[BostonCard]

It's abundantly clear that trump is banking on a hail mary from cholorquine to save the day.  When that fails (evidence points that way so far), he has nothing else to offer us.

I think Remdesivir offers better odds.  More a skinny post than Hail Mary...

I agree that the PTS (probability of technical success) is higher with remdesivir.  We know the mechanism of action of remdesivir, and it has shown clinical activity against other RNA viruses (namely Ebola), though clinically it did worse than the alternatives in this study:

https://www.nejm.org/doi/full/10.1056/NE...%200pubmed

It has also shown activity in vitro against coronaviruses (MERS)

https://pubmed.ncbi.nlm.nih.gov/32094225...from_pos=2

The downside is that chlorquine and hydroxychloroquine are both already approved, so their safety is well-characterized, while remdesivir isn't yet.  In addition, generics have been making the drugs for a while so supplies, though somewhat constrained, can be ramped up quickly.  Remdesivir manufacturing will need to be ramped up.

Of course, it is not remdesivir versus chloroquine/hydroxychloroquine.  In an ideal world, they all work and provide additive benefit.

BC

[BostonCard]

It's abundantly clear that trump is banking on a hail mary from cholorquine to save the day.  When that fails (evidence points that way so far), he has nothing else to offer us.

I think Remdesivir offers better odds.  More a skinny post than Hail Mary...

I agree that the PTS (probability of technical success) is higher with remdesivir.  We know the mechanism of action of remdesivir, and it has shown clinical activity against other RNA viruses (namely Ebola), though clinically it did worse than the alternatives in this study:

https://www.nejm.org/doi/full/10.1056/NE...%200pubmed

It has also shown activity in vitro against coronaviruses (MERS)

https://pubmed.ncbi.nlm.nih.gov/32094225...from_pos=2

The downside is that chlorquine and hydroxychloroquine are both already approved, so their safety is well-characterized, while remdesivir isn't yet.  In addition, generics have been making the drugs for a while so supplies, though somewhat constrained, can be ramped up quickly.  Remdesivir manufacturing will need to be ramped up.

Of course, it is not remdesivir versus chloroquine/hydroxychloroquine.  In an ideal world, they all work and provide additive benefit.

BC

[OutsiderFan]

Was hoping not to have this discussion in the antibody test thread, but I suppose given the point of the antibody test, it's probably unavoidable.

We not only need testing for the antibody, but also studies on if/how these distancing and protection measures are working. I just got back from the same shopping trip I took three weeks ago, to Costco and Trader Joe's.

Three Weeks Ago
- Only Costco wiped down cart handles
- No crowd control
- Nobody wearing a face covering

Today
- Nobody could exit in same space as those entering
- Queue lines 
- Attendant handed cart that was just wiped
- Everyone wearing face covering
- No line at checkout (never seen that before at Costco)
- Plexiglass shield at checkout counter

My point being it stands to reason if we follow similar measures everywhere, we will certainly mitigate spread. Of course, the issue becomes what can be opened up, how, and when?

These grocery store queues and spacing can't be replicated too many places. Can face covering be enough to really slow spread to the same degree staying home can?  Can face covering be made compulsory? Can our governments pass laws requiring face coverings in public places? Might everyone who entered a building be required to wear a face covering to get in?  Will orgs like ACLU throw a fit if they try? 

But then how do restaurants allow people in? Can't eat with a mask on. Same goes for sports. Maybe outdoor sports can let fans in if they wear a mask, but good luck ensuring tens of thousands of fans keep them on once inside a stadium. And there is no chance this could be monitored in an arena or theatre either. What about shopping centers, even going to offices?  If we don't make face coverings mandated by law I really don't see how we can return to normalcy until there is a vaccine, or we otherwise develop herd immunity. The antibody test is all about knowing how we can get to this point faster, assuming having the antibody means immunity, something that hasn't been proven to date unless I've missed something.

My great concern is all this talk about "stay home for a few weeks to flatten the curve" is going to work, everyone is going to see the "wave" has passed and many will demand to go back to normal, some will and we'll see another outbreak. I remain skeptical anything will be responsible for falling spread other than these extreme distancing measures, and there really is no such thing as dissipating numbers in warmer Summer weather and then returning in colder Fall weather. The waves are all about our behavior until proven otherwise.

[OutsiderFan]

Was hoping not to have this discussion in the antibody test thread, but I suppose given the point of the antibody test, it's probably unavoidable.

We not only need testing for the antibody, but also studies on if/how these distancing and protection measures are working. I just got back from the same shopping trip I took three weeks ago, to Costco and Trader Joe's.

Three Weeks Ago
- Only Costco wiped down cart handles
- No crowd control
- Nobody wearing a face covering

Today
- Nobody could exit in same space as those entering
- Queue lines 
- Attendant handed cart that was just wiped
- Everyone wearing face covering
- No line at checkout (never seen that before at Costco)
- Plexiglass shield at checkout counter

My point being it stands to reason if we follow similar measures everywhere, we will certainly mitigate spread. Of course, the issue becomes what can be opened up, how, and when?

These grocery store queues and spacing can't be replicated too many places. Can face covering be enough to really slow spread to the same degree staying home can?  Can face covering be made compulsory? Can our governments pass laws requiring face coverings in public places? Might everyone who entered a building be required to wear a face covering to get in?  Will orgs like ACLU throw a fit if they try? 

