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3/31/2020

  • The Quarantine has been upgraded to 30 days to slow the spread
  • The Treasury and Small Business Administration announced further details on paycheck protection program: Nearly $350B in loans will be available through lending partners for small businesses up to 2 months. The loans will be forgiven as long as folks keep folks employed. This is available starting April 3rd.
  • Trump spoke to Verizon, ATT, T-Mobile, Charter, Comcast, Liberty Media, Altiz, Sprint, Lion Tree, Cox, Centurylink, all are holding up incredibly well.
  • Equipment: 
    • N95:  11.6m
    • ventilators: 10k ready to go, dist “a large number to mi, lousianna, ny, nj” 
    • Gowns: 
    • Gloves: 
    • Resps:
  • In NY, FEMA is supplying 250 ambulances and 500 EMTs. In California the Army is making 8 facilities with 50k beds.
  • Mercy is taking patients, with Comfort to follow suit
  • FEMA has provided 100 travel trailers to assist with housing needs
  • In MI, FEMA will deliver 250-bed field hospitals and the Army Corp of Engineers is evaluating locations for alternative care facilities.
  • In Louisiana 2 field hospitals with 500 hospital beds and a 3k bed alternate care site in New Orleans will be operational this week
  • We are giving facilities flexibility to use surgical care centers for patients that are not infected, IE: Expectant mothers.
  • The US State Department organized the largest complex evacuation in us history 2 months ago.
  • 25k americans were repatriated from other countries.
  • The next 2 weeks will be a very tough 2 weeks.
  • This is the time for all Americans to come together and do their part.
  • Trump commended the doctors and reiterated that they’re warriors.
  • He is urging cities to adhere to guidelines.
  • Trump stated that we’re doing everything we can for testing with highly accurate and quick tests coming out.
  • 100k is a very low number and it is unlikely we’ll be unable to attain that. Trump thinks we’re doing better than that and said it’s not the flu. It is vicious and he found out one of his friends is in the hospital in a coma. We can’t just ride it out as if we did it’d be 1.5-1.6m at minimum to 2.2m people dead in a short amount of time.
  • If people wanna wear a scarf instead of a mask or a fabric mask, the common person can do it, not a bad idea.
  • We hope the 30 day mitigation will be enough, we have been very harsh about it but if we see things that are obviously wrong we will stop it.
  • We will see 99 cents per gallon for gas, prices will look like they’re from the 1950s.
  • We’re holding ventilators because we’re gonna need them over the next few weeks. We can’t take them to places that don’t need them. We have requests that don’t need them at the moment so we’re holding them back for flexibility with 10k in stock.
  • In some areas we might have a ventilator shortage at the moment.
  • When the surge occurs, we can distribute them quickly before the need is critical.
  • The hospitals are facing a medical warzone, Trump has heard from some paramedics that have been in war zones and they have never seen anything like this.
  • No early data on hydroxychloroquine. There are 1100 in NY testing it so far, we haven’t heard anything bad but too little data and  too soon to talk about it.
  • We are looking at other antivirals that are showing promise but a vaccine doesn’t help the infected. We need to test the vaccine – the drug has been out for a long time, and is a very powerful drug with Z-PAK.
  • Hydroxychloroquine and erythromycin – some docs are and some aren’t using it and there is a theory going around that people who are in direct care are using it, it may work.
  • Rather than having items brought into the stockpile, we’re trying to send supplies directly to the states, we don’t want supplies in a warehouse and sitting in another, we’re sending it directly where it’s going.
  • We took over a virtually empty supply stockpile, we’re trying to have it delivered where it’s needed.
  • Mitch McConnell said impeachment averted the attention of the virus Trump feels that it didn’t., 
  • Trump will be speaking to the Florida governor about the two cruise ships with people who are sick, and will consider letting them dock.
  • Ventilator acquisition is like being on ebay because people are competing in all 50 states. Trump feels that people shouldn’t be competing and is requesting people call the president so the price doesn’t get driven up
  • The President feels that we’re having more issues with people than ventilators. We are looking at the homeless populace very carefully and how they could spread COVID.
  • According to the President, we’ve never seen numbers of deaths like this [note: not since the Spanish Flu of 1918] and Trump is trying to be a cheerleader for our country and doesn’t like to try to make people scared.
  • Has Trump reached out to pastors? Graham is someone who is special, and there are many special Evangelicals in the Christian community. You can talk rabbis too, Trump has tremendous support from spiritual leaders.
  • Numerous countries as they get into a worse position, may be banning travel with different countries as they become hot.
  • Trump doubts he’s gonna leave the White House, though he wants to go to the NY hospital opening and the boat sailing in [note: Likely Comfort] but the Secret Service wouldn’t let him. They think it’s important he remains healthy, he’s cancelled many events to do so.
  • In less than a week, 3 governors have called up that hated Trump and have said “I have to tell you, you’ve done a great job. Like or not like, you and your team have done an incredible job.”
  • We’re hoping at after this we will have a larger stockpile in the future, as we were caught unaware to all this.

