sanitation is an afterthought.
“I don’t think there’s much of a rush for new construction,” said one construction worker, whose job site partner is in the hospital awaiting the results of his COVID-19 test. “It’s going to take people with a bunch of money and give them more money — at what cost?”
Texican
Live Free & Die Free.... God Freedom Country....
Its 2:24 am so off to bed. This staying up late eats the morning hours.
God bless and goodnight to all.
Spent time trying to order from Sam's and when I checked out the only item left on the list was cheese, so no order tonight. Hope you are having better luck. Will probably make another trip to Sherman to get the items from Sam's, Kroger's and Albertson's. Will be a long day. 130 mile one way trip. At least fuel prices are below $2.00.
Be careful out there. Remember gloves, mask, googles and hand sanitizer when you go out.
Texican....
God bless and goodnight to all.
Spent time trying to order from Sam's and when I checked out the only item left on the list was cheese, so no order tonight. Hope you are having better luck. Will probably make another trip to Sherman to get the items from Sam's, Kroger's and Albertson's. Will be a long day. 130 mile one way trip. At least fuel prices are below $2.00.
Be careful out there. Remember gloves, mask, googles and hand sanitizer when you go out.
Texican....
marsh
On TB every waking moment
Here's who qualifies for coronavirus paid sick leave under new federal law
Here's who qualifies for paid sick leave, and who doesn't, under the new federal emergency coronavirus relief package.
www.latimes.com
Here’s who qualifies for coronavirus paid sick leave under new federal law
Medical staff test a person for the coronavirus in a drive-through setting at the Kaiser Permanente Geary campus in San Francisco on March 11.
(Jessica Christian / San Francisco Chronicle)
By JAMES F. PELTZSTAFF WRITER
MARCH 24, 2020
The federal government’s emergency coronavirus relief law includes paid sick leave benefits for American employees at small to midsize firms who have to take time off because of the spreading virus.
But the law signed by President Trump last week includes exceptions that some analysts said could exclude nearly 20 million private sector workers, including an exemption for small businesses that’s causing confusion as to how it will be implemented.
Congressional Democrats have introduced additional legislation to close those gaps and make paid sick leave available to all U.S. workers.
California already has a law providing full- and part-time workers at least three days of paid sick leave each year. Workers in Los Angeles are eligible for twice that: at least six paid sick days annually.
The new federal law — which marks the first time that paid sick leave has been mandated nationwide — would expand that for eligible workers, and it came in response to the sudden, dramatic slowdown in U.S. economic activity caused by the coronavirus pandemic.
Businesses big and small are shutting down or cutting their operating hours, and a surging number of employees are being furloughed or laid off. That has led to skyrocketing claims for unemployment benefits, and many of those still employed are getting fewer hours of work.
Under the new law, qualified employees include those who have COVID-19, the disease caused by the virus; who are in quarantine; who are caring for a family member affected by the virus — that is, a relative who has COVID-19, is subject to a government quarantine or has been advised by a doctor to self-quarantine; or who are caring for children whose schools or day care centers have closed.
Firms paying the sick leave would be reimbursed with federal tax credits.
Full-time workers would get up to two weeks of paid leave, and part-time workers would get a period of leave equal to the number of hours they work on average over a two-week period.
The payments would be capped at $511 a day for those who are sick with the virus or seeking care, and $200 a day for those caring for a sick family member or children.
The law says the benefit is not contingent on the employee finding a replacement worker, and businesses must post the law’s requirements “in conspicuous places” where their employees work.
However, the new law excludes companies that employ more than 500 people, many of which have their own sick leave plans. It also gives the Department of Labor the authority to exempt firms that employ healthcare workers and emergency responders if those companies want to opt out of paying sick leave.
The bill also gives the Labor Department the authority to let small businesses with fewer than 50 workers opt out if the sick leave payments “would jeopardize the viability of the business as a going concern” — in other words, if the company fears that paying the benefit would help drive it out of business.
That exemption “is a huge loophole” in the new law, said Elise Gould, senior economist at the Economic Policy Institute, a labor think tank. “There’s no reason why it should be so onerous for a small business to take this up, because they’re going to get that back in tax credits.”
She said that federal data show 27% of U.S. private sector workers are employed at firms with 50 or fewer workers, and that 36% of those employees don’t have access to paid sick leave.
The result is that 12.8 million workers at small businesses are in jeopardy of not getting paid sick leave even with the new law, Gould said. An additional 6 million to 7 million workers employed at firms with more than 500 workers also would be ineligible, she said.
What’s confusing is whether small firms that want an exemption must obtain one from the Labor Department before they refuse to pay sick leave to workers, or they can immediately decline to pay sick leave while waiting for such an exemption, said David Barron, a labor attorney with the law firm Cozen O’Connor.
“Typically, a law is passed and the enforcement agency would have the ability to clarify and explain that law in the form of regulation,” Barron said. “But this situation is moving so quickly, I don’t know how fast the Department of Labor would be able to provide that sort of guidance.”