But then how do restaurants allow people in? Can't eat with a mask on. Same goes for sports. Maybe outdoor sports can let fans in if they wear a mask, but good luck ensuring tens of thousands of fans keep them on once inside a stadium. And there is no chance this could be monitored in an arena or theatre either. What about shopping centers, even going to offices?  If we don't make face coverings mandated by law I really don't see how we can return to normalcy until there is a vaccine, or we otherwise develop herd immunity. The antibody test is all about knowing how we can get to this point faster, assuming having the antibody means immunity, something that hasn't been proven to date unless I've missed something.

My great concern is all this talk about "stay home for a few weeks to flatten the curve" is going to work, everyone is going to see the "wave" has passed and many will demand to go back to normal, some will and we'll see another outbreak. I remain skeptical anything will be responsible for falling spread other than these extreme distancing measures, and there really is no such thing as dissipating numbers in warmer Summer weather and then returning in colder Fall weather. The waves are all about our behavior until proven otherwise.

[burger]

It's abundantly clear that trump is banking on a hail mary from cholorquine to save the day.  When that fails (evidence points that way so far), he has nothing else to offer us.

I think Remdesivir offers better odds.  More a skinny post than Hail Mary...

Fox news has yet to cover remedesivir, so Trump has never heard of it.

Also, can they scale up production of it fast enough to make a difference if it passes trials?

[burger]

It's abundantly clear that trump is banking on a hail mary from cholorquine to save the day.  When that fails (evidence points that way so far), he has nothing else to offer us.

I think Remdesivir offers better odds.  More a skinny post than Hail Mary...

Fox news has yet to cover remedesivir, so Trump has never heard of it.

Also, can they scale up production of it fast enough to make a difference if it passes trials?

[BostonCard]

Was hoping not to have this discussion in the antibody test thread, but I suppose given the point of the antibody test, it's probably unavoidable.

We not only need testing for the antibody, but also studies on if/how these distancing and protection measures are working. I just got back from the same shopping trip I took three weeks ago, to Costco and Trader Joe's.

Three Weeks Ago
- Only Costco wiped down cart handles
- No crowd control
- Nobody wearing a face covering

Today
- Nobody could exit in same space as those entering
- Queue lines 
- Attendant handed cart that was just wiped
- Everyone wearing face covering
- No line at checkout (never seen that before at Costco)
- Plexiglass shield at checkout counter

My point being it stands to reason if we follow similar measures everywhere, we will certainly mitigate spread. Of course, the issue becomes what can be opened up, how, and when?

These grocery store queues and spacing can't be replicated too many places. Can face covering be enough to really slow spread to the same degree staying home can?  Can face covering be made compulsory? Can our governments pass laws requiring face coverings in public places? Might everyone who entered a building be required to wear a face covering to get in?  Will orgs like ACLU throw a fit if they try? 

But then how do restaurants allow people in? Can't eat with a mask on. Same goes for sports. Maybe outdoor sports can let fans in if they wear a mask, but good luck ensuring tens of thousands of fans keep them on once inside a stadium. And there is no chance this could be monitored in an arena or theatre either. What about shopping centers, even going to offices?  If we don't make face coverings mandated by law I really don't see how we can return to normalcy until there is a vaccine, or we otherwise develop herd immunity. The antibody test is all about knowing how we can get to this point faster, assuming having the antibody means immunity, something that hasn't been proven to date unless I've missed something.

My great concern is all this talk about "stay home for a few weeks to flatten the curve" is going to work, everyone is going to see the "wave" has passed and many will demand to go back to normal, some will and we'll see another outbreak. I remain skeptical anything will be responsible for falling spread other than these extreme distancing measures, and there really is no such thing as dissipating numbers in warmer Summer weather and then returning in colder Fall weather. The waves are all about our behavior until proven otherwise.

Masks are not a panacea, and they should be viewed as a complement and not a substitute for social distancing measures.

BC

[BostonCard]

Was hoping not to have this discussion in the antibody test thread, but I suppose given the point of the antibody test, it's probably unavoidable.

We not only need testing for the antibody, but also studies on if/how these distancing and protection measures are working. I just got back from the same shopping trip I took three weeks ago, to Costco and Trader Joe's.

Three Weeks Ago
- Only Costco wiped down cart handles
- No crowd control
- Nobody wearing a face covering

Today
- Nobody could exit in same space as those entering
- Queue lines 
- Attendant handed cart that was just wiped
- Everyone wearing face covering
- No line at checkout (never seen that before at Costco)
- Plexiglass shield at checkout counter

My point being it stands to reason if we follow similar measures everywhere, we will certainly mitigate spread. Of course, the issue becomes what can be opened up, how, and when?

These grocery store queues and spacing can't be replicated too many places. Can face covering be enough to really slow spread to the same degree staying home can?  Can face covering be made compulsory? Can our governments pass laws requiring face coverings in public places? Might everyone who entered a building be required to wear a face covering to get in?  Will orgs like ACLU throw a fit if they try? 

But then how do restaurants allow people in? Can't eat with a mask on. Same goes for sports. Maybe outdoor sports can let fans in if they wear a mask, but good luck ensuring tens of thousands of fans keep them on once inside a stadium. And there is no chance this could be monitored in an arena or theatre either. What about shopping centers, even going to offices?  If we don't make face coverings mandated by law I really don't see how we can return to normalcy until there is a vaccine, or we otherwise develop herd immunity. The antibody test is all about knowing how we can get to this point faster, assuming having the antibody means immunity, something that hasn't been proven to date unless I've missed something.

