Concerns about some of the things said at the White House COVID Task Force meeting tonight 1/x
Millions of masks were said to have been shipped. Very good to see that volume of equipment out there, but there are hospitals in badly affected places that still have scant supplies. nytimes.com/2020/03/25/nyr… 2/x
We need a federal logistics dashboard that shows what hospitals need around the country with high granularity, and when they are going to get it 3/x
Having the right available masks is literally life and death issues for health care workers nytimes.com/2020/03/26/nyr… Discussions about large supplies being available in the country do not tell us whether the hospitals and HCWs that need it most are getting it 4/x
Still comments being made about how states and hospitals should acquire this equipment on their own. This is the wrong approach. The fed govt should invoke the Defense Production Act to acquire maximum level of critical masks, gowns, reagents, swabs, ventilators et al. 5/x
Then, once equipment is acquired, fed gov should distribute it thru private sector logistics companies to places where it's most needed. Otherwise states, hosps. have to fight w/ other states, hosps to get critical supplies, w/ scarcity driving up prices.This wont work. 6/x
Comments were also made at the Task Force press conf saying that attack rate has been low in other countries and that models of higher attack rates are not realistic. 7/x
But the leading national and international models have used the demonstrated reproductive rate of this virus, the demonstrated case fatality rate, and the best scientific estimates of the number of people susceptible to this virus in the world. 8/x
It is true that we've not yet seen full impact of predicted models play out yet. First reason for this is that we are at the very start of an epidemic that will continue for a long time absent a vaccine. 9/x
A second reason for this is that severe and unprecedented social distancing measures have been put in place in countries dealing w/ COVID-- see examples of China and Italy. 10/x
If social distancing had not been used in those countries, data suggests that exponential growth would have continued w/ huge rises in numbers in hospitals and ICUs, far beyond the extraordinary numbers they have had to contend with. 11/x
But there continues to be discussion of considering the end of social distancing after the 15 day mark set by the Task Force, though fortunately it now seems caveated by the need to see if the data supports that. 12/x
Unfortunately given the continued sharp rise in national cases, as well as the acute rise in cases in NY, Chicago, Michigan and elsewhere, the data will not support ending social distancing at day 15 or soon thereafter. 13/x
To consider letting off on social distancing will require sharp decline in cases, widely available rapid diagnostics wherever pts get clinical care, the right PPE available to all HCWS who need it, safe and good hospital capacity to deal with all pts with COVID. 14/x
Comments also made at the Task Force meeting that this is no time to talk about rationing of ventilators. 15/x
But clinicians and hosps in Wash state, NY, NJ, beyond are seeing full ICUs, rising COVID cases. They recognize potential need for rationing soon. It would be irresponsible to wait longer to openly discuss this - they need to prepare staffs and communities for what may come.16/x
Good news that new ventilators may be able to be produced on scale. Bad news is that production delayed around cost concerns. Given overall cost to country of COVID, the price seems worth it to get tens of thousands new vents. There's no time to waste nytimes.com/2020/03/26/us/… 17/x
