huffpost--2020-04-14--Republicans Demand Answers About WHO's 'Failed And Delayed' Response To Coronavirus

In the face of overwhelming evidence that the Trump administration has failed to heed warnings and bungled its response to the growing coronavirus pandemic , some Republicans in the Senate are on the trail of the real culprit in this catastrophe : the World Health Organization .
In a letter to the United Nations agency in charge of public health on Tuesday , a group of GOP senators demanded information about what they called the WHO ’ s “ failed and delayed ” response to the outbreak , accusing the agency of “ helping Communist China cover up ” the @ @ @ @ @ @ @ originated in the Chinese city of Wuhan late last year .
“ American taxpayers deserve answers about how their taxpayer dollars are spent , and whether Congress should continue to spend millions of dollars every year to fund the WHO , ” read the letter , which was signed by Republican Sens .
Ron Johnson of Wisconsin , Rick Scott of Florida , Todd Young of Indiana , Kevin Cramer of North Daktoa , Joni Ernst of Iowa , and Martha McSally of Arizona .
The document requested information and documents from the @ @ @ @ @ @ @ and data on the salaries of its top officials .
Republicans have also called on the WHO director-general to appear before Congress at a future hearing on the agency ’ s response to the coronavirus .
China has been accused of understating its epidemic by censoring and vastly undercounting its official death toll .
The nation ’ s public figures even alarmed the CIA , which warned the White House about understated infection numbers from China in early February .
Beijing claims that only a little over 3,000 people in China have been @ @ @ @ @ @ @ in other countries .
Republicans say the WHO is to blame because it bowed to China ’ s influence and failed to alert the world about the true threat of the virus .
“ It looks like the World Health Organization was parroting their propaganda , ” McSally said in a Fox News interview earlier this month .
“ One thing is for sure , we would be in a better place as a country , clear-eyed , realistic , to attack this virus and kill this virus and minimize the economic impact @ @ @ @ @ @ @ and the World Health Organization wasn ’ t so reckless.
” WHO ’ s actions aside , the allegations miss another key part of the story : the U.S. government ’ s own bungled response to the crisis .
President Donald Trump , in particular , downplayed the virus for weeks by comparing it to the common flu even after it had begun to spread in the U.S .
Moreover , Trump repeatedly praised Chinese President Xi Jinping by saying he had handled the epidemic “ really well ” and was doing “ @ @ @ @ @ @ @ , very tough situation.
” The Trump administration , meanwhile , has failed to make COVID-19 tests readily available to every American who needs one and has struggled to provide enough key supplies like protective gear and ventilators to health care professionals .
The outbreak has claimed the lives of at least 25,000 people in the U.S , officially the most of any country .
“ It ’ s widely ironic that the president and his allies are now criticizing the WHO for being soft on China when in fact it was the @ @ @ @ @ @ @ for China during the early stages of this crisis , ” Sen. Chris Murphy ( D-Conn. ) said during a press call on Tuesday .

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In the face of overwhelming evidence that the Trump administration has failed to heed warnings and bungled its response to the growing coronavirus pandemic, some Republicans in the Senate are on the trail of the real culprit in this catastrophe: the World Health Organization.
In a letter to the United Nations agency in charge of public health on Tuesday, a group of GOP senators demanded information about what they called the WHO’s “failed and delayed” response to the outbreak, accusing the agency of “helping Communist China cover up” the true extent of the coronavirus, which originated in the Chinese city of Wuhan late last year.
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“American taxpayers deserve answers about how their taxpayer dollars are spent, and whether Congress should continue to spend millions of dollars every year to fund the WHO,” read the letter, which was signed by Republican Sens. Ron Johnson of Wisconsin, Rick Scott of Florida, Todd Young of Indiana, Kevin Cramer of North Daktoa, Joni Ernst of Iowa, and Martha McSally of Arizona.
The document requested information and documents from the WHO about its communications with Chinese officials and data on the salaries of its top officials. Republicans have also called on the WHO director-general to appear before Congress at a future hearing on the agency’s response to the coronavirus.
China has been accused of understating its epidemic by censoring and vastly undercounting its official death toll. The nation’s public figures even alarmed the CIA, which warned the White House about understated infection numbers from China in early February. Beijing claims that only a little over 3,000 people in China have been killed by COVID-19, far fewer than in other countries.
Republicans say the WHO is to blame because it bowed to China’s influence and failed to alert the world about the true threat of the virus.
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“It looks like the World Health Organization was parroting their propaganda,” McSally said in a Fox News interview earlier this month. “One thing is for sure, we would be in a better place as a country, clear-eyed, realistic, to attack this virus and kill this virus and minimize the economic impact, if China, communist China, and the World Health Organization wasn’t so reckless.”
WHO’s actions aside, the allegations miss another key part of the story: the U.S. government’s own bungled response to the crisis. President Donald Trump, in particular, downplayed the virus for weeks by comparing it to the common flu even after it had begun to spread in the U.S. Moreover, Trump repeatedly praised Chinese President Xi Jinping by saying he had handled the epidemic “really well” and was doing “a very good job with a very, very tough situation.”