My great concern is all this talk about "stay home for a few weeks to flatten the curve" is going to work, everyone is going to see the "wave" has passed and many will demand to go back to normal, some will and we'll see another outbreak. I remain skeptical anything will be responsible for falling spread other than these extreme distancing measures, and there really is no such thing as dissipating numbers in warmer Summer weather and then returning in colder Fall weather. The waves are all about our behavior until proven otherwise.

Masks are not a panacea, and they should be viewed as a complement and not a substitute for social distancing measures.

BC

[oldalum]

Also, can they scale up production of it fast enough to make a difference if it passes trials?

If there's even just slim evidence of remdesivir's effectiveness, the feds should consider funding scaled-up production of it now, even though it's a 
gamble--and an expensive one at that. Would save 1-2 months time at least. At worst we'd have a supply to use against other viruses that it works on.

[oldalum]

Also, can they scale up production of it fast enough to make a difference if it passes trials?

If there's even just slim evidence of remdesivir's effectiveness, the feds should consider funding scaled-up production of it now, even though it's a 
gamble--and an expensive one at that. Would save 1-2 months time at least. At worst we'd have a supply to use against other viruses that it works on.

[burger]

Also, can they scale up production of it fast enough to make a difference if it passes trials?

If there's even just slim evidence of remdesivir's effectiveness, the feds should consider funding scaled-up production of it now, even though it's a 
gamble--and an expensive one at that. Would save 1-2 months time at least. At worst we'd have a supply to use against other viruses that it works on.

Meanwhile, instead of taking action to make the drug more available, the Trump admin granted it orphan status which means that the company making it would have a monopoly on it for 7 years.  The company, facing horrible PR, withdrew the application after the fact: https://www.nytimes.com/2020/03/25/healt...-drug.html

[burger]

Also, can they scale up production of it fast enough to make a difference if it passes trials?

If there's even just slim evidence of remdesivir's effectiveness, the feds should consider funding scaled-up production of it now, even though it's a 
gamble--and an expensive one at that. Would save 1-2 months time at least. At worst we'd have a supply to use against other viruses that it works on.

Meanwhile, instead of taking action to make the drug more available, the Trump admin granted it orphan status which means that the company making it would have a monopoly on it for 7 years.  The company, facing horrible PR, withdrew the application after the fact: https://www.nytimes.com/2020/03/25/healt...-drug.html

[Goose]

The states lack the resources to implement the testing and contact tracing that would be necessary--maybe CA and NY could pull it off, but it will never happen in poorer states, and I doubt that CA can or would close its borders.  So even if CA does it right (and I haven't seen any evidence they are working on post-peak planning yet), if AZ screws things up (their governor already waited weeks too long to shut down the state), it just takes a few cases moving from AZ to CA to set things off again.


Newsom is saying to expect restrictions until August or September, but I think even that is optimistic.  I expect political pressure will result in things opening up by the fall or even the summer, but the virus will not be gone in the US, and there will be a second outbreak.

Burger, I am not sure why you believe the states/counties lack the resources  to implement the testing and contact tracing. I don't know how many people it would take to do it. I have guessed that Santa Clara county would need to hire at least 500 people to trace a residual level of cases. They certainly have the resources to do that. Even if it was 10 times that, they could do it. They can also temporarily redirect staff from some of their other departments to assist in this task. There is an upper limit on what is possible, but it is certain the counties can do a lot more than they are currently staffed to do. Fortunately the large urban centers who will need the most tracing capability are also the richest counties. They can afford to do a lot. Rural (poorer) counties can't afford to do nearly as much, but they have less population density and normally will need many fewer people.

The state can and should provide a "back up" capability that can apply additional personnel to any "hot spots" that would overwhelm the county capability. They can also deal with coordinating information about possible contacts across county lines, although in many cases adjacent counties can do it themselves more efficiently.

The USPHS is responsible for maintaining control of any interstate transmission issues. A state may, if their is a demonstrable public health reason, prevent entry into the state by people from another state. The USPHS can do so as well, without the political backlash state politicians would face (at least in theory). The CDC can and should coordinate "best practices" and such.

I say nothing that isn't obvious when I say many (most) people on this board have no confidence in the POTUS and his approach to this epidemic. Fortunately, there are people in the Federal government that are competent and can do their job. However, IMHO this experience should make it entirely clear to all citizens why it is a really terrible idea to rely on the Federal government to be the primary resource in  response to epidemics. It is even more inadvisable for them to be the sole response. With the best will in the world, the Federal government will always be slow to act on these types of problems. Epidemics seldom start out as a national crisis. They start out as a local one that gets out of hand. That is also why we don't have Federal fire protection and nothing else. At the Federal level, we suffered greatly from "victory disease". We beat back H1N1, SARS, MERS, and ZIKA virus without really any difficulty. The CDC is (justly) world renowned for its help with serious epidemics (Ebola). However, the current situation is none of the above, and the Feds weren't ready. There was also a lot of "crying wolf" syndrome. All these previous viruses were supposed to be "big deals", and it turned out they weren't. Was our lack of response and lack of preparation at the Federal level really stupid? Sure it was, but also entirely predictable. Was our lack of preparedness at the state and county level also stupid. Yes, and I would argue even more so, because the "plan" has always relied on a robust local and state based response.

