vox--2020-03-17--The Pentagon just offered ventilators for the coronavirus response. It could do much more.

The Pentagon just offered ventilators for the coronavirus response .
It could do much more .
Share All sharing options for : The Pentagon just offered ventilators for the coronavirus response .
It could do much more .
With civilian hospitals increasingly overwhelmed and the coronavirus outbreak in America deepening , a question is coming up of whether there ’ s a bigger role the US military to play in responding .
President Donald Trump isn ’ t so sure , yet .
“ We ’ re starting the process .
And it ’ s a process — we hope @ @ @ @ @ @ @ necessary , but it could be necessary , ” he said during the White House briefing on Tuesday morning .
Hours later , Defense Secretary Mark Esper said the Pentagon would at least offer some support .
He told reporters that his department would be willing to offer up to 2,000 ventilators and 5 million respirators if asked , as well as offer labs to test civilians for the disease .
But , Esper made sure to say , he believes calling up military to help in the coronavirus response should be a @ @ @ @ @ @ @ the Pentagon ’ s actions are a start , but that defense officials could still do much , much more .
For over a century , America ’ s armed forces have dealt with medical crises across the globe .
Many service members today have the expertise to assist with medical care ; build MASH hospitals ; provide shelter ; or transport food , medical equipment , and people to meet the needs of the public .
That ’ s already happening in Georgia and Florida and New York , for example , @ @ @ @ @ @ @ called to help combat Covid-19 , the disease caused by the coronavirus .
“ The Department of Defense provides the ability to scale up like no other part of the US government can , ” Andrew Weber , the Pentagon ’ s top biological defense official from 2011 to 2014 , told me .
“ Whatever is needed to mount an appropriate response , the military can do it at scale.
” It ’ s important to note that America ’ s troops wouldn ’ t be leading efforts to combat Covid-19 .
@ @ @ @ @ @ @ from the Federal Emergency Management Agency ( FEMA ) or the Department of Health and Human Services ( HHS ) with extra people , expertise , and technology .
That ’ s likely why , during the Democratic presidential debate on Sunday night , former Vice President Joe Biden called for the military to be deployed across America .
“ It ’ s a national emergency , and I would call out the military , ” he said .
“ We ’ re at war with the virus.
” But the military ’ @ @ @ @ @ @ @ , and it has strict limitations on what it can do .
Laws prohibit most troops from performing law enforcement functions , for example , and its actions are curtailed to helping states with things like emergency medical treatment and evacuations .
What ’ s more , the military only has a few small hospitals in the United States that are set up to treat military medical problems like bodily trauma , top Pentagon officials told reporters on Monday .
Those facilities aren ’ t particularly ready to deal with the coronavirus outbreak @ @ @ @ @ @ @ .
In other words , the military can help , but it can ’ t solve the government ’ s response problems .
It also doesn ’ t help that the Army alone , for instance , is short $ 1 billion to respond to the outbreak .
“ We ’ re trying to be very careful about not overpromising , ” Air Force Brig .
Gen. Paul Friedrichs , the Joint Staff surgeon , told reporters on Monday .
However , experts and some at the Pentagon believe the military can come @ @ @ @ @ @ @ it wanted to .
As of now , there ’ s no real indication Trump wants to deploy the military .
Most jarring is that he doesn ’ t have a senior Pentagon official on his Coronavirus Task Force .
( It ’ s possible the military doesn ’ t want to be involved — more on that later . )
It ’ s therefore not as easy a call for Trump to make as some might think , but the dozen current and former defense officials and medical experts I spoke with @ @ @ @ @ @ @ to put the military to work now .
“ There ’ s just so much capacity in the Defense Department that ’ s completely untapped at the moment , and that ’ s a mistake , ” Kelly Magsamen , a former top Pentagon official in the Obama administration , told me .
The legality of using the US military in the coronavirus response Before going into what the military could do to help with the coronavirus , it ’ s first important to know what it ’ s allowed to do at @ @ @ @ @ @ @ US military is barred from using its capabilities directly to enforce US domestic laws unless Congress specifically authorizes it to do so .
This stipulation , known as “ posse comitatus , ” is why US troops can only support civilian agencies like FEMA but not take direct action themselves .
Per FEMA ’ s own website , the military is prohibited from interdicting “ vehicles , conducting searches and seizures , making arrests or apprehensions , surveillance , investigation , or undercover work.
” There ’ s no indication that long-standing statute @ @ @ @ @ @ @ However , this rule doesn ’ t apply to the National Guard and the Coast Guard — which means both services could perform law enforcement functions if asked by a state ’ s governor .
That means they could conceivably block roads or keep people from visiting family and friends , though that would be a severe response and it ’ s unclear any governor wants to authorize that yet .
The president , or at least his lawyers , knows all this .
On Friday , Trump issued two declarations to deal @ @ @ @ @ @ @ the Stafford Act , and one based on the National Emergencies Act .
As my colleague Ian Millhiser wrote , “ Title IV of the Stafford Act permits the president to declare that a particular crisis is a ‘ major disaster , ’ and such a declaration does provide the president with new powers that he may use to combat such a disaster.
” Additionally , the statute says “ all requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State.
@ @ @ @ @ @ @ Trump “ can not simply issue a declaration and seize broad new powers.
” There ’ s still plenty the US government can do under this act , including coordinating relief efforts , helping state governments , and handing out food and medicine as needed .
If the military can be helpful in any of those endeavors , HHS , another agency , or a state ’ s governor can ask the Pentagon for assistance with them .
As for the National Emergencies Act , it gives the president more sweeping authorities , @ @ @ @ @ @ @ Liberty and National Security Program at the Brennan Center , wrote for the Atlantic on Monday .
For Trump to use those authorities , though , he must “ specify which powers he intends to invoke , and he must issue updates if he adds new powers to the list , ” she explained .
It ’ s therefore possible that under this statute , Trump could order the military to do more than a state ’ s governor wants , but he ’ d have to notify everyone of those intentions .
@ @ @ @ @ @ @ , though , is that the military will abide by its long-standing process and doctrine of “ Defense Support for Civilian Authorities , ” or DSCA .
For emergencies in the homeland like the coronavirus outbreak , the military sees its role as providing “ support to prepare , prevent , protect , respond , and recover from domestic incidents.
” Such support is “ provided in response to requests from civil authorities and upon approval from appropriate authorities.
