Contributor Post Created with Sketch. Recommended by Ricochet Members Created with Sketch. Put the Pedal to the Metal! Medical Theater Matters. [update: over 10,000]

 

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.

Yes, Mike.

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.


Army Combat Support Hospitals Converting to New Modular Field Hospitals

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.

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  1. The Dowager Jojo Member

    It is stunning that schools and businesses are closed and as you say we are taking a mighty self inflicted economic hit as a preventive measure….

    Yet my daughter working as a resident doctor seeing patients in a hospital eighty hours a week cannot even have an N95 mask, because some were stolen and the rest are locked up for use by emergency room personnel only- she does not have access even though she often works on emergency traumas- even the face shields to protect from spattered blood and vomit are locked up.

    Getting health workers protective equipment would seem to be the most effective way of not overwhelming the medical system, but it wasn’t done at her hospital and hasn’t been done yet.

    • #1
    • March 17, 2020, at 2:15 AM PDT
    • 17 likes
    • This comment has been edited.
  2. Phil Turmel Coolidge

    I suspect the middle case for the U.S. in this crisis will exceed the normal capacity of some cities hospital networks. But with enough uncertainty as to which cities as to justify holding back the reserves.

    I don’t think Trump would allow HHS to hold back if the evidence already showed where those reserves needed to go.

    • #2
    • March 17, 2020, at 5:21 AM PDT
    • 3 likes
  3. Bryan G. Stephens Thatcher
    Bryan G. Stephens Joined in the first year of Ricochet Ricochet Charter Member

    Based on your other OP, Cliff, this sounds like good Czarism to me. You are fast to blame the workers.

    If Dr. Fausi is making mistakes, Trump owns them. We cannot fall into a Trap of Orange Man Good.

    Personally, I think Phil has the gist of it, based on my reading of the situation. Of course, I could be wrong. 

    • #3
    • March 17, 2020, at 5:36 AM PDT
    • 2 likes
  4. Clifford A. Brown Contributor
    Clifford A. Brown

    Bryan G. Stephens (View Comment):

    Based on your other OP, Cliff, this sounds like good Czarism to me. You are fast to blame the workers.

    If Dr. Fausi is making mistakes, Trump owns them. We cannot fall into a Trap of Orange Man Good.

    Personally, I think Phil has the gist of it, based on my reading of the situation. Of course, I could be wrong.

    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency? 

    And wouldn’t the American people feel more confident, wouldn’t the stock market get some certainty at this point, if these “thousands upon thousands” were seen, on camera, being shipped on military transport planes in deplorable packages, postured around the nation?

    • #4
    • March 17, 2020, at 9:21 AM PDT
    • 6 likes
  5. Stina Member

    The Dowager Jojo (View Comment):
    It is stunning that schools and businesses are closed and as you say we are taking a mighty self inflicted economic hit as a preventive measure….

    If you consider the age of teachers, it might not be that surprising.

    • #5
    • March 17, 2020, at 9:39 AM PDT
    • 1 like
  6. Bryan G. Stephens Thatcher
    Bryan G. Stephens Joined in the first year of Ricochet Ricochet Charter Member

    Clifford A. Brown (View Comment):

    Bryan G. Stephens (View Comment):

    Based on your other OP, Cliff, this sounds like good Czarism to me. You are fast to blame the workers.

    If Dr. Fausi is making mistakes, Trump owns them. We cannot fall into a Trap of Orange Man Good.

    Personally, I think Phil has the gist of it, based on my reading of the situation. Of course, I could be wrong.

    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency?

    And wouldn’t the American people feel more confident, wouldn’t the stock market get some certainty at this point, if these “thousands upon thousands” were seen, on camera, being shipped on military transport planes in deplorable packages, postured around the nation?

    I’d like to know all sorts of things. Like that reporter on Friday demanding to know when there would be more tests. When is that, huh? Why won’t they tells us? 

    Look, I am always for telling everyone the truth and the whole truth from day one. Often, people don’t do that. I don’t know the full story here. I’d just as soon not jump to the conclusion everyone Pence is working with is nefarious, and Trump is pure and spotless. 

