[2006alum]

More evidence that calls for unity are pretty hollow when they exclude the one at the top:

[tweet]https://twitter.com/MSNNews/status/1252046985550426113?s=20[/tweet]
Seriously??? Not really sure how to come together when some people are singled out and excluded on purpose.

[2006alum]

More evidence that calls for unity are pretty hollow when they exclude the one at the top:

[tweet]https://twitter.com/MSNNews/status/1252046985550426113?s=20[/tweet]
Seriously??? Not really sure how to come together when some people are singled out and excluded on purpose.

[teejers1]

Incidentally, stories like this evidence, in part, for why divisions are emerging: the feds are literally forcing hospital administrations to import PPE as if they are running a blockade in order to get necessary equipment for their healthcare providers.
[tweet]https://twitter.com/dwallacewells/status/1251922312770748417?s=20[/tweet]

Here's a snippet of the most interesting part from the New England Journal of Medicine letter writer:

 It’s worth reading the correspondence, written by an executive running a small health system, at some length:

Our supply-chain group has worked around the clock to secure gowns, gloves, face masks, goggles, face shields, and N95 respirators. These employees have adapted to a new normal, exploring every lead, no matter how unusual. Deals, some bizarre and convoluted, and many involving large sums of money, have dissolved at the last minute when we were outbid or outmuscled, sometimes by the federal government. Then we got lucky, but getting the supplies was not easy. . . .

Hours before our planned departure, we were told to expect only a quarter of our original order. We went anyway, since we desperately needed any supplies we could get. Upon arrival, we were jubilant to see pallets of KN95 respirators and face masks being unloaded. We opened several boxes, examined their contents, and hoped that this random sample would be representative of the entire shipment. Before we could send the funds by wire transfer, two Federal Bureau of Investigation agents arrived, showed their badges, and started questioning me. No, this shipment was not headed for resale or the black market. The agents checked my credentials, and I tried to convince them that the shipment of PPE was bound for hospitals. After receiving my assurances and hearing about our health system’s urgent needs, the agents let the boxes of equipment be released and loaded into the trucks. But I was soon shocked to learn that the Department of Homeland Security was still considering redirecting our PPE. Only some quick calls leading to intervention by our congressional representative prevented its seizure. I remained nervous and worried on the long drive back, feelings that did not abate until midnight, when I received the call that the PPE shipment was secured at our warehouse.

In this instance, the executive managed to secure the supplies, but what is most horrifying about his account is that this experience was not all that surprising to him — he expected interference from federal officials, and did everything he could (including staging the shipment in food-service trucks to avoid detection) to get around that interference.

And we wonder why there's a catastrophic shortage of PPE and dissatisfied governors. Reminds me of that old aphorism, "Lead, follow, or get out of the way."

First of all, I'm fascinated by the tweets you share here - wonder what your search threshold is.

Second, the boxed story is an almost horrifying story.  But the health provider received its PPE.  Maybe there is some grand conspiracy/blockade going on, but the part you highlighted doesn't show that . . . does it?

And BTW - and I'm in no way saying this is related to your story - but let me ask you this:  should there be any effort (state or federal) to try and ensure that PPEs are distributed in some equitable fashion to the end facilities?  Or should it just be first-come, first served?  Or whoever can pay the most, fastest?

I mean, I'm down on hoarders at the grocery store; and do not believe hoarding by medical facilities is much better, at least in theory.

[teejers1]

Incidentally, stories like this evidence, in part, for why divisions are emerging: the feds are literally forcing hospital administrations to import PPE as if they are running a blockade in order to get necessary equipment for their healthcare providers.
[tweet]https://twitter.com/dwallacewells/status/1251922312770748417?s=20[/tweet]

Here's a snippet of the most interesting part from the New England Journal of Medicine letter writer:

 It’s worth reading the correspondence, written by an executive running a small health system, at some length:

Our supply-chain group has worked around the clock to secure gowns, gloves, face masks, goggles, face shields, and N95 respirators. These employees have adapted to a new normal, exploring every lead, no matter how unusual. Deals, some bizarre and convoluted, and many involving large sums of money, have dissolved at the last minute when we were outbid or outmuscled, sometimes by the federal government. Then we got lucky, but getting the supplies was not easy. . . .