” US troops , then , won ’ t start deploying to parts of @ @ @ @ @ @ @ agencies asking them to , and even then the military will act strictly in support of what that agency wants .
In essence , Trump couldn ’ t use the military as his own personal coronavirus response force and law enforcement agency .
It ’ ll be subordinate to the government agencies that request its assistance .
How a National Guard unit acts , though , is highly dependent on a state ’ s governor .
HHS has already asked the Pentagon for help with quarantining Americans coming back from Wuhan , China @ @ @ @ @ @ @ well as infected passengers aboard the Diamond Princess cruise liner .
Military officials are also at the 11 feeder airports that passengers from abroad must go through for medical screenings before entering the US .
But so far , that ’ s it .
“ We ’ ve not received any other [ requests ] at this time , ” Jonathan Hoffman , a top Pentagon spokesperson , told reporters on Monday .
Yet experts tell me that , if states and agencies would just request it , the Pentagon could be even @ @ @ @ @ @ @ help the US coronavirus response There are four main ways the US military could assist in the country ’ s pandemic response : 1 ) provide care ; 2 ) assist with logistics ; 3 ) develop a vaccine or other treatment ; and 4 ) control crowds and provide other calming effects .
Even as Americans aim to “ flatten the curve ” to keep coronavirus cases in the country low , hospitals find that they ’ re struggling to keep up with the number of patients that need medical care .
@ @ @ @ @ @ @ , and rested physicians means a spike in people requiring hospitalization could greatly overwhelm the civilian health system .
Should those resources run low , the Defense Department “ could use authorities under the Defense Production Act to rapidly acquire a range of equipment such as N-95 respirators , gloves for medical personnel , and ventilators , ” James Miller , the top Pentagon policy official from 2012 to 2014 , told me .
The military also has thousands of physicians who could help treat patients .
Dr. Angela Rasmussen , an infectious @ @ @ @ @ @ @ me the military could create new hospitals if needed — as New York Gov .
Andrew Cuomo called on the Army Corps of Engineers to do — or repurpose current ones , for example by converting parts of hospitals into intensive care units .
But it should be noted that the military isn ’ t completely stocked up to help on all of this .
As mentioned before , the Pentagon has fewer than 40 military hospitals , each of them small and geared toward healing troops in specific communities .
“ Our @ @ @ @ @ @ @ that we have there — not 1,000-bed medical centers all over the United States , ” Friedrichs , the Joint Staff surgeon , told reporters on Monday .
By contrast , there are around 6,000 civilian hospitals in the country up and running today .
And while the military also has 424 medical clinics , including a massive hospital ship named USNS Comfort , they ’ re not built to quarantine patients that have the disease .
Still , if there are many patients who require care at one time , the military @ @ @ @ @ @ @ their military bases as a kind of overflow facility .
The Department of Veterans Affairs ( VA ) could also lend its doctors and facilities for the response if the VA secretary authorizes their use .
“ The VA system was explicitly designed with the idea of not only treating veterans but providing redundancy for the civilian system , ” said Sasha Baker , a top aide to former Defense Secretary Ash Carter .
And the VA says it ’ s ready to help if called upon .
“ VA stands ready to @ @ @ @ @ @ @ in the event those systems encounter capacity issues , but at this time they are not encountering such issues , ” Christina Mandreucci , the VA ’ s press secretary , told me .
“ Requests for such support would flow through the HHS , which is leading the federal government ’ s Covid-19 response efforts.
” But should the National Disaster Medical System ( NDMS ) — a government program consisting of about 5,000 medical professionals — be called into action by a state or the federal government , the VA would @ @ @ @ @ @ @ work .
“ The VA is the backbone for the NDMS , ” said Anthony Principi , the VA secretary from 2001 to 2005 .
When I asked a current Marine officer how the military could best help if called upon , the officer ’ s response was short and to the point : “ We are good at logistics.
” “ We ’ ve got trucks , warehouses , and people , ” the officer continued , “ plus a few cargo planes and helicopters.
” In other words , the military @ @ @ @ @ @ @ top-of-the-line equipment that could be incredibly useful for transporting civilian officials and materials around the country .
That last part is key as doctors may need additional medical tools quickly to treat patients , or those in affected areas might require food and water to survive .
Indeed , if so many people are sick that even grocery stores close down , they ’ ll need all the sustenance they can get .
Only the military , really , has the trucks , helicopters , and planes necessary to deliver everything in an @ @ @ @ @ @ @ prove useful should someone require a medical evacuation .
Armed forces could coordinate all this in command and control centers , Barry McCaffrey , a retired Army general , told me .
That would help streamline all these efforts so the response isn ’ t so haphazard .
Experts also noted that the armed forces have communications equipment allowing better coordination among several parts of the government .
For example , if there needs to be a teleconference meeting , the military has the technology to set up such a meeting for personnel @ @ @ @ @ @ @ can offer generators to provide electricity around the clock if needed .
Generators are especially useful for field hospitals or if electrical workers in a particularly badly affected area have to stay home .
But , here again , there ’ s still a problem .
The military is failing to come up with money for its own coronavirus response .
Part of that comes from Trump administration efforts to cut the amount of military medical personnel the US can have by 18,000 , or 20 percent of the force .
3 ) @ @ @ @ @ @ @ for the virus The Army leads the US military ’ s medical research , primarily at Fort Detrick in Maryland .
Gen. James McConville , the Army ’ s chief , told Breaking Defense earlier this month that there are already researchers working on finding a vaccine for the novel coronavirus .
“ They ’ ve been dealing with Ebola , they ’ ve been dealing with Zika , they ’ ve been dealing with MERS , and now they ’ re dealing with coronavirus , ” McConville said .
Weber , now @ @ @ @ @ @ @ told me that the only viable vaccine candidates and experimental drugs created during the 2014 Ebola crisis came from the Pentagon ( in partnership with the Canadian Ministry of Defense ) .
Once it looked like that vaccine could work , the National Institutes of Health took it “ the last 10 yards , ” said Weber .
But that ’ s not all .
Columbia ’ s Rasmussen told me that other Pentagon agencies , such as the Defense Threats Reduction Agency and the Defense Advanced Research Projects Agency ( DARPA ) @ @ @ @ @ @ @ potentially help fight the virus .
In DARPA ’ s case , it has a program called the Pandemic Prevention Platform that will “ temporarily protect someone from contracting the virus before a vaccine is ready , ” Amy Jenkins , the program ’ s director , told NPR in February .
