Corona Virus: It's a Marathon, Not a Sprint

[Dogstar]

... and I don't feel so good. Thought a new thread might be appropriate for P&R given the potential for this to dominate the news in the months to come... and this isn't likely the last germ or virus we're likely to see with P&R implications.

So to get things started... no one knows what's going on with Iran exactly, except that there are probably more cases than they've let the world know about. Their former Ambassador to the Vatican has died of the virus. Their Vice-President has it. Their Deputy Health Minister has it (he was noticeably sweating and looking sick in their last press conference about Corona). This is one of the fears (or at least one of mine) -- a nation without a robust health infrastructure gets potentially overrun with cases, which causes refugees to flee...

But some good news, as Smoove pointed out in non-P&R, is that while the actual infection rate may be higher, as there might be quite a few undiagnosed cases, that could potentially lower the mortality rate as deaths are deaths (unless they're being mis-attributed).

[Blackhawk]

You know, one advantage to where I live is that with everything so rural, the schools already have systems in place for days when the school has to close. When lots of kids live on rural back roads that aren't in good repair and aren't plowed, it takes a lot less snow for it to become a big enough safety issue to cancel school. Our kids' school used to schedule two weeks worth of snow days, and sometimes exceeded those, requiring that school be extended. It led to standardized test coming out before material had been taught due to delays, too.

So three years ago the school transitioned all of the their textbooks to Chromebooks, most of their assignments to Google Classroom, and implemented an 'eLearning' system through which the students could receive all of their assignments and turn in all of their work online. After a couple of practice runs, the school eliminated snow days altogether, shortening the school year by two weeks, likely saving much of the cost of the program from that alone. Had we lived in a more urbanized area, this would all have been less of a budget priority.

It also means that the schools will be less hesitant to close should it come to that, and the impact on education will be lessened.

[stessier]

Can we change the thread title to spell it correctly? Unless this was a dig at our fearless leader, I guess.

[Blackhawk]

When you gonna give to me, a gift to me
Is it just a matter of time, Carona?
Is it d-d-destiny, d-destiny
Or is it just a game in my mind, Carona?

[Dogstar]

Can we change the thread title to spell it correctly? Unless this was a dig at our fearless leader, I guess.

That it was.

[Smoove_B]

a nation without a robust health infrastructure gets potentially overrun with cases, which causes refugees to flee...

So one of my all time favorite public health experts is Laurie Garrett. I had the luck of hearing her on the radio this morning and she really brought this issue to the forefront. We're a global society at this point, however there is no ability for a global, coordinated response. This is bad and there are absolutely going to be non-disease related implications associated with how other nations around the world start dealing with this.

For us here in the U.S. her concerns were specifically related to tabletop exercises she's participated in over the last 30 years. I myself have only ever participated in county-level exercises, but I have no doubts what she's fearing will happen. Namely that each state is going to have its own response and if this escalates cooperation, sharing of resources, etc... is going to stop. NJ is literally *the worst* with home-rule issues and the idea that 49 states would behave similarly is really concerning. Again, not directly disease related but instead the delivery of things like food or medical supplies might become a problem. The way to deal with that is with guidance/assistance from the federal government but unfortunately all of those positions and agencies have been shuttered/eliminated/starved/reassigned as to no longer be "response-ready".

It's still far to early to know exactly how this will all unfold, but in the short term I absolutely see chaos. Not from a virus, but from how we collectively respond.

[gilraen]

In the U.S., the biggest problem with the virus spreading won't be from the healthcare system that's overwhelmed but from the healthcare system that's unaffordable to large swaths of the population. People who have crappy insurance or no insurance at all may think that they have a cold or flu, and unless they feel sick enough to go to the ER, they'll keep going to work, spreading the virus around. Ironically, many of those people are in service professions (hotel housekeeping, fast food & restaurant staff, store clerks) - so they can potentially interact with hundreds of people every day.

[Dogstar]

In the U.S., the biggest problem with the virus spreading won't be from the healthcare system that's overwhelmed but from the healthcare system that's unaffordable to large swaths of the population. People who have crappy insurance or no insurance at all may think that they have a cold or flu, and unless they feel sick enough to go to the ER, they'll keep going to work, spreading the virus around. Ironically, many of those people are in service professions (hotel housekeeping, fast food & restaurant staff, store clerks) - so they can potentially interact with hundreds of people every day.