The Trump administration, meanwhile, has failed to make COVID-19 tests readily available to every American who needs one and has struggled to provide enough key supplies like protective gear and ventilators to health care professionals.
The outbreak has claimed the lives of at least 25,000 people in the U.S, officially the most of any country.
“It’s widely ironic that the president and his allies are now criticizing the WHO for being soft on China when in fact it was the president who was being the chief apologist for China during the early stages of this crisis,” Sen. Chris Murphy (D-Conn.) said during a press call on Tuesday.


huffpost--2020-04-14--Death Toll At Virginia Nursing Home Climbs To 45: 'It Is Just A Tinderbox'

She ’ s bedbound and susceptible to seizures .
A sore on her foot went unnoticed for so long , he said , that it led to the amputation of her leg .
When he called her last month after she tested positive for COVID-19 , she sounded disoriented , and he stayed on the line as she pressed a call button and waited an hour and a half for a nurse who never came .
Nearly all of Canterbury ’ s residents rely on Medicaid funding for care of health problems that in many cases were the product of @ @ @ @ @ @ @ the amenities and space to keep people apart .
And it lacks the pay to hire and keep enough staff .
Studies have shown nursing homes heavily dependent on Medicaid for revenue have fewer nurses and other staff per patient than average and lower quality of care overall .
And some off the biggest outbreaks so far have been at homes tied closely to the government payment program , including ones in Wayne , West Virginia , and the Crown Heights section of Brooklyn in New York .
Canterbury , which had about @ @ @ @ @ @ @ thrown into turmoil from the first COVID-19 diagnosis on March 18 .
Many of the staff who work at multiple facilities — Wright couldn ’ t say exactly how many — quit because they otherwise wouldn ’ t have been able to continue at their other jobs .
Other workers began to get sick themselves .
Around the same time , the second doctor who typically saw patients just stopped showing up , which Wright said had a severe impact on the ability to monitor patients .
His wife , a palliative care @ @ @ @ @ @ @ Canterbury had no choice but to take on unfamiliar tasks .
COVID-19 tests were available but scarce at the beginning of the outbreak , but Canterbury was not initially able to test all of its residents and staff because of guidance from state and national officials at the time .
Virginia ’ s rules said even long-term care residents had to first be tested to rule out the flu and other respiratory pathogens , something Wright and other medical directors asked the health department to change because of the delay it created .
@ @ @ @ @ @ @ their emergency power to do the same for their homes .
The National Guard was called in to evacuate a home in Tennessee , take over another one in Massachusetts and run tests at a third in Wisconsin .
And special “ strike teams ” have been tapped to run tests and ferry supplies to homes in Ohio , Indiana and Maryland .
“ Where is the state in some of this ?
Why wasn ’ t more done on a state level as well to come in and take over the situation @ @ @ @ @ @ @ at one point the victims from Canterbury accounted for about a third of the state ’ s dead .
“ There ’ s lots of blame to go around .
”

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RICHMOND, Va. (AP) — Ronald Mitchell worried about his mother’s care at a suburban Richmond nursing home long before she was swept up in one of the nation’s deadliest coronavirus outbreaks.
She’s bedbound and susceptible to seizures. A sore on her foot went unnoticed for so long, he said, that it led to the amputation of her leg. When he called her last month after she tested positive for COVID-19, she sounded disoriented, and he stayed on the line as she pressed a call button and waited an hour and a half for a nurse who never came.
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Mitchell then called Canterbury Rehabilitation & Healthcare Center directly and was told that they were doing the best they could with just two nurses looking after 40 patients at a time in the coronavirus quarantine wing.
With the death toll from the Canterbury outbreak rising to 45, Mitchell can only hope that his 62-year-old mother now on a ventilator in a hospital won’t be next.
“It’s the worst feeling in the world,” he said.
Canterbury, which has surpassed the most recent death toll of 43 in the outbreak at the Life Care Center in suburban Seattle, is the kind of facility that’s particularly vulnerable to a coronavirus wildfire that has raged through the nation’s frail, elderly long-term care populations, claiming more than 4,000 lives.
This Friday March 27, 2020 file photo shows the Canterbury Rehabilitation & Healthcare Center in Richmond, Va. Soon after the first coronavirus case hit the rehabilitation facility, many of the staffers quit. ASSOCIATED PRESS
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Nearly all of Canterbury’s residents rely on Medicaid funding for care of health problems that in many cases were the product of a lifetime of poverty. It lacks the amenities and space to keep people apart. And it lacks the pay to hire and keep enough staff.
“A publicly funded nursing home is a virus’s dream,” said Dr. Jim Wright, Canterbury’s medical director. “It is the best place for a virus to be. People are close together. Their immune systems are compromised. It is just a tinderbox for that match.”
Studies have shown nursing homes heavily dependent on Medicaid for revenue have fewer nurses and other staff per patient than average and lower quality of care overall. And some off the biggest outbreaks so far have been at homes tied closely to the government payment program, including ones in Wayne, West Virginia, and the Crown Heights section of Brooklyn in New York.