Basically , it ’ s a treatment that protects someone from the virus for about six months .
It serves as a temporary fix while waiting for a vaccine that can take several weeks to kick in , and it consists @ @ @ @ @ @ @ had Covid-19 and recovered .
“ This technology could be used in this current coronavirus , ” she said , “ but this is still a very early technology.
” At the time of the interview , Jenkins noted that the technology might be available within 90 days .
The military ’ s manpower could be helpful in managing large crowds , experts say .
They could direct traffic at drive-through testing centers , for example , or control the flow of entries at medical facilities .
This would mostly be a job @ @ @ @ @ @ @ officer told me , as people tend to freak out if they see other services trying to keep people calm within the US .
And , as mentioned above , there are legal reasons why the National Guard would have to be the service doing the crowd control work and not the federal military .
So far there are about 670 National Guard members activated in 15 states .
The public ’ s trust in the military might help calm nerves that the US government has the situation under control .
“ It @ @ @ @ @ @ @ ” Weber told me .
Experts told me it ’ s therefore surprising that Esper and Army Gen. Mark Milley , the Joint Chiefs chair , haven ’ t been more visible so far in reassuring the nation that all will be well .
The risks of having the military involved in the coronavirus response While everyone I spoke with said the military had some role to play , many noted that deploying the armed forces also comes with very real risks .
One Air Force officer I talked to worried about exposing @ @ @ @ @ @ @ increase the number of cases in the ranks .
Having a large number of mostly young service members around crowds could also cause the virus to spread , since younger people may be infected without showing any symptoms .
“ That hurts our ability to respond without endangering the very people we intend to protect , ” the officer said .
Plus , the military is already reluctant to help with pandemic response .
During the 2014 Ebola crisis , former defense officials told me , top military officials didn ’ t want @ @ @ @ @ @ @ to help .
The feeling among some US uniformed leaders was that America ’ s service members should be focused on fighting wars , not curing diseases .
Under immense White House pressure , though , the military did deploy and by most accounts proved instrumental in quelling the crisis .
Today ’ s military brass seems to hold similar views , as the Defense Department is still mainly focused on the health of the force .
From March 16 to May 11 , for example , troops aren ’ t allowed to @ @ @ @ @ @ @ that Pentagon leadership has turned its attention to a national response yet , experts tell me .
The Air Force officer has one theory as to why that may be : Surging military physicians to treat civilians means there ’ s a “ risk of no treatment for your defense force in an era where soldiers are still getting rocket attacked downrange and North Korea is firing missiles into the East Sea , ” the officer said .
“ There ’ s still an argument for readiness ” — meaning the military ’ @ @ @ @ @ @ @ — “ and our physicians and medical professionals help us maintain that posture.
” Other experts also noted that the Trump administration wants the armed forces focused on “ great power competition ” — preparing for fighting major wars in the future with the likes of China and Russia .
If troops start spending months on the coronavirus crisis , they might be less prepared to engage in those conflicts .
Despite those concerns , though , most I spoke with believe Trump will turn to the military sooner rather than later — @ @ @ @ @ @ @ so earlier .
“ He downplayed the virus , and appeared not to understand what was happening , let alone what was coming , ” Miller told me .
“ The price will be paid in American lives .
”

The Pentagon just offered ventilators for the coronavirus response. It could do much more.
Share All sharing options for: The Pentagon just offered ventilators for the coronavirus response. It could do much more.
With civilian hospitals increasingly overwhelmed and the coronavirus outbreak in America deepening, a question is coming up of whether there’s a bigger role the US military to play in responding.
President Donald Trump isn’t so sure, yet.
“We’re starting the process. And it’s a process — we hope it’s not going to be necessary, but it could be necessary,” he said during the White House briefing on Tuesday morning.
Hours later, Defense Secretary Mark Esper said the Pentagon would at least offer some support. He told reporters that his department would be willing to offer up to 2,000 ventilators and 5 million respirators if asked, as well as offer labs to test civilians for the disease.
But, Esper made sure to say, he believes calling up military to help in the coronavirus response should be a “last resort.”
That’s not all. The US military will also be sending the US Army Corps of Engineers to New York state to assess how to build more medical centers, and it will deploy the USNS Comfort — a large medical ship with room for 1,000 patients — off the coast of New York.
Experts tell me the Pentagon’s actions are a good start, but that defense officials could still do much, much more.
For over a century, America’s armed forces have dealt with medical crises across the globe. Many service members today have the expertise to assist with medical care; build MASH hospitals; provide shelter; or transport food, medical equipment, and people to meet the needs of the public. That’s already happening in Georgia and Florida and New York, for example, where those states’ National Guards were called to help combat Covid-19, the disease caused by the coronavirus.
“The Department of Defense provides the ability to scale up like no other part of the US government can,” Andrew Weber, the Pentagon’s top biological defense official from 2011 to 2014, told me. “Whatever is needed to mount an appropriate response, the military can do it at scale.”
It’s important to note that America’s troops wouldn’t be leading efforts to combat Covid-19. They’d be supporting civilian leaders from the Federal Emergency Management Agency (FEMA) or the Department of Health and Human Services (HHS) with extra people, expertise, and technology.
That’s likely why, during the Democratic presidential debate on Sunday night, former Vice President Joe Biden called for the military to be deployed across America. “It’s a national emergency, and I would call out the military,” he said. “We’re at war with the virus.”
But the military’s involvement isn’t a panacea, and it has strict limitations on what it can do. Laws prohibit most troops from performing law enforcement functions, for example, and its actions are curtailed to helping states with things like emergency medical treatment and evacuations.
What’s more, the military only has a few small hospitals in the United States that are set up to treat military medical problems like bodily trauma, top Pentagon officials told reporters on Monday. Those facilities aren’t particularly ready to deal with the coronavirus outbreak or provide what civilian hospitals might need.
In other words, the military can help, but it can’t solve the government’s response problems. It also doesn’t help that the Army alone, for instance, is short $1 billion to respond to the outbreak. “We’re trying to be very careful about not overpromising,” Air Force Brig. Gen. Paul Friedrichs, the Joint Staff surgeon, told reporters on Monday. However, experts and some at the Pentagon believe the military can come up with the money to help if it wanted to.