It's not just this -- it's that with the amount of debt and savings a chunk of America has, they literally cannot afford to miss much time at work, if any -- let alone adding any medical bills on top of that.

[$iljanus]

a nation without a robust health infrastructure gets potentially overrun with cases, which causes refugees to flee...

So one of my all time favorite public health experts is Laurie Garrett. I had the luck of hearing her on the radio this morning and she really brought this issue to the forefront. We're a global society at this point, however there is no ability for a global, coordinated response. This is bad and there are absolutely going to be non-disease related implications associated with how other nations around the world start dealing with this.

For us here in the U.S. her concerns were specifically related to tabletop exercises she's participated in over the last 30 years. I myself have only ever participated in county-level exercises, but I have no doubts what she's fearing will happen. Namely that each state is going to have its own response and if this escalates cooperation, sharing of resources, etc... is going to stop. NJ is literally *the worst* with home-rule issues and the idea that 49 states would behave similarly is really concerning. Again, not directly disease related but instead the delivery of things like food or medical supplies might become a problem. The way to deal with that is with guidance/assistance from the federal government but unfortunately all of those positions and agencies have been shuttered/eliminated/starved/reassigned as to no longer be "response-ready".

It's still far to early to know exactly how this will all unfold, but in the short term I absolutely see chaos. Not from a virus, but from how we collectively respond.

I've always enjoyed Laurie Garrett's written work and would love to hear her speak someday.

When there's a national disaster, the lines of coordination between the state or states affected and the Federal response were pretty clear and usually robust (with exceptions of course, ie Katrina). I think that natural disasters are more tangible for people such as power lines down, fires, roads and bridges impassible, etc. so it makes sense to listen to authorities. I get the feeling though that people can't wrap their mindset around epidemics and I don't know of many people left alive who remember the Spanish Flu. Also it's a fact that a biological agent doesn't really care about borders, whether you live in a red or blue state, etc. It will go where the people are. When we go to war, it's not "The East Coast sends regiments to battle" but a coordinated response by the Federal government with a national military. You may have the argument about government overreach into our lives but many folks agree that the defense of the US is usually put under the purview of the Federal government. The defense of its citizens from an epidemic should have the same mindset and we're not talking about troops in the streets like some movie but guidance from agencies that work on this sort of thing, money for states to help manage things locally, etc.

The politicization of this outbreak is reprehensible and is yet another thing that makes me want to bang my head against the wall when I hear the usual people talk about the "deep state" or "plot against Trump" and other such nonsense.

She could always be replaced at any time if politically expedient for the Toddler in Chief but I'm somewhat put at ease that Pence has named Ambassador Debbie Birx as the "White House Coronavirus Response Coordinator".

From Wiki:

Birx served as a physician in the United States Army, rising to the rank of colonel[4] before she retired from military service. She started her career with the United States Department of Defense as a clinician in immunology, focusing on HIV/AIDS vaccine research. She then served as an Assistant Chief of the Hospital Immunology Service at Walter Reed Army Medical Center from 1985 to 1989. In 1996, she became the Director of the United States Military HIV Research Program at the Walter Reed Army Institute of Research, a role she held until 2005.[5]

From 2005 to 2014, Ambassador Birx served as the director of CDC's Division of Global HIV/AIDS (DGHA), which is part of the agency's Center for Global Health.[6]

In her role as ambassador she is leading the organization to meet the HIV prevention and treatment targets set by President Barack Obama in 2015 and achieving the goal of ending the AIDS epidemic by 2030.[7] She says that PEPFAR has cut pediatric HIV infection rates by 50 percent in several African countries.[8]

On February 27, 2020, Vice President Mike Pence named Ambassador Birx as the coronavirus response coordinator for the White House.[9]

[Pyperkub]

Can we change the thread title to spell it correctly? Unless this was a dig at our fearless leader, I guess.

Plus, it will take me away to a Corona Beach!

[malchior]

When there's a national disaster, the lines of coordination between the state or states affected and the Federal response were pretty clear and usually robust (with exceptions of course, ie Katrina).

