Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
I went a bit darker than usual yesterday. Thanks to some constructive feedback, I rallied back to my experience as a divisional Army officer in the late 1980s. That particular army was, for a relatively brief period, intensively focused on learning from training hard enough to fail, without blame fixing or avoidance. So, take it as given that plans will not survive contact with the enemy, human or otherwise, and get on with adapting faster than the enemy. With that perspective, things look a little brighter at this moment.
President Trump needs to get further ahead in the new coronavirus OODA loop. He finally has all of the federal agencies moving together in the same direction now, with changes that are breathtakingly fast for bureaucracies with decades of accreted layers of regulations and procedures. Each day it seems he is leveraging the media-driven panic to force federal bureaucracies into even further real innovation. He is desperately trying to limit the economic catastrophe dictated by his medical experts. The key state governors, all hard left, are actually acting in their states’ interests, with President Trump in full support. And.
President Trump has the capability to visually disrupt the narrative of doomed seniors drowning in their own lung fluids for lack of advanced medical support. It is this image, reinforced from an apparently failing city in Italy, that has driven us off the economic cliff. That could all change tomorrow. Consider the information that Secretary Azar revealed on Monday, and its link to the whole discussion about the need to “flatten the curve.”
A reporter asked a good, if politically pointed, question of Vice President Pence during the Coronavirus Task Force press briefing on Sunday, March 15. He put Secretary Azar in front of the microphone to answer [emphasis added]:
Q Mr. Vice President, what is your plan to build more hospital beds so tens of thousands of Americans don’t die? And how many more ventilators are you looking at ordering so people don’t suffocate?
THE VICE PRESIDENT: Well, let me let the Secretary step up. I know that there’s long-term planning that takes place at HHS for those circumstances. And when I traveled to HHS yesterday, we reviewed all the numbers about stockpiles, everything from masks to ventilators to gowns.
Mr. Secretary, you might just speak about capacity issues. And let me say it’s — it’s a very good question on your part.
Right now, our focus, as the White House Coronavirus Task Force, is to have widespread testing across the country, using this new partnership with our commercial labs that the President has forged, and work with states to make those tests available.
We’re also going to continue to work every single day to promote best practices for mitigation, working closely with and supporting state governments for decisions that they’re making on mitigation to prevent the spread. But the whole issue of personal protective equipment and supplies and the capacity of our healthcare system is in the forefront of what we’re talking about every day, and the Secretary can address it.
SECRETARY AZAR: […]
In addition to that, the entire point of our pandemic planning, over the last 15 years, has been to put extra flex into our healthcare system. That’s why we have hospital preparedness grants that we fund every year through our preparedness program. That’s why we have in our Strategic National Stockpile ventilators, field hospital units — like MASH units, if you’ll remember those — that have capacity for hundreds of individuals.
In terms of supplies, obviously this is an unprecedented challenge. Unprecedented. And so we will work to increase the supplies of personal protective equipment, of ventilators, of field medical unit hospitals that we can deploy. We have tremendous supplies, but we want to acquire more. And that’s thanks to the bipartisan work of Congress funding the emergency supplemental that gives us the money to scale up production here and abroad. And we’re doing that.
We don’t disclose concrete numbers on particular items for national security purposes, but we have many ventilators — thousands and thousands of ventilators in our system. We have received, so far, only, I think, one request for just several ventilators.
One of the things in terms of hospital capacity that’s going to be really important — it’s a really good learning from China that we got from the World Health Organization team that went there — is if we have communities where we have enough capacity where we can put people who are positive with COVID-19 and have them be exclusively reserved for individuals who are positive for COVID-19, this reduces our need to try to protect our patients from other patients, because they’re all positive already.
We learned from Secretary Azar that we have “thousands and thousands” of ventilators, as we should if we are prepared for a chemical or biological attack that would inflict mass respiratory casualties. How many? Oh, that is classified, “national security.” That is strictly true for everyone on the Coronavirus Task Force, even Vice President Pence. Only President Trump has the authority to free them to speak the full truth to the American public. If it is so bad, so unprecedented as to require driving us voluntarily into economic ruin, on the claim that we are so rich that we can afford it in order to stop a certain number of elderly and vulnerable younger people dying of this particular disease, then it is time for the president to put all the cards on the table, to force the federal bureaucracies to give up all their secret stashes as he has forced them to give up control over-testing. He can do so with the enthusiastic support of the faces of expertise, I believe, and perhaps shift the medical logistics model from pull/beg by the states, to push/anticipate by the feds in support of visible emerging needs.