Hours before our planned departure, we were told to expect only a quarter of our original order. We went anyway, since we desperately needed any supplies we could get. Upon arrival, we were jubilant to see pallets of KN95 respirators and face masks being unloaded. We opened several boxes, examined their contents, and hoped that this random sample would be representative of the entire shipment. Before we could send the funds by wire transfer, two Federal Bureau of Investigation agents arrived, showed their badges, and started questioning me. No, this shipment was not headed for resale or the black market. The agents checked my credentials, and I tried to convince them that the shipment of PPE was bound for hospitals. After receiving my assurances and hearing about our health system’s urgent needs, the agents let the boxes of equipment be released and loaded into the trucks. But I was soon shocked to learn that the Department of Homeland Security was still considering redirecting our PPE. Only some quick calls leading to intervention by our congressional representative prevented its seizure. I remained nervous and worried on the long drive back, feelings that did not abate until midnight, when I received the call that the PPE shipment was secured at our warehouse.

In this instance, the executive managed to secure the supplies, but what is most horrifying about his account is that this experience was not all that surprising to him — he expected interference from federal officials, and did everything he could (including staging the shipment in food-service trucks to avoid detection) to get around that interference.

And we wonder why there's a catastrophic shortage of PPE and dissatisfied governors. Reminds me of that old aphorism, "Lead, follow, or get out of the way."

First of all, I'm fascinated by the tweets you share here - wonder what your search threshold is.

Second, the boxed story is an almost horrifying story.  But the health provider received its PPE.  Maybe there is some grand conspiracy/blockade going on, but the part you highlighted doesn't show that . . . does it?

And BTW - and I'm in no way saying this is related to your story - but let me ask you this:  should there be any effort (state or federal) to try and ensure that PPEs are distributed in some equitable fashion to the end facilities?  Or should it just be first-come, first served?  Or whoever can pay the most, fastest?

I mean, I'm down on hoarders at the grocery store; and do not believe hoarding by medical facilities is much better, at least in theory.

[BostonCard]

Second, the boxed story is an almost horrifying story.  But the health provider received its PPE.  Maybe there is some grand conspiracy/blockade going on, but the part you highlighted doesn't show that . . . does it?



And BTW - and I'm in no way saying this is related to your story - but let me ask you this:  should there be any effort (state or federal) to try and ensure that PPEs are distributed in some equitable fashion to the end facilities?  Or should it just be first-come, first served?  Or whoever can pay the most, fastest?

I had a similar reaction as you did.  You would ideally want a concerted government response that would take hold of all acquisition and distribution of needed supplies. In fact, many governors bemoaned having to compete with other states to procure supplies. Ironically, this is one of the powers granted the government by the defense production act, though most people think of it as the government taking over production.  So, it is possible that this wasn't as problematic as is being portrayed.

The issue is that there is a massive trust and transparency gap going on. If this is what is happening, the government should just go out and publicly announce, from here on out that they are using the powers of the defense production act to take over all US acquisition and distribution of ventilators, PPE, etc. and here are the rules for allocating them to the states and hospital groups.  The transparency step, however, is key, and while it is missing, it is very easy to see why people are ascribing malign intent to the government.

BC

[BostonCard]

Second, the boxed story is an almost horrifying story.  But the health provider received its PPE.  Maybe there is some grand conspiracy/blockade going on, but the part you highlighted doesn't show that . . . does it?



And BTW - and I'm in no way saying this is related to your story - but let me ask you this:  should there be any effort (state or federal) to try and ensure that PPEs are distributed in some equitable fashion to the end facilities?  Or should it just be first-come, first served?  Or whoever can pay the most, fastest?

I had a similar reaction as you did.  You would ideally want a concerted government response that would take hold of all acquisition and distribution of needed supplies. In fact, many governors bemoaned having to compete with other states to procure supplies. Ironically, this is one of the powers granted the government by the defense production act, though most people think of it as the government taking over production.  So, it is possible that this wasn't as problematic as is being portrayed.