As an aside, I have mostly liked Newsom's response to this crisis. However, I think he revealed, perhaps inadvertently, a real problem with his thinking. He stated "We have to rely disproportionately on ourselves". This is nonsense. The problem he needs to solve is here in California. There is nothing disproportionate about that. We don't expect him to fix New York or elsewhere. This problem wasn't inflicted on us by somebody else. It is just part of modern society. It is our problem, it is here and and it is now, and therefore also his. We have no reasonable expectation that "they" are going to save us. We are fools to think otherwise.

[Goose]

The states lack the resources to implement the testing and contact tracing that would be necessary--maybe CA and NY could pull it off, but it will never happen in poorer states, and I doubt that CA can or would close its borders.  So even if CA does it right (and I haven't seen any evidence they are working on post-peak planning yet), if AZ screws things up (their governor already waited weeks too long to shut down the state), it just takes a few cases moving from AZ to CA to set things off again.


Newsom is saying to expect restrictions until August or September, but I think even that is optimistic.  I expect political pressure will result in things opening up by the fall or even the summer, but the virus will not be gone in the US, and there will be a second outbreak.

Burger, I am not sure why you believe the states/counties lack the resources  to implement the testing and contact tracing. I don't know how many people it would take to do it. I have guessed that Santa Clara county would need to hire at least 500 people to trace a residual level of cases. They certainly have the resources to do that. Even if it was 10 times that, they could do it. They can also temporarily redirect staff from some of their other departments to assist in this task. There is an upper limit on what is possible, but it is certain the counties can do a lot more than they are currently staffed to do. Fortunately the large urban centers who will need the most tracing capability are also the richest counties. They can afford to do a lot. Rural (poorer) counties can't afford to do nearly as much, but they have less population density and normally will need many fewer people.

The state can and should provide a "back up" capability that can apply additional personnel to any "hot spots" that would overwhelm the county capability. They can also deal with coordinating information about possible contacts across county lines, although in many cases adjacent counties can do it themselves more efficiently.

The USPHS is responsible for maintaining control of any interstate transmission issues. A state may, if their is a demonstrable public health reason, prevent entry into the state by people from another state. The USPHS can do so as well, without the political backlash state politicians would face (at least in theory). The CDC can and should coordinate "best practices" and such.

I say nothing that isn't obvious when I say many (most) people on this board have no confidence in the POTUS and his approach to this epidemic. Fortunately, there are people in the Federal government that are competent and can do their job. However, IMHO this experience should make it entirely clear to all citizens why it is a really terrible idea to rely on the Federal government to be the primary resource in  response to epidemics. It is even more inadvisable for them to be the sole response. With the best will in the world, the Federal government will always be slow to act on these types of problems. Epidemics seldom start out as a national crisis. They start out as a local one that gets out of hand. That is also why we don't have Federal fire protection and nothing else. At the Federal level, we suffered greatly from "victory disease". We beat back H1N1, SARS, MERS, and ZIKA virus without really any difficulty. The CDC is (justly) world renowned for its help with serious epidemics (Ebola). However, the current situation is none of the above, and the Feds weren't ready. There was also a lot of "crying wolf" syndrome. All these previous viruses were supposed to be "big deals", and it turned out they weren't. Was our lack of response and lack of preparation at the Federal level really stupid? Sure it was, but also entirely predictable. Was our lack of preparedness at the state and county level also stupid. Yes, and I would argue even more so, because the "plan" has always relied on a robust local and state based response.

As an aside, I have mostly liked Newsom's response to this crisis. However, I think he revealed, perhaps inadvertently, a real problem with his thinking. He stated "We have to rely disproportionately on ourselves". This is nonsense. The problem he needs to solve is here in California. There is nothing disproportionate about that. We don't expect him to fix New York or elsewhere. This problem wasn't inflicted on us by somebody else. It is just part of modern society. It is our problem, it is here and and it is now, and therefore also his. We have no reasonable expectation that "they" are going to save us. We are fools to think otherwise.

[OutsiderFan]

Goose, your point about relying on others to save us applies to everything. It is so disheartening when I see people expressing beliefs that would be or current public office holders are somehow our saviors. It’s akin to Christian faith thinking, and nothing in this world bothers me more than faith - in absence of proof, fact, or reason - as resolution to solve or ameliorate problems. Hope is not a strategy. We as people must work together to address the issues we face, based on mutual respect for others and a recognition that others may have better answers than we do. Government office holders are suppose to implement what we want, but we’ve allowed them to create structures that have continually lessened the accountability they have while allowing them to consolidate power against our interests.

The greatest quote I’ve ever heard on the topic of organizing ourselves to address challenges we face came from Barack Obama: We are the people we’ve been waiting for. It’s an empowering message that tries to tell us we are surrounded by an endless supply of metaphorical Legos, to form whatever it is we have the collective will to imagine and build together. We just need to start. It’s trite, but a journey of a thousand miles starts with one initial step.

I have an anecdote to share about this topic of government not cut out to do something big, sort of tangentially related to Covid-19, involving what I know is now going on in the MA state legislature. Will share separately in another thread.

[OutsiderFan]

Goose, your point about relying on others to save us applies to everything. It is so disheartening when I see people expressing beliefs that would be or current public office holders are somehow our saviors. It’s akin to Christian faith thinking, and nothing in this world bothers me more than faith - in absence of proof, fact, or reason - as resolution to solve or ameliorate problems. Hope is not a strategy. We as people must work together to address the issues we face, based on mutual respect for others and a recognition that others may have better answers than we do. Government office holders are suppose to implement what we want, but we’ve allowed them to create structures that have continually lessened the accountability they have while allowing them to consolidate power against our interests.