Canterbury, which had about 160 residents before its outbreak, was thrown into turmoil from the first COVID-19 diagnosis on March 18. Many of the staff who work at multiple facilities — Wright couldn’t say exactly how many — quit because they otherwise wouldn’t have been able to continue at their other jobs. Other workers began to get sick themselves.
Around the same time, the second doctor who typically saw patients just stopped showing up, which Wright said had a severe impact on the ability to monitor patients. His wife, a palliative care physician, started volunteering. Everyone at Canterbury had no choice but to take on unfamiliar tasks.
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“I was changing patients, cleaning beds. My administrator was delivering meal trays,” Wright said.
“You pick any element, or any arena in our facility that needed to be up and running at its best and nothing was,” he said.
This April 8, 2020 file photo shows a sign stating the 'Heroes Work Here' has been placed in the grounds of the Canterbury Rehabilitation & Healthcare Center in Richmond, Va. ASSOCIATED PRESS
Exactly how the coronavirus got into Canterbury was not clear, though health officials suspect either an infected worker or someone else who came in before visitations and get-togethers were halted in mid-March.
COVID-19 tests were available but scarce at the beginning of the outbreak, but Canterbury was not initially able to test all of its residents and staff because of guidance from state and national officials at the time. Virginia’s rules said even long-term care residents had to first be tested to rule out the flu and other respiratory pathogens, something Wright and other medical directors asked the health department to change because of the delay it created.
By the time tests were finally conducted on everyone at Canterbury about two weeks after the first confirmed case, more than half the residents infected with coronavirus — 53 out of 92 — showed no symptoms of the disease.
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“It’s impossible to build walls around something that spreads so insidiously,” said Dr. Danny Avula, the state health department’s area director who has noted that Canterbury has been doing its best.
Even in normal times, Canterbury merited just one out of five stars in Medicare’s rating system, with inspection records showing the facility had such poor staffing levels that it impacted patient care.
One nurse told an inspector last year “residents would stay in bed because it is almost impossible for two people to assist 62 or 63 residents.” Previous inspections also found infection-control problems and failure to report an attempted rape of a patient.
Relatives of Canterbury residents described a facility with long-running quality-of-care problems and said they thought more could have been done to prevent the spread. They also said they had not received adequate communication during the crisis.
Kim Thompson’s phone rang before 6 a.m. Thursday, and when Wright told her that her 72-year-old mother, Minnie Brown, had died, she thought it had to be a mistake.
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Thompson had spoken with her mother over FaceTime two days earlier and she seemed in good health and spirits. Since that phone call, the family had received no updates from Canterbury letting them know her condition had deteriorated.
“It’s neglect. It’s negligence,” Thompson said in an interview.
Family members visit a relative through a window at the Canterbury Rehabilitation & Healthcare Center Saturday April 4, 2020, in Richmond, Va. The Center has numerous had Covid-19 cases and deaths. ASSOCIATED PRESS
Thompson said as Canterbury’s death toll began to climb, she started researching the response at the Life Care Center outbreak near Seattle, where a special federal group of doctors and nurses was sent to help.
Since then, several governors have used their emergency power to do the same for their homes. The National Guard was called in to evacuate a home in Tennessee, take over another one in Massachusetts and run tests at a third in Wisconsin. And special “strike teams” have been tapped to run tests and ferry supplies to homes in Ohio, Indiana and Maryland.
“Where is the state in some of this? Why wasn’t more done on a state level as well to come in and take over the situation?” Thompson asked, noting that at one point the victims from Canterbury accounted for about a third of the state’s dead. “There’s lots of blame to go around.”
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Virginia Gov. Ralph Northam recently proposed a budget amendment that increases the rates paid to nursing homes and long-term care facilities by an additional $20 for Medicaid recipients per day. He’s also announced the creation of a task force that is working with such facilities to try and cut the infection rates and deaths.
“This boost in funding will help these facilities address staffing issues during this epidemic,” Northam said.
Wright, who continues to care for the Canterbury patients who remain, was asked in a news conference last week if he would have done anything differently.
“I would have a nursing home that had enough staff around-the-clock, around all the time. I would have a nursing home where everyone had private rooms. I would have a nursing home where there was greater access to the outdoors,” he said.
“In other words, I would have a nursing home funded by a society that puts more emphasis on treating our elders the way they should be treated.”
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huffpost--2020-03-17--How To Get More Ventilators And What To Do If We Can't

Scaling Up Factories Is The Easy Part They have to be the exact components .
… You can ’ t @ @ @ @ @ at Home Depot and call it good .
An engineer at a medical device company @ @ @ @ @ May Be The Biggest Problem Finding People To Run Ventilators Is An Issue Innovating At @ @ @ @ @ ― May Be Necessary

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The coronavirus pandemic could cause a dramatic upsurge of hospital patients in the U.S., creating unprecedented demand for ventilators. And it’s not clear hospitals have enough of them.