The issue is that there is a massive trust and transparency gap going on. If this is what is happening, the government should just go out and publicly announce, from here on out that they are using the powers of the defense production act to take over all US acquisition and distribution of ventilators, PPE, etc. and here are the rules for allocating them to the states and hospital groups.  The transparency step, however, is key, and while it is missing, it is very easy to see why people are ascribing malign intent to the government.

BC

[oldalum]

they are using the powers of the defense production act to take over all US acquisition and distribution of ventilators, PPE, etc. and here are the rules for allocating them to the states and hospital groups. 

This is what should have been done from the start, and distribution should have been handled transparently on the basis of need by a non-political appointee such as a military person in charge of supply chains, to deflect any suspicion of partisanship in distribution. But the president did not want the federal government to play any part in this:

"President Donald Trump told reporters at a press conference that governors should be buying medical supplies for their states and that the federal government is not a "shipping clerk.'"

[oldalum]

they are using the powers of the defense production act to take over all US acquisition and distribution of ventilators, PPE, etc. and here are the rules for allocating them to the states and hospital groups. 

This is what should have been done from the start, and distribution should have been handled transparently on the basis of need by a non-political appointee such as a military person in charge of supply chains, to deflect any suspicion of partisanship in distribution. But the president did not want the federal government to play any part in this:

"President Donald Trump told reporters at a press conference that governors should be buying medical supplies for their states and that the federal government is not a "shipping clerk.'"

[2006alum]

they are using the powers of the defense production act to take over all US acquisition and distribution of ventilators, PPE, etc. and here are the rules for allocating them to the states and hospital groups. 

This is what should have been done from the start, and distribution should have been handled transparently on the basis of need by a non-political appointee such as a military person in charge of supply chains, to deflect any suspicion of partisanship in distribution. But the president did not want the federal government to play any part in this:

"President Donald Trump told reporters at a press conference that governors should be buying medical supplies for their states and that the federal government is not a "shipping clerk.'"

Yeah, I think what bothered me about this article was that the chief physician executive, who rarely has to have any direct involvement in acquiring supplies, is having to go to such great lengths and deploy such deception just to receive a fraction of an order of essential supplies to keep his physicians and nurses safe. There is no system in place, it's a total free for all, and the feds reserve the right to arbitrarily block or take PPE deliveries at any time. It's appalling that the federal government is not only not helping, but actively making the whole process more confused, unreliable, and haphazard.

[2006alum]

they are using the powers of the defense production act to take over all US acquisition and distribution of ventilators, PPE, etc. and here are the rules for allocating them to the states and hospital groups. 

This is what should have been done from the start, and distribution should have been handled transparently on the basis of need by a non-political appointee such as a military person in charge of supply chains, to deflect any suspicion of partisanship in distribution. But the president did not want the federal government to play any part in this:

"President Donald Trump told reporters at a press conference that governors should be buying medical supplies for their states and that the federal government is not a "shipping clerk.'"

Yeah, I think what bothered me about this article was that the chief physician executive, who rarely has to have any direct involvement in acquiring supplies, is having to go to such great lengths and deploy such deception just to receive a fraction of an order of essential supplies to keep his physicians and nurses safe. There is no system in place, it's a total free for all, and the feds reserve the right to arbitrarily block or take PPE deliveries at any time. It's appalling that the federal government is not only not helping, but actively making the whole process more confused, unreliable, and haphazard.

[Goose]

Nothing like this has happened in the US in 100 years.

Recognize these?



The first of those was 1952 and 1946 & polio. (The 58K cases is equivalent to 116K cases today.)  1853 and 1855 were yellow fever epidemics.

M T there is one of gigantic proportions difference between the current COVID-19 epidemic and all the examples you cite. While the epidemics you cite were certainly serious, they all involved disease that was known and had previously been encountered. The local health departments knew what to expect, and so did the population at large. There was no argument that yellow fever was "no big deal". People knew it was, because they had suffered from it before. The health professionals also knew what to do. Ditto Polio. In many cases they couldn't do much, but they at least knew it and they knew it wasn't going to spread like wildfire.