The National Strategic Stockpile is controlled by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR).
The mission of the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) is to save lives and protect Americans from 21st century health security threats.
Last time I checked, we are in the midst of a “21st-century health security threat,” and we are being told by the experts that we must accept having our jobs, finances, and economy destroyed to save lives. You would think that they would already be all in on resourcing the medical fight against this health security threat. The HHS National Emergency Stockpile website certainly suggests this is their intent:
Strategic National Stockpile is the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.
When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency. Organized for scalable response to a variety of public health threats, this repository contains enough supplies to respond to multiple large-scale emergencies simultaneously.
It is time to show just how much we can raise the line at which our medical system is actually maxed out. Are there really “enough supplies to respond to multiple large-scale emergencies simultaneously?” How about telling the American people we need to hold down the number of cases needed medical support to X, because that is the number that maxes our real national capacity to medically support severe respiratory cases, based on a worst or most likely case scenario?
It may be that we are about to get just such an answer this week. The Tuesday Coronavirus Task Force press briefing included this interesting statement by Dr. Birx [emphasis added]:
Q Okay, thank you. Can you give us a sense of how long these tough, new restrictions will need to be in place until we start to see the rate of this virus going down?
Also, can you speak to this study that as many as 2.2 million people in the United States could die if there weren’t this type of action by the government taken? To what extent did that prompt what we saw yesterday?
DR. BIRX: So, I think, you know, models are models. And they’re based on input, and they’re based on infectiousness without any controls. I can tell you we’ve never seen that level of infections that modeled up to that 2.2 million in mortality.
So we are looking at that. We are having a particularly model meeting tomorrow. I think that’s really going to be important. I’ve dealt with a lot of modelers in my time. They’re wonderful people, but they all have their favorite inputs, and they all have their favorite integration functions. So we’re evaluating all of those so we can integrate and create the best model for the United States based on the best data. And that first set of recommendations you saw were based on what we could do today to prevent anything that looks like that.
If I could just say one other thing to the hospitals and dentists out there: Things that don’t need to be done over the next two weeks, don’t get it done. If you’re a person with an electric sur- — elective surgery, you don’t want to go into a hospital right now. There’s a lot of distraction. There’s a lot of people doing a lot of other things to save people’s lives. So let’s all be responsible and cancel things that we can cancel to really free up hospital beds and space, and then let’s do everything that we can to ensure that we don’t need the ventilators because we protected the people who would have needed to use them.
The president got hammered with questions about all these extra ventilators Monday, then he recovered his footing, and the tone of questions shifted Tuesday. President Trump and Vice President Pence pointed to two ways the Department of Defense could respond to the localized need in states: both the Army Corps of Engineers adapting structures to be dedicated coronavirus medical facilities, as Governor Cuomo is recommending, and immediate bed and ventilator support in modular medical tents like our military has used for the past two decades.
Q Mr. President, just to follow up on John’s question: Specifically, how many new hospital facilities could the Army Corps of Engineers build? And also, what specific measures are you taking to try to increase the number of ventilators in the stockpiles?
THE PRESIDENT: Right. We’ve ordered massive numbers of ventilators. We have — by any normal standards, we have a lot of respirators, ventilators. We have tremendous amounts of equipment. But compared to what we’re talking about here, this has never been done before.
And yesterday I gave the governors the right to go order directly if they want, if they feel they can do it faster than going through the federal government.
Now, we’ve knocked out all of the bureaucracy; it’s very direct, but it’s still always faster to order directly. And I gave them — that was totally misinterpreted by the New York Times, on purpose, unfortunately.
But the — but it’s very important.
THE VICE PRESIDENT: If I could amplify —
THE PRESIDENT: Yeah, please. Yeah.