I wonder if there is a commonality here.

The politicization of this outbreak is reprehensible and is yet another thing that makes me want to bang my head against the wall when I hear the usual people talk about the "deep state" or "plot against Trump" and other such nonsense.

She could always be replaced at any time if politically expedient for the Toddler in Chief but I'm somewhat put at ease that Pence has named Ambassador Debbie Birx as the "White House Coronavirus Response Coordinator".

I'm not. The worst time to figure out how to coordinate incident response is during the incident. The plans that were in place have contact lists that point to roles that dont exist anymore. There are RACIs and processes that likely don't work anymore. The response will be ad hoc and much less efficient.

To be clear, I'm not an expert in health incident response but I am an expert in Cyber incident response and we work off the exact same principles. I am very concerned because they obliterated our preparedness just before a major event. Like all things Trump touches it all turns to shit. A coordinator is only as good as the process/playbook they have. She is stepping into something that is bound to fail no matter what.

[Smoove_B]

but I'm somewhat put at ease that Pence has named Ambassador Debbie Birx as the "White House Coronavirus Response Coordinator".

It's encouraging, yes. However, Pence also named Larry Kudlow to the task force as well. Two days ago Kudlow told the press that the virus was "well contained". Not sure if Pence is truly smart enough to bring people into this that will be useful -or- if he's looking to make sure he can't be fully blamed for what's going to happen next.

[LawBeefaroni]

CDC coding guidance (interim until October)

Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory distress
syndrome, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Exposure to COVID-19
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after
evaluation, it would be appropriate to assign the code Z03.818, Encounter for observation for suspected
exposure to other biological agents ruled out.
For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would
be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral
communicable diseases.




Note: Diagnosis code B34.2, Coronavirus infection, unspecified, would in generally not be appropriate
for the COVID-19, because the cases have universally been respiratory in nature, so the site would not
be “unspecified.”

If the provider documents “suspected”, “possible” or “probable” COVID-19, do not assign code B97.29.
Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828).

[$iljanus]

but I'm somewhat put at ease that Pence has named Ambassador Debbie Birx as the "White House Coronavirus Response Coordinator".

It's encouraging, yes. However, Pence also named Larry Kudlow to the task force as well. Two days ago Kudlow told the press that the virus was "well contained". Not sure if Pence is truly smart enough to bring people into this that will be useful -or- if he's looking to make sure he can't be fully blamed for what's going to happen next.

Now it would make sense to have an economic adviser that can provide input on the effects of an epidemic on the economy. Hmmm, this Larry Kudlow sounds really familiar (goes to look him up)

Oh fucking dear, now I know why he's familiar. What a shit show. Why not add Lou Dobbs to the task force while you're at it. Where the hell is a vomit emoji?

[Dogstar]

Governor Newsom - California with 28 confirmed cases; monitoring 8400 others.

https://www.sfchronicle.com/bayarea/amp ... yR&ampcf=1

[Smoove_B]

Note this element from that link:

The CDC is sending 10 officials to assist in helping to track down people who came in contact with the patient.

This is also normal and to be expected. The problem will be as this evolves, the CDC isn't going to be able to send investigators out to the various locations to assist. In other words, the first sites are going to get the most attention and as it spreads and expands, resources will get stretched. This is also expected -however- the issues at the federal level (budget, cuts/reassignment) are working against plans that have been in place for 10+ years. My email has been flooded today with information from the state and the county I (sorta) work in regarding activation of our plan that was updated in 2013 - and that's good. The problem is that our plan ultimately assumes assistance from the feds is coming at some point. The longer that takes, the more stress it will cause. In terms of planning, the worst case scenario is multiple simultaneous outbreaks occurring nationwide and unofficially, that seems to be a reasonable assumption for what is going to happen here.

To be clear, I'm not an expert in health incident response but I am an expert in Cyber incident response and we work off the exact same principles. I am very concerned because they obliterated our preparedness just before a major event. Like all things Trump touches it all turns to shit. A coordinator is only as good as the process/playbook they have. She is stepping into something that is bound to fail no matter what.