No comparison whatsoever with COVID-19 which we have never seen before and still understand very little about. You DO have to go back to 1918 to find a novel agent that had no history (and no immunity) in the general populace and no "playbook" in the public health system. That makes a big difference when trying to decide what is an appropriate response.

[Goose]

Nothing like this has happened in the US in 100 years.

Recognize these?



The first of those was 1952 and 1946 & polio. (The 58K cases is equivalent to 116K cases today.)  1853 and 1855 were yellow fever epidemics.

M T there is one of gigantic proportions difference between the current COVID-19 epidemic and all the examples you cite. While the epidemics you cite were certainly serious, they all involved disease that was known and had previously been encountered. The local health departments knew what to expect, and so did the population at large. There was no argument that yellow fever was "no big deal". People knew it was, because they had suffered from it before. The health professionals also knew what to do. Ditto Polio. In many cases they couldn't do much, but they at least knew it and they knew it wasn't going to spread like wildfire.

No comparison whatsoever with COVID-19 which we have never seen before and still understand very little about. You DO have to go back to 1918 to find a novel agent that had no history (and no immunity) in the general populace and no "playbook" in the public health system. That makes a big difference when trying to decide what is an appropriate response.

[chrisk]

Nothing like this has happened in the US in 100 years.

Recognize these?



The first of those was 1952 and 1946 & polio. (The 58K cases is equivalent to 116K cases today.)  1853 and 1855 were yellow fever epidemics.

M T there is one of gigantic proportions difference between the current COVID-19 epidemic and all the examples you cite. While the epidemics you cite were certainly serious, they all involved disease that was known and had previously been encountered. The local health departments knew what to expect, and so did the population at large. There was no argument that yellow fever was "no big deal". People knew it was, because they had suffered from it before. The health professionals also knew what to do. Ditto Polio. In many cases they couldn't do much, but they at least knew it and they knew it wasn't going to spread like wildfire.

No comparison whatsoever with COVID-19 which we have never seen before and still understand very little about. You DO have to go back to 1918 to find a novel agent that had no history (and no immunity) in the general populace and no "playbook" in the public health system. That makes a big difference when trying to decide what is an appropriate response.

But the Federal government has been doing pandemic planning for many years and in the current Administration has been running exercises to identify weaknesses in current plans. Was anything that happened really a surprise to HHS, CDC, and NIH? You seem to be repeating Trump's personal talking points.

https://www.cnn.com/2020/04/14/politics/...index.html

[chrisk]

Nothing like this has happened in the US in 100 years.

Recognize these?



The first of those was 1952 and 1946 & polio. (The 58K cases is equivalent to 116K cases today.)  1853 and 1855 were yellow fever epidemics.

M T there is one of gigantic proportions difference between the current COVID-19 epidemic and all the examples you cite. While the epidemics you cite were certainly serious, they all involved disease that was known and had previously been encountered. The local health departments knew what to expect, and so did the population at large. There was no argument that yellow fever was "no big deal". People knew it was, because they had suffered from it before. The health professionals also knew what to do. Ditto Polio. In many cases they couldn't do much, but they at least knew it and they knew it wasn't going to spread like wildfire.

No comparison whatsoever with COVID-19 which we have never seen before and still understand very little about. You DO have to go back to 1918 to find a novel agent that had no history (and no immunity) in the general populace and no "playbook" in the public health system. That makes a big difference when trying to decide what is an appropriate response.

But the Federal government has been doing pandemic planning for many years and in the current Administration has been running exercises to identify weaknesses in current plans. Was anything that happened really a surprise to HHS, CDC, and NIH? You seem to be repeating Trump's personal talking points.

https://www.cnn.com/2020/04/14/politics/...index.html

[Goose]

But the Federal government has been doing pandemic planning for many years and in the current Administration has been running exercises to identify weaknesses in current plans.  Was anything that happened really a surprise to HHS, CDC, and NIH?