Ventilators are the machines that push and pull air through a tube connected to the lungs, allowing people with compromised pulmonary capacity to breathe. For people with severe infections from this coronavirus, which attacks respiratory cells, these machines can literally be the difference between life and death.
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Nobody is quite sure how many of the devices are available in the U.S. because there’s no central system of accounting for them. And nobody knows how many will be required because that depends on the course of the pandemic and whether efforts to slow its spread are successful.
The consequences of a shortage would be dire. Doctors would have to make harrowing decisions about who gets the ventilators and who doesn’t, decisions that doctors in coronavirus-ravaged China, Iran and Italy say they are making already.
Public officials like New York Gov. Andrew Cuomo (D) have been warning about this possibility with increasing urgency and begging the federal government for help. “We are looking for ventilators desperately,” Cuomo said in a press conference on Tuesday.
“The industry has shifted into overtime. ... There’s a limit, however, to how much capacity it can ramp up on its own.” - Mark Van Sumeren, managing director of Health Industry Advisor
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President Donald Trump and his advisers say they are on the case. At their own daily briefing, hours after Cuomo’s, they said they were taking a complete inventory of available ventilators while also ordering more. A day earlier, Trump had told governors to obtain them on their own, as The New York Times reported. The president on Tuesday said he never intended to suggest that federal authorities wouldn’t also take action.
Whatever the Trump administration is or isn’t doing already, it’s clear that the availability of ventilators depends in part on what steps the federal government takes and when it takes them.
Over the past week, HuffPost talked to about a dozen engineers, current and former executives in the medical device industry, and critical care physicians about how to make the most of the country’s existing ventilator stock and how to increase the supply as quickly as possible. Several asked that HuffPost not use their names because they still work in the industry.
None felt comfortable making firm pronouncements about what was possible. They cited the many unknowns, from the availability of electronic components to the severity and timing of the pandemic itself.
But they all said the federal government could make a big difference by making advance purchases, rushing the regulatory process, financing or even providing transportation, and making sure ventilators get to the places that need them most. Factories are already speeding up, they said, but there’s a chance to do even more.
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“The industry has shifted into overtime to produce much-needed medical supplies, devices and equipment, such as ventilators,” Mark Van Sumeren, a device industry veteran who is managing director of the firm Health Industry Advisor, told HuffPost. “There’s a limit, however, to how much capacity it can ramp up on its own. Government can be a key partner here.”
Assessing The Current Ventilator Supply Is Difficult
Precise, reliable counts of available ventilators do not exist yet. The estimate most people cite comes from a 2009 survey that said 62,000 units were scattered across hospitals and clinics around the country. The number today is probably at least a few thousand higher, if only because that figure is a decade old and the population has grown significantly since then.
So that sounds like a lot. But it’s not as if those machines are just sitting there waiting for somebody to use them. On a normal day, the majority of working ventilators are already in use for patients with everything from cancer to heart disease. Usage rises even more during flu season.
“The need for ventilation services during a severe pandemic could quickly overwhelm these day-to-day operational capabilities,” a February report from the Johns Hopkins University Center for Health Security warned.
Hospitals can free up ventilators by cutting back on certain elective surgeries, as they are already, and by switching patients to alternative forms of breathing assistance that would not be appropriate for COVID-19, the illness caused by the coronavirus. (Some breathing devices can disperse droplets from the patient’s airway, potentially spreading infection.)
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And there are other ventilators, possibly quite a lot of them, that could be put to use. The federal government keeps an emergency stockpile and officials have indicated it’s about 10,000 units, although the precise number and location are classified because it is part of the government’s defense plans against bioterrorism and biological warfare.
On Tuesday, the Defense Department announced it was releasing 2,000 ventilators to the Department of Health and Human Services.
Nobody is quite sure how many ventilators the U.S. has ― or how many it will need. Bibiz1 via Getty Images
Older, technically obsolete ventilators are also stored in warehouses and other facilities around the country, perhaps as many as 100,000 of them, according to the Society of Critical Care Medicine (SCCM), which represents doctors, nurses and other health professionals who work with patients who need intensive care.
Nobody is confident of the number or the reliability of those old units, but they could make a big difference if the crisis gets severe.
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“Many patients would do fine with older ventilators,” said Craig Coopersmith, former president of SCCM and current interim director for the Emory University Critical Care Center in Atlanta. “These would represent patients who are sick enough to require mechanical ventilation but do not have the most severe form of respiratory failure.”
Overall, SCCM estimates, up to 200,000 ventilators could be available right now. The worry is that even that might not be enough to handle surges, which is why hospital administrators and public officials all over the country are trying to figure out if there are ways to get more.
Scaling Up Factories Is The Easy Part
The idea of American factories going on a wartime footing to churn out breathing machines the way they churned out tanks, planes and ships for World War II has a certain romance to it.
A version of that may be happening already. Ventilator production is a global enterprise, with companies operating across Europe and Asia. But several large producers, including General Electric, ResMed and Vyaire, are either based in the U.S. or have large assembly operations here.
