Discussion:
Trump's 250,000 COVID19 Dead Is Proof That USA Has Greatest Healthcare In The Developing World
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BeamMeUpScotty
2020-12-14 15:24:33 UTC
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How Covid-19 is Unveiling US Healthcare Weaknesses
Three questions to Eric Schneider by Angèle Malatre-Lansac
INTERVIEW - 27 March 2020
Angèle Malâtre-Lansac
Associate Director - Healthcare Policy
Eric Schneider
Senior Vice President for Policy and Research at The Commonwealth Fund
With 81,000 people infected with the coronavirus on March 27 and more than
1,000 deaths, the United States are now the new epicenter of the disease.
According to Eric Schneider, senior vice president for policy and research
at The Commonwealth Fund, a national philanthropy engaged in independent
research on health and social policy issues, the very decentralized nature
of the American Healthcare system where states set their own policies, the
weaknesses of care delivery as well as a series of lost opportunities made
the United States the country hardest hit by the pandemic.
The first known case of COVID-19 in the U.S. was confirmed on January 20,
2020 and cases have now been confirmed in all 50 US States. The
coronavirus pandemic exposes any and all health care systems’ weaknesses.
What are the biggest challenges for the American healthcare system?
The first challenge is the decentralization and weakness of our public
health and disease surveillance systems. When facing a pandemic, a nation
as large as the U.S. needs a central agency to collect and monitor data
from abroad and from within the country to detect emerging disease threats
early and coordinate a response. These functions are decentralized in the
U.S. Each state funds and operates its own public health and disease
surveillance system. As this pandemic started, the consequence of that
decentralization was a failure to understand the magnitude of the problem
and to pursue the kind of testing done that other countries did early to
detect cases and start contact tracing. Despite several experts’ warning
of the threat in January, our nation’s Center for Disease Control was very
slow to ramp up testing and failed on some crucial decisions about which
test kits to permit and how to distribute them. We lost many weeks in this
process.
On the other hand, a strength of our decentralized system is that an
independent team of researchers in Washington State, frustrated by the
slow federal response, started testing on their own. At state level,
public health agencies stepped in to fill the vacuum in leadership.
On the healthcare delivery side, one big challenge is that our system
depends heavily on private companies, private practices and private
hospitals. We tend to rely on the market to deliver primary care services
and hospital services. Half of healthcare spending in the U.S. is private
spending. Spending from our government is channeled through private
delivery systems. Some weaknesses of that approach are that those private
organizations operate with a high degree of independence. It is rare for
the government to order them to change their procedures and coordinate
except in a crisis.
A strength of our decentralized system is that an independent team of
researchers in Washington State, frustrated by the slow federal response,
started testing on their own.
They also rely on a fee-for-service revenue stream that depends on people
coming in for face-to-face visits. What we are seeing now because of stay-
at-home orders and the shut-down of much of our economy, is that those
private practices are experiencing serious challenges to their revenue. We
are hearing of a 30 to 50% decline in revenues because providers can’t
bill for visits that don’t happen and because there is no payment for
telephone consultations. That creates a weak spot in our primary care
system.
bed capacities are lower in the United States than in most other high-
income nations. In part this is because we let market forces, who can pay
the most, drive the availability of services. There is a misallocation of
resources: we have too few intensive care units’ beds and too few
ventilators for the crisis we are facing. Many of the hospitals in New
York already report that they have reached their capacity and many are
“safety-net” hospitals that serve poor patients. Another issue is
staffing, we don’t have enough people trained and respiratory therapists
to manage the ventilators. One of the reasons for this shortage is that
respiratory therapists are traditionally paid less than many other health
professionals.
Another third weakness is the lack of universal insurance coverage: we
still have around 10% of the population lacking any health insurance and
half of Americans reporting that they are underinsured. Those people face
high deductibles and copays when they seek healthcare and their out of
pocket spending can be very high. We have known for decades that people
who lack financial means end up going without care. They avoid going to a
doctor and going to hospitals until they are really sick. And in a
pandemic like this one, we want people to identify that they have a
problem early so that they can be dealt with. The spread of coronavirus
may be accelerated by the lack of access to healthcare. Initially, people
did not want to face the cost of testing because it wouldn’t be covered by
insurance companies. Now insurance companies have agreed that they will
cover testing without copay, but even that doesn’t solve the problem: once
a person is sick and goes to the hospital, or if they need an ambulance to
go to the hospital, they can face significant financial costs.
Another weak point is that Americans may be in worse health than their
counterparts in other countries. On average Americans are a bit younger
than people in Japan or in Europe. But a higher proportion of the
population suffers from chronic diseases: high cholesterol, diabetes,
heart problems, and respiratory conditions. The excess burden of chronic
diseases is partly a result of inadequate insurance and access to care. We
also have a large homeless population that carries its own set of health
challenges. All of those individuals are in the high risk category if they
get sick with Covid-19. We don’t have the hospital capacity, the ICU and
medical capacity and ventilators. In New York City, now the epicenter of