    • #6
    • March 17, 2020, at 10:21 AM PDT
    • 4 likes
  7. Clifford A. Brown Contributor
    Clifford A. Brown

    Bryan G. Stephens (View Comment):

    Clifford A. Brown (View Comment):

    Bryan G. Stephens (View Comment):

    Based on your other OP, Cliff, this sounds like good Czarism to me. You are fast to blame the workers.

    If Dr. Fausi is making mistakes, Trump owns them. We cannot fall into a Trap of Orange Man Good.

    Personally, I think Phil has the gist of it, based on my reading of the situation. Of course, I could be wrong.

    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency?

    And wouldn’t the American people feel more confident, wouldn’t the stock market get some certainty at this point, if these “thousands upon thousands” were seen, on camera, being shipped on military transport planes in deplorable packages, postured around the nation?

    I’d like to know all sorts of things. Like that reporter on Friday demanding to know when there would be more tests. When is that, huh? Why won’t they tells us?

    Look, I am always for telling everyone the truth and the whole truth from day one. Often, people don’t do that. I don’t know the full story here. I’d just as soon not jump to the conclusion everyone Pence is working with is nefarious, and Trump is pure and spotless.

    I do not claim that “everyone Pence is working with is nefarious.” I get your response to my phrasing, and am going to rework this post to accentuate the possible positives. 

    • #7
    • March 17, 2020, at 10:34 AM PDT
    • 5 likes
  8. Phil Turmel Coolidge

    Clifford A. Brown (View Comment):
    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency? 

    I think it is too simplistic to think of this as a single line. It’s really a bunch of lines, metro area by metro area, big and small. People who need a respirator in an ICU aren’t exactly mobile. Whichever geographical cluster of hospitals gets ’em is pretty much stuck with them. Ergo my musings on reserves.

    • #8
    • March 17, 2020, at 10:58 AM PDT
    • 4 likes
  9. Bryan G. Stephens Thatcher
    Bryan G. Stephens Joined in the first year of Ricochet Ricochet Charter Member

    Clifford A. Brown (View Comment):

    Bryan G. Stephens (View Comment):

    Clifford A. Brown (View Comment):

    Bryan G. Stephens (View Comment):

    Based on your other OP, Cliff, this sounds like good Czarism to me. You are fast to blame the workers.

    If Dr. Fausi is making mistakes, Trump owns them. We cannot fall into a Trap of Orange Man Good.

    Personally, I think Phil has the gist of it, based on my reading of the situation. Of course, I could be wrong.

    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency?

    And wouldn’t the American people feel more confident, wouldn’t the stock market get some certainty at this point, if these “thousands upon thousands” were seen, on camera, being shipped on military transport planes in deplorable packages, postured around the nation?

    I’d like to know all sorts of things. Like that reporter on Friday demanding to know when there would be more tests. When is that, huh? Why won’t they tells us?

    Look, I am always for telling everyone the truth and the whole truth from day one. Often, people don’t do that. I don’t know the full story here. I’d just as soon not jump to the conclusion everyone Pence is working with is nefarious, and Trump is pure and spotless.

    I do not claim that “everyone Pence is working with is nefarious.” I get your response to my phrasing, and am going to rework this post to accentuate the possible positives.

    Fair enough

    • #9
    • March 17, 2020, at 11:34 AM PDT
    • 3 likes
  10. David Foster Member
    David Foster Joined in the first year of Ricochet Ricochet Charter Member

    How many US companies have the ability to *make* ventilators and do it in a relevant time frame? I bet it’s a lot, if the design and production documentation was made available to them together with appropriate license.

    • #10
    • March 17, 2020, at 6:47 PM PDT
    • 3 likes
  11. Clifford A. Brown Contributor
    Clifford A. Brown

    David Foster (View Comment):

    How many US companies have the ability to *make* ventilators and do it in a relevant time frame? I bet it’s a lot, if the design and production documentation was made available to them together with appropriate license.

    And some liability relief, as was granted inside the Medicare/Medicaid system as to billing and as to doctors using personal cellphones or tablets to tele-consult/video-consult with patients.

    • #11
    • March 17, 2020, at 7:12 PM PDT
    • 4 likes
  12. Barfly Member

    Clifford A. Brown (View Comment):
    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency? 