Normally these factories run relatively close to capacity. Orders for new machines started increasing in December and January, according to industry sources, as soon as the coronavirus started spreading. Many are at or even above their normal production levels now, they said, with some running extra shifts.
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Adding even more shifts wouldn’t be out of the question. In theory, factories could run 24 hours a day, seven days a week. They could give extra hours to current workers or hire new ones, depending on their circumstances, though new workers would require training.
That strategy does have its limits. Production of medical devices requires sterile rooms that need daily cleaning, forcing a pause in the process, and a third shift might involve less-experienced workers or workers who are tired from laboring through other shifts. In either case, they might be less productive.
“When you add a third shift to a factory running two, you can’t think it as adding 50% capacity,” an executive said.
Still, assembly plants could dial up their output quickly, industry sources said, if the government is willing to guarantee purchases. One way to do that would be through the Defense Production Act, which authorizes the federal government to make “loans, loan guarantees, purchases, and purchase commitments, to improve, expand, and maintain domestic production capabilities needed to support national defense and homeland security procurement requirements.”
Several members of Congress, led by Rep. Andy Levin (D-Mich.), sent the White House a letter on Monday urging Trump to do just that. Trump on Tuesday said the option was under consideration.
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At some point, increasing capacity would require getting manufacturers to build new factories or signing contracts with different manufacturers. In either case, federal regulators who watch over the production process for quality assurance would have to “validate” the new facilities, meaning they would have to certify them as producing ventilators with almost no chance of error or failure.
“They have to be the exact components. … You can’t just pick up different screws at Home Depot and call it good.” - An engineer at a medical device company that manufactures ventilators
The federal government could expedite those reviews. Certifying a new factory or manufacturing process can take up to 180 days, industry executives said. But there are ways to reduce that time, especially if it’s a company that already manufactures ventilators adding factories rather than new entrants trying to build them for the first time.
“I could build a facility and have a clean room up and running ― I can do that in 90 days or less,” one executive said. “It would normally be another 6 to 9 months after that before I could get [Food and Drug Administration] approval for that facility. If we could have the FDA to fast-track that approval, it’d obviously make a big difference.”
Gathering the materials that factories need to build ventilators is a bit more complicated since many of the essential parts come from other countries. Both cargo carriers and passenger airlines (which still carry cargo) have been reducing overseas flights.
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But this is another place where the federal government could help, by chartering some of the planes that carriers have idled or having the military run airlifts, and using similar strategies to transport goods by sea when appropriate. The government can also speed up the customs process, to make sure parts get to factories as soon as they arrive in the U.S.
“Government clearly has a role in facilitating the physical transportation of the vital supplies to U.S. hospitals from across the globe,” said Van Sumeren, “by relaxing importation and customs delays and addressing the certain backlogs we should expect at our nation’s ports.”
Sourcing Components May Be The Biggest Problem
But in order to transport component parts, there have to be component parts to transport. And there may not be, at least in the quantities that ventilator producers need right away. The sources HuffPost consulted all thought this would ultimately be the biggest factor limiting production.
“The biggest challenge on the pure supply chain side is just getting more parts so that you can build these ventilators,” one executive said. “They’re complex devices. They easily will have bills of material [that is, lists of components] with hundreds and hundreds of parts.”
These parts include everything from plastic casings to circuit boards, and they come from all over the world. But the majority are single-source: They come from one company and are custom designed for particular ventilator producers.
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“They have to be the exact components. … You can’t just pick up different screws at Home Depot and call it good,” one engineer said. “They have to be tested and validated.”
Making matters worse, electronic components in particular frequently come from China, which has been reeling from the initial COVID-19 outbreak.
So far, the industry executives said, the supply chain from China doesn’t seem to be slowing down. But they worry that it’s only a matter of time. Existing inventories may have allowed the flow of parts from China to continue even while many workers were in isolation and quarantine. At some point, those inventories will be depleted.
In theory, manufacturers could get their parts from elsewhere, including within the U.S. But anytime a manufacturer wants to switch suppliers, it has to get approval from regulators, who have to make sure the new parts ― like the old ones ― will have reliably high quality with minimal failure rates.
Another problem with finding new parts suppliers, or even extracting more production from existing ones, is that the entire world is looking to buy more ventilators right now. The companies that know how to make the parts are already running at or over capacity.
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Finding People To Run Ventilators Is An Issue
In a normal medical setting, ventilators require attention from several health care professionals. A physician makes the decision to use a ventilator and “intubate” a patient ― meaning, to put a tube down the patient’s throat so that the ventilator can deliver air. Then respiratory therapists have to monitor the machine to make sure the patient is getting the oxygen they need.
As with every other health care worker involved with coronavirus treatment, the worry is that the respiratory therapists will be exposed to COVID-19, forcing them into isolation or quarantine, which could mean there won’t be enough respiratory therapists to handle the machines.
New York Gov. Andrew Cuomo says his state is desperate for ventilators and wants federal help. Spencer Platt via Getty Images
That’s a scary proposition, although perhaps not as cataclysmic as it sounds. Anesthesiologists and nurse anesthetists can operate ventilators. Typically they are too busy with other work to monitor ventilators, but delays in elective procedures would give them extra time.