the US pandemic, tens of thousands of people are homeless, living in the
streets, subways, and in shelters. The virus can be transmitted easily
through those communities. Their risk of death is very high. We’ve seen in
the last few days a tremendous surge in people, arriving at New York
hospitals seriously ill with Covid-19.
We see that every country has a different response to the outbreak. What
can be done in the U.S. to contain and mitigate coronavirus?
I’m in New York city, and the State of New York has become the epicenter
of the epidemic in the United States within the last two weeks. It’s
likely due to a combination of New York being a place with a lot of
travelers, and because of the city’s high population density: New York
City has two times the population density of Los Angeles.
What we are seeing in the State of New York is a very dramatic response.
The first response was a physical distancing strategy (some people call it
a social distancing). The state moved quickly to close schools and non-
essential businesses, and issue stay-at-home orders: those changes can
slow the progression of the disease (as they did very successfully in
China). New York started this lockdown a week and a half ago. Hopefully
that will reduce the number of people demanding hospital care in the
coming weeks.
The second response was to increase the hospital capacity to answer the
needs of the population. New York is beginning to mobilize the equipment
that is needed: ventilators, opening new hospital beds, building new
facilities such as temporary field hospitals. That’s all beginning to
happen. Another response is testing. We’ve been flying blind for the last
several weeks in terms of knowing the magnitude of the demand for care.
Other countries such as South Korea have tested hundreds of thousands of
people and have set up drive-through testing centers. Testing has now
expanded dramatically in New York. We started late but the production of
tests finally ramped up to allow testing tens of thousands of people.
Other states like Texas and Florida have been much further behind in terms
of testing.
We are going to need a federal coordinated response. States right now are
actually competing against one another to acquire ventilators and
protective equipment for healthcare workers.
We also need a federal response. A lot of people fled New York for other
states and cities over the past several weeks going to other cities. Now
the first cases are surging in those other cities. We see New Orleans
becoming another epicenter in the U.S. It is speculated that the Mardi
Gras festival in February may have drawn a lot of people to New Orleans,
some of whom were carrying the infection. In March, Spring break brings
lots of students to Florida. The number of infected people is still low in
Florida but they are not testing actively. The point is that the pandemic
is unfolding differently in different parts of the country. We are going
to need a federal coordinated response. States right now are actually
competing against one another to acquire ventilators and protective
equipment for healthcare workers. And companies that are selling that
equipment are raising prices. That’s not a great way to allocate resources
in a crisis. Our federal government really needs to step in to prevent
misallocation and price gouging and to allocate resources to where the
needs are greatest. And the needs are going to change and spread
throughout the country at different times. A federal coordinating response
could really help.
Last but not least, we also need a centralized monitoring system. One of
the strengths we see in the United States is the high level of
telecommunication and computerization of daily life that enables the
sharing of data despite much of the economy being locked down. Healthcare
professionals are able to share ideas and information on the nature of the
disease and how to manage it. But we still don’t have the monitoring and
measurement system we want that would help us understand where the disease
outbreak is at its worst, and where supplies are needed. We have a very
weak federal central capacity that is hurting the states that need the
most help, such as New York City, Seattle, and California. These places
are experiencing major epidemic outbreaks and have to face them without
sufficient federal help right now.
With 33 remaining primaries and caucuses and the presidential elections in
November, the Coronavirus crisis has put politics in an entirely new light
and the impact of the situation on campaigns and elections is becoming
increasingly evident. How is Covid-19 reshaping politics?
We are already beginning to see a small shift in the balance of political
power because of the absence of quarantined Senators.
This is unprecedented of course, and we are in an election year. One of
the very urgent worries is whether our government can maintain its
functioning capacity. Members of our Congress have to vote in-person at
the Capitol in Washington D.C. Several members of Congress have already
tested positive for the disease. We are already beginning to see a small
shift in the balance of political power because of the absence of
quarantined Senators.
There is also a level of uncertainty about whether our elections can be
conducted. Several primary elections in states across the country have
been postponed. There are even concerns about whether the November
presidential election can be held. But there is still time to sort that
out. Certainly, what we see is that the ability of politicians to campaign
to the public is threatened.
In a pandemic, the need for strong leadership is clear. We’ve seen very
gratifying leadership among our state governors: governor Cuomo in New
York, governor Newsom in California or governor Inslee in Washington State
have really stepped up by making hard decisions to shut down schools and
business activity to control the pandemic. Other state leaders have been
less active: Florida is still not willing to shut down businesses for
example. We don’t see cooperation. On the contrary, some states are
starting to talk about restricting travelers from other states and sealing
their borders, something we have not seen since the US Civil War in the
1860s.
Time to nuke the Chinese Communist Party HQ for their Bio-Weapon attack
that has killed 300,000 Americans.
--
TAKE THE RED PILL

