[guest post by Dana]

The White House released their plan to open up America. President Trump said today that some states could even start reopening “literally tomorrow.”:

Trump’s plan to re-open the American economy after a near-total shutdown consists of three graduated phases.

In a call with governors, state leaders were instructed that they could move through the guidelines at their own pace and that the guidelines are not formal orders from the federal government, according to a person familiar with the call.

“Encouraging developments have put us in a very strong position to finalize guidelines for states on reopening the country,” Trump said earlier Thursday, as the U.S. death toll from the coronavirus pandemic neared 30,000 Wednesday evening.

…

While Trump and his task force pointed to areas of the country with fewer cases, the government’s top expert on infectious diseases Dr. Anthony Fauci, absent from the Wednesday briefing, told ABC News anchor David Muir on “World News Tonight” to expect a slow rollout dictated by local authorities — one that’s heavily dependent on that community’s ability to test, provide medical care and do contact tracing.

It’s a good thing these are non-binding guidelines. It’s also good to see that Trump resisted the urge to exercise his total authority(!) and left it up to the state governors to set the pace for reopening. After all, who better to know what will best fit their state’s needs, and the pace at which to proceed. It also seems that Trump listened to Dr.Fauci’s caution from last week when he said that a one-size-fits-all plan wasn’t going to work: “You’re going to call your own shots,” Mr. Trump said in a telephone call on Thursday with the governors, according to an audio recording provided to The New York Times. “You’re going to be calling the shots.”

I’m just going to post the guideline’s Gating Criteria. It seems like a pretty tall order on it’s own. These benchmarks must be satisfied before moving into Phase One:

SYMPTOMS: Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period AND Downward trajectory of covid-like syndromic cases reported within a 14-day period

CASES: Downward trajectory of documented cases within a 14-day period OR Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)

HOSPITALS: Treat all patients without crisis care AND Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

–Dana

[guest post by Dana]

In what is being called an “unprecedented” moment, Bay Area food banks are struggling to meet the increased demand of families in crisis:

When dozens of desperate people began showing up at its warehouse — which is not a food distribution center — the Alameda County Community Food Bank realized that the coronavirus pandemic and widespread layoffs were causing a hunger crisis.

“It was a telling moment when we realized we needed to readjust in real time,” said Mike Altfest, director of community engagement and marketing. “We are seeing an unprecedented surge in demand.”

The agency scrambled to open up a new drive-through distribution center nearby where families could drive up, pop their trunks and have groceries loaded inside. It started March 30 serving about 30 households. Within 10 days, that was up to 470 households with cars weaving around a huge parking lot. On Friday, a staggering 743 cars showed up.

Throughout the Bay Area, food banks — nonprofits that distribute free groceries to those in need, often via social service agencies — tell similar stories of being inundated with urgent requests from people who’ve lost their incomes during the shutdown that has left at least 2.4 million Californians newly unemployed. The vast majority of job loss occurred among lower-income people — hotel housekeepers, cooks, waiters, janitors, cabbies, health aides, day care workers and others who often live paycheck to paycheck.

“It gives you chills thinking about how deep the hunger is now,” said Andrew Cheyne, director of government affairs for the California Association of Food Banks.

“We’ve seen the emergence of a new population that has never before relied on food banks,” said Cassidie Carmen Bates, policy and advocacy manager for the Food Bank of Contra Costa & Solano. “Circumstances have made it impossible for many people to provide the food their family needs.”

With that, Nancy Pelosi, who represents California’s 12th congressional district in San Francisco, made an (online) appearance on the Late Late Show With James Corden this week. She was asked by Corden to show the audience something from her home, and viewers were shown a large basket of chocolates on her counter. She then moved over to her spiffy refrigerator, opened the freezer drawer, and pionted out an impressive stash of gourmet ice cream:

Twelve containers of Jeni’s Splendid Ice Creams can be seen in her freezer (along with Dove bars). The price for six pint-size containers runs $68 (dairy-free $58). Viewers got a glimpse of more than $135 of designer ice cream in Pelosi’s freezer. I don’t begrudge Pelosi one bit for buying expensive ice cream. She can do what she wants with her money. She can buy the whole ice cream factory. I don’t care. But given that so many Bay Area residents have recently lost their incomes, and are desperately trying to stay afloat as they visit area food banks, maybe keeping the freezer drawer shut would have been the better option.