Barron likewise noted that those small firms that do pay for sick leave “will get a dollar-for-dollar credit on their taxes” under the law, and that the Labor Department has until April 2, when the law takes effect, to issue guidance.
“The Department of Labor could establish some mechanism for small employers to apply for waivers and have that hashed out before this thing takes effect,” he said.
Another labor lawyer, Shannon Liss-Riordan, said that “in the meantime, I believe the employer would be responsible for paying sick leave under the act.”
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Three Democratic members of Congress — Sen. Patty Murray of Washington, Sen. Kirsten Gillibrand of New York and Rep. Rosa De Lauro of Connecticut — have introduced a bill, called the PAID Leave Act, that would provide “all employees and independent contractors” with 14 emergency paid sick days, to be “reimbursed in full by the federal government.”
The new bill is needed “so no one falls through the cracks,” she said.
Sen. Edward J. Markey (D-Mass.) also called on Congress to ensure that the next relief package include paid leave provisions that “specifically apply to gig workers,” or on-demand workers such as Uber and Lyft drivers.
“They are the reason that so many gig companies have become household names and are able to successfully provide important services to millions of American customers,” Markey said in a letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Charles E. Schumer (D-N.Y.).
“The failure of their employers to properly categorize them as employees means that gig economy workers are essentially left on their own during this crisis,” Markey wrote.
Other politicians, including Sen. Mark Warner (D-Va.), and gig advocacy groups have urged Congress to alleviate some of the financial burden on gig workers if they become ill with COVID-19 or choose to limit their exposure by staying home.
Liss-Riordan has taken the issue to court. She’s filed federal lawsuits in San Francisco seeking emergency motions requiring Uber and Lyft to classify their drivers as employees so they can at least be covered under the California law.
“Uber’s failure to provide paid sick leave as mandated by state law means Uber drivers will need to work while sick to make ends meet and substantially increases the likelihood Uber drivers will spread illnesses to the general public,” the suit against that company states.
Uber and Lyft declined to comment on the litigation, but reiterated their past comments that they would provide funds to drivers diagnosed with the virus or placed under quarantine. Uber said its drivers would receive unspecified financial assistance for up to 14 days, and Lyft also said it would provide unspecified financial support to its drivers.
marsh
On TB every waking moment
New York state has 10 times the COVID-19 cases California has. Why?
New York’s COVID-19 numbers have blown up over the past few days, while California and...
www.sfchronicle.com
New York state has 10 times the COVID-19 cases California has. Why?
Erin Allday March 24, 2020 Updated: March 25, 2020 9:07 a.m.
New York’s coronavirus outbreak has violently erupted over the past few days, and the state is now driving the national epidemic — while on the West Coast, public health experts are wondering if an early and aggressive response saved California from a similar fate.
California reported some of the earliest coronavirus cases in the United States in late January. And in the first week of March, California and New York were neck and neck on cases of COVID-19, the disease caused by the coronavirus. But over the past week, New York case counts have doubled every few days, and the state now has 10 times the cases California does: 25,000 to 2,500.
Infectious-disease experts say early maneuvers in California, especially in the Bay Area — first discouraging people from gathering in crowds and then ordering them to shelter in place — may have had a dramatic impact, even if they came only a few days ahead of those in New York.
But other factors may also be in play. New York is testing far more people — three times as many as California — and therefore identifying more cases, for example. And it’s possible that what’s happening 3,000 miles away could be California’s future.
Coronavirus Outbreak
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Coronavirus Map: Tracking COVID-19 cases across California - Coronavirus Map: Tracking COVID-19 cases across the Bay Area and California
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“But we went into shelter in place quicker; we got people apart quicker,” Greene said. “That could be a contributing factor to what we’re seeing in California now. And that’s why I think the whole country should be sheltering in place.”
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1of9Doctors test hospital staff with flu-like symptoms for coronavirus at St Barnabas Hospital in the Bronx, New York.Photo: Misha Friedman / Getty Images
2of9Dr. George Rutherford is a UCSF infectious-disease expert who has been consulting with Bay Area officials on the coronavirus response.Photo: Santiago Mejia / The Chronicle
3of9Robert Siegel, a Stanford virologist, looks at a rubber ball that is shaped like the coronavirus.Photo: Jim Gensheimer / Special to The Chronicle
The World Health Organization on Tuesday identified the United States as the next potential epicenter of the pandemic, with China and South Korea both on a path to recovery and Italy starting to see signs of its outbreak slowing down, though gradually.
New York state now makes up roughly half of the United States’ 50,000 cases of COVID-19. Tuesday afternoon, experts on the White House Coronavirus Task Force advised that residents who have fled New York City, where the bulk of cases are located, should place themselves in a two-week quarantine to avoid infecting people in other parts of the country.