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Dutch
2020-12-14 21:21:25 UTC
Permalink
Post by BeamMeUpScotty
Time to nuke the Chinese Communist Party HQ for their Bio-Weapon attack
that has killed 300,000 Americans.
Aided and abetted by Donald J.Trump. Let him ride the nuke like Slim
Pickens.
Tony Faucci <@×÷.>
2020-12-14 21:58:06 UTC
Permalink
Post by Dutch
Post by BeamMeUpScotty
Time to nuke the Chinese Communist Party HQ for their Bio-Weapon
attack that has killed 300,000 Americans.
Aided and abetted by Donald J.Trump. Let him ride the nuke like Slim
Pickens.
The US is only 4% of the world population, but accountable for more than
20% of Trump virus deaths.

Trump is guilty of more than 307,000 counts of "criminal negligence
causing death", and more than 16.8 million counts of "criminal
negligence causing bodily harm" due to mishandling of the COVID pandemic.

https://couriernewsroom.com/2020/04/09/experts-predicted-a-coronavirus-pandemic-as-far-back-as-2017-trump-ignored-them/
<https://www.google.com/url?q=https%3A%2F%2Fcouriernewsroom.com%2F2020%2F04%2F09%2Fexperts-predicted-a-coronavirus-pandemic-as-far-back-as-2017-trump-ignored-them%2F&sa=D&sntz=1&usg=AFQjCNF7hXDB3RNl2Geh7reKSdvYZ8w3Xg>


Experts Predicted a Coronavirus Pandemic as Far Back as 2017. Trump
Ignored Them.


The Trump administration ignored warning signs, failed to adequately
prepare for PPE shortages, botched the rollout of tests, and
repeatedly downplayed the severity of the coronavirus.

The novel coronavirus outbreak didn’t become a full-fledged pandemic
until March, but with each passing day, it’s become increasingly clear
that President Trump and his administration failed to heed numerous
warning signs and wasted two months of valuable time that could have
been used to prepare for the devastation now being unleashed on the
United States.

Here are some of the ways in which the Trump administration’s failures
have affected the nation’s response to the pandemic.


*Ignoring Warning Signs*

American intelligence officials issued a warning as far back as late
November
<https://abcnews.go.com/Politics/intelligence-report-warned-coronavirus-crisis-early-november-sources/story?id=70031273>
that a contagion was spreading through China’s Wuhan region, ABC News
reported on Wednesday. This warning, which was detailed in a November
intelligence report by the military’s National Center for Medical
Intelligence, was the result of analysis of wire and computer
intercepts, along with satellite images.