As of now, there’s no real indication Trump wants to deploy the military. Most jarring is that he doesn’t have a senior Pentagon official on his Coronavirus Task Force. (It’s possible the military doesn’t want to be involved — more on that later.)
It’s therefore not as easy a call for Trump to make as some might think, but the dozen current and former defense officials and medical experts I spoke with say he should still use his authority to put the military to work now.
“There’s just so much capacity in the Defense Department that’s completely untapped at the moment, and that’s a mistake,” Kelly Magsamen, a former top Pentagon official in the Obama administration, told me.
The legality of using the US military in the coronavirus response
Before going into what the military could do to help with the coronavirus, it’s first important to know what it’s allowed to do at the president’s request.
The US military is barred from using its capabilities directly to enforce US domestic laws unless Congress specifically authorizes it to do so. This stipulation, known as “posse comitatus,” is why US troops can only support civilian agencies like FEMA but not take direct action themselves. Per FEMA’s own website, the military is prohibited from interdicting “vehicles, conducting searches and seizures, making arrests or apprehensions, surveillance, investigation, or undercover work.”
There’s no indication that long-standing statute is going to change anytime soon. However, this rule doesn’t apply to the National Guard and the Coast Guard — which means both services could perform law enforcement functions if asked by a state’s governor. That means they could conceivably block roads or keep people from visiting family and friends, though that would be a severe response and it’s unclear any governor wants to authorize that yet.
The president, or at least his lawyers, knows all this. On Friday, Trump issued two declarations to deal with the outbreak: one reliant on the Stafford Act, and one based on the National Emergencies Act.
As my colleague Ian Millhiser wrote, “Title IV of the Stafford Act permits the president to declare that a particular crisis is a ‘major disaster,’ and such a declaration does provide the president with new powers that he may use to combat such a disaster.” Additionally, the statute says “all requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State.”
So, as Millhiser notes, Trump “cannot simply issue a declaration and seize broad new powers.”
There’s still plenty the US government can do under this act, including coordinating relief efforts, helping state governments, and handing out food and medicine as needed. If the military can be helpful in any of those endeavors, HHS, another agency, or a state’s governor can ask the Pentagon for assistance with them.
As for the National Emergencies Act, it gives the president more sweeping authorities, Elizabeth Goiten, the co-director of the Liberty and National Security Program at the Brennan Center, wrote for the Atlantic on Monday. For Trump to use those authorities, though, he must “specify which powers he intends to invoke, and he must issue updates if he adds new powers to the list,” she explained.
It’s therefore possible that under this statute, Trump could order the military to do more than a state’s governor wants, but he’d have to notify everyone of those intentions.
What’s most likely to happen, though, is that the military will abide by its long-standing process and doctrine of “Defense Support for Civilian Authorities,” or DSCA.
For emergencies in the homeland like the coronavirus outbreak, the military sees its role as providing “support to prepare, prevent, protect, respond, and recover from domestic incidents.” Such support is “provided in response to requests from civil authorities and upon approval from appropriate authorities.”
US troops, then, won’t start deploying to parts of the country without HHS or other government agencies asking them to, and even then the military will act strictly in support of what that agency wants.
In essence, Trump couldn’t use the military as his own personal coronavirus response force and law enforcement agency. It’ll be subordinate to the government agencies that request its assistance. How a National Guard unit acts, though, is highly dependent on a state’s governor.
HHS has already asked the Pentagon for help with quarantining Americans coming back from Wuhan, China — where the outbreak started — as well as infected passengers aboard the Diamond Princess cruise liner. Military officials are also at the 11 feeder airports that passengers from abroad must go through for medical screenings before entering the US.
But so far, that’s it. “We’ve not received any other [requests] at this time,” Jonathan Hoffman, a top Pentagon spokesperson, told reporters on Monday.
Yet experts tell me that, if states and agencies would just request it, the Pentagon could be even more helpful.
How the military can help the US coronavirus response
There are four main ways the US military could assist in the country’s pandemic response: 1) provide care; 2) assist with logistics; 3) develop a vaccine or other treatment; and 4) control crowds and provide other calming effects.
1) Provide care
Even as Americans aim to “flatten the curve” to keep coronavirus cases in the country low, hospitals find that they’re struggling to keep up with the number of patients that need medical care. A dearth of hospital beds, ventilators, and rested physicians means a spike in people requiring hospitalization could greatly overwhelm the civilian health system.
Should those resources run low, the Defense Department “could use authorities under the Defense Production Act to rapidly acquire a range of equipment such as N-95 respirators, gloves for medical personnel, and ventilators,” James Miller, the top Pentagon policy official from 2012 to 2014, told me.
The military also has thousands of physicians who could help treat patients. Dr. Angela Rasmussen, an infectious disease expert at Columbia University, told me the military could create new hospitals if needed — as New York Gov. Andrew Cuomo called on the Army Corps of Engineers to do — or repurpose current ones, for example by converting parts of hospitals into intensive care units.
But it should be noted that the military isn’t completely stocked up to help on all of this. As mentioned before, the Pentagon has fewer than 40 military hospitals, each of them small and geared toward healing troops in specific communities. “Our fixed facilities are designed to the force that we have there — not 1,000-bed medical centers all over the United States,” Friedrichs, the Joint Staff surgeon, told reporters on Monday.
By contrast, there are around 6,000 civilian hospitals in the country up and running today.
And while the military also has 424 medical clinics, including the USNS Comfort, they’re not built to quarantine patients that have the disease. Still, if there are many patients who require care at one time, the military would surely look to house them on their military bases as a kind of overflow facility.
The Department of Veterans Affairs (VA) could also lend its doctors and facilities for the response if the VA secretary authorizes their use. “The VA system was explicitly designed with the idea of not only treating veterans but providing redundancy for the civilian system,” said Sasha Baker, a top aide to former Defense Secretary Ash Carter.
And the VA says it’s ready to help if called upon. “VA stands ready to surge capabilities into civilian health care systems in the event those systems encounter capacity issues, but at this time they are not encountering such issues,” Christina Mandreucci, the VA’s press secretary, told me. “Requests for such support would flow through the HHS, which is leading the federal government’s Covid-19 response efforts.”
But should the National Disaster Medical System (NDMS) — a government program consisting of about 5,000 medical professionals — be called into action by a state or the federal government, the VA would play a huge role in making it work. “The VA is the backbone for the NDMS,” said Anthony Principi, the VA secretary from 2001 to 2005.