In theory, other medical professionals could also step in with extra training. At Tuesday’s press conference, Cuomo talked about calling up retired health workers, which could include retired respiratory care experts.
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Yet another option would be the employees of the ventilator manufacturers ― in particular, their training and repair staff typically include respiratory therapists who worked previously in clinical settings. If interested, and given incentive, they could move to the front lines.
“These are people who go out and either train hospital personnel to use the products, or they repair them,” an executive said. “Well, guess what, they know how to run the machines too.”
Innovating At The Factory ― And Bedside ― May Be Necessary
So in the end, how many more ventilators could the industry produce ― and how quickly? Forbes quoted one manufacturing executive who said that normal worldwide output is 40,000 to 50,000 units a year. That executive said that his company, one of the smaller ones, could increase its production five-fold within 90 to 120 days.
The sources HuffPost consulted were skeptical that the industry as a whole could replicate that figure. They speculated that quickly increasing capacity by 20% or 30% was possible, and maybe with an all-hands-on-deck approach 50% or even 100% within a few months. “But if you’re talking like five times the number we have now, I mean that’s just a huge undertaking that would take time,” said Larry Smith, a retired medical device executive who is now director of graduate business programs at Rider University.
Another executive still in the industry recalled the story of World War II factories ramping up production of “Liberty ships” and compressing the build time to just a few weeks and eventually a few days. But the executive also gave a warning: It took about two years to develop that capacity.
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“It’s the quintessential American story, but they weren’t pumping them out that quickly in 1941,” the executive said. “There was a ramp-up period for that as well.”
Desperate circumstances sometimes lead to unexpected innovations. A few days ago, U.K. Prime Minister Boris Johnson pleaded with British manufacturers to start building ventilators. Companies like Rolls Royce are reportedly going over blueprints to see what they can do. Maybe they will discover they can retool and mass-produce more quickly than they realized.
The same could happen here, whether it’s existing manufacturers finding ways to increase production, new entrants getting into the business, or the U.S. turning to producers abroad. “You might be able to cut through the red tape and do something to get new manufacturers approved that are already making ventilators, but they weren’t selling in the USA,” Smith said.
And then there is always the possibility of creativity, sometimes very close to the patient’s bedside. A widely publicized example comes from Italy, where a hospital ran out of valves to connect patients with breathing machines and a local business with a 3D printer figured out a way to manufacture them. It probably saved dozens of lives.
The solution was far from ideal. Medical devices are intricate machines on which people’s lives depend. Every step of the production process has to be precise. In normal times, one device failure would be too many. But these are not normal times.
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The surest solution to the ventilator shortage is to slow the spread of the pandemic, to “flatten the curve” of the infected population, so that the shortages never happen. But the surge of patients is likely to test the U.S. health care system’s capacity even under the best of circumstances, which is why the federal government should be acting now to increase that capacity as much as possible.


huffpost--2020-03-18--Prisoners Fearful Of Coronavirus Argue For Release

NEW YORK ( AP ) — Coronavirus has become a “ get out of jail ” card for hundreds of low-level inmates across the country , and even hard-timers are seeking their freedom with the argument that it ’ s not a matter of if but when the deadly illness sweeps through tightly packed populations behind bars .
Among those pleading for compassionate release or home detention are the former head of the Cali drug cartel , President Donald Trump ’ s former personal attorney Michael Cohen , Ponzi schemer Bernard Madoff and dozens of inmates at New York City @ @ @ @ @ @ @ a jail system that lost an employee to the virus this week .
“ He is in poor health .
He is 81 years old , ” David Oscar Markus , the attorney for cocaine kingpin Gilberto Rodriguez-Orejuela , wrote in emergency court papers this week seeking his release after serving about half of a 30-year drug-trafficking sentence .
“ When ( not if ) COVID-19 hits his prison , he will not have much of a chance.
” While widespread outbreaks of coronavirus behind bars have yet to happen , the frenzy @ @ @ @ @ @ @ that ’ s only beginning to sink in : America ’ s nearly 7,000 jails , prisons and correction facilities are an ideal breeding ground for the virus , as dangerous as nursing homes and cruise ships but far less sanitary .
Stepped-up cleanings and a temporary halt to visitations at many lockups across the country in the midst of the crisis can ’ t make up for the fact that ventilation behind bars is often poor , inmates sleep in close quarters and share a small number of bathrooms .
The 81-year-old @ @ @ @ @ @ @ sentence for bilking thousands of investors in a $ 17.5 billion Ponzi scheme , had just asked last month to be released early in light of his terminal kidney disease .
Now his attorney is calling on all at-risk federal prisoners to be released for their own safety because of the coronavirus .
As of Wednesday , two federal Bureau of Prisons staff members have tested positive for coronavirus , a person familiar with the matter told the AP .