The greatest quote I’ve ever heard on the topic of organizing ourselves to address challenges we face came from Barack Obama: We are the people we’ve been waiting for. It’s an empowering message that tries to tell us we are surrounded by an endless supply of metaphorical Legos, to form whatever it is we have the collective will to imagine and build together. We just need to start. It’s trite, but a journey of a thousand miles starts with one initial step.

I have an anecdote to share about this topic of government not cut out to do something big, sort of tangentially related to Covid-19, involving what I know is now going on in the MA state legislature. Will share separately in another thread.

[Goose]

I have an anecdote to share about this topic of government not cut out to do something big, sort of tangentially related to Covid-19, involving what I know is now going on in the MA state legislature. Will share separately in another thread.

Looking forward to hearing about that one OF. One difference between religious faith and the prevailing attitude towards government is that at least God is omniscient and all powerful. Government is neither. God could in theory solve any problem. It seems people expect the Federal government to supply ventilators they don't have and materials they can't buy. They are also expected to deploy personnel that don't exist. When these things don't happen, people get mad. When God doesn't solve our problems, very few get mad at him.

[Goose]

I have an anecdote to share about this topic of government not cut out to do something big, sort of tangentially related to Covid-19, involving what I know is now going on in the MA state legislature. Will share separately in another thread.

Looking forward to hearing about that one OF. One difference between religious faith and the prevailing attitude towards government is that at least God is omniscient and all powerful. Government is neither. God could in theory solve any problem. It seems people expect the Federal government to supply ventilators they don't have and materials they can't buy. They are also expected to deploy personnel that don't exist. When these things don't happen, people get mad. When God doesn't solve our problems, very few get mad at him.

[OutsiderFan]

When God doesn't solve our problems, very few get mad at him.

Or her, or it :)

[OutsiderFan]

When God doesn't solve our problems, very few get mad at him.

Or her, or it :)

[BostonCard]

We are a federal Republic, and the response should work accordingly.  Contact tracing should be based locally; you need people on the ground, interviewing contacts, enforcing isolation (which necessarily has to be done locally), and is best done by local public health departments.
That being said, because a strict travel ban between states is both inadvisable (the food supply, for one, needs to be able to flow between states, and as bad as the shutdown is to local economies, a lockdown of inter-state commerce exacerbate the economic impact), and would be difficult to enforce, you need coordination on a federal level.  This is a fast moving crisis, and it helps for the federal government to help foster best practices among the states.

You can criticize states all you want for under-funding their public health institutions, but the way our federal health system is set up, there is a strong disincentive to invest a lot of money in preparedness "just in case".  For better or worse, states compete between each other to attract jobs and residents on the basis of taxes and service provided; preparedness costs money but doesn't provide a visible benefit during normal times.  Moreover, most states are required by law to balance their budgets, and are going to be facing a massive financial hole due to both decreased revenues from the economic hit and increased expenditures fighting the pandemic and its economic sequelae.

The federal government can step into the breach here, as it has a very large capacity for budget deficits and to issue debt.  Moreover, it is appropriate to do so, since Californians benefit from minimizing infections in New York, since New Yorkers can fly or drive to California and bring coronavirus with them.  Yes, the pandemic is based on a bunch of local epidemics, but there is enough cross-talk between localities that it does no good to quench the pandemic in one location if it is raging in another.

In addition, a federal stockpile of critical therapy (ventilators) and protective equipment makes a lot of sense.  In most disasters (for example, Katrina), the challenge is regional, so the federal government can efficiently deploy the equipment to regions at need it.  Even within Covid-19, the pandemic is hitting regions heterogeneously, and there is some temporal differences between when regions will have peak requirements, so a federal response, which can deploy resources strategically to areas that are in highest need, and then redeploy them after the wave reseeds.
Furthermore, if states are left to their own devices to procure equipment in the midst of the crisis, they are basically competing with one another.  A unified federal procurement system with strategic deployment makes more sense for this reason.

Your point about the federal government being all powerful is well taken, but the federal government can at least be transparent.  Instead of blaming the states for an inadequate stockpile, it would be preferable to say, "here are the number of ventilators we have in the stockpile, here is how they are deployed, here are the numbers we are using to make the calculations of how to deploy them, and here is what we are doing to get more."  In a time of crisis, clear and transparent communication is paramount, and we have seen conflicting messages, misleading statements, which, frankly have been dangerous. The system will work best when the federal government and the state governments complement each other, instead of fighting one another.

BC

[BostonCard]

We are a federal Republic, and the response should work accordingly.  Contact tracing should be based locally; you need people on the ground, interviewing contacts, enforcing isolation (which necessarily has to be done locally), and is best done by local public health departments.
That being said, because a strict travel ban between states is both inadvisable (the food supply, for one, needs to be able to flow between states, and as bad as the shutdown is to local economies, a lockdown of inter-state commerce exacerbate the economic impact), and would be difficult to enforce, you need coordination on a federal level.  This is a fast moving crisis, and it helps for the federal government to help foster best practices among the states.