    I don’t think the data can be that good yet, to work up an answer to quantitative questions with the precision we’d like. I don’t think epidemiology models will be able to give usefully accurate answers until after this wave has peaked.

    • #12
    • March 17, 2020, at 8:37 PM PDT
    • 3 likes
  13. Jerry Giordano (Arizona Patrio… Member

    I see no reason for this panic.

    Worldometer is reporting 12 serious or critical cases in the US, and 6,288 active cases. The 12 seems really low, but if we use Italy’s rate of about 10%, we’re only talking about roughly 630 cases possibly needing ICU care.

    We have about 900,000 hospital beds in this country, and about 95,000 ICU beds. I don’t think that we need to deploy the Army to handle fewer than 1,000 potentially serious cases.

    Things may change, and it would be good to have resources standing by, but flying them out somewhere at this time seems like a waste of money and gas.

    • #13
    • March 17, 2020, at 9:33 PM PDT
    • 4 likes
  14. Clifford A. Brown Contributor
    Clifford A. Brown

    Barfly (View Comment):

    Clifford A. Brown (View Comment):
    Wouldn’t you like to know, cards on the table, whether the line under which these drastic economic actions are supposed to keep the curve is the real line? What if that line could move up significantly if we put into play all the medical resources stockpiled against a national emergency?

    I don’t think the data can be that good yet, to work up an answer to quantitative questions with the precision we’d like. I don’t think epidemiology models will be able to give usefully accurate answers until after this wave has peaked.

    I agree, in part. Note, however, that Dr. Birx is leading a models meeting to settle on an agreed model for this country. That will address the best guess on the curve. What I am arguing we should have a fair grasp on is the number of ventilators in the country, those currently in hospitals PLUS this secret number “thousands and thousands” stash. Assume the feds can fly in packages of this stash where needed. Now, what is the point at which, today, we would be overwhelmed, given seasonal demand on other conditions plus this new source of potential demand?

    I’m not happy with Azar focusing on how happy he is to leverage this crisis to add even more stuff to the stockpile. We have paid for this stockpile in the name of being ready for disasters. Here it is, now show us HHS were good stewards and don’t cover it over with new orders. Are the units in storage in fact properly maintained and actually deployable tonight, as promised for the past 15 years or so? A fair chunk should already be load configured in flyaway packages. If, say, Hawaii raises the alarm tomorrow, or if the CDC staff properly assess the state nearing maximum capacity tomorrow, there should be military airlift winging to the islands tomorrow night with enough additional resources to meet projected need.

    • #14
    • March 17, 2020, at 9:40 PM PDT
    • 2 likes
  15. Clifford A. Brown Contributor
    Clifford A. Brown

    Jerry Giordano (Arizona Patrio… (View Comment):

    I see no reason for this panic.

    Worldometer is reporting 12 serious or critical cases in the US, and 6,288 active cases. The 12 seems really low, but if we use Italy’s rate of about 10%, we’re only talking about roughly 630 cases possibly needing ICU care.

    We have about 900,000 hospital beds in this country, and about 95,000 ICU beds. I don’t think that we need to deploy the Army to handle fewer than 1,000 potentially serious cases.

    Things may change, and it would be good to have resources standing by, but flying them out somewhere at this time seems like a waste of money and gas.

    My point is to stop panic, driven by the unknown, by showing the American people, that we really, truly can put resources on site anywhere anytime. Show and tell. Create the compelling visual.

    • #15
    • March 17, 2020, at 9:43 PM PDT
    • 4 likes
  16. Kozak Member
    Kozak Joined in the first year of Ricochet Ricochet Charter Member

    David Foster (View Comment):

    How many US companies have the ability to *make* ventilators and do it in a relevant time frame? I bet it’s a lot, if the design and production documentation was made available to them together with appropriate license.

    Modern ventilators are pretty complex pieces of equipment. I doubt if many are made in the US at all.

    I’m betting all the components are made guess where? China.

    Also, Trump is going to have to EO the laws on Medical Equipment. Everything needs extensive testing and approval of FDA, one of the key players in our testing disaster.

     

    There is an old form of ventilator, no longer used which is a very simple mechanical device. It’s not as good as the new ones. But it saved tens of thousands of lives in the 60’s and 70’s.