2) Assist with logistics
When I asked a current Marine officer how the military could best help if called upon, the officer’s response was short and to the point: “We are good at logistics.”
“We’ve got trucks, warehouses, and people,” the officer continued, “plus a few cargo planes and helicopters.” In other words, the military is full of highly trained professionals with top-of-the-line equipment that could be incredibly useful for transporting civilian officials and materials around the country.
That last part is key as doctors may need additional medical tools quickly to treat patients, or those in affected areas might require food and water to survive. Indeed, if so many people are sick that even grocery stores close down, they’ll need all the sustenance they can get. Only the military, really, has the trucks, helicopters, and planes necessary to deliver everything in an efficient manner. They’d also prove useful should someone require a medical evacuation.
Armed forces could coordinate all this in command and control centers, Barry McCaffrey, a retired Army general, told me. That would help streamline all these efforts so the response isn’t so haphazard.
Experts also noted that the armed forces have communications equipment allowing better coordination among several parts of the government. For example, if there needs to be a teleconference meeting, the military has the technology to set up such a meeting for personnel stationed in remote places.
And troops can offer generators to provide electricity around the clock if needed. Generators are especially useful for field hospitals or if electrical workers in a particularly badly affected area have to stay home.
But, here again, there’s still a problem. The military is failing to come up with money for its own coronavirus response. Part of that comes from Trump administration efforts to cut the amount of military medical personnel the US can have by 18,000, or 20 percent of the force.
3) Help develop a vaccine or effective treatment for the virus
The Army leads the US military’s medical research, primarily at Fort Detrick in Maryland. Gen. James McConville, the Army’s chief, told Breaking Defense earlier this month that there are already researchers working on finding a vaccine for the novel coronavirus. “They’ve been dealing with Ebola, they’ve been dealing with Zika, they’ve been dealing with MERS, and now they’re dealing with coronavirus,” McConville said.
Weber, now at the Council on Strategic Risks, told me that the only viable vaccine candidates and experimental drugs created during the 2014 Ebola crisis came from the Pentagon (in partnership with the Canadian Ministry of Defense). Once it looked like that vaccine could work, the National Institutes of Health took it “the last 10 yards,” said Weber.
But that’s not all. Columbia’s Rasmussen told me that other Pentagon agencies, such as the Defense Threats Reduction Agency and the Defense Advanced Research Projects Agency (DARPA), are working on tools that could potentially help fight the virus.
In DARPA’s case, it has a program called the Pandemic Prevention Platform that will “temporarily protect someone from contracting the virus before a vaccine is ready,” Amy Jenkins, the program’s director, told NPR in February.
Basically, it’s a treatment that protects someone from the virus for about six months. It serves as a temporary fix while waiting for a vaccine that can take several weeks to kick in, and it consists of antibodies from people who’ve had Covid-19 and recovered. “This technology could be used in this current coronavirus,” she said, “but this is still a very early technology.”
At the time of the interview, Jenkins noted that the technology might be available within 90 days.
4) Crowd control and calming effects
The military’s manpower could be helpful in managing large crowds, experts say. They could direct traffic at drive-through testing centers, for example, or control the flow of entries at medical facilities.
This would mostly be a job for the National Guard, the Marine officer told me, as people tend to freak out if they see other services trying to keep people calm within the US.
And, as mentioned above, there are legal reasons why the National Guard would have to be the service doing the crowd control work and not the federal military.
So far there are about 670 National Guard members activated in 15 states.
The public’s trust in the military might help calm nerves that the US government has the situation under control. “It would give the American public confidence,” Weber told me.
Experts told me it’s therefore surprising that Esper and Army Gen. Mark Milley, the Joint Chiefs chair, haven’t been more visible so far in reassuring the nation that all will be well.
The risks of having the military involved in the coronavirus response
While everyone I spoke with said the military had some role to play, many noted that deploying the armed forces also comes with very real risks.
One Air Force officer I talked to worried about exposing troops to sick people, which could increase the number of cases in the ranks. Having a large number of mostly young service members around crowds could also cause the virus to spread, since younger people may be infected without showing any symptoms. “That hurts our ability to respond without endangering the very people we intend to protect,” the officer said.
Plus, the military is already reluctant to help with pandemic response.
During the 2014 Ebola crisis, former defense officials told me, top military officials didn’t want 4,000 US troops going to West Africa to help. The feeling among some US uniformed leaders was that America’s service members should be focused on fighting wars, not curing diseases. Under immense White House pressure, though, the military did deploy and by most accounts proved instrumental in quelling the crisis.
Today’s military brass seems to hold similar views, as the Defense Department is still mainly focused on the health of the force. From March 16 to May 11, for example, troops aren’t allowed to travel domestically. It’s unclear that Pentagon leadership has turned its attention to a national response yet, experts tell me.
The Air Force officer has one theory as to why that may be: Surging military physicians to treat civilians means there’s a “risk of no treatment for your defense force in an era where soldiers are still getting rocket attacked downrange and North Korea is firing missiles into the East Sea,” the officer said. “There’s still an argument for readiness” — meaning the military’s ability to respond to any contingency — “and our physicians and medical professionals help us maintain that posture.”
Other experts also noted that the Trump administration wants the armed forces focused on “great power competition” — preparing for fighting major wars in the future with the likes of China and Russia. If troops start spending months on the coronavirus crisis, they might be less prepared to engage in those conflicts.
Despite those concerns, though, most I spoke with believe Trump will turn to the military sooner rather than later — though they wish he’d done so earlier.
“He downplayed the virus, and appeared not to understand what was happening, let alone what was coming,” Miller told me. “The price will be paid in American lives.”


vox--2020-03-17--America’s hospitals are not ready for coronavirus

The coronavirus surge is coming , America ’ s hospitals are struggling to prepare , and the eventual demand for intensive care unit beds for Covid-19 cases could far exceed what US hospitals will be able to provide .
Researchers at the Imperial College London wrote in a devastating new analysis that even stringent mitigation measures of case isolation , home quarantine , and social distancing “ would still result in an 8-fold higher peak demand on critical care beds over and above the available surge capacity in ... the US.
” America ’ s hospitals do not appear ready @ @ @ @ @ @ @ under President Barack Obama , told me that in “ any place there is community transmission , ” hospitals should cancel elective surgeries so they can make more beds available to Covid-19 patients .
Surgeon General Jerome Adams has made a similar plea .