The state is also testing more people than anywhere else in the country — 90,000 as of Monday, compared with about 27,000 in California.
How and why New York’s testing is so far beyond California’s isn’t clear. California officials will “explain the ambiguity” on Wednesday, Gov. Gavin Newsom said earlier this week when asked about the discrepancy at a news conference.
But testing alone doesn’t explain why New York’s case counts are so much higher than California’s, or why the rate is spiraling up so fast on the East Coast. The death toll in New York was four times higher than California’s — 210 deaths to 51, as of Tuesday evening. Deaths tend to be a much more reliable marker of the spread of the disease than cases because determining how someone died is not dependent on the availability of testing kits.
Also, hospitals across New York state, and in New York City in particular, are filling up, but California hasn’t yet seen a similar surge.
New York Gov. Andrew Cuomo issued “stay at home” orders last Friday, one day after Newsom did the same for California and four days after Bay Area health officers told 6.7 million people to shelter in place.
New York City and the Bay Area had about 450 and 300 cases, respectively, when the Bay Area stay-home orders were issued on March 16. When Cuomo shut down the state on March 20, New York City had 5,500 cases. The Bay Area: 539.
Shelter-in-place orders hadn’t been in effect long enough to entirely account for the dramatic differences, but the Bay Area issued other directives earlier, such as shutting down mass gatherings, advising people to work at home when possible, and asking older adults and people with compromised immune systems to stay home.
“We were more aggressive; we got out there a little earlier,” said Dr. John Swartzberg, an infectious disease expert at UC Berkeley. “We were maybe a week up on New York, and that doesn’t sound like much time, but in terms of the spread of this pandemic, it’s enormous.”
Indeed, lessons from the 1918 influenza pandemic taught public health leaders that speedy, assertive actions could save lives, said Dr. George Rutherford, a UCSF infectious-disease expert who has been consulting with Bay Area officials on the coronavirus response.
A New York City subway rider protects her hand with a tissue as she holds onto a pole as COVID-19 concerns shrink ridership.
Photo: John Minchillo / Associated Press
“Time is critical. You can’t be late, not even by a week,” Rutherford said. “We moved to lockdown, for lack of a better phrase, relatively quickly. I think we’re reaping the benefits.”
There are other explanations for New York’s particularly brutal outbreak. New York City has the densest population in the country, and for a virus that spreads primarily by close contact, density could make a huge difference. For weeks, if not months, New Yorkers were crowding subways, high-rise elevators and even sidewalks while the coronavirus spread among them.
Even in the Bay Area, where BART trains can be packed at commute hours, there isn’t nearly the same level of close gathering.
“Different places appear to have very different disease dynamic,” said Dr. Robert Siegel, a Stanford infectious-disease expert. “You could have predicted New York was going to have a big problem because of the high density of people, which is ideal for spreading the virus. We’re spread out more in California.”
marsh
On TB every waking moment
Why do California companies have so many masks to donate?
Wildfires are one big reason. California passed a new regulation last year that requires...
www.sfchronicle.com
Why do California companies have so many masks to donate?
J.D. Morris March 25, 2020 Updated: March 25, 2020 7:55 p.m.
Comments
Marco Zaldana, 19, of Berkeley, holds his N95 mask after entering a building at Clark Kerr campus in Berkeley, Calif. on Monday, Oct. 28, 2019.
Photo: Sarahbeth Maney / Special to The Chronicle 2019
Bay Area companies, including some of the biggest names in Silicon Valley, say they are giving millions of face masks and other protective gear to health care workers fighting the coronavirus pandemic.
The donations from Apple, Facebook, Salesforce and others are welcome developments for nurses and doctors facing a nationwide strain on the personal protective equipment they need to safely help patients with COVID-19, the disease caused by the new virus.
But why do these companies have so many masks to begin with? California wildfires could be the driving factor.
In 2019, the year after a historically brutal wildfire season inundated California cities with smoke, the state adopted a regulation that requires employers to make respirators available when the air quality is unhealthy. The regulation notes that an N95 respirator, which is currently in high demand at hospitals, “is the minimum level of protection for wildfire smoke.”
Some companies appear to have amassed a supply of masks beyond what the new rule requires or are obtaining more to help hospitals now.
Intel Corp. said Monday that it is donating more than 1 million items of personal protective equipment, including masks, to health care workers. Spokeswoman Linda Qian told The Chronicle that Intel has “some inventory on hand to support our global operations, including protective equipment required by local regulations and for on-site emergency response personnel.”
“We are also working with our supply chain to source additional items,” Qian said in an email.
The biggest mask pledge has come from Apple. CEO Tim Cook announced on Wednesday that the technology giant had “sourced, procured and is donating” 10 million masks to aid U.S. medical workers.
“These people deserve our debt of gratitude for all of the work that they’re doing on the front lines,” Cook said in a video he posted on Twitter.