You can criticize states all you want for under-funding their public health institutions, but the way our federal health system is set up, there is a strong disincentive to invest a lot of money in preparedness "just in case".  For better or worse, states compete between each other to attract jobs and residents on the basis of taxes and service provided; preparedness costs money but doesn't provide a visible benefit during normal times.  Moreover, most states are required by law to balance their budgets, and are going to be facing a massive financial hole due to both decreased revenues from the economic hit and increased expenditures fighting the pandemic and its economic sequelae.

The federal government can step into the breach here, as it has a very large capacity for budget deficits and to issue debt.  Moreover, it is appropriate to do so, since Californians benefit from minimizing infections in New York, since New Yorkers can fly or drive to California and bring coronavirus with them.  Yes, the pandemic is based on a bunch of local epidemics, but there is enough cross-talk between localities that it does no good to quench the pandemic in one location if it is raging in another.

In addition, a federal stockpile of critical therapy (ventilators) and protective equipment makes a lot of sense.  In most disasters (for example, Katrina), the challenge is regional, so the federal government can efficiently deploy the equipment to regions at need it.  Even within Covid-19, the pandemic is hitting regions heterogeneously, and there is some temporal differences between when regions will have peak requirements, so a federal response, which can deploy resources strategically to areas that are in highest need, and then redeploy them after the wave reseeds.
Furthermore, if states are left to their own devices to procure equipment in the midst of the crisis, they are basically competing with one another.  A unified federal procurement system with strategic deployment makes more sense for this reason.

Your point about the federal government being all powerful is well taken, but the federal government can at least be transparent.  Instead of blaming the states for an inadequate stockpile, it would be preferable to say, "here are the number of ventilators we have in the stockpile, here is how they are deployed, here are the numbers we are using to make the calculations of how to deploy them, and here is what we are doing to get more."  In a time of crisis, clear and transparent communication is paramount, and we have seen conflicting messages, misleading statements, which, frankly have been dangerous. The system will work best when the federal government and the state governments complement each other, instead of fighting one another.

BC

[Goose]

Instead of blaming the states for an inadequate stockpile, it would be preferable to say, "here are the number of ventilators we have in the stockpile, here is how they are deployed, here are the numbers we are using to make the calculations of how to deploy them, and here is what we are doing to get more."  In a time of crisis, clear and transparent communication is paramount, and we have seen conflicting messages, misleading statements, which, frankly have been dangerous. The system will work best when the federal government and the state governments complement each other, instead of fighting one another.


BC

I think that the division of responsibility between the states and the federal government is appropriate. The current epidemic clearly demonstrates several problems. Clear thinking in times of crisis is often in short supply at all levels. If all the resources exist at the federal level, and if the feds don't "think clearly", everybody is screwed. Andrew Cuomo goes ballistic when he finds out the feds are holding back ventilators because there may be other hot spots. Rhode Island turns back people with New Your license plates. The states are players. They need to be positive players.

Congress has the same (or worse) political constraints on what they can actually get passed as the states do. The fact they can borrow money and run a deficit is not something that can or should be used to solve any and all problems. Disaster preparedness obviously wasn't a "hot button", as over several administrations the national stockpile of PPE was drawn down without replacement being purchased. The priority of disaster preparedness is always going to be an issue. If every level is approaching the problem as if they had to totally solve the issue themselves, we might actually have close to enough material when the time comes. The trick is to be properly organized to do so.

I favor a federal stockpile that can be focused on hot spots and moved around by the feds. The states also need a stockpile that is the minimum they think is adequate for the hospitals in the state. States can also share resources as we are now proving. It is great that the federal stockpiles can be fully utilized in regional disasters, and (hopefully) used intelligently in more widespread ones. However, everybody depending on the same stockpile and doing nothing themselves will for sure produce "double (or more) counting" and total failure in a situation like we have today.

It is surely true that the states and the feds should meet often and simulate this kind of situation. The federal and state responses need to be coordinated for best results. That is hard to do if not practiced. The fighting each other for limited resources is always going to be an issue, and having agreements in place on how to handle it are important. Just saying "the feds will do it" is politically untenable, because CNN will show some federal screwup and the pressure on Governor to "do something" will become too great. The Governors acting together can diffuse the pressure and provide a better outcome than relying on a central agency, especially in times when that central agency is not being outstandingly well supervised at the highest levels. The Governors are going to act in any case. It is best they have resources to act with, and experience working together so they can do so when needed. It appears that they have hammered out a way to avoid competing with each other too much. If this event had been practiced, it could have been much more seamless.

[Goose]

Instead of blaming the states for an inadequate stockpile, it would be preferable to say, "here are the number of ventilators we have in the stockpile, here is how they are deployed, here are the numbers we are using to make the calculations of how to deploy them, and here is what we are doing to get more."  In a time of crisis, clear and transparent communication is paramount, and we have seen conflicting messages, misleading statements, which, frankly have been dangerous. The system will work best when the federal government and the state governments complement each other, instead of fighting one another.


BC

I think that the division of responsibility between the states and the federal government is appropriate. The current epidemic clearly demonstrates several problems. Clear thinking in times of crisis is often in short supply at all levels. If all the resources exist at the federal level, and if the feds don't "think clearly", everybody is screwed. Andrew Cuomo goes ballistic when he finds out the feds are holding back ventilators because there may be other hot spots. Rhode Island turns back people with New Your license plates. The states are players. They need to be positive players.