But when Vox asked more than a dozen hospitals in major metro areas across the country where there is community transmission , we found that guidance is not being uniformly adopted .
Hospitals are trying to balance the needs of the coronavirus pandemic with the needs of their regular @ @ @ @ @ @ @ expand their capacity ahead of a surge in coronavirus cases .
States are starting to take drastic steps to try to increase the number of hospital beds available , but there are limits on what they can do .
New York Gov .
Andrew Cuomo said Monday he would order the National Guard and building developers to convert existing facilities — dormitories and former nursing homes , for example — into makeshift hospitals .
That order is expected to add 9,000 new beds to the 53,000 already available in the state .
Maryland @ @ @ @ @ @ @ order the same day , adding 6,000 beds to the 9,000 existing beds in his state .
Governors are urging the Trump administration to get the Army Corps of Engineers and the US military involved to set up temporary hospitals .
Complicating matters further is a shortage of basic medical supplies — masks , gloves , gowns , etc .
— that hospital staff need to care for patients and protect themselves .
The strain on health care workers will only get worse if nurses and doctors get sick because they lacked protective @ @ @ @ @ @ @ .
I ’ ve spoken with nurses at major US hospitals who are certain they have already been exposed to the coronavirus because of these shortages and some lax protocols in the early coronavirus panic .
“ We just need supplies , ” Melissa Tizon , a spokesperson for the Providence St. Joseph hospital system , which has facilities in Seattle , the worst-hit US city so far , told me .
“ That ’ s the main thing we need to care for our patients.
” America has been , from the @ @ @ @ @ @ @ to the coronavirus pandemic .
The next few weeks , and this test of our ability to dramatically expand US health care capacity , will determine how the outbreak goes from here .
America does not have enough ICU beds for the coronavirus outbreak America has about 924,000 hospital beds , about 98,000 of which can be used for people who need intensive care , according to the American Hospital Association .
The number of Covid-19 cases that will require ICU care could expand far beyond what the US is currently capable of @ @ @ @ @ @ @ are just one set of estimates among many ( based largely on modeling for influenza outbreaks instead of the current facts on the ground ) , but they paint a grim picture .
The short version is that even the most aggressive mitigation strategies — general social distancing , quarantines , closing schools — will not be enough to prevent US hospitals from being overwhelmed eventually unless we commit to such drastic measures until a vaccine becomes available .
For people 60 and older , between 17 percent and 25 percent of cases @ @ @ @ @ @ @ those , 25 percent or more will require intensive care ( as many as 70 percent for patients 80 and older ) , according to this analysis .
The ability of hospitals to provide that care will be imperative if we are to protect those most vulnerable populations .
Frieden suggested hospitals could , for starters , attempt to turn operating rooms into temporary ICUs .
Tizon , with the Providence hospitals in Washington , told me they were running predictive modeling on how many critical cases they can expect and that they @ @ @ @ @ @ @ hospitals could be converted into ICUs .
“ We are definitely taking steps to significantly increase our capacity to accommodate a rise in critical care patients , ” Mona Locke , a spokesperson for the Swedish Medical Center in Seattle , told me .
But she acknowledged they were still crunching numbers and could not be more specific : “ Everything is fluid.
” Other hospitals told me they were adapting their existing surge capacity plans for the current crisis , but added that an extreme surge in Covid-19 cases would require help @ @ @ @ @ @ @ We have ventilators for our current patients and for our surge plan , ” a spokesperson for the Los Angeles County-USC Medical Center said in an email .
“ However , like all hospitals , if an extreme surge of patients presents , LAC+USC will depend on external resources from state and federal agencies.
” This is where the steps already being taken in New York and Maryland to set up temporary facilities could be useful .
And the US military , though limited practically and legally in what it can do , @ @ @ @ @ @ @ health care capacity , as Vox ’ s Alex Ward reported : But it will still be a race to increase hospital beds and ICUs quickly enough to meet the steadily rising number of coronavirus cases here in the US .
And at the same time , hospitals must continue to care for the patients they already have .
Hospitals are not uniformly postponing elective surgeries , as public health officials have urged Frieden told me that hospitals in areas where there is community transmission ( which means the virus is spreading naturally @ @ @ @ @ @ @ from other places ) should postpone elective surgeries .
Adams made a similar plea on Twitter over the weekend .
That is easier said than done .
While “ elective ” surgeries might sound like plastic surgery or something less urgent , any procedure that can be scheduled in advance falls under that category .
So elective surgeries can include heart surgeries , removing kidney stones , cancer treatments , and more .
That ’ s why hospitals have bristled at these broad recommendations , asking government leaders to trust them to evaluate @ @ @ @ @ @ @ sent over the weekend to the Surgeon General by the major hospital associations explained their position : Based on Vox ’ s reporting , hospitals in Covid-19 hotspots are generally making the decision to postpone elective surgeries .
The Seattle hospitals I have been in contact with said they were postponing most or all of their elective surgeries with the hope of freeing up their staff and facilities to treat coronavirus patients .
“ The decision to postpone elective surgeries will free up staff from operating rooms , and they can hopefully be @ @ @ @ @ @ @ ” Locke at Swedish hospitals in Seattle told me .
“ This may allow Swedish to admit more medical patients as it decreases surgical patients .
This is a delicate balance between the communities ’ medical needs and surgical needs.
” Mount Sinai and New York-Presbyterian hospitals in New York City have delayed elective surgeries , as have the George Washington University hospital system in Washington , DC , Massachusetts General in Boston , and the LAC-USC medical system in Los Angeles .
But other hospitals where the virus is now starting to @ @ @ @ @ @ @ taken that step .
Some hospitals in Denver , Chicago , and DC — all places where there are suspected cases of community transmission — have not postponed elective surgeries , according to their responses to our inquiries and internal communications reviewed by Vox .
All of them said they were constantly reviewing their caseloads and the potential need for a delay in those procedures .
These are difficult decisions .
One of the paramount public health concerns during a pandemic is how other patients will be affected as resources are taken away @ @ @ @ @ @ @ emergency .
But the push and pull on elective surgeries compounds hospitals ’ struggles to get ready for the crisis .
US hospitals do not have enough gear for their nurses and doctors Another huge problem for US hospitals is basic protective gear , particularly masks for health care workers who are interacting with Covid-19 patients , as well as gloves , gowns , and more .