We hear a lot about wealth disparity in America. And we know that a lot of Americans resent the wealthy, powerful, and well-connected, even on a good day. Reports about privileged Americans fleeing the nation’s hot spots to sit out the pandemic in their summer homes have been numerous, and descriptions of these privileged “visitors” depleting limited supplies and resources that locals depend upon, have been troubling. So how hard is it for a powerful and wealthy elected official to realize that, during a pandemic when unemployement is through the roof and food banks are struggling to meet demand, the haves need to be cognizant of the have-nots, and act accordingly. Bad optics aside, this was a tone-deaf move on her part.

We all have found our ways to keep our spirits up during these trying times. Mine just happens to fill up my freezer. #LateLateShow pic.twitter.com/dqA32d5lU1

— Nancy Pelosi (@SpeakerPelosi) April 14, 2020

–Dana

[guest post by Dana]

This sounds pretty awful:

Nurse Mike Gulick was meticulous about not bringing the novel coronavirus home to his wife and their 2-year-old daughter. He’d stop at a hotel after work just to take a shower. He’d wash his clothes in Lysol disinfectant. They did a tremendous amount of handwashing.

But at Providence Saint John’s Health Center in Santa Monica, California, Gulick and his colleagues worried that caring for infected patients without first being able to don an N95 respirator mask was risky. The N95 mask filters out 95% of all airborne particles, including ones too tiny to be blocked by regular masks. But administrators at his hospital said they weren’t necessary and didn’t provide them, he said.

His wife, also a nurse, not only wore an N95 mask, but covered it with a second air-purifying respirator while she cared for COVID-19 patients at Cedars-Sinai Medical Center across town in Los Angeles.

Then, last week, a nurse on Gulick’s ward tested positive for the coronavirus, which causes the disease COVID-19. The next day doctors doing rounds on their ward asked the nurses why they weren’t wearing N95 masks, Gulick said, and told them they should have better protection.

For Gulick, that was it. He and a handful of nurses told their managers they wouldn’t enter COVID-19 patient rooms without N95 masks. The hospital suspended them, according to the National Nurses Union, which represents them. Ten nurses are now being paid but not allowed to return to work pending an investigation from human resources, the union said.

Note:

Guidelines from the Centers for Disease Control and Prevention don’t require N95 masks for COVID-19 caregivers, but many hospitals are opting for the added protection because the infection has proven to be extremely contagious. The CDC said Wednesday at least 9,200 health care workers have been infected.

Three days ago, the CDC updated it’s website, with regard to Infection Control:

Major distributors in the United States have reported shortages of PPE, including N95 respirators, facemasks, eye protection, gowns, and gloves. Healthcare facilities are responsible for protecting their HCP from exposure to pathogens, including by providing appropriate PPE.

In times of shortages, alternatives to N95s should be considered, including powered air-purifying respirators (PAPRs), other classes of disposable FFRs, elastomeric half-mask, and full facepiece air-purifying respirators where feasible. Special care should be taken to ensure that respirators are reserved for situations where respiratory protection is most important, such as performance of aerosol generating procedures on patients with suspected or confirmed COVID-19 or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella).

The anticipated timeline for return to routine levels of PPE is not yet known. Information about strategies to optimize the current supply of N95 respirators, including the use of devices that provide higher levels of respiratory protection (e.g., powered air-purifying respirators [PAPRs]) when N95s are in limited supply…

Specifically:

Some procedures performed on patients with known or suspected COVID-19 could generate infectious aerosols. Procedures that pose such risk should be performed cautiously and avoided if possible. If performed, the following should occur: HCP in the room should wear an N95 or higher-level respirator such as disposable filtering facepiece respirators, PAPRs, and elastomeric respirators, eye protection, gloves, and a gown.