Details about Apple’s access to masks were unclear, and the company had no comment beyond Cook’s public statements. Vice President Mike Pence said Tuesday that Apple officials “went to their storehouses” and would donate 9 million N95 masks.
Meanwhile, Facebook is donating 720,000 N95 respirators and surgical masks. CEO Mark Zuckerberg said in a Sunday post on Facebook that the company had purchased masks “in case the wildfires continued” and was “working on sourcing millions ... more to donate.” Facebook is also donating 1.5 million pairs of gloves for health care workers worldwide.
Pacific Gas and Electric Co. tapped into its stockpile of masks to help doctors and nurses. PG&E said Friday that it would give 950,000 N95 and surgical masks to state emergency officials for distribution to hospitals, and it has already given 40,000 masks to Kaiser Permanente. The company maintains a mask supply for utility crews working in construction zones or responding to wildfires.
Even with the donations from large companies, California still has a huge need for more protective equipment.
Heliobas Disciple
TB Fanatic
Cheesecake Factory tells landlords it won’t be able to pay rents on April 1
The chain restaurant says closed dining rooms and "extraordinary events" are the reason for not paying rents
la.eater.com
The Cheesecake Factory Tells Landlords Across the Country It Won’t Be Able to Pay Rent on April 1
The chain restaurant says closed dining rooms and “extraordinary events” are the reason for not paying rents
by Matthew Kang
Mar 25, 2020, 2:22pm PDT
The Cheesecake Factory, one of the most popular sit-down restaurant chains in the country, says it will not be able to make upcoming rent payments for any of its storefronts on April 1 because of significant loss of income due to the coronavirus crisis.
The Calabasas Hills-based company informed all of its landlords in a letter dated March 18 (reproduced below) that a severe decline in restaurant traffic has decreased its cash flow and “inflicted a tremendous financial blow” to business. Cheesecake Factory’s affiliated restaurants, such as Rock Sugar and North Italia, will also not make April 1 rent payments.
Company chairman and CEO David Overton writes, “Due to these extraordinary events, I am asking for your patience, and frankly, your help.” He continues, “we appreciate our landlords’ understanding given the exigency of the current situation.” The letter says that the company hopes to resume paying rent as soon as possible.
When asked for comment regarding the non-payment of rent on April 1, Cheesecake Factory representatives said the following:
In these unprecedented times, there are many factors that are changing on a daily basis given governmental regulations and landlord decisions to close properties. We have to take both into consideration in terms of understanding the nature of our rent obligations and with respect to managing our financial position. We have very strong, longstanding relationships with our landlords. We are certain that with their partnership, we will be able to work together to weather this storm in the appropriate manner.
The Cheesecake Factory was founded in Beverly Hills in 1972 and maintains its original location on Beverly Drive, with 39 locations in California. In total, it operates 294 restaurants in 39 states, plus the District of Columbia, Puerto Rico, and Toronto, Canada. In 2019, the company also acquired Phoenix-based Fox Restaurants, including North Italia, Flower Child, and The Henry. Most of the company’s landlords are malls, including Simon and Westfield.
In telling landlords that it will not able to pay rent, the Cheesecake Factory essentially confirms that it is in the same position that many independent restaurateurs currently find themselves in. In a statement to investors on March 23 — five days after the letter to landlords — the Cheesecake Factory announced that it would curtail development of unopened restaurants and tap into a $90 million credit line to increase its available cash. Since the outbreak of the coronavirus, the Cheesecake Factory has closed 27 locations across the country, and pivoted other locations to a takeout and delivery-only model — which it said just days ago was enabling the company to “operate sustainably at present” — and its stock price has fallen by more than 50 percent in the past month.
With 38,000 employees, the Cheesecake Factory is one of the largest restaurant employers in the country. Given its recent stock woes and the ongoing reduction in business due to the coronavirus pandemic, it seems possible that it, like many restaurants, could end up needing a bailout to survive.
marsh
On TB every waking moment
Coronavirus patients filled nearly half the beds at Kaiser Permanente’s San Jose hospital, executive says
“We’ve literally had to revamp the hospital to make sure we’ve got enough capacity...
www.sfchronicle.com
Coronavirus patients filled nearly half the beds at Kaiser Permanente’s San Jose hospital, executive says
Matt Kawahara March 25, 2020 Updated: March 25, 2020 8:07 p.m.
Comments
A drive-through COVID-19 testing site is operational at Kaiser Permanente - San Jose Main Campus Tuesday, March 17, 2020, in San Jose, Calif.
Photo: Jim Gensheimer / Special to The Chronicle
Nearly half of the patients at Kaiser Permanente San Jose Medical Center have or are believed to have COVID-19, the disease caused by the coronavirus, a Kaiser executive told a medical association.
Dr. Stephen Parodi, a Kaiser executive vice president, said in an interview with the Journal of the American Medical Association last Thursday that the San Jose facility “actually has almost half the hospital filled with either COVID-confirmed or persons under investigation.”