I ’ ve heard that worry from hospitals and nurses , as have other reporters .
From BuzzFeed News ’ s Rosalind Adams : As of @ @ @ @ @ @ @ a major supplier to US hospitals , reported it had seen demand for surgical masks double from what they usually see : 55 million versus the typical annual demand of between 22 million and 25 million of the N95 masks that are the standard for health care workers .
“ Most hospitals have only a couple weeks of supply , ” the company wrote in an update on the supply chain .
Making more masks will be a challenge , as NPR reported : Chinese factories , where many such masks are made @ @ @ @ @ @ @ masks on average every day due to the difficulty in procuring the necessary materials .
One nurse at a large hospital in a major US city , who asked for anonymity to avoid retribution from their employer , shared with me one concerning story about the mask shortage .
A patient was brought into the hospital ’ s ICU unit ; the patient tested negative for flu but did not meet the CDC ’ s guidelines for coronavirus testing .
The nurses were therefore not required to wear a mask when they interacted @ @ @ @ @ @ @ .
It was later revealed one of the patient ’ s family members had recently been in Wuhan , China , and been confirmed to have Covid-19 .
After that information was revealed , then the patient was finally scheduled for a test and masks were used again .
But there were several hours in between the negative flu test and the discovery that the patient could be a Covid-19 case when protective gear was not used .
The patient ended up coughing most of the night , potentially exposing nurses and other @ @ @ @ @ @ @ even after the nurse gave notice about the potential exposure , their superiors said they could continue to work and did not need to wear a mask “ because we ’ re on shortage.
” Nurses were instructed that , even if they had confirmed exposure , they should come into work unless they have symptoms .
“ They ’ re not protecting us .
They ’ re taking away our masks , ” the nurse said .
“ The one thing we are all worried about is we are shedding the virus @ @ @ @ @ @ @ US is trying to ramp up production of medical masks , with the federal government contracting with the company 3M to make tens of millions , but 3M faces the same challenges as Chinese manufacturers : a shortage of raw materials .
The Trump administration has also considered , but not yet followed through on , utilizing the Defense Production Act in order to compel private manufacturers to increase their production of these needed supplies .
The entire health system is in a scramble to respond to the Covid-19 outbreak .
Perfect processes @ @ @ @ @ @ @ as the scale of the problem becomes apparent , and the virus continues to spread , US hospitals are playing catch-up in a crisis .

The coronavirus surge is coming, America’s hospitals are struggling to prepare, and the eventual demand for intensive care unit beds for Covid-19 cases could far exceed what US hospitals will be able to provide.
Researchers at the Imperial College London wrote in a devastating new analysis that even stringent mitigation measures of case isolation, home quarantine, and social distancing “would still result in an 8-fold higher peak demand on critical care beds over and above the available surge capacity in ... the US.”
America’s hospitals do not appear ready. Tom Frieden, former CDC director under President Barack Obama, told me that in “any place there is community transmission,” hospitals should cancel elective surgeries so they can make more beds available to Covid-19 patients. Surgeon General Jerome Adams has made a similar plea.
But when Vox asked more than a dozen hospitals in major metro areas across the country where there is community transmission, we found that guidance is not being uniformly adopted. Hospitals are trying to balance the needs of the coronavirus pandemic with the needs of their regular patients, making it more difficult to expand their capacity ahead of a surge in coronavirus cases.
States are starting to take drastic steps to try to increase the number of hospital beds available, but there are limits on what they can do. New York Gov. Andrew Cuomo said Monday he would order the National Guard and building developers to convert existing facilities — dormitories and former nursing homes, for example — into makeshift hospitals. That order is expected to add 9,000 new beds to the 53,000 already available in the state. Maryland Gov. Larry Hogan issued a similar order the same day, adding 6,000 beds to the 9,000 existing beds in his state. Governors are urging the Trump administration to get the Army Corps of Engineers and the US military involved to set up temporary hospitals.
Complicating matters further is a shortage of basic medical supplies — masks, gloves, gowns, etc. — that hospital staff need to care for patients and protect themselves. The strain on health care workers will only get worse if nurses and doctors get sick because they lacked protective gear and then are unable to work.
I’ve spoken with nurses at major US hospitals who are certain they have already been exposed to the coronavirus because of these shortages and some lax protocols in the early coronavirus panic.
“We just need supplies,” Melissa Tizon, a spokesperson for the Providence St. Joseph hospital system, which has facilities in Seattle, the worst-hit US city so far, told me. “That’s the main thing we need to care for our patients.”
America has been, from the start, lagging behind in our response to the coronavirus pandemic. The next few weeks, and this test of our ability to dramatically expand US health care capacity, will determine how the outbreak goes from here.
America does not have enough ICU beds for the coronavirus outbreak
America has about 924,000 hospital beds, about 98,000 of which can be used for people who need intensive care, according to the American Hospital Association. The number of Covid-19 cases that will require ICU care could expand far beyond what the US is currently capable of providing.
The Imperial College London projections are just one set of estimates among many (based largely on modeling for influenza outbreaks instead of the current facts on the ground), but they paint a grim picture. The short version is that even the most aggressive mitigation strategies — general social distancing, quarantines, closing schools — will not be enough to prevent US hospitals from being overwhelmed eventually unless we commit to such drastic measures until a vaccine becomes available.
For people 60 and older, between 17 percent and 25 percent of cases are expected to require hospitalization; of those, 25 percent or more will require intensive care (as many as 70 percent for patients 80 and older), according to this analysis. The ability of hospitals to provide that care will be imperative if we are to protect those most vulnerable populations.
Frieden suggested hospitals could, for starters, attempt to turn operating rooms into temporary ICUs. Tizon, with the Providence hospitals in Washington, told me they were running predictive modeling on how many critical cases they can expect and that they are evaluating which other areas of the hospitals could be converted into ICUs.
“We are definitely taking steps to significantly increase our capacity to accommodate a rise in critical care patients,” Mona Locke, a spokesperson for the Swedish Medical Center in Seattle, told me. But she acknowledged they were still crunching numbers and could not be more specific: “Everything is fluid.”
Other hospitals told me they were adapting their existing surge capacity plans for the current crisis, but added that an extreme surge in Covid-19 cases would require help from federal and state authorities.
“We have ventilators for our current patients and for our surge plan,” a spokesperson for the Los Angeles County-USC Medical Center said in an email. “However, like all hospitals, if an extreme surge of patients presents, LAC+USC will depend on external resources from state and federal agencies.”