    Bird Ventilator

    • #16
    • March 18, 2020, at 5:02 AM PDT
    • 4 likes
  17. The Reticulator Member

    Clifford A. Brown (View Comment):
    Note, however, that Dr. Birx is leading a models meeting to settle on an agreed model for this country.

    Why does there have to be an agreed-upon model, I wonder? If there are dissenting models, why can’t they be allowed to continue and be publicized?

    This is one reason I’m distrustful of public health authorities. They seem to find it necessary to come up with consensus recommendations even where there is no consensus.

    • #17
    • March 18, 2020, at 6:40 AM PDT
    • 3 likes
    • This comment has been edited.
  18. MichaelKennedy Coolidge

    I think the concern about ventilators is most likely overblown. The use of drugs like Chloroquine and some antivirals being used in India will probably reduce the numbers requiring ventilators. I don’t know enough about the details of the type of respiratory insufficiency to know if Bird respirators would be useful. They were largely replaced b y volume controlled types for ICU cases although the pressure controlled types like the Bird may still be used in IPPB, a short term treatment for people not respirator dependent.

    It is very important to consider that the US is a low density population country. NY City is right to worry but much of the population lives in suburbs (hated by the left) or rural settings. This will probably have a huge impact on the total load on the medical system. Every winter is flu season and hospitals fill up, but that is ending now. That should help with the capacity situation. I just hope some company in the US, not China, is stamping out Chloroquine tablets. Last week there were supplies and I was able to order some from my son who is a paramedic. By Monday, all pharmacies were “out of stock.”

    • #18
    • March 18, 2020, at 8:35 AM PDT
    • 4 likes
    • This comment has been edited.
  19. Instugator Thatcher
    Instugator Joined in the first year of Ricochet Ricochet Charter Member

    MichaelKennedy (View Comment):
    Last week there were supplies and I was able to order some from my son who is a paramedic. By Monday, all pharmacies were “out of stock.”

    Probably from those of us buying them for relatives in Asia

    • #19
    • March 18, 2020, at 9:09 AM PDT
    • 3 likes
  20. Instugator Thatcher
    Instugator Joined in the first year of Ricochet Ricochet Charter Member

    Jerry Giordano (Arizona Patrio… (View Comment):
    We have about 900,000 hospital beds in this country, and about 95,000 ICU beds. I don’t think that we need to deploy the Army to handle fewer than 1,000 potentially serious cases.

    What is the usage rate?

    Those 95,000 ICU beds have an occupancy near 68% – that is from a 2005 study showing an increase in occupancy rate from 65% (2000) to 68% (2005). So at any given time there are 30,400 empty.

    Furthermore, those 30,400 empty beds are’t conveniently located – while the Army can move to a hot spot (New Rochelle, NY) and set up additional capacity. 

    • #20
    • March 18, 2020, at 9:31 AM PDT
    • 2 likes
  21. Kozak Member
    Kozak Joined in the first year of Ricochet Ricochet Charter Member

    Jerry Giordano (Arizona Patrio… (View Comment):
    Worldometer is reporting 12 serious or critical cases in the US, and 6,288 active cases. The 12 seems really low, but if we use Italy’s rate of about 10%, we’re only talking about roughly 630 cases possibly needing ICU care.

    Today. Today.  

    Do you not understand the fact infections are growing exponentially, and there’s a lag between getting sick and needing to go to the hospital or ICU.

    • #21
    • March 18, 2020, at 9:45 AM PDT
    • 3 likes
  22. Barfly Member

    Kozak (View Comment):

    Jerry Giordano (Arizona Patrio… (View Comment):
    Worldometer is reporting 12 serious or critical cases in the US, and 6,288 active cases. The 12 seems really low, but if we use Italy’s rate of about 10%, we’re only talking about roughly 630 cases possibly needing ICU care.

    Today. Today.

    Do you not understand the fact infections are growing exponentially, and there’s a lag between getting sick and needing to go to the hospital or ICU.

    Evidently not. It seems the dynamic nature of the epidemic is difficult for people to grasp.