Trump ^

  • Penced reminded everyone to not be discouraged, do what you can do to protect your health/family/health care providers. We have capacity and resources, keep putting into practice the guidelines
  • We are working with governors around the nation and have declared 29 major disaster declarations which allows for Title 32 funding.
  • 17k national guard have been activated for supporting FEMA.
  • Testing that has been completed so far: 1.1m. We are working with governors to assist them with drive thru and community testing centers.
  • It is imperative they continue to report the results.
  • Pence also stated the importance in using the National Guard if need be to deliver supplies from warehouses to hospitals.
  • FEMA is literally working and contracting around the world, 51 flights around the world
  • FEMA is delivering 400 ventilators to MI, 300 to NJ, 50 to CT, 450 ventilators to IL, 4400 directed to NY.
  • Pence reminded everyone to listen to your state and local authorities! Check your temperature and self quarantine for 14 days if you’ve been in NY at all.
  • He will be going to a Walmart distribution center in VA to see how food supplies are moving.
  • The Vice President assured Americans that we’re working their hearts out, and anyone struggling will have the healthcare and support they need.
  • The team is working closely with FEMA to make sure the quick test is distributed around the country with 50k tests a day and several thousands on the shelf now.
  • At the President’s direction, we will defer to state and local health authorities, in the next 30 day people need to do mitigation.
  • Pence reminded everyone that on Jan 31 we suspended travel to china, and screened all passengers, the President’s initial efforts were designed to prevent the coronavirus from coming in.
  • FEMA was stood up when the declaration was signed and when the task force meets the whole FEMA team is at the other end of the table where Pence is at the head.
  • The Abbott Lab’s point of contact test was approved last Fri, announced on Sun, and information was sent to every governor. This team the President has assembled, the advisors on the taskforce, and FEMA is pushing it, we’re seeing the process spinning up more every day.
  • Pence did say that the President and Vice President sign off on who gets ventilators and when.

Pence ^

  • Dr. Birx again stated that every American needs to follow the guidelines so we get to only 100-200k deaths.
  • The model of the predicted mortalities of the US were shown, and it is a stark reality as it moves through the communities.
  • Our goal is to make sure the 48 states maintain a lower level with the hope we don’t have significant outbreaks.
  • Italy has began to turn the corner in cases, fourth week in full mitigation, and we have hope it’s possible if we continue with the next 30 days.
  • No one has been turned away, nobody who needed ventilatiors have not received them.
  • There is no magic vaccine, it is our behaviors that will change the course of the pandemic.
  • Dr. Birx reminded everyone that the projection of the death rate if folks keep adhering: is 100-200k.
  • Over the next  2 weeks, there will be an upslope of cases and will likely decrease after.
  • People need to be more stringent in following the guidelines.
  • We’re still going to see deaths in June in according to the projection.
  • The model is based and heavily laden by NY, NJ, and CT. It can skew to a higher peak and higher mortality: If all the states are able to hold that case number down, it’ll be a very different picture.
  • We have had 4k deaths with a projection of over 90k deaths over the next weeks according to the model using info in NY/NJ.. Washington state, before NY and NJ really, talked to their communities and started to mitigate before they saw the huge cases. If you wait till you see it, it is too late. Most people under age 30/40 are recovering.
  • We pushed a lot of tests out and they’re not being utilized.
  • California and Washington State have reacted early to this and for a month have been tracking it with a small increase of cases and not a logarithmic form. We’re trying to prevent NYC, Detroit, Chicago from getting worse and make most cities work more like California.
  • The CDC suggests if you’re working with someone sick in the household you should be wearing masks. They’re discussing if the recommendation should be revisited.
  • We don’t have a quarantine/lockdown like in China because we trust the American people.

Dr. Birx ^

  • There are two dynamic forces that are opposing each other: The virus if left to it’s own devices, vs what we’re doing/trying to do with mitigation.
  • What you have is an increase in new cases at this rate. When they begin to level off there will be less hospitalization, less ICU, and less deaths. We’re seeing little inklings in NY of this starting.
  • In the next several days we’re going to see things keeping go up, we can’t be discouraged, it’s working and will continue to work as long as we keep mitigation going.
  • Our goal is to get to the hotspot places and help them to get around the curve, and prevent the clusters of areas that have not gone to that spike from going to it. The answer is mitigation.
  • The 15 days have clearly had an effect, now is the time, when you’re having the effect, to not take your foot off the accelerator, or use the break, but to press down the accelerator.
  • This will be the answer to our problems, we need to do it with all the intensity and force we can.
  • Our hope is to get the bell curve as low as possible. We don’t accept 100-200k deaths and we’re doing everything we can to get it lower.
  • We’re hoping it won’t be that much, but being realistic we need to prepare ourselves for that being what we see.
  • 50k deaths in a month – it will be difficult and we’re seeing what’s happening in NY.
  • If we can suppress other states so there’s no spike, we’re going to try to keep it low.
  • Now it is the time to make people adhere
  • We are testing a number of drug candidates that already exist for other things and there is a whole menu of drugs and interventions that aren’t approved for any other thing yet such as hyperimmune globulin etc. There is a lot of activity behind the scenes and we need an answer so if it doesn’t work get it off the table. It takes several months and that’s the reason it takes a lot of activity because they already are there.
  • We hope that as we get into the summer, if there’s cases out there during a phase 2 or 3, we might get an early signal. If even though it is not proven it works, if you can get enough data that it works, that is enough to get an emergency use declaration done.
  • If we had started the social distancing earlier, the models could have been smaller.
  • Would like to see a Hydroxychloroquine clinical trial to see what it was like without the drug, there’s a number of trials going on everywhere. 
  • Looking at the distance that droplets fly by coughing and sneezing, you might get 27 feet if you throw your head back and sneeze. It is not very practical and is very misleading, all of a sudden the 6 ft distance doesn’t work? 27 ft is a robust sneeze.

Dr. Falchi ^

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