One of the staffers works in a correctional facility in Berlin , New @ @ @ @ @ @ @ an office in Grand Prairie , Texas , but there were still no confirmed cases among any of the 175,000 inmates in the BOP system , the person said .
The person , who wasn ’ t authorized to discuss the matter publicly and spoke to the AP on condition of anonymity , would not say how many inmates , if any , have been tested for coronavirus .
In New York , public defenders asked judges to release older and at-risk inmates from the city ’ s beleaguered federal jails , saying @ @ @ @ @ @ @ for the transmission of contagious disease.
” The motions cite a provision of the Bail Reform Act allowing for the temporary release of pretrial inmates under “ compelling ” circumstances .
“ I truly believe the jails are ticking time bombs , ” said David Patton , executive director of the Federal Defenders of New York .
“ They ’ re overcrowded and unsanitary in the best of times .
They don ’ t provide appropriate medical care in the best of times , and these certainly are not the best of times.
@ @ @ @ @ @ @ ’ s largest jail system has trimmed its population by more than 600 since Feb. 28 , allowing many inmates with fewer than 30 days left on their sentences to be released early .
In Cleveland , judges held a special session over the weekend to settle cases with guilty pleas and release more than 200 low-level , non-violent inmates .
And in Miami , the top state attorney has urged the release of all non-violent felons and those being held on misdemeanors .
New York City ’ s Board of Correction this @ @ @ @ @ @ @ all high-risk inmates after an an investigator assigned to the jail system died over the weekend of the coronavirus .
The 56-year-old man was said to have a pre-existing health condition and only limited contact with inmates .
The city ’ s jail system has about 8,000 inmates , most at notorious Rikers Island .
However , accommodating the surge of requests poses its own challenge .
Courts around the country are shutting down , with only a skeletal staff working .
The chief federal judge in Brooklyn on Monday postponed indefinitely all @ @ @ @ @ @ @ judges to conduct court business via telephone or video conferencing when possible , and to delay in-person proceedings .
Prosecutors said in court filings that the Federal Bureau of Prisons has been planning for the outbreak since January , including by establishing a task force with experts at the Centers for Disease Control and Prevention .
The BOP last week suspended visitation for all federal inmates , facility transfers , staff travel and training for 30 days .
Newly arriving inmates are being screened for COVID-19 , and even asymptomatic inmates deemed to @ @ @ @ @ @ @ Immigration and Customs Enforcement announced that they would take similar steps .
Public health officials stress that older people and those with existing health problems are most at risk from coronavirus but that the vast majority of people will only suffer mild or moderate symptoms , such as fever and cough , with recovery in a matter of weeks .

A jail cell in the Enhanced Supervision Housing Unit at the Rikers Island Correctional facility in New York March 12, 2015. Brendan McDermid / Reuters
NEW YORK (AP) — Coronavirus has become a “get out of jail” card for hundreds of low-level inmates across the country, and even hard-timers are seeking their freedom with the argument that it’s not a matter of if but when the deadly illness sweeps through tightly packed populations behind bars.
Among those pleading for compassionate release or home detention are the former head of the Cali drug cartel, President Donald Trump’s former personal attorney Michael Cohen, Ponzi schemer Bernard Madoff and dozens of inmates at New York City’s Rikers Island, part of a jail system that lost an employee to the virus this week.
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“He is in poor health. He is 81 years old,” David Oscar Markus, the attorney for cocaine kingpin Gilberto Rodriguez-Orejuela, wrote in emergency court papers this week seeking his release after serving about half of a 30-year drug-trafficking sentence. “When (not if) COVID-19 hits his prison, he will not have much of a chance.”
While widespread outbreaks of coronavirus behind bars have yet to happen, the frenzy of legal activity underscores a crude reality that’s only beginning to sink in: America’s nearly 7,000 jails, prisons and correction facilities are an ideal breeding ground for the virus, as dangerous as nursing homes and cruise ships but far less sanitary.
Stepped-up cleanings and a temporary halt to visitations at many lockups across the country in the midst of the crisis can’t make up for the fact that ventilation behind bars is often poor, inmates sleep in close quarters and share a small number of bathrooms.
“Simply put, it’s impossible to do social distancing,” said David S. Weinstein, a former federal prosecutor in Miami.
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The 81-year-old Madoff, who is serving a 150-year sentence for bilking thousands of investors in a $17.5 billion Ponzi scheme, had just asked last month to be released early in light of his terminal kidney disease. Now his attorney is calling on all at-risk federal prisoners to be released for their own safety because of the coronavirus.
“The federal prison system has consistently shown an inability to respond to major crises,” Madoff attorney Brandon Sample told The Associated Press. “My concerns are even more amplified for prisoners at federal medical centers and those who are aged.”
As of Wednesday, two federal Bureau of Prisons staff members have tested positive for coronavirus, a person familiar with the matter told the AP. One of the staffers works in a correctional facility in Berlin, New Hampshire, and the other works in an office in Grand Prairie, Texas, but there were still no confirmed cases among any of the 175,000 inmates in the BOP system, the person said. The person, who wasn’t authorized to discuss the matter publicly and spoke to the AP on condition of anonymity, would not say how many inmates, if any, have been tested for coronavirus.
