COVID Daily - Natl Stay at Home Now, Surge Health Supplies, More Tests - Tue Edition

This is a live document which was last updated Mon March 31th at 620pm. 

Top Lines

Monday morning's numbers from the COVID Tracking Pro:

162,399 cases up from 141,232

2,981 deaths up from 2,464

1,013,932 tests up 916,995

States over 75,000 cases - NY

Over 10,000 cases - NJ

Over 5,000 cases (6) - CA, FL, IL, LA, MA, MI

Over 2,500 cases (6) - CO, CT, GA, PA, TX, WA

Over 1,000 cases (11) - AZ, IN, MD, MO, NC, NV, OH, SC, TN, VA, WI

As this FT analysis and chart shows the US is currently experiencing the most serious surge of new cases of any nation since the pandemic began.  This global tracker now has the US, with 5% of the world's population, clocking in with 19% of all the world's infections.  The FT's data suggests the world has to start worrying about Turkey - it's current infection suggests the virus is really out of control there.  Should be noted that of all the states with large outbreaks WA may have done the most so far to "flatten the curve." 

We are officially now once again worried about the what's happening with testing in the US.  After making very rapid progress a week or so ago, the number of daily tests in the US has leveled off, bouncing around at 100,000 a day.  For weeks now, on a per capita basis, Germany has been close to 300,000 a day, and South Korea at 130,000-140,000 a day.  So we are not only still trailing their daily testing numbers but lag very far behind in the total # of tests conducted over the past few monthsWe've conducted less a million tests in this vast country over the past 10 weeks - a number Germany is hitting every 3-4 days, South Korea in a week.  And this is with NY and WA producing many of their own tests. 

Clearly with many accounts of 5 plus day test results turnarounds and "millions" of tests on their way the Administration dangerously oversold their initial response to the testing fiasco, and far more must be done to get us to where we need to be (we discuss this below).  We also have to consider whether current levels of testing, or even slightly improved levels, will be adequate if we start getting into hundreds of thousands new infections each day. 

Seriously, where are all the tests?

It should be noted that we are using private data, as the government's efforts to track what is happening with the COVID19 pandemic - from test results to masks - has been truly awful. The truth is that our testing regime starting so late and still in its early days we really have no idea whats going on with the virus here in the US. 

America Needs A Plan to Defeat COVID19, Not More Magical Thinking

Almost ten weeks into the COVID-19 crisis, it is hard to put into words has little the US government has done to tackle the public health side of this crisis.  The President’s main initiative, his travel bans, clearly didn’t work; the testing regime still isn’t fully up and running; the President's unwillingness to provide equipment to hospitals remains reckless, inexplicable and sadistic; social distancing and school/business closures have all been done at the state and local level despite the disease being everywhere (that the President allowed Florida's Spring Break partying to continue last week was a sign of the lack of seriousness of his efforts). 

Recently the President said that he doesn't believe that fighting COVID19 is a federal responsibility despite his "wartime" language. He ignored repeated warnings from his own intelligence community that COVID could be the big one.  His refusal to craft a single national strategy to mitigate the spread of the virus will end up costing us many many lives and untold damage to our economy and society more broadly; that the President is relentlessly lying and misninforming all of us about what is happening makes it all that much more worse.  We agree with with the assessment of Jeremy Konyndyk in this new thorough Guardian look at what wrong here in the US: "We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.” 

The exploding infection rate here in the US proves the President's approach hasn't worked.  In recent weeks expert opinion has settled around a plan similar to the one we've been advocating:

1. surge medical equipment/beds/staff to the front lines,

2. a testing/isolation regime like South Korea's

3. 21 day mandatory national stay at home program (not just recommendations)

(NDN's #4 is a Manhattan Project for a vaccine/testing/etc). 

The economy cannot stand back up until the virus is tamed, and time for the President's magical thinking to end.  As we wrote earlier this week, now that Congress has taken dramatic steps to aid the US economy, it must step in now and make sure America finally has a plan to defeat the virus.  Our hope is that Speaker Pelosi form some kind of alliance with the nation's governors to not just get this plan in place but oversee its implementation in the coming months.  Getting America stood back up depends on it.  Such an alliance will also make it far harder for the President to keep pitting state against state, region against region. 

And don't take it from us - in a Today show interview on Monday Dr. Brix acknowledged the national social distancing effort has been inadequate, and the testing regime is still not yet stood up.  Senator Chris Murphy echoed this dispair at the lack of an effective national response in a new interview with Greg Sargent. 

For more on what we need to do right now see these excellent essays:

Laurie Garrett "Sorry, America, the Full Lockdown Is Coming." Foreign Policy

Dr. Ezekiel Emanuel "Fourteen Days. That’s the Most Time We Have to Defeat Coronavirus." NYTimes

Drs. Carroll and Jha "Don’t Halt Social Distancing. Instead, Do It Right." The Atlantic

Professors Romer and Garber "Will Our Economy Die From Coronavirus?" NYTimes

Ed Yong "How the Pandemic Will End."  The Atlantic

NDN's been asking  our readers and members to call Congress every day until the President puts a plan in place and is clearly producing real results.  As we say above, the plan should include 3 core elements:

Surge Equipment/Beds/Staff To the Frontlines – The President and Congress have to take responsibility for a national plan to handle the extraordinary health care crisis that the nation will face in just a few days’ time.  We need wartime-level production of protective gear, ventilators, ICU beds, and isolation/quarantine wards.  We will need a way to employ more health care workers too – perhaps with temporary unemployment rising there can be a way to take qualified people and crash train them as hospital/health care staff. 