Parodi said Kaiser needed to increase staffing at the San Jose hospital, which has 242 beds, where one intensive care unit was serving only COVID-19 patients.
In the interview, Parodi said the San Jose hospital had repurposed a separate unit to care for regular ICU patients with one ICU unit dedicated to COVID-19 response.
“We’ve literally had to revamp the hospital to make sure we’ve got enough capacity from a personnel standpoint,” Parodi told JAMA editor-in-chief Howard Bauchner.
Parodi offered a stark overview of the COVID-19 response in the region. At two hospitals in Santa Clara County, he said, about a quarter of patients were in intensive care, including some who had previously sought outpatient care and then “rapidly deteriorated.”
“A person is relatively stable and (then) can rapidly deteriorate within hours, requiring intubation or a rapid response,” Parodi said.
Parodi said the “jury’s still out” on whether certain age demographics are likelier to end up in the hospital, but it’s clear the virus can affect younger patients.
“We have people as young as their 30s or 40s who have clinically deteriorated or required mechanical ventilation,” Parodi said. “There is, of course, the other cohort that’s the older cohort, in their 80s and 70s, that are also in the ICU.”
Patients requiring ventilators typically need between 10 and 14 days of mechanical ventilation, said Parodi, who said he’s “concerned” about having enough ventilators nationwide to respond to a potential surge in ICU patients.
“This thing can come on very quickly,” Parodi said. “When you go from zero to having 10 patients - that happened for us in terms of in the ICU within one week.”
https://www.sfchronicle.com/bayarea/article/Coronavirus-live-updates-news-bay-area-15151165.php
marsh
On TB every waking moment
marsh
On TB every waking moment
One of my farmer friends pointed out that they use this with livestock. He didn't understand why they weren't doing it with people
Global Biodefense
@GlobalBioD
FDA Allows Emergency Use of Investigational Convalescent Plasma for Critical COVID-19 Patients | Global Biodefense https://bit.ly/3drmDZd
View: https://twitter.com/GlobalBioD/status/1242660035370590208?s=20
********************************
FDA Allows Emergency Use of Investigational Convalescent Plasma for Critical COVID-19 Patients
by Global Biodefense
24 Mar 2020
The FDA is facilitating access to convalescent plasma, antibody-rich blood products that are taken from blood donated by people who have recovered from the COVID-19 virus, that could potentially shorten the length, or lessen the severity, of the illness. The agency will be using multiple pathways to support these efforts and has posted information for investigators wishing to study convalescent plasma for use in patients with serious or immediately life-threatening COVID-19 infections through the process of single patient emergency Investigational New Drug Applications for individual patients. The FDA also is actively engaging with researchers to discuss the possibility of collaboration on the development of a master protocol for the use of convalescent plasma, with the goal of reducing duplicative efforts.
Use of convalescent plasma has been studied in outbreaks of other respiratory infections, including the 2009-2010 H1N1 influenza virus pandemic, 2003 SARS-CoV-1 epidemic, and the 2012 MERS-CoV epidemic.
Although promising, convalescent plasma has not been shown to be effective in every disease studied. It is therefore important to determine through clinical trials, before routinely administering convalescent plasma to patients with COVID-19, that it is safe and effective to do so. Clinical trials have been initiated to this aim and are one way for patients to obtain access to convalescent plasma, but such trials may not be readily available to all patients in potential need during the COVID-19 response.
The Food and Drug Administration (FDA) therefore today authorized access to COVID-19 convalescent plasma for use in patients with serious or immediately life-threatening COVID-19 infections through the process of single patient emergency Investigational New Drug Applications (eINDs) for Individual patients under 21 CFR 312.310. This process allows the use of an investigational drug for the treatment of an individual patient by a licensed physician upon FDA authorization. This does not include the use of COVID-19 convalescent plasma for the prevention of infection.
COVID-19 convalescent plasma must only be collected from recovered individuals with a prior diagnosis of COVID-19 documented by a laboratory test if they are eligible to donate blood. Required testing must be performed and the donation must be found suitable. Donors must also have resolved all symptoms at least 14 days prior to donation and have a verified negative follow-up test.
How to obtain authorization for use of COVID-19 convalescent plasma
- Eligible patients for use under expanded access provisions:
- Must have laboratory confirmed COVID-19
- Must have severe or immediately life-threatening COVID-19, for example:1
- Severe disease is defined as:
- dyspnea,
- respiratory frequency ≥ 30/min,
- blood oxygen saturation ≤ 93%,
- partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, and/or
- lung infiltrates > 50% within 24 to 48 hours
- Life-threatening disease is defined as:
- respiratory failure,
- septic shock, and/or
- multiple organ dysfunction or failure
- Must provide informed consent
In addition to the above, FDA is continuing to work with its government partners including the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) to develop master protocols for use by multiple investigators in order to coordinate the collection and use of COVID-19 convalescent plasma.