Analysts determined that the emerging disease could lead to a
“cataclysmic event,” and according to ABC News, the report was briefed
“multiple times” to the White House and various federal agencies.
President Trump reportedly even received a detailed explanation of the
problem in his daily brief of intelligence matters in early January,
weeks before the virus emerged in the U.S., but then spent the better
part of January and February downplaying the severity of the virus.

On Monday, the New York Times also reported that Trump’s trade advisor,
Peter Navarro, had written his own memo in late January warning the
administration
<https://www.nytimes.com/2020/04/06/us/politics/navarro-warning-trump-coronavirus.html>
that the coronavirus could cost the U.S. trillions of dollars and put
millions of American lives at risk.

“The lack of immune protection or an existing cure or vaccine would
leave Americans defenseless in the case of a full-blown coronavirus
outbreak on U.S. soil,” Navarro wrote in his Jan. 29 memo. “This lack of
protection elevates the risk of the coronavirus evolving into a
full-blown pandemic, imperiling the lives of millions of Americans.”

Navarro’s warning appears to have gone unheeded, and President Donald
Trump has denied
<https://www.politico.com/news/2020/04/07/trump-peter-navarro-coronavirus-memos-174237>
he ever saw the January memo or a follow-up February memo from
Navarro—even though that second memo was addressed to Trump directly
through the offices of the National Security Council, Trump’s then-chief
of staff Mick Mulvaney, and the White House coronavirus task force.


RELATED: Officials Tried To Warn Trump A Pandemic Was Coming In
January. He Didn’t Listen.
<https://couriernewsroom.com/2020/03/20/officials-tried-to-warn-trump-a-pandemic-was-coming-in-january-he-didnt-listen/>

“I didn’t see them. I didn’t look for them,” Trump told reporters on
Monday during a coronavirus task force news briefing.

The Trump administration also ignored the results
<https://www.nytimes.com/2020/03/19/us/politics/trump-coronavirus-outbreak.html>
of a 2019 simulated exercise imagining how a modern-day influenza
pandemic would affect the United States. In the simulation, 110 million
Americans were expected to become ill, leading 7.7 million people to be
hospitalized and 586,000 Americans to die. The results of that scenario,
reported by the New York Times in March, showed how underfunded,
underprepared, and uncoordinated the federal government would be in
fighting a novel pandemic.

The Pentagon also knew a pandemic caused by a novel coronavirus was
likely and warned the Trump administration of such a possibility in
2017. According to exclusive documents obtained by The Nation, the
Pentagon even predicted the shortages
<https://www.thenation.com/article/politics/covid-military-shortage-pandemic/>
of masks, hospital beds, and ventilators that American hospitals are
currently experiencing. The documents
<https://www.scribd.com/document/454422848/Pentagon-Influenza-Response>,
which detail how the U.S. military could respond to such a pandemic, are
eerily prescient.

“The most likely and significant threat is a novel respiratory disease,
particularly a novel influenza disease,” the military plan states.
COVID-19 is a respiratory disease caused by the novel coronavirus, and
the document specifically cites coronaviruses on several occasions, in
one instance saying, “Coronavirus infections [are] common around the world.”

Despite all these warnings, Trump has repeatedly insisted that no one
could have seen the coronavirus coming.

“Nobody knew there would be a pandemic or epidemic of this proportion.
Nobody has ever seen anything like this before,” Trump said on March 19,
contradicting the reality that his own Department of Health and Human
Services oversaw the simulation.


*PPE Shortages*

American hospitals are facing “severe” and “widespread shortages”
<https://couriernewsroom.com/2020/04/07/trump-doesnt-think-theres-a-medical-supply-shortage-these-hospitals-beg-to-differ/>
of personal protective equipment (PPE), such as N95 masks and surgical
masks, as well as shortages of medical equipment, such as ventilators
according to a new watchdog report from the Department of Health and
Human Services Office of Inspector General.