It’s not just attorneys for the wealthy and powerful seeking release.
In New York, public defenders asked judges to release older and at-risk inmates from the city’s beleaguered federal jails, saying pretrial confinement “creates the ideal environment for the transmission of contagious disease.” The motions cite a provision of the Bail Reform Act allowing for the temporary release of pretrial inmates under “compelling” circumstances.
“I truly believe the jails are ticking time bombs,” said David Patton, executive director of the Federal Defenders of New York. “They’re overcrowded and unsanitary in the best of times. They don’t provide appropriate medical care in the best of times, and these certainly are not the best of times.”
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Some authorities around the nation appear to agree. Police departments are incarcerating fewer people, prosecutors are letting non-violent offenders out early and judges are postponing or finding alternatives to jail sentences.
In Los Angeles, the nation’s largest jail system has trimmed its population by more than 600 since Feb. 28, allowing many inmates with fewer than 30 days left on their sentences to be released early. In Cleveland, judges held a special session over the weekend to settle cases with guilty pleas and release more than 200 low-level, non-violent inmates. And in Miami, the top state attorney has urged the release of all non-violent felons and those being held on misdemeanors.
“No judge wants to have a dead prisoner on his conscience,” said Bill Barzee, a Miami defense attorney.
New York City’s Board of Correction this week called for the immediate release of all high-risk inmates after an an investigator assigned to the jail system died over the weekend of the coronavirus. The 56-year-old man was said to have a pre-existing health condition and only limited contact with inmates. The city’s jail system has about 8,000 inmates, most at notorious Rikers Island.
However, accommodating the surge of requests poses its own challenge. Courts around the country are shutting down, with only a skeletal staff working. The chief federal judge in Brooklyn on Monday postponed indefinitely all criminal and civil jury trials, encouraging judges to conduct court business via telephone or video conferencing when possible, and to delay in-person proceedings.
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Prosecutors said in court filings that the Federal Bureau of Prisons has been planning for the outbreak since January, including by establishing a task force with experts at the Centers for Disease Control and Prevention. The BOP last week suspended visitation for all federal inmates, facility transfers, staff travel and training for 30 days. Newly arriving inmates are being screened for COVID-19, and even asymptomatic inmates deemed to be at risk are being quarantined. Immigration and Customs Enforcement announced that they would take similar steps.
Public health officials stress that older people and those with existing health problems are most at risk from coronavirus but that the vast majority of people will only suffer mild or moderate symptoms, such as fever and cough, with recovery in a matter of weeks.
But such assurances are small solace for inmates.
The Twitter account of Michael Cohen, Trump’s former attorney who is serving a three-year sentence for crimes including tax evasion and campaign finance violations, shared over the weekend an online petition seeking the transfer of non-violent federal prisoners to home confinement. Addressed specifically to Trump, it argues the move would “give the prison facilities additional (and much needed) medical triage and logistic space for those who will become infected.”


huffpost--2020-04-17--Why Some Coronavirus Patients Get Sicker Than Others

There ’ s a critical point , somewhere around the second week of coronavirus symptoms , where patients usually start to recover .
Sometimes , though , they don ’ t .
Some people can take a turn for the worse even after they ’ ve started to feel somewhat better .
The progression of symptoms is one of the more mysterious elements of this illness .
As you probably know , the novel coronavirus is a respiratory virus .
When an infected person coughs , sneezes or touches a surface , another person can pick up the virus when @ @ @ @ @ @ @ contact with a surface where those droplets have landed , according to Kirsten Hokeness , professor and chair of the Department of Science and Technology at Bryant University and an expert in immunology .
“ Once it makes its many copies , the new viruses then exit that cell and go on to infect more and more cells , ” she said .
“ In some cases , the virus may stay more localized here , and in other cases , the virus replicates and then makes its way down into the lungs @ @ @ @ @ @ @ , as well.
” People can still get better when this happens , but it often takes longer .
They may start to decline in week two if the virus does not subside ― even if , at some points , they seem to feel like they ’ re recovering .
And it ’ s not always the virus to blame .
Why People Can Get Worse In Week Two “ Around week two is when the immune system should be resolving , and the virus should be just about cleared , ” @ @ @ @ @ @ @ have underlying conditions , or who are older and whose immune system may not be functioning properly , they may not be able to handle this balance .
There may initially be some relief , but then the virus escapes and persists and the immune response goes somewhat out of control.
” As the immune response is “ reenergized ” to keep fighting the virus , “ you get collateral damage , ” Schaffner said .
“ You get an over-response .
The response is not like a rifle that just targets the @ @ @ @ @ @ @ shotgun , and as you get those shotgun blasts , the inflammatory response can damage its own tissue.
” How Can Critical Patients Be Helped ?
Schaffner said all the supportive care a person gets in the ICU is meant “ to tide you over while the inflammatory response fights the virus and dies down.
” This includes supplemental oxygen or intubation , if needed .
“ Then , as