- For request that are not highly time sensitive (response from FDA provided within 4 to 8 hours), the requesting physician may contact FDA by completing form 3926 and submitting the form by email to CBER_eIND_Covid-19@FDA.HHS.gov.
- The completed form should include a brief clinical history of the patient, including: diagnosis, current therapy, and rationale for requesting the proposed investigational treatment in order to meet the expanded access use requirements of 21 CFR 312.305 and 312.310.
- The form should include information regarding where the COVID-19 convalescent plasma will be obtained.
- Providers should complete the form to the extent possible, and FDA will work with the provider if additional information is required.
- FDA will review the request and, upon approval, FDA will send the requesting physician a confirmatory email that includes the emergency IND number.
- In the event of an emergency that is highly time sensitive (response required in less than 4 hours) or where the provider is unable to complete and submit form 3926 due to extenuating circumstances, the provider may contact FDA’s Office of Emergency Operations at 1-866-300-4374 to seek verbal authorization.
- If verbal authorization is given, the requestor must agree to submit an expanded access application (e.g., form 3926) within 15 working days of FDA’s authorization of the use.
1Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648
Source: Food and Drug Administration
posted for fair use
FDA Allows Emergency Use of Investigational Convalescent Plasma for Critical COVID-19 Patients
The FDA is facilitating access to convalescent plasma, antibody-rich blood products that are taken from blood donated by people who have recovered fromglobalbiodefense.com
marsh
On TB every waking moment
the "pines" are good.
end game
Veteran Member
Nah, they just box them up and sell to the fed as MBS.
35.2 billion this week:
Fed to buy $35.2 billion of MBS this week
The Fed purchased about $32.7 billion in agency mortgage-backed securities this week, and is slated to spend another $2.5 billion by end of day Friday.
www.housingwire.com
marsh
On TB every waking moment
That is the way the Stafford Act works: bottom up requests for specific enumerated resources from the local level on up to the state level and then requested for assistance from the federal government. After a state emergency has been justified and requested and approved.
marsh
On TB every waking moment
Coronavirus at SF’s Laguna Honda Hospital: More staff fall ill as officials scramble to contain spread
A lockdown was ordered at Laguna Honda Hospital, San Francisco’s 780-bed nursing home,...
www.sfchronicle.com
Coronavirus at SF’s Laguna Honda Hospital: More staff fall ill as officials scramble to contain spread
Trisha Thadani , Jason Fagone and Cynthia Dizikes March 25, 2020 Updated: March 25, 2020 8:29 p.m.
Comments
Laguna Honda Hospital on Friday, March 20, 2020, in San Francisco, Calif.
Photo: Santiago Mejia / The Chronicle
A full lockdown was ordered Wednesday at Laguna Honda Hospital, San Francisco’s 780-bed nursing home, as five staff members tested positive for the virus and officials scrambled to protect elderly and vulnerable residents.
As the city sought to reassure the public that it is taking the “appropriate measures” to contain the virus, staff members at Laguna Honda say they are working in an atmosphere of confusion, growing anxiety and shortages of crucial supplies.
On Wednesday, a fifth staff member at the nursing home tested positive for the new coronavirus, a second unit was placed under quarantine and the city health department barred residents from leaving the facility and coming back for fear that they may contract the virus outside.
Of the infected staff members, four are nurses and one is a porter. The porter has been on quarantine since March 5. The department publicly acknowledged that any staff members had contracted the virus this week.
None of the 750 residents had tested positive for the virus as of Wednesday afternoon, which is notable given that many of the elderly patients have underlying health conditions that make them particularly vulnerable to the illness. But the department said it has tested only 15 people with symptoms.
It is unclear if the staffers are getting infected at Laguna Honda or if they are contracting the virus outside. Any outbreak that took hold inside the 780-bed facility likely would be devastating; the majority of patients are over 65 years old with underlying health conditions.
The city took early steps to mitigate the risk at the hospital; since March 6, visitors and nonessential personnel have been barred from entering the hospital.
As the situation at Laguna Honda escalated Wednesday, Dr. Grant Colfax, director of the health department, did not mention Laguna Honda in his prepared remarks at an afternoon news conference; he mentioned it only in response to a question from a reporter.
“From the beginning, it (Laguna Honda) has been a key focus of the department’s efforts,” he said.
Colfax said the hospital has increased its screening of staff who may have come in contact with infected co-workers and that “all the proper precautions are being taken at this time.” The department also said front-line health workers have enough protective equipment to keep themselves safe — even though city officials put out a call for donations of masks, gowns and hazmat suits.
“All supplies, PPE and the like, have been centralized to ensure they are available to front-line staff when needed,” said Deirdre Hussey, a veteran spokeswoman in the city, who has been put in charge of communications for the hospital. “As a result, Laguna Honda, like many city departments, has centralized distribution. Laguna Honda is adequately supplied and PPE is available when staff makes a request.