The President’s refusal to take responsibility for this part of our national response remains hard to understand and explain.  Congress must step in here and force both a funded national strategy and compliance with it in the coming days.  If the President really wants to show his support for a robust US healthcare system, the President should withdraw his support for a lawsuit which could cripple the ACA in the midst of this pandemic and encourage every state to expand Medicaid so more of our citizens get the care they need.  That states are being allowed to reopen the ACA sign up window is a welcome and smart step. 

Congressshould open up an immediate investigation into news reports that Trump has sent life saving equipment to favored states and held it from ones he didn't like. The Governors of MA, MI and MT have all complained that supply orders they made were cancelled, or they were outbid by the federal government - why is this still happening? We need to know much more about what is happening here. 

On the "way overdue but good news" front it appears the Army Corp of Engineers is beginning to be deployed to help build more medical facilities in US hot spots. On Friday the President did take two additional steps which could be meaningful in the days ahead - he began nationalizing the supply chain for medical equipment, and he has started to mobilize the military to provide more direct personnel support fo the front lines in the days ahead.

More, Better, Faster Tests – While things have gotten much better on the testing front, we still have a very long way to go before our tests are ubiquitous and rapid – everywhere and done in minutes/hours, not days.  If we are ever to return to normal, efforts to aggressively screen and isolate those with infection (in public buildings, ports of entry, schools, and sports arenas) will have to become routine – like texting a friend.  This Guardian story looks at how mass testing helped slow the virus's spread in one Italian town, and this new article in Science magazine explains how mass testing was key to South Korea's flattening of the curve without major lock downs.  This new Atlantic article by Alexis Madrigal and Robinson Meyer is an excellent deep dive on the importance of testing, and our massive failure to get it right so far. 

Developing ways of proving that you’ve had the virus and are now immune will also be really important, and would require, obviously, that every single American be tested at some point.  We found this thread by Yale Professor Nicholas Christakis to be helpful in understanding the issues around immunity and the need for rapid, ubiqitous "serological" tests which are of a different kind than the "PCR" tests which are being deployed right now. 

So, yes, we are talking about billions, not tens of thousands, of tests. The government should be making this kind of ubiquitous rapid testing regime part of the mandate of a new “Manhattan Project” which works to not just defeat COVID but give America far better tools to fight future pandemics.  For more on the need for crashing a broad regime for advance a vaccine, therapeutics, hospital equipment and diagnostics see this thread from Dr. Scott Gottlieb and this Boston Globe op-ed from Senator Markey and Peter Slavin.   

We've started receiving good news on the testing front - the FDA just announced the approval of a rapid point of care PCR COVID19 test by the California company, Cepheid.  This test will be particularly important in hospitals and other triage facilities, and in keeping our front line health care professionals from getting sick themselves.  On Friday Abbott announced FDA approval for a 5-13 minute desktop PRC test - a huge advance if it is can realized in the coming weeks. 

Implement National Stay at Home/Develop A National Strategy For Students and Kids – As part of eventually developing a true national "stay at home" social/physical distancing strategy the US govt will have to help communities and families come to terms with what it means that kids may be home until the fall semester (no schools, summer activities).  This is a large and important area which needs far more attention and creativity, but two initial thoughts:

1) Their Health – the early messages about young people being less vulnerable to COVID-19 and thus somehow less responsible has to be corrected aggressively in the days ahead.  We know from data that young people in other countries have become infected at very high rates, and seem to be critical to the rapid transmission of COVID.  But it is also for themselves – early data here in the US show that young people are turning up in ICU units at much higher rates than in China, and COVID can permanently damage the lungs of anyone infected. 

Gov Cuomo weighed in last Saturday on the need to change our collective mindset about young people, Tweeting "Younger people listen up: 55% of NYS #Coronavirus cases are ages 18-49. Young people aren’t invincible. You can get this and you can give it to someone older you love. You shouldn’t endanger your own health & you certainly shouldn't endanger other people's health. #StayAtHome." More leadership like this please.

2) Their Sanity - What do we do with our kids for the next six months if schools and summer camps are cancelled? This is not just a sanity thing for these students and families - having kids at home will make it far harder to stand the economy back up when the virus ebbs. 

It is our recommendation that all schools and colleges involved in distance learning now develop a “pandemic module” to help young people better understand how to stay safe, reduce infection, and navigate the rigors of life at home, away from their friends and the lives they’ve built for themselves.  These kinds of courses may be the most valuable things that schools can do in the months ahead.

Do note that after weeks of embracing a strategy similar to what the President is apparently now fliting with, the UK has now gone into a full national "stay at home" approach for three weeks.  India has also announced a three week stay at home period.  It is time the US does the same.  A new Morning Consult poll shows supprt for a national stay at home period to be 77/19 - dramatic level of support for immediate, comprehensive action. 

The President's floating "Easter" as a return to normal date was deeply dangerous. It undermined the current social distancing efforts underway, and moves on the oppositive direction we should be heading in.  Perhaps the nation thought can use that date as a way of measuring whether our national government has gotten COVID under control, and if not, the President should resign and make way for others who can get the job done. 

So, he's backed off on Easter it appears, but still failed to do what he needed to do - implement a 21 mandatory national stay at home order.  It's cowardice, not strong stready leadership - he's letting others do the hard work of managing this crisis each day.