That I can't really say. What I can say is that the CDC clearly had no plan to mass produce a test that could be rapidly distributed to local labs and run in the hundreds of thousands on short notice. That is evident from the problems that ensued. Even if the "original" CDC test had no contamination issues, the CDC couldn't mass produce it and it was also not targeted (or approved by the FDA) to the high throughput machines. So, whatever planning they had done certainly was not appropriate to what happened. Furthermore, it is pretty obvious that getting a test up and running nationwide is going to require the cooperation of industry. There was no plan in place to do this. It was a happening.

Courtesy of BC I have a couple of links to the "Influenza Plan" that the government put together.
https://www.cdc.gov/flu/pandemic-resourc...2017v2.pdf
https://www.cdc.gov/mmwr/preview/mmwrhtm...rr6306a1_e
 I will let you judge it for yourself, but from my reading it is at best bureaucratic sweetness and light. It is not actionable. You can't "follow" it. The plan in these documents is for "novel"  Influenza. Making a plan for a disease that is broadly similar but with some very different parameters is difficult.  Maybe there was another, more actionable plan in the files somewhere. I can't say. As far as I can tell, whatever "plan" existed was overcome by events early on. The events speak for themselves.

You seem to be repeating Trump's personal talking points.


https://www.cnn.com/2020/04/14/politics/...index.html

My God, I hope not :-). My point here has always been that expecting people to make quick, correct decisions in the face of an event that hasn't actually happened in 100 years is unrealistic. There is a very large bias against accepting the idea that something new and catastrophic is happening. That is a big reason why so many nations were caught "flat footed". They simply couldn't believe it was happening to them. It should just go away like SARS did. The nations that responded well (relatively) to this event (Korea, HK etc.) did so because their "foot soldiers" were doing their job and were present in adequate numbers. The weren't mobilized for this event. They were already present. It didn't require the heads of state to be decisive and right from day 1. In addition, these nations (unlike the US or Europe) had a very bad SARS experience and knew that it could happen to them, because it substantially had not long ago.

[Goose]

But the Federal government has been doing pandemic planning for many years and in the current Administration has been running exercises to identify weaknesses in current plans.  Was anything that happened really a surprise to HHS, CDC, and NIH?

That I can't really say. What I can say is that the CDC clearly had no plan to mass produce a test that could be rapidly distributed to local labs and run in the hundreds of thousands on short notice. That is evident from the problems that ensued. Even if the "original" CDC test had no contamination issues, the CDC couldn't mass produce it and it was also not targeted (or approved by the FDA) to the high throughput machines. So, whatever planning they had done certainly was not appropriate to what happened. Furthermore, it is pretty obvious that getting a test up and running nationwide is going to require the cooperation of industry. There was no plan in place to do this. It was a happening.

Courtesy of BC I have a couple of links to the "Influenza Plan" that the government put together.
https://www.cdc.gov/flu/pandemic-resourc...2017v2.pdf
https://www.cdc.gov/mmwr/preview/mmwrhtm...rr6306a1_e
 I will let you judge it for yourself, but from my reading it is at best bureaucratic sweetness and light. It is not actionable. You can't "follow" it. The plan in these documents is for "novel"  Influenza. Making a plan for a disease that is broadly similar but with some very different parameters is difficult.  Maybe there was another, more actionable plan in the files somewhere. I can't say. As far as I can tell, whatever "plan" existed was overcome by events early on. The events speak for themselves.

You seem to be repeating Trump's personal talking points.


https://www.cnn.com/2020/04/14/politics/...index.html

My God, I hope not :-). My point here has always been that expecting people to make quick, correct decisions in the face of an event that hasn't actually happened in 100 years is unrealistic. There is a very large bias against accepting the idea that something new and catastrophic is happening. That is a big reason why so many nations were caught "flat footed". They simply couldn't believe it was happening to them. It should just go away like SARS did. The nations that responded well (relatively) to this event (Korea, HK etc.) did so because their "foot soldiers" were doing their job and were present in adequate numbers. The weren't mobilized for this event. They were already present. It didn't require the heads of state to be decisive and right from day 1. In addition, these nations (unlike the US or Europe) had a very bad SARS experience and knew that it could happen to them, because it substantially had not long ago.