The official remarks contradict the experience of some front-line workers on the ground.
In interviews with The Chronicle over the past week, multiple Laguna Honda medical professionals have said they don’t have enough N-95 respirators, face shields and regular surgical masks.
In a Wednesday email to city health leaders, Tim Jenkins, senior representative for the union that represents doctors at the nursing home, the Union of American Physicians and Dentists, asked for a current inventory of protective gear at Laguna Honda, including N-95 masks, surgical masks, shoe covers and face shields.
“Doctors I have spoken with are suffering significant anxiety created by the uncertainty of their safety at work due to a lack of information about the availability of personal protective equipment (PPE),” he wrote. The union representing nurses and other hospital staffers, SEIU Local 1021, made similar demands in a statement Monday evening.
Meanwhile, Quoc Nguyen, an administrator at the nursing home, posted a request on the site donateppe.org for “N95 masks, surgical masks, hospital gowns, hazmat suits,” noting that “Laguna Honda hospital is a 780 bed nursing home with a vulnerable population.” The site was created by UCSF students and other volunteers. Nguyen did not respond to a call and email requesting comment.
The lockdown means that residents no longer will be able to re-enter the hospital. They will continue to have access to outdoor areas of the 62-acre campus. The lockdown was to begin at 5 p.m. Wednesday and will last as long as California is under a stay-at-home order.
The city health department also mandated Wednesday that all staff in the city who come into contact with patients wear masks.
A medical professional at Laguna Honda said staff members are largely being left in the dark about the situation. The medical professional, who is not authorized to speak publicly and asked for anonymity, found out on Wednesday that another staff member was infected only because the professional read The Chronicle news feed.
The city’s “increasing secrecy is both baffling and infuriating,” the medical professional said.
Lizette Medrano, 36, said she is worried about her father, Jose, an 82-year-old resident of the nursing home who suffers from dementia. Medrano, a nurse at another local hospital, said Laguna Honda hasn’t sent her family any emails or letters about staffers testing positive for coronavirus.
“If employees are infected, most likely patients will be infected as well,” Medrano said. “We haven’t gotten any information from them.”
marsh
On TB every waking moment
I believe it came out today.When we have a quick test for antibodies, to show who has already had it, gotten over it,
and also can't infect any others now, all those people can start going back to work, yes?
Panic Early, Beat the Rush!
- Shane
View attachment 188802
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marsh
On TB every waking moment
You can use hand sanitizer on them while your hands are still in them
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Hospitals across U.S. consider universal do-not-resuscitate orders for coronavirus patients
In a sign of the grim choices ahead, officials worry that “all hands” responses may expose doctors and nurses to infection and some prioritize the survival of the many over the one.www.adn.com
Hospitals across U.S. consider universal do-not-resuscitate orders for coronavirus patients
- Author: Ariana Eunjung Cha, The Washington Post
A nurse holds swabs and test tube to test people for COVID-19 at a drive through station set up in the parking lot of the Beaumont Hospital in Royal Oak, Mich., Monday, March 16, 2020. (AP Photo/Paul Sancya)
Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes - how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.
The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment - such as masks, gowns and gloves - may be too great to justify the conventional response when a patient "codes," and their heart or breathing stops.
Northwestern Memorial Hospital in Chicago has been discussing a universal do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members - a wrenching decision to prioritize the lives of the many over the one.
Richard Wunderink, one of Northwestern's intensive-care medical directors, said hospital administrators have asked Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.
"It's a major concern for everyone," he said. "This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances."
Officials at George Washington University Hospital in Washington say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country's major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.
Several large hospital systems - Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks - are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.
Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at different institutions are sharing draft policies to address their changed reality.
"We are now on crisis footing," he said. "What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources - including staff."
The new protocols are part of a larger rationing of lifesaving procedures and equipment - including ventilators - that is quickly become a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.
Alta Charo, a University of Wisconsin-Madison bioethicist, said that while the idea of withholding treatments may be unsettling, especially in a country as wealthy as ours, it is pragmatic. "It doesn't help anybody if our doctors and nurses are felled by this virus and not able to care for us," she said. "The code process is one that puts them at an enhanced risk."
Wunderink said all of the most critically ill patients in the 12 days since they had their first coronavirus case have experienced steady declines rather than a sudden crash. That allowed medical staff to talk with families about the risk to workers and how having to put on protective gear delays a response and decreases the chance of saving someone's life.
A consequence of those conversations, he said, is that many family members are making the difficult choice to sign do-not-resuscitate orders.
- - -
Health-care providers are bound by oath - and in some states, by law - to do everything they can within the bounds of modern technology to save a patient's life, absent an order, such as a DNR, to do otherwise. But as cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19.
Some of the most anxiety-provoking minutes in a health-care worker's day involve participating in procedures that send virus-laced droplets from a patient's airways all over the room.