Doctors and nurses from across the country have spoken out about the PPE
shortage
<https://couriernewsroom.com/2020/04/07/trump-doesnt-think-theres-a-medical-supply-shortage-these-hospitals-beg-to-differ/>
and how it puts their lives—and their patients’ lives—at risk. Many
doctors and nurses are breaking protocol and reusing masks, while others
have been forced to use swim goggles, bandanas, and trash bags
<https://www.propublica.org/article/medical-workers-treating-coronavirus-are-resorting-to-homemade-masks>
to protect themselves. Some nurses have even quit their jobs
<https://couriernewsroom.com/2020/04/02/im-a-hospice-nurse-heres-why-i-chose-to-step-away-from-the-job-i-love-during-coronavirus/>
over the lack of protections.


RELATED: Trump Doesn’t Think There’s A Medical Supply Shortage.
These Hospitals Beg to Differ.
<https://couriernewsroom.com/2020/04/07/trump-doesnt-think-theres-a-medical-supply-shortage-these-hospitals-beg-to-differ/>

That the United States, the wealthiest country in the world, failed to
prepare enough supplies to deal with the coronavirus has become
something of a scandal, especially because a 69-page National Security
Council playbook on fighting pandemics
<https://www.politico.com/news/2020/03/25/trump-coronavirus-national-security-council-149285>
includes guidance on when and how to start obtaining PPE.


The Trump administration ignored that playbook, which says the
government should have begun efforts to obtain personal protective
equipment such as masks, gloves, and gowns in mid to late January.
Instead, as the Associated Press reported this week, the Trump
administration squandered nearly two months
<https://apnews.com/090600c299a8cf07f5b44d92534856bc> that could have
been used to bolster the federal stockpile of critically needed medical
supplies and equipment.

Federal agencies waited until mid-March to begin placing bulk orders of
N95 respirator masks, mechanical ventilators, and other equipment needed
by front-line health care workers. By that time, hospitals in several
states were treating thousands of infected patients without adequate
equipment and pleading for shipments from the Strategic National
Stockpile. That federal cache of supplies was created more than 20 years
ago to help bridge gaps in the medical and pharmaceutical supply chains
during a national emergency.

Now, three months into the crisis, that stockpile is nearly drained just
as the number of patients needing critical care is surging. Some state
and local officials report receiving broken ventilators and decade-old
dry-rotted masks.

“We basically wasted two months,” Kathleen Sebelius, health and human
services secretary during the Obama administration, told the AP.

Rather than do everything he can to help states deal with the PPE crisis
now, Trump has instead called the federal government a “backup,”
<https://couriernewsroom.com/2020/04/02/trump-passes-the-buck-to-states-on-giving-nurses-and-doctors-what-they-need/>
told states to find supplies on their own
<https://couriernewsroom.com/2020/03/30/trump-seems-to-be-playing-politics-with-medical-equipment-thats-risking-lives/>,
interfered with their efforts to do just that
<https://couriernewsroom.com/2020/03/28/trumps-personal-grudge-with-whitmer-may-have-led-to-supply-slowdown-to-state/>,
and accused governors of lying about their needs
<https://www.vice.com/en_us/article/5dm8w5/trump-says-states-are-lying-about-how-many-ventilators-they-need-to-fight-coronavirus>.



*Testing Kits*

The national shortage of COVID-19 tests has been well-documented, but
the highlights bear repeating: After deciding not to adopt the test used
by the World Health organization, the CDC botched
<https://apnews.com/c335958b1f8f6a37b19b421bc7759722> the development of
its first coronavirus test, which dramatically slowed the roll-out of
tests and caused a devastating delay.

The federal government was also slow to engage the private sector and
academic labs in testing; the Food and Drug administration waited until
Feb. 29
<https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-new-policy-help-expedite-availability-diagnostics>
to engage private labs in the testing space. These delays and shortages
caused the government to issue strict, inconsistent, and ever-evolving
guidelines on who could be tested for COVID-19. The Trump
administration’s testing failures were so severe that in February, as
more people across the U.S. became sick, government labs processed only
352 COVID-19 tests, an average of only 12 per day
<https://apnews.com/c335958b1f8f6a37b19b421bc7759722> in a nation of
more than 300 million people, according to an AP analysis of CDC data.