St. Johns released a statement, which indicated that

[A]s of Tuesday it’s providing N95 masks to all nurses caring for COVID-19 patients and those awaiting test results. The statement said the hospital had increased its supply and was disinfecting masks daily.

“It’s no secret there is a national shortage,” said the statement. The hospital would not comment on the suspended nurses.

Here’s what happened to one nurse:

Angela Gatdula, a Saint John’s nurse who fell ill with COVID-19, said she asked hospital managers why doctors were wearing N95s but nurses weren’t. She says they told her that the CDC said surgical masks were enough to keep her safe.

Then she was hit with a dry cough, severe body aches and joint pain.

“When I got the phone call that I was positive I got really scared,” she said.

She’s now recovering and plans to return to work next week.

“The next nurse that gets this might not be lucky. They might require hospitalization. They might die,” she said.

Although the report doesn’t confirm that Gatdula was infected directly by one of her patients, it does speak to the serious problems nurses (and healthcare workers) are facing, and the seeming double-standard in the distribution of N95s.

Finally, the report also reminds us that, due to the shortage of N95s in the U.S., the CDC had lowered its standards, and recommended that health care workers use bandannas if masks were unavailable.

–Dana

[guest post by Dana]

No, there won’t be a Radio Trump. Not yet, anyway… Instead of running with his idea to host an open line call-in radio show, 2 hours a day, every day , Trump scrapped the plan because his envisioned show would have put him in competition with Rush Limbaugh:

On a Saturday in early March, Donald J. Trump, clad in a baseball cap, strode into the Situation Room for a meeting with the coronavirus task force. He didn’t stop by the group’s daily meetings often, but he had an idea he was eager to share: He wanted to start a White House talk radio show.

At the time, the virus was rapidly spreading across the country, and Mr. Trump would soon announce a ban on European travel. A talk radio show, Mr. Trump excitedly explained, would allow him to quell Americans’ fears and answer their questions about the pandemic directly, according to three White House officials who heard the pitch. There would be no screening, he said, just an open line for people to call and engage one-on-one with the president.

But that Saturday, almost as suddenly as he proposed it, the president outlined one reason he would not be moving forward with it: He did not want to compete with Rush Limbaugh.

Although he won’t be hosting a radio show, Trump, nonetheless, continues to benefit greatly from Limbaugh’s radio show:

The president may have dropped plans for his own talk radio show. But for Mr. Trump, what Mr. Limbaugh offers is perhaps second best: a taste of the validation he craves, as well as a blueprint for how to make his supporters even happier.

Upon hearing that Trump had opted not to go forward with his proposed radio plans, Limbaugh made his own offer:

“If the president wants to do this — if he wants to come on and have a show — we’ll let him do it,” Limbaugh said on his national broadcast Wednesday.

“I’m here making it known — and I will call later, too — but I’m doing it here, making it known that this program is available to the president if he wants to audition, if he wants to use it for a town hall, if he wants to have direct connect with you, that we got it handled.”

“We could do it noon to three for as long as he wants. He could have direct connect with you in the audience. You know, not a bunch of bureaucrat experts up on the stage, and certainly no journalists choosing the questions or any of that. We’ll do it in a different way than anybody’s ever done town halls or any of that stuff.”

I can see this as a great way for Trump to rally his base during a pandemic, given that he is unable to hold in-person rallies. While he could address issues concerning the pandemic, it would likely end up being an on-air extension of his Twitter feed – basically, another avenue for airing his grievances at those whom he perceives as having wronged him and boasting about himself. Obviously it wouldn’t be the same as an in-person rally, but he could still generate a significant audience of supporters, and the call-in aspect could provide him with several hours of callers singing his praises, seven days a week. (Of course callers would be screened. He’s not foolish enough to risk getting shredded day after day…) And if he jumps on Limbaugh’s offer, he will already have a built-in audience of loyal supporters.

–Dana