These include endoscopies, bronchoscopes and other procedures in which tubes or cameras are sent down the throat and are routine in ICUs to look for bleeds or examine the inside of the lungs.
Changing or eliminating those protocols is likely to decrease some patients' chances for survival. But hospital administrators and doctors say the measures are necessary to save the most lives.
The most extreme of these situations is when a patient, in hospital lingo, "codes."
When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel - usually somewhere around eight but sometimes as many as 30 people - rush into the room to begin live-saving procedures without which the person would almost certainly perish.
"It's extremely dangerous in terms of infection risk because it involves multiple bodily fluids," explained one ICU physician in the Midwest, who did not want her name used because she was not authorized to speak by her hospital.
Fred Wyese, an ICU nurse in Muskegon, Michigan, describes it like a storm:
A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a "crash cart" stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.
As soon as possible, a breathing tube will be placed down the throat and the person will be hooked up to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there's often no clear cut answer for when there's still hope and when it's too late.
In the process, heaps of protective equipment are used - often many dozens of gloves, gowns, masks, and more.
Bruno Petinaux, chief medical officer at George Washington University Hospital, said the hospital has had a lot of discussion about how - and whether - to resuscitate covid-19 patients who are coding.
"From a safety perspective you can make the argument that the safest thing is to do nothing," he said. "I don't believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely."
However, he said, the decision comes down to a hospital's resources and "every hospital has to assess and evaluate for themselves." It's still early in the outbreak in the Washington, D.C. area, and GW still has sufficient equipment and manpower. Petinaux said he cannot rule out a change in protocol if things get worse.
GW's procedure for responding to coronavirus patients who are coding includes using a machine called a Lucas device, which looks like a bumper, to deliver chest compressions. But the hospital has only two. If the Lucas devices are not readily accessible, doctors and nurses have been told to drape plastic sheeting - the 7-millimeter kind available at Home Depot or Lowe's - over the patient's body to minimize the spread of droplets and then proceed with chest compressions. Because the patient would presumably be on a ventilator, there is no risk of suffocation.
In Washington state which had the nation's first covid-19 cases, UW Medicine's chief medical officer, Tim Dellit, said the decision to send in fewer doctors and nurses to help a coding patient is about "minimizing use of PPE as we go into the surge." He said the hospital is monitoring health-care workers' health closely. So far, the percentage of infections among those tested is less than in the general population, which, he hopes, means their precautions are working.
A woman exits a COVID-19 testing site while hundreds wait in line at Elmhurst Hospital Center, Wednesday, March 25, 2020, in New York. Gov. Andrew Cuomo sounded his most dire warning yet about the coronavirus pandemic Tuesday, saying the infection rate in New York is accelerating and the state could be as close as two weeks away from a crisis that sees 40,000 people in intensive care. Such a surge would overwhelm hospitals, which now have just 3,000 intensive care unit beds statewide. (AP Photo/John Minchillo)
- - -
Bioethicist Scott Halpern at the University of Pennsylvania is the author of one widely circulated model guideline being considered by many hospitals. In an interview, he said a blanket stop to resuscitations for infected patients is too "draconian" and may end up sacrificing a young person who is otherwise in good health. However, health-care workers and limited protective equipment cannot be ignored.
"If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair," he said.
Halpern's document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree.
Wyese, the Michigan ICU nurse, said his own hospital has been thinking about these issues for years but still is unprepared.
"They made us do all kinds of mandatory education and fittings and made it sound like they are prepared," he said. "But when it hits the fan, they don't have the supplies so the plans they had in place aren't working."
Over the weekend, Wyese said, a suspected covid-19 patient was rushed in and put into a negative pressure room to prevent the virus spread. In normal times, a nurse in full hazmat-type gear would sit with the patient to care for him, but there was little equipment to spare. So Wyese had to monitor him from the outside. Before he walked inside, he said, he would have to put on a face shield, N95 mask, and other equipment and slather antibacterial foam on his bald head as the hospital did not have any more head coverings. Only one powered air-purifying respirator or PAPR was available for the room and others nearby that could be used when performing an invasive procedure - but it was 150 feet away.
While he said his hospital's policy still called for a full response to patients whose heart or breathing stopped, he worried any efforts would be challenging, if not futile.
"By the time you get all gowned up and double-gloved the patient is going to be dead," he said. "We are going to be coding dead people. It is a nightmare."
- - -
The Washington Post’s Ben Guarino in New York and Desmond Butler contributed to this report.
While I understand the logic that they are using in this decision, I again have to ask, what the hell is wrong with the management of these hospitals and why in the hell haven't heads rolled for not stocking up months ago with the supplies that they would need when they saw how this virus was progressing in other parts of the world. I, not a lawyer, could make a pretty good argument that this is/was incompetence on part of the hospital administration, and therefore the hospital is liable, but I am sure we will see those type lawsuits in the coming days.