    • #22
    • March 18, 2020, at 9:52 AM PDT
    • 2 likes
  23. David Foster Member
    David Foster Joined in the first year of Ricochet Ricochet Charter Member

    There’s at least one US company that makes ventilators….Ventec, in Bothell, Washington. They say that they could increase production 5X in a 90-120 day period. Hospitals have apparently been reluctant to place orders, out of fear of being caught with expensive equipment they don’t need.

    https://www.forbes.com/sites/baldwin/2020/03/14/ventilator-maker-we-can-ramp-up-production-five-fold/#2bcb57d05e9a

    The US Government should place the orders *now*; they can be switched to the hospitals if the need arises, otherwise, we have a larger strategic stockpile. There are worse things.

     

     

     

    • #23
    • March 18, 2020, at 10:44 AM PDT
    • 2 likes
  24. Roderic Coolidge

    Jerry Giordano (Arizona Patrio… (View Comment):

    I see no reason for this panic.

    Worldometer is reporting 12 serious or critical cases in the US, and 6,288 active cases. The 12 seems really low, but if we use Italy’s rate of about 10%, we’re only talking about roughly 630 cases possibly needing ICU care.

    We have about 900,000 hospital beds in this country, and about 95,000 ICU beds. I don’t think that we need to deploy the Army to handle fewer than 1,000 potentially serious cases.

    Things may change, and it would be good to have resources standing by, but flying them out somewhere at this time seems like a waste of money and gas.

    I’m not sure of the reason for the low rate of serious cases in the US. Hopefully it’s because we have a milder strain of the virus here, but it might just be because most people in the total are newly infected. 

    Also, it might be that more of the infected people are young here. A lot of young people aren’t being very serious about this. They got chased out of the bars in a lot of places so they go to private parties, I hear.

    On average, people dying now were infected 2 weeks ago. People getting a serious case go into the hospital soon after symptoms appear.

    Everyone coming into my building is being screened and having their temperatures taken. Everyone is required to wear a mask. The administration is trying to clear the decks and transition to video calls for the clinics. 

    It will probably take a week or two before the effect of any of these measures, if any, is seen.

    • #24
    • March 18, 2020, at 12:41 PM PDT
    • 5 likes
  25. Clifford A. Brown Contributor
    Clifford A. Brown

    The Reticulator (View Comment):

    Clifford A. Brown (View Comment):
    Note, however, that Dr. Birx is leading a models meeting to settle on an agreed model for this country.

    Why does there have to be an agreed-upon model, I wonder? If there are dissenting models, why can’t they be allowed to continue and be publicized?

    This is one reason I’m distrustful of public health authorities. They seem to find it necessary to come up with consensus recommendations even where there is no consensus.

    The question is which one informs public policy. There is no talk of silencing dissenting models.

    • #25
    • March 18, 2020, at 2:46 PM PDT
    • Like
  26. Clifford A. Brown Contributor
    Clifford A. Brown

    David Foster (View Comment):
    Hospitals have apparently been reluctant to place orders, out of fear of being caught with expensive equipment they don’t need.

    Secretary Azar seemed to be claiming that these hospitals have been accepting federal dollars for years to do just this sort of thing. Surging equipment out of the National Strategic Stockpile is a demand signal to order replacements and more, so HHS should sent out pre-positioning packages to the hottest areas now and drop a big order for replacements now.

    • #26
    • March 18, 2020, at 2:54 PM PDT
    • 1 like
  27. Clifford A. Brown Contributor
    Clifford A. Brown

    MichaelKennedy (View Comment):

    I think the concern about ventilators is most likely overblown. The use of drugs like Chloroquine and some antivirals being used in India will probably reduce the numbers requiring ventilators. I don’t know enough about the details of the type of respiratory insufficiency to know if Bird respirators would be useful. They were largely replaced b y volume controlled types for ICU cases although the pressure controlled types like the Bird may still be used in IPPB, a short term treatment for people not respirator dependent.

    It is very important to consider that the US is a low density population country. NY City is right to worry but much of the population lives in suburbs (hated by the left) or rural settings. This will probably have a huge impact on the total load on the medical system. Every winter is flu season and hospitals fill up, but that is ending now. That should help with the capacity situation. I just hope some company in the US, not China, is stamping out Chloroquine tablets. Last week there were supplies and I was able to order some from my son who is a paramedic. By Monday, all pharmacies were “out of stock.”