Congress has the same (or worse) political constraints on what they can actually get passed as the states do. The fact they can borrow money and run a deficit is not something that can or should be used to solve any and all problems. Disaster preparedness obviously wasn't a "hot button", as over several administrations the national stockpile of PPE was drawn down without replacement being purchased. The priority of disaster preparedness is always going to be an issue. If every level is approaching the problem as if they had to totally solve the issue themselves, we might actually have close to enough material when the time comes. The trick is to be properly organized to do so.

I favor a federal stockpile that can be focused on hot spots and moved around by the feds. The states also need a stockpile that is the minimum they think is adequate for the hospitals in the state. States can also share resources as we are now proving. It is great that the federal stockpiles can be fully utilized in regional disasters, and (hopefully) used intelligently in more widespread ones. However, everybody depending on the same stockpile and doing nothing themselves will for sure produce "double (or more) counting" and total failure in a situation like we have today.

It is surely true that the states and the feds should meet often and simulate this kind of situation. The federal and state responses need to be coordinated for best results. That is hard to do if not practiced. The fighting each other for limited resources is always going to be an issue, and having agreements in place on how to handle it are important. Just saying "the feds will do it" is politically untenable, because CNN will show some federal screwup and the pressure on Governor to "do something" will become too great. The Governors acting together can diffuse the pressure and provide a better outcome than relying on a central agency, especially in times when that central agency is not being outstandingly well supervised at the highest levels. The Governors are going to act in any case. It is best they have resources to act with, and experience working together so they can do so when needed. It appears that they have hammered out a way to avoid competing with each other too much. If this event had been practiced, it could have been much more seamless.

[OutsiderFan]

Here we go. This has been my concern for over a month, that just because someone has the antibody for SARS-CoV-2, that doesn't mean the virus can't re-infect them. 

https://www.scmp.com/news/china/science/...ions-about

My worst case scenario for this is that younger and healthier people like pro athletes contract the virus and recover with limited symptoms.  They don't build up enough antibodies to prevent re-infection, it occurs, and they experience the cytokine storm that can be more deadly than the virus itself.  But there are also implication for vaccine development.  

Do we consider a vaccine a solution if it won't work on 30% of the population for whatever reason? Keep in mind, not even close to 30% of the population is infected now, and look at the casualties from it.

Adam Silver said it best when he said this week that he knows less about the virus situation no than he did a month ago. Everyone is operating on this assumption testing is our salvation, and that if people have the antibody they are good to go. This preliminary research demonstrates it may not be this simple.

[OutsiderFan]

Here we go. This has been my concern for over a month, that just because someone has the antibody for SARS-CoV-2, that doesn't mean the virus can't re-infect them. 

https://www.scmp.com/news/china/science/...ions-about

My worst case scenario for this is that younger and healthier people like pro athletes contract the virus and recover with limited symptoms.  They don't build up enough antibodies to prevent re-infection, it occurs, and they experience the cytokine storm that can be more deadly than the virus itself.  But there are also implication for vaccine development.  

Do we consider a vaccine a solution if it won't work on 30% of the population for whatever reason? Keep in mind, not even close to 30% of the population is infected now, and look at the casualties from it.

Adam Silver said it best when he said this week that he knows less about the virus situation no than he did a month ago. Everyone is operating on this assumption testing is our salvation, and that if people have the antibody they are good to go. This preliminary research demonstrates it may not be this simple.

[oldalum]

yes, it's simply unknown at this point, but no reason to lose sleep yet. These people with low post-infection titers may truly be immune. They do have memory cells that might generate a protective antibody response, or they might just be able to fight off the infection with low levels of antibodies. Or, giving them the vaccine might generate a big, protective response. They are a different population than those who have never been infected. For the latter, vaccine developers often link molecules to the vaccine antigen(s) that augment the immune response (called adjuvants), in order to provoke an immune response strong enough to be protective.

[oldalum]

yes, it's simply unknown at this point, but no reason to lose sleep yet. These people with low post-infection titers may truly be immune. They do have memory cells that might generate a protective antibody response, or they might just be able to fight off the infection with low levels of antibodies. Or, giving them the vaccine might generate a big, protective response. They are a different population than those who have never been infected. For the latter, vaccine developers often link molecules to the vaccine antigen(s) that augment the immune response (called adjuvants), in order to provoke an immune response strong enough to be protective.

[OutsiderFan]

I hear you, oldalum.

As much as I'm keenly aware we can't account for and reduce all risk, that doesn't mean those in positions of responsibility, can ignore them. Data has to drive decision-making to protect lives and liability, but there is so much confusing, incomplete, and unknown data that complicates matters. We also don't have much time to figure things out.

[OutsiderFan]

I hear you, oldalum.

As much as I'm keenly aware we can't account for and reduce all risk, that doesn't mean those in positions of responsibility, can ignore them. Data has to drive decision-making to protect lives and liability, but there is so much confusing, incomplete, and unknown data that complicates matters. We also don't have much time to figure things out.

[dabigv13]

Here we go. This has been my concern for over a month, that just because someone has the antibody for SARS-CoV-2, that doesn't mean the virus can't re-infect them. 

https://www.scmp.com/news/china/science/...ions-about

My worst case scenario for this is that younger and healthier people like pro athletes contract the virus and recover with limited symptoms.  They don't build up enough antibodies to prevent re-infection, it occurs, and they experience the cytokine storm that can be more deadly than the virus itself.  But there are also implication for vaccine development.  