This is where the steps already being taken in New York and Maryland to set up temporary facilities could be useful. And the US military, though limited practically and legally in what it can do, could help to expand America’s health care capacity, as Vox’s Alex Ward reported:
The military also has thousands of physicians who could help treat patients. Dr. Angela Rasmussen, an infectious disease expert at Columbia University, told me the military could create new hospitals if needed — as New York Gov. Andrew Cuomo called on the Army Corps of Engineers to do — or repurpose current ones, for example by converting parts of hospitals into intensive care units.
But it will still be a race to increase hospital beds and ICUs quickly enough to meet the steadily rising number of coronavirus cases here in the US. And at the same time, hospitals must continue to care for the patients they already have.
Hospitals are not uniformly postponing elective surgeries, as public health officials have urged
Frieden told me that hospitals in areas where there is community transmission (which means the virus is spreading naturally among residents, not being brought in from other places) should postpone elective surgeries. Adams made a similar plea on Twitter over the weekend.
Hospital & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve!
Each elective surgery you do:
1) Brings possible #Coronavirus to your facilities
2) Pulls from PPE stores
3) Taxes personnel who may be needed for #COVIDー19 response https://t.co/WAUTXF5Vyc — U.S. Surgeon General (@Surgeon_General) March 14, 2020
That is easier said than done. While “elective” surgeries might sound like plastic surgery or something less urgent, any procedure that can be scheduled in advance falls under that category. So elective surgeries can include heart surgeries, removing kidney stones, cancer treatments, and more.
That’s why hospitals have bristled at these broad recommendations, asking government leaders to trust them to evaluate their situations and needs. The letter sent over the weekend to the Surgeon General by the major hospital associations explained their position:
We agree that the crisis as it develops may require the curtailment of the least critical or time-sensitive hospital services, but any curtailment must be nuanced to meet the needs of all severely ill patients. Our patients will be best served by carefully evaluating and prioritizing gradients of “elective” care to ensure that the most time-sensitive medically necessary care can be delivered by physicians and hospitals.
Based on Vox’s reporting, hospitals in Covid-19 hotspots are generally making the decision to postpone elective surgeries. The Seattle hospitals I have been in contact with said they were postponing most or all of their elective surgeries with the hope of freeing up their staff and facilities to treat coronavirus patients.
“The decision to postpone elective surgeries will free up staff from operating rooms, and they can hopefully be moved where they are most needed,” Locke at Swedish hospitals in Seattle told me. “This may allow Swedish to admit more medical patients as it decreases surgical patients. This is a delicate balance between the communities’ medical needs and surgical needs.”
Mount Sinai and New York-Presbyterian hospitals in New York City have delayed elective surgeries, as have the George Washington University hospital system in Washington, DC, Massachusetts General in Boston, and the LAC-USC medical system in Los Angeles.
But other hospitals where the virus is now starting to circulate in the community have not yet taken that step. Some hospitals in Denver, Chicago, and DC — all places where there are suspected cases of community transmission — have not postponed elective surgeries, according to their responses to our inquiries and internal communications reviewed by Vox. All of them said they were constantly reviewing their caseloads and the potential need for a delay in those procedures.
These are difficult decisions. One of the paramount public health concerns during a pandemic is how other patients will be affected as resources are taken away from them and directed to the current emergency. But the push and pull on elective surgeries compounds hospitals’ struggles to get ready for the crisis.
US hospitals do not have enough gear for their nurses and doctors
Another huge problem for US hospitals is basic protective gear, particularly masks for health care workers who are interacting with Covid-19 patients, as well as gloves, gowns, and more. I’ve heard that worry from hospitals and nurses, as have other reporters. From BuzzFeed News’s Rosalind Adams:
One of the nation’s top cancer hospitals has informed its staff it has a shortage of masks and other personal protective equipment, even as at least five employees and three patients have been diagnosed with COVID-19. The hospital, Memorial Sloan Kettering Cancer Center in New York, has only a week’s supply of masks on hand, according to a transcript of a staff meeting last Friday afternoon. The shortage, Kreg Koford, senior vice president of supply chain and sustaining care, told employees, is due to production and distribution delays in China, where most personal protective equipment, or PPE, is manufactured.
As of late last week, Premier Inc., a major supplier to US hospitals, reported it had seen demand for surgical masks double from what they usually see: 55 million versus the typical annual demand of between 22 million and 25 million of the N95 masks that are the standard for health care workers.
“Most hospitals have only a couple weeks of supply,” the company wrote in an update on the supply chain.
Making more masks will be a challenge, as NPR reported: Chinese factories, where many such masks are made, only produce about 600,000 of those masks on average every day due to the difficulty in procuring the necessary materials.
One nurse at a large hospital in a major US city, who asked for anonymity to avoid retribution from their employer, shared with me one concerning story about the mask shortage. A patient was brought into the hospital’s ICU unit; the patient tested negative for flu but did not meet the CDC’s guidelines for coronavirus testing. The nurses were therefore not required to wear a mask when they interacted with the patient after that negative test.
It was later revealed one of the patient’s family members had recently been in Wuhan, China, and been confirmed to have Covid-19. After that information was revealed, then the patient was finally scheduled for a test and masks were used again. But there were several hours in between the negative flu test and the discovery that the patient could be a Covid-19 case when protective gear was not used.
The patient ended up coughing most of the night, potentially exposing nurses and other patients in the ICU ward. Yet even after the nurse gave notice about the potential exposure, their superiors said they could continue to work and did not need to wear a mask “because we’re on shortage.” Nurses were instructed that, even if they had confirmed exposure, they should come into work unless they have symptoms.
“They’re not protecting us. They’re taking away our masks,” the nurse said. “The one thing we are all worried about is we are shedding the virus to the most vulnerable populations.”
The US is trying to ramp up production of medical masks, with the federal government contracting with the company 3M to make tens of millions, but 3M faces the same challenges as Chinese manufacturers: a shortage of raw materials. The Trump administration has also considered, but not yet followed through on, utilizing the Defense Production Act in order to compel private manufacturers to increase their production of these needed supplies.
The entire health system is in a scramble to respond to the Covid-19 outbreak. Perfect processes can’t be expected. But as the scale of the problem becomes apparent, and the virus continues to spread, US hospitals are playing catch-up in a crisis.