    I am not impressed that the experts are not talking progress on therapeutics. It should obviously be on the front burner as part of “flattening the curve” and reducing death rates. We got the vaccine story, so what about the same crew taking ownership for driving the train, or not, on getting therapeutics into testing on the most expedited possible schedule? If an old, inexpensive, and proven drug, with well known side effect rates, just might help, why would we not be pushing forward with it, waiving “off label” restrictions in this national emergency? Put a pin in it. At a meeting with nurses, the President seems to be tipping something about to come out of FDA tomorrow:

    The FDA will be — they’ve been working very, very hard, and I appreciate what they’re doing. And I think we have some very interesting things that will be brought up tomorrow at the news conference. It’ll be set up, I think, at around 11 o’clock or so, but we look forward to seeing you tomorrow.

     

    • #27
    • March 18, 2020, at 3:04 PM PDT
    • Like
  28. Clifford A. Brown Contributor
    Clifford A. Brown

    MichaelKennedy (View Comment):
    I think the concern about ventilators is most likely overblown.

    Whether or not the concern is overblown, medical theater is important right now, creating some fact-based reassurances with highly visible federal reinforcement of equipment and facilities from war stocks and the National Strategic Stockpile. I personally would like to see that the feds can actually get a lot of stuff out of their warehouses and on site in hours, not days.

    • #28
    • March 18, 2020, at 3:10 PM PDT
    • 1 like
  29. The Reticulator Member

    Clifford A. Brown (View Comment):

    The Reticulator (View Comment):

    Clifford A. Brown (View Comment):
    Note, however, that Dr. Birx is leading a models meeting to settle on an agreed model for this country.

    Why does there have to be an agreed-upon model, I wonder? If there are dissenting models, why can’t they be allowed to continue and be publicized?

    This is one reason I’m distrustful of public health authorities. They seem to find it necessary to come up with consensus recommendations even where there is no consensus.

    The question is which one informs public policy. There is no talk of silencing dissenting models.

    I long ago decided to serve on no committee whose final report wouldn’t allow for dissenting opinions to be published with it. That decision coincided with the end of my service as a representative of the public on school committees. Bureaucrats who have the confidence and openness to allow and acknowledge dissent are a rare breed, and should be respected.

    • #29
    • March 18, 2020, at 3:28 PM PDT
    • 4 likes
  30. MichaelKennedy Coolidge

    Clifford A. Brown (View Comment):

    MichaelKennedy (View Comment):

    I think the concern about ventilators is most likely overblown. The use of drugs like Chloroquine and some antivirals being used in India will probably reduce the numbers requiring ventilators. I don’t know enough about the details of the type of respiratory insufficiency to know if Bird respirators would be useful. They were largely replaced b y volume controlled types for ICU cases although the pressure controlled types like the Bird may still be used in IPPB, a short term treatment for people not respirator dependent.

    It is very important to consider that the US is a low density population country. NY City is right to worry but much of the population lives in suburbs (hated by the left) or rural settings. This will probably have a huge impact on the total load on the medical system. Every winter is flu season and hospitals fill up, but that is ending now. That should help with the capacity situation. I just hope some company in the US, not China, is stamping out Chloroquine tablets. Last week there were supplies and I was able to order some from my son who is a paramedic. By Monday, all pharmacies were “out of stock.”

    I am not impressed that the experts are not talking progress on therapeutics. It should obviously be on the front burner as part of “flattening the curve” and reducing death rates. We got the vaccine story, so what about the same crew taking ownership for driving the train, or not, on getting therapeutics into testing on the most expedited possible schedule? If an old, inexpensive, and proven drug, with well known side effect rates, just might help, why would we not be pushing forward with it, waiving “off label” restrictions in this national emergency? Put a pin in it. At a meeting with nurses, the President seems to be tipping something about to come out of FDA tomorrow:

    The FDA will be — they’ve been working very, very hard, and I appreciate what they’re doing. And I think we have some very interesting things that will be brought up tomorrow at the news conference. It’ll be set up, I think, at around 11 o’clock or so, but we look forward to seeing you tomorrow.

     

    I just wonder if chloroquine and hydroxychloroquine are made in China.

    • #30
    • March 18, 2020, at 5:21 PM PDT
    • 1 like