Michael1942's Blog

Unfortunately what ever TOTUS says is usually false or misunderstood by him. MA

Shane Harris, Felicia Sonmez, Mike DeBonis

2 Days ago

President Trump said on Sunday that the federal government is stepping up efforts to obtain vital supplies for coronavirus testing, hours after several governors from both parties faulted his administration for not doing enough to help states.

Public health experts say testing on a larger scale is a crucial step before resuming normal social and economic activity in the country. But Trump defended the administration’s approach of leaving testing largely to states.

“Testing is a local thing,” Trump said at a White House briefing. He said that too many governors were relying on state government labs and should turn to commercial labs to help them process more tests. He didn’t name any particular states or officials.

But earlier Sunday, Republican and Democratic governors were unanimous in putting the onus on the federal government to help secure vital testing components, including swabs and reagents, the chemical solutions required to run the tests, which the governors said have been in short supply.

“To try to push this off to say that the governors have plenty of testing, and they should just get to work on testing, somehow we aren’t doing our job, is just absolutely false,” Republican Gov. Larry Hogan of Maryland told CNN’s “State of the Union.” “Every governor in America has been pushing and fighting and clawing to get more tests, not only from the federal government, but from every private lab in America and from all across the world.”

Democratic Gov. Ralph Northam of Virginia, which is working closely with officials in neighboring Maryland and the District, called Trump administration claims of sufficient testing “delusional.”

“We’ve been fighting for testing,” Northam, a physician, told CNN. “It’s not a straightforward test. We don’t even have enough swabs, believe it or not. And we’re ramping that up.”

Trump, displaying a nasal swab to reporters, said the federal government was procuring millions more swabs, and then claimed some states had lost the ones they were already sent.

“We also are going to be using, and we’re preparing to use the Defense Production Act to increase swab production in one U.S. facility by over 20 million additional swabs per month,” Trump said. “We’ve had a little difficulty with one. So we’re going to call in — as we have in the past, as you know, we’re calling in the Defense Production Act, and we’ll be getting swabs very easily. Swabs are easy.”

White House officials did not respond to requests for details about how the measure would be implemented (and as of Sunday evening there was no official paperwork released showing that the Defense Production Act had been invoked for swabs).

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, also announced that nursing homes will be required to inform the CDC when they confirm a positive case of covid-19 in their facilities. Some of the most severe outbreaks have occurred in those facilities.

The pushback from governors came on a day that the total number of confirmed deaths from covid-19, the disease caused by the new coronavirus, passed 40,000. Although some states have reported a leveling off in the number of deaths and new infections, nationally those figures are still rising. More than 749,000 confirmed infections have been reported as of Sunday night.

Trump suggested the number of deaths nationally could eventually reach 60,000, though that figure seemed optimistic considering the toll so far.

Experts say the number of tests has not kept pace with the severity of the infection. Nationally, the number of tests has plateaued to an average of about 146,000 per day. But some state officials, business leaders and public health experts say that is woefully short of the several hundred thousands or perhaps even millions of daily tests it might take to safely restart the economy.

Some governors said only the federal government had the authority to make decisions that could speed up the deployment of testing kits.

Ohio’s Republican governor, Mike DeWine, said his state’s “big problem” is that the federal Food and Drug Administration has not prioritized companies that are “putting a slightly different formula together” for their testing kits. “I could probably double, maybe even triple testing in Ohio virtually overnight” if the FDA would do that, DeWine told NBC News’s “Meet the Press.”

Michigan Gov. Gretchen Whitmer (D) said on NBC that her state has “the capacity to double or triple the number of tests that we are doing, but we need some of these supplies.”

“The reagents and the swabs are absolutely essential,” she said. “You can’t process all these tests if you can’t take the sample and protect it and move forward through testing. And so while our capabilities are there, these important supplies are not.”

© AP/AP Michigan Gov. Gretchen Whitmer (D) addresses the state during a speech in Lansing, Mich., on Friday.

In Massachusetts, which is now seeing a surge in infections of covid-19, Republican Gov. Charlie Baker emphasized that states need “guidance” from federal agencies, including the FDA and Centers for Disease Control and Prevention, “especially the ability to put the foot on the accelerator with respect to advancements in testing.”

“Everything associated with testing ultimately has to be approved by the CDC and the FDA,” he said on CBS New’s “Face the Nation.”

Trump defended his administration’s performance, tweeting on Sunday afternoon: “Just like I was right on Ventilators (our Country is now the ‘King of Ventilators’, other countries are calling asking for help-we will!), I am right on testing. Governors must be able to step up and get the job done. We will be with you ALL THE WAY!”

For all the bipartisan agreement that testing must increase, there were signs that the public’s patience was fraying with restrictive orders to remain at home and stop working.

In Washington state, more than 2,000 protesters showed up at the capitol in Olympia calling on Gov. Jay Inslee (D) to lift a stay-at-home order meant to slow the spread of the virus, according to the Washington State Patrol.

Smaller protests have erupted across the country in response to state stay-at-home orders. Trump has signaled his support for some, tweeting that residents of Virginia, Michigan and Minnesota should “liberate” their states following demonstrations last week.