As I've been saying, the overwhelming majority of this is on the backs of the locals. But services nationwide are by no means equal, and that's a huge problem. I wouldn't label myself an expert by any means, but I am incident command certified and in practice would be part of the "shoe leather" investigation element, chasing down cases and following up with quarantine elements. I have no idea if I'll be called up to help, but it's certainly possible. I'm confident in our state and local plans. I have nothing but faith in my immediate peers and superiors - we're not a large contingent, but we're mighty. I know we have resources and stockpiles and have been through training and simulations for almost 2 decades. However, at some point we'd need help from the feds and that's where I think the weak link currently is.

[Pyperkub]

Getting the investigators to California as an early state, but also the most populous and with the greatest ties to Asia does make sense.

[Smoove_B]

From an article in the NYT earlier today:

"Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infections Diseases, told associates that the White House had instructed him not to say anything else without clearance."

W.T.F.

[Combustible Lemur]

From an article in the NYT earlier today:

"Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infections Diseases, told associates that the White House had instructed him not to say anything else without clearance."

W.T.F.

That's now get reported by at least msnbc.

Sent from my SM-N975U using Tapatalk

[LordMortis]

From an article in the NYT earlier today:

"Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infections Diseases, told associates that the White House had instructed him not to say anything else without clearance."

W.T.F.

He works for Federal Gov't so that's the prerogative of the White House... More than that I'd vent my spleen in from R&P.

Wait, this is R&P. So yeah, just throw another log on the fire of this administration, where we shit on health care, blame the mess on the democrats, and then all but proclaim executive privilege when it comes to a literal current epidemic. I guess we wait for the black sharpie to tell us what's up.

[Blackhawk]

From an article in the NYT earlier today:

"Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infections Diseases, told associates that the White House had instructed him not to say anything else without clearance."

W.T.F.

I figured that since Trump had them speak at his "everything's fine" briefing, it was already assumed that every one of the experts had been gagged, and every one of their presentations was scripted and approved.

[Smoove_B]

He works for Federal Gov't so that's the prerogative of the White House... More than that I'd vent my spleen in from R&P.

I mean, it's true. But Dr. Fauci reports ultimately to the head of HHS (Secretary Azar) so to have The White House tell him to pipe down would be unprecedented. To be clear, there should be an understanding behind the scenes as to what's being communicated (that's risk communication 101), but for Dr. Fauci to come out and say what he did? Trouble. "Expert" doesn't even begin to do him justice.

Then there's this nugget:



Pence does not want to be in charge; Pence does not want to be involved with this at all.

[Smoove_B]

Oh boy, developing...

SCOOP: HHS sent workers to assist with coronavirus-exposed U.S. passengers evacuated from Wuhan without proper training or protective gear, a whistleblower claims.

[Holman]

Oh boy, developing...

SCOOP: HHS sent workers to assist with coronavirus-exposed U.S. passengers evacuated from Wuhan without proper training or protective gear, a whistleblower claims.

Well, you can stop worrying. The whistleblower has been reassigned.

[Holman]

So... maybe the unsourced California case was actually infected by the administration's protocol failure?

https://twitter.com/brianbeutler/status ... 30720?s=20

I am so glad that the best and brightest are in charge of all of this.

To recap: infected US citizens were brought to Travis AFB and dealt with my officials not using correct protection or contact protocols. Those officials were then allowed to wander around in public.

Travis AFB is between San Francisco and Sacramento, but that's fine because people in California don't move around much.

[Smoove_B]

Yup. It's a solid theory and if it turns out to be true, a nightmare.

[malchior]

However, at some point we'd need help from the feds and that's where I think the weak link currently is.

This is my concern in particular. If big decisions need to be made it should have been table topped out and people should be aware who is communicating/coordinating response. And these people are likely working off plans that don't reflect the current state. And you know if it gets bad this asshole is going to flex and start shit that make that old scene from Downfall look sane.

[Holman]

CDC has issued notices like "Take precautions: stay at home if you are sick."

What percentage of Americans have jobs where they can just stay at home if they are sick?

I think the stock market understands this, which is why it's tanking.