THE VICE PRESIDENT: Thank you. The President directed us to work with the Department of Defense. There’s two ways that DOD can be helpful, in terms of expanding medical capacity. I know the governor of New York has asked us to look at the Army Corps of Engineer, which could perhaps renovate existing buildings. But the President also has us inventorying what you all would understand as field hospitals, or MASH hospitals, that can be deployed very quickly.
We spoke with Governor Inslee yesterday in Washington State. We have resources in that part of the country that we can move. And as governors make these requests, we will process them, bring them to the President.
[Here the vice president is talking about war stockpiles or medical unit equipment at Fort Lewis, Washington, home to both a medical center (one star medical command) and an Army corps (level above divisions, with associated robust support units).]
But there are two different lanes that DOD can provide, in addition to many medical supplies to augment our national reserves. And the President has tasked us to evaluate, make available, and to consider every — every request from governors for either field hospitals, expanding facilities, or the Army Corps of Engineer that could retrofit existing buildings.
THE PRESIDENT: The Army Corps is very prepared to do as we say. And we’re looking at where it’s going.
But — and they do call them MASH hospitals, but the field hospitals go up very quickly. They’re — we have them. We have all of this equipment in stock. And we’re looking at different sites in a few different locations.
[Actually they are called a CSH, pronounced “cash,” if they have not converted to the new Field Hospital equipment and personnel configuration.*]
I do say this, though: The Army Corps of Engineers is ready, willing, and able. We have to give them the go-ahead if we find that it’s going to be necessary. We think we can have quite a few units up very rapidly. I’m going to work with Governor Cuomo. I’m going to work with a number of the governors. Governor Newsom has been very generous in his words, and I’m being generous to him, too, because we’re all working together very well. And I think a lot of very positive things have taken place. We’re talking to California about different sites. But we can have a lot of units up fairly quickly if we think we need them.
The Tuesday briefing revealed that the claimed supplies were “being inventoried.” This means that HHS has finally gotten around to shaking out the stockpile and checking the condition of the stored supplies, I take it. President Trump should order a very public demonstration of the claimed federal stockpile by the earliest possible deployment of palletized loads of ventilators and modular medical tents, with support equipment, to the three hottest spots in the country. Show them being flown in and show the military helping set up the first minimum configuration in hours.
President Trump should also show more surge capacity, as suggested by Secretary Azar, popping up coronavirus facilities with respiratory care capability separate from existing hospitals so the hospitals do not need to do biohazard containment for this virus. Perhaps rent out entire large hotels at government rates, with food service support, so every last person in the area who tests positive checks in and does not check out until they test clear twice in a row. Those who need more medical support progress from hotel rooms to a modular tent ward with ventilator support as needed. Hotels need the business and could pay their staff to stay home or work in outside support roles, like meal preparation.
The pieces are all there in what Secretary Azar revealed under good questioning. Governor Cuomo is already calling for massive military support to increase respiratory care capability, calling on the Army Corps of Engineers to retrofit buildings for coronavirus patient support. The American people are being deprived of their jobs, the ability to pay their bills, and even the right to vote, all in the name of fighting the latest coronavirus. Vice President Pence said he was shown the numbers, briefed on our real strategic reserves. The federal agencies and resources just need to be ordered into operation. It is time to move past reacting to dramatically demonstrating medical support at the very moment that the numbers of reported cases will spike, with the surge this week in testing capability. Mr. President, put the hammer down!
UPDATE: Over 10,000 plus 2,000 more from DOD is the magic answer on ventilator stockpiles.
The conversion reconfigures the 248-bed CSH into a smaller, more modular 32-bed FH with three additional augmentation detachments including a 24-bed surgical detachment, a 32-bed medical detachment, and a 60-bed Intermediate Care Ward detachment. The FH and the augmentation detachments will all operate under the authority of a headquarters hospital center.
The FH design is based on lessons learned from more than a decade of combat that have reinforced the Army’s need to have forward-based medical capabilities that are advanced yet also agile and logistically scalable. Traditional CSHs have proven to be too large and logistically difficult to deploy as a whole, which is why the Army has historically only deployed “slices” or sections of the CSH. The move to the FH design codifies that practice by restructuring the CSH in the way it is primarily used — as a customizable, scalable resource.