On Saturday, a few dozen protesters gathered outside the Utah state capitol, demanding that officials allow people to return to work.

Protests were planned for Monday in California and Pennsylvania and later this week in Missouri and Wisconsin.

Vice President Pence, asked on Sunday talk shows if Trump was inciting citizens to rise up against their state governments, defended Trump’s comments and pledged to work with governors to safely reopen the economy.

A former head of the FDA, who served under Trump, agreed with governors who were critical of the administration and said that the federal government must do more to safely resume normal activity.

The administration has pursued a “loose strategy” and needs to focus more closely on obtaining supplies, Scott Gottlieb said on CBS News’s “Face the Nation.”

“I think states are largely on their own trying to get testing resources into their states,” he said, noting the shortage of swabs and reagents is a more urgent matter than lack of lab capacity.

“If you have the government more engaged in trying to manage that supply chain, getting supplies to the states that need it most, and trying to look for ways to increase manufacturing at a national level, that could help the states get the supplies they need,” he added.

New York Gov. Andrew M. Cuomo (D), whose state has seen by far the largest numbers of infections and deaths from covid-19, said states also must begin wide testing for antibodies, which could indicate who was already infected with the virus and may be immune. He pledged at a news conference that New York would pursue antibody testing “in the most aggressive way in the nation.”

The FDA has authorized four antibody tests on an emergency basis, but dozens more have been put on the market without any review by the federal agency. Some experts, including at the FDA, are concerned that those unvetted tests may be of dubious quality and yield unreliable results.

Since the first case of covid-19 was confirmed in the U.S., public health officials have called for more testing, both as a means of understanding how many people were infected and isolating people with the virus before they can infect others.

Deborah Birx, the Trump administration’s coronavirus response coordinator, shifted the emphasis of the debate slightly, telling CBS that mass testing in areas that do not have known outbreaks of the virus could be counterproductive.

“Testing needs to be focused critically where you start to see early evidence [of transmission] because no test is 100 percent specific and 100 percent sensitive,” she said. “And so if you test and overtest in areas where there isn’t virus, you can end up with false positives and false negatives.”

Experts agree that future testing will need to focus aggressively on outbreaks and be accompanied by contact tracing of the people who may have been exposed to the infected patient. But before that can ocurr, health officials say they need much more testing to develop baselines that will indicate when a new outbreak is happening.

Birx said that the White House task force was “working with every laboratory director across the country . . . to really understand and find solutions for them on their issues related to supplies.”

She questioned whether nearly a million tests a day were necessary and emphasized that outbreaks have to be addressed on a case-by-case basis, rather than with a single national approach.

“[T]his has to be looked at as a community by community,” she said, resisting questions about when the country would know that it was safe to begin a return to normal life. “It needs to be down to the communities so the communities can see what happens in their communities and make decisions with the local and health officials and the state officials, what can be opened and what needs to remain closed.”

Some communities have decided that time is now.

In Florida, local officials allowed the public back onto some beaches, after Republican Gov. Ron DeSantis on Friday said beachfront governments could make those decisions on their own.

Despite admonitions to maintain social distancing, local news showed photos and videos of shoreline dotted with people closer than six feet apart.

shane.harris@washpost.com

felicia.sonmez@washpost.com

mike.debonis@washpost.com

Meryl Kornfield, Samantha Pell and Steven Goff contributed to this report.

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There are important lessons in this story/ MA

By Brenda Goh

2 days ago

WUHAN, China (Reuters) – Dressed in a hazmat suit, two masks and a face shield, Du Mingjun knocked on the mahogany door of a flat in a suburban district of Wuhan on a recent morning.

A man wearing a single mask opened the door a crack and, after Du introduced herself as a psychological counsellor, burst into tears.

“I really can’t take it anymore,” he said. Diagnosed with the novel coronavirus in early February, the man, who appeared to be in his 50s, had been treated at two hospitals before being transferred to a quarantine centre set up in a cluster of apartment blocks in an industrial part of Wuhan.

Why, he asked, did tests say he still had the virus more than two months after he first contracted it?

The answer to that question is a mystery baffling doctors on the frontline of China’s battle against COVID-19, even as it has successfully slowed the spread of the coronavirus across the country.

Chinese doctors in Wuhan, where the virus first emerged in December, say a growing number of cases in which people recover from the virus, but continue to test positive without showing symptoms, is one of their biggest challenges as the country moves into a new phase of its containment battle.

Those patients all tested negative for the virus at some point after recovering, but then tested positive again, some up to 70 days later, the doctors said. Many have done so over 50-60 days.

The prospect of people remaining positive for the virus, and therefore potentially infectious, is of international concern, as many countries seek to end lockdowns and resume economic activity as the spread of the virus slows. Currently, the globally recommended isolation period after exposure is 14 days.

So far, there have been no confirmations of newly positive patients infecting others, according to Chinese health officials.

China has not published precise figures for how many patients fall into this category. But disclosures by Chinese hospitals to Reuters, as well as in other media reports, indicate there are at least dozens of such cases.