While testing has since ramped up, issues remain. The shortage of tests
remains substantial
<https://www.nytimes.com/2020/03/30/us/politics/trump-governors-coronavirus-testing.html>,
patients have reported waits of up to two weeks to receive test results
<https://www.nytimes.com/2020/04/06/health/coronavirus-testing-us.html>,
and many labs are now short on the swabs and chemicals
<https://www.nytimes.com/2020/03/18/health/coronavirus-test-shortages-face-masks-swabs.html>
needed to run the test.

As Bloomberg wrote
<https://www.bloomberg.com/news/articles/2020-04-07/coronavirus-testing-accuracy-and-availability-shortages-remain>
on Tuesday, “Coronavirus testing has become a massive logistical
failure, one that’s made it impossible to know how much the virus has
truly spread.”

The U.S. has by far the most known cases of COVID-19 in the world, with
more than 430,000 confirmed cases
<https://coronavirus.jhu.edu/map.html>. Nearly 15,000 Americans have
died as of Wednesday evening. While the U.S. has now completed two
million tests <https://covidtracking.com/data/us-daily> according to the
COVID Tracking Project, the country continues to lag behind many other
countries
<https://www.npr.org/sections/coronavirus-live-updates/2020/04/02/826368789/fact-check-trump-claims-u-s-testing-for-coronavirus-most-per-capita-its-not>
in testing per capita. In short, the surge in tests came entirely too late.

“Many local communities are flying blind, making decisions in the
absence of full information largely due to the failure of the federal
government to provide sufficient testing capacity,” Chrissie Juliano,
executive director of the Big Cities Health Coalition, told
<https://www.nytimes.com/2020/03/18/health/coronavirus-test-shortages-face-masks-swabs.html>
the New York Times. “This testing shortage, and lack of available
information about the actual burden of the virus, has set our country’s
response back by an order of magnitude we will never know.”


*Downplaying the Coronavirus*

Despite the various warnings the administration received about the
coronavirus, President Trump has repeatedly downplayed the dangers of
the virus
<https://couriernewsroom.com/2020/04/01/pence-says-trump-never-downplayed-coronavirus-19-times-he-did/>.
Since late January, Trump has said “We have it totally under control,”
declared that the virus would “go away in April,” said the number of
cases would soon be “down close to zero,” called it a democratic “hoax,”
and compared it to the flu.

Trump has minimized the risks of the coronavirus dozens of times, doing
so as recently as late March, after his own administration had already
issued stringent “social distancing” guidelines.

Mike Pence says Trump never “belittled” the threat of coronavirus.

We did some digging and here's a bunch of times he did just that.
pic.twitter.com/bMoNEWPk3O <https://t.co/bMoNEWPk3O>

— COURIER (@CourierNewsroom) April 2, 2020
<https://twitter.com/CourierNewsroom/status/1245843762506543104?ref_src=twsrc%5Etfw>

The president has also refused to take any responsibility
<https://www.theatlantic.com/notes/2020/03/2020-time-capsule-3-i-dont-take-responsibility-at-all/608005/>
for the administration’s missteps, and has instead tried to deflect
blame onto Democrats, former President Obama, China, the media, and the
World Health Organization. He has also said
<https://www.msn.com/en-us/video/animals/trump-im-a-cheerleader-for-the-country/vp-BB11Z6ej>
that he made his previous comments minimizing the severity of the virus
because he regards himself as America’s cheerleader.

He does not appear to be succeeding, either as cheerleader or president.
A new CNN poll
<http://cdn.cnn.com/cnn/2020/images/04/08/rel4a.-.coronavirus.pdf>
released Wednesday found that 55% of Americans think the federal
government has done a “poor job” of preventing the spread of COVID-19,
while only 41% think it has done a good job. Similarly, 52% said they
disapprove of Trump’s handling of the coronavirus outbreak and 55% said
they think he could be doing more to fight the pandemic.

Only 43% of Americans think Trump is doing everything he can.


https://couriernewsroom.com/2020/04/09/experts-predicted-a-coronavirus-pandemic-as-far-back-as-2017-trump-ignored-them/
<https://couriernewsroom.com/2020/04/09/experts-predicted-a-coronavirus-pandemic-as-far-back-as-2017-trump-ignored-them/>
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