[malchior]

You know what creeps me the fuck out of me. Not so much this situation yet. It is the Press Conferences by Trump. He is saying that it will vanish like a miracle and he is surrounded by literal yes men chiming in with a chorus of mhms and yes's. WTF is going on? Every day I see something new that makes me realize how far into the abyss we are.

[Kraken]

I think the stock market understands this, which is why it's tanking.

The stock market understands that consumers are the only thing driving growth now, and they're spooked.

[LordMortis]

You know what creeps me the fuck out of me. Not so much this situation yet. It is the Press Conferences by Trump. He is saying that it will vanish like a miracle and he is surrounded by literal yes men chiming in with a chorus of mhms and yes's. WTF is going on? Every day I see something new that makes me realize how far into the abyss we are.

It will vanish like a miracle just like SARS and MERS. But not before it takes it toll. And even then Trump will believe he fixed it and the will of his belief will be enough for his prophets and his believers.

[Holman]

Mick Mulvaney was just at CPAC ranting that the media is hyping coronavirus to hurt Trump.

Meanwhile Japan is shutting down schools for two months. Mighty nice of them to go along with the scam like that.

[malchior]

You know what creeps me the fuck out of me. Not so much this situation yet. It is the Press Conferences by Trump. He is saying that it will vanish like a miracle and he is surrounded by literal yes men chiming in with a chorus of mhms and yes's. WTF is going on? Every day I see something new that makes me realize how far into the abyss we are.

It will vanish like a miracle just like SARS and MERS. But not before it takes it toll. And even then Trump will believe he fixed it and the will of his belief will be enough for his prophets and his believers.

That's one part. But the chorus of yes's complete with Diamond & Silk sitting there as he says this...it ain't right. It is weird North Korean cult-like activity.

Here is a video of it. This isn't the nation I grew up in anymore.

https://twitter.com/RiegerReport/status ... 7702519808

[wonderpug]

Does anyone know who's been pushing the "it's no worse than a common cold" line? I'm seeing people parroting that on NextDoor and I'm pretty much ready to give up on humanity.

[Octavious]

Our medal of freedom winner Rush has been pushing it. F this timeline.

[LawBeefaroni]

You know what creeps me the fuck out of me. Not so much this situation yet. It is the Press Conferences by Trump. He is saying that it will vanish like a miracle and he is surrounded by literal yes men chiming in with a chorus of mhms and yes's. WTF is going on? Every day I see something new that makes me realize how far into the abyss we are.

It will vanish like a miracle just like SARS and MERS. But not before it takes it toll. And even then Trump will believe he fixed it and the will of his belief will be enough for his prophets and his believers.

That's one part. But the chorus of yes's complete with Diamond & Silk sitting there as he says this...it ain't right. It is weird North Korean cult-like activity.

Here is a video of it. This isn't the nation I grew up in anymore.

https://twitter.com/RiegerReport/status ... 7702519808

Yeah, the chorus in the background is unbelievable. What the motherfucking fuck has happened to us? That is literally one of the dumbest things I have heard anyone say in months. Like a stump full of bullshit dumb. And they're agreeing. Clearly they know it's bullshit. Unconscionable.

[malchior]

https://twitter.com/Popehat/status/1233417935407869953

Be sure to shake lots of hands.

[LordMortis]

That full quote is just an embarrassment. That's not what a PoTUS says. That's not the level of assessment a PoTUS should have... and convey. That's what a drone says when they take a break from the grindstone. The drone puts their faith in a government so they can continue to put their nose down.

[Skinypupy]

Mulvaney is now jumping on the "it's all a media hoax to bring down Trump" bandwagon as well.

https://twitter.com/anniekarni/status/1 ... 1660198914

Mulvaney is saying that the press is now covering Coronavirus because "they think this will bring down the president. That’s what it’s all about."

More Mulvaney: "It’s not a death sentence. It’s not the same as the Ebola crisis. "

These fucking people...

[Smoove_B]

He's likely been consulting with Dr. Jenny McCarthy

He attended Charlotte Catholic High School and then Georgetown University, where he majored in international economics, commerce and finance. Mulvaney attended law school at the University of North Carolina at Chapel Hill. He earned a full scholarship to attend law school, where his focus was on antitrust law. He graduated with his J.D. degree in 1992