In South Korea, about 1,000 people have been testing positive for four weeks or more. In Italy, the first European country ravaged by the pandemic, health officials noticed that coronavirus patients could test positive for the virus for about a month.

As there is limited knowledge available on how infectious these patients are, doctors in Wuhan are keeping them isolated for longer.

Zhang Dingyu, president of Jinyintan Hospital, where the most serious coronavirus cases were treated, said health officials recognised the isolations may be excessive, especially if patients proved not to be infectious. But, for now, it was better to do so to protect the public, he said.

He described the issue as one of the most pressing facing the hospital and said counsellors like Du are being brought in to help ease the emotional strain.

“When patients have this pressure, it also weighs on society,” he said.

The plight of Wuhan’s long-term patients underlines how much remains unknown about COVID-19 and why it appears to affect different people in numerous ways, Chinese doctors say. So far global infections have hit 2.5 million with over 171,000 deaths.

As of April 21, 93% of 82,788 people with the virus in China had recovered and been discharged, official figures show.

Yuan Yufeng, a vice president at Zhongnan Hospital in Wuhan, told Reuters he was aware of a case in which the patient had positive retests after first being diagnosed with the virus about 70 days earlier.

“We did not see anything like this during SARS,” he said, referring to the 2003 Severe Acute Respiratory Syndrome outbreak that infected 8,098 people globally, mostly in China.

Patients in China are discharged after two negative nucleic acid tests, taken at least 24 hours apart, and if they no longer show symptoms. Some doctors want this requirement to be raised to three tests or more.

China’s National Health Commission directed Reuters to comments made at a briefing Tuesday when asked for comment about how this category of patients was being handled.

Wang Guiqiang, director of the infectious disease department of Peking University First Hospital, said at the briefing that the majority of such patients were not showing symptoms and very few had seen their conditions worsen.

“The new coronavirus is a new type of virus,” said Guo Yanhong, a National Health Commission official. “For this disease, the unknowns are still greater than the knowns.”

REMNANTS AND REACTIVATION

Experts and doctors struggle to explain why the virus behaves so differently in these people.

Some suggest that patients retesting as positive after previously testing negative were somehow reinfected with the virus. This would undermine hopes that people catching COVID-19 would produce antibodies that would prevent them from getting sick again from the virus.

Zhao Yan, a doctor of emergency medicine at Wuhan’s Zhongnan Hospital, said he was sceptical about the possibility of reinfection based on cases at his facility, although he did not have hard evidence.

“They’re closely monitored in the hospital and are aware of the risks, so they stay in quarantine. So I’m sure they were not reinfected.”

Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention, has said the virus may have been “reactivated” in 91 South Korean patients who tested positive after having been thought to be cleared of it.

Other South Korean and Chinese experts have said that remnants of the virus could have stayed in patients’ systems but not be infectious or dangerous to the host or others.

Few details have been disclosed about these patients, such as if they have underlying health conditions.

Paul Hunter, a professor at the University of East Anglia’s Norwich School of Medicine, said an unusually slow shedding of other viruses such as norovirus or influenza had been previously seen in patients with weakened immune systems.

In 2015, South Korean authorities disclosed that they had a Middle East Respiratory Syndrome patient stricken with lymphoma who showed signs of the virus for 116 days. They said his impaired immune system kept his body from ridding itself of the virus. The lymphoma eventually caused his death.

Yuan said that even if patients develop antibodies, it did not guarantee they would become virus-free.

He said that some patients had high levels of antibodies, and still tested positive to nucleic acid tests.

“It means that the two sides are still fighting,” he said.

MENTAL TOLL

As could be seen in Wuhan, the virus can also inflict a heavy mental toll on those caught in a seemingly endless cycle of positive tests.

Du, who set up a therapy hotline when Wuhan’s outbreak first began, allowed Reuters in early April to join her on a visit to the suburban quarantine centre on the condition that none of the patients be identified.

One man rattled off the names of three Wuhan hospitals he had stayed at before being moved to a flat in the centre.  He had taken over 10 tests since the third week of February, he said, on occasions testing negative but mostly positive.

“I feel fine and have no symptoms, but they check and it’s positive, check and it’s positive,” he said. “What is with this virus?”

Patients need to stay at the centre for at least 28 days and obtain two negative results before being allowed to leave. Patients are isolated in individual rooms they said were paid for by the government.

The most concerning case facing Du during the visit was the man behind the mahogany door; he had told medical workers the night before that he wanted to kill himself.

“I wasn’t thinking clearly,” he told Du, explaining how he had already taken numerous CT scans and nucleic acid tests, some of which tested negative, at different hospitals. He worried that he had been reinfected as he cycled through various hospitals.

His grandson missed him after being gone for so long, he said, and he worried his condition meant he would never be able to see him again.

He broke into another round of sobs. “Why is this happening to me?”

(Reporting by Brenda Goh; Additional reporting by Jack Kim in Seoul, Elvira Pollina in Milan, Belen Carreno in Madrid, and Shanghai newsroom; Editing by Philip McClellan)

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