Do we consider a vaccine a solution if it won't work on 30% of the population for whatever reason? Keep in mind, not even close to 30% of the population is infected now, and look at the casualties from it.

Adam Silver said it best when he said this week that he knows less about the virus situation no than he did a month ago. Everyone is operating on this assumption testing is our salvation, and that if people have the antibody they are good to go. This preliminary research demonstrates it may not be this simple.

Preprint, not peer reviewed. Straight media not covering the science very well.

I wouldn't worry about this.

[dabigv13]

Here we go. This has been my concern for over a month, that just because someone has the antibody for SARS-CoV-2, that doesn't mean the virus can't re-infect them. 

https://www.scmp.com/news/china/science/...ions-about

My worst case scenario for this is that younger and healthier people like pro athletes contract the virus and recover with limited symptoms.  They don't build up enough antibodies to prevent re-infection, it occurs, and they experience the cytokine storm that can be more deadly than the virus itself.  But there are also implication for vaccine development.  

Do we consider a vaccine a solution if it won't work on 30% of the population for whatever reason? Keep in mind, not even close to 30% of the population is infected now, and look at the casualties from it.

Adam Silver said it best when he said this week that he knows less about the virus situation no than he did a month ago. Everyone is operating on this assumption testing is our salvation, and that if people have the antibody they are good to go. This preliminary research demonstrates it may not be this simple.

Preprint, not peer reviewed. Straight media not covering the science very well.

I wouldn't worry about this.

[BostonCard]

A couple comments.  I think it is fair not to assume there is no risk of reinfection.  A lot of our assumptions about many infectious diseases (such as asymptomatic transmission) have been challenged by COVID-19. However, it would be a deviation from most other diseases that don't have multiple strains (like influenza).  Secondly, our immune response to viruses is not exclusively dependent on antibodies; we have a whole host of defenses, particularly T lymphocytes, which work via other means.  For now, of course, we have plenty to worry about the initial pandemic; in time we will learn whether reinfection is a problem, and if so, how common it is.  Since there is not much you can do about it, I would file this tidbit under the category of "things you can't control".

BC

[BostonCard]

A couple comments.  I think it is fair not to assume there is no risk of reinfection.  A lot of our assumptions about many infectious diseases (such as asymptomatic transmission) have been challenged by COVID-19. However, it would be a deviation from most other diseases that don't have multiple strains (like influenza).  Secondly, our immune response to viruses is not exclusively dependent on antibodies; we have a whole host of defenses, particularly T lymphocytes, which work via other means.  For now, of course, we have plenty to worry about the initial pandemic; in time we will learn whether reinfection is a problem, and if so, how common it is.  Since there is not much you can do about it, I would file this tidbit under the category of "things you can't control".

BC

[OutsiderFan]

Don't know if these people are contagious or if they will develop symptoms. Hopefully not on both counts.

https://www.nydailynews.com/coronavirus/...story.html

[OutsiderFan]

Don't know if these people are contagious or if they will develop symptoms. Hopefully not on both counts.

https://www.nydailynews.com/coronavirus/...story.html

[M T]

Regarding the Stanford antibody test, does anyone know how candidates are selected or the test is announced so people may volunteer?  I know of an individual in an area that is reportedly going to have some tests run next week.  He had a bad flu (apparently flu, as he didn't get tested) earlier, not long after someone else at his company had what reputedly was COVID-19.   He'd be interested in finding out.

The Stanford Daily mentioned Facebook ads for the Santa Clara County test, but the researchers didn't realize how explosive the response would be.

Since this is a self-selected set of subjects, I don't think this current sampling can answer how widespread the virus is.  It could be biased high or low:

“Thankfully, for the most part, people say, ‘Yeah, I’m just at home bored, and this is the first time I’ve been out in weeks,’” Hsueh said. “But at the same time, I’ve also had people come by who tell me things aren’t going well, like, ‘My wife has COVID, and she’s in the ICU.’ It’s a broad spectrum.”

"Sampling" is my word.  I'm not suggesting that the researchers consider this a sample.  I imagine this is a shakedown run, looking to see what procedural problems might arise.

[M T]

Regarding the Stanford antibody test, does anyone know how candidates are selected or the test is announced so people may volunteer?  I know of an individual in an area that is reportedly going to have some tests run next week.  He had a bad flu (apparently flu, as he didn't get tested) earlier, not long after someone else at his company had what reputedly was COVID-19.   He'd be interested in finding out.

The Stanford Daily mentioned Facebook ads for the Santa Clara County test, but the researchers didn't realize how explosive the response would be.

Since this is a self-selected set of subjects, I don't think this current sampling can answer how widespread the virus is.  It could be biased high or low:

“Thankfully, for the most part, people say, ‘Yeah, I’m just at home bored, and this is the first time I’ve been out in weeks,’” Hsueh said. “But at the same time, I’ve also had people come by who tell me things aren’t going well, like, ‘My wife has COVID, and she’s in the ICU.’ It’s a broad spectrum.”

"Sampling" is my word.  I'm not suggesting that the researchers consider this a sample.  I imagine this is a shakedown run, looking to see what procedural problems might arise.

[magnus]

For those where the virus reappeared, at least those in China's studies,  the claim was that these individuals did not develop symptoms and there was no evidence of close contacts getting infected by them.

[magnus]

For those where the virus reappeared, at least those in China's studies,  the claim was that these individuals did not develop symptoms and there was no evidence of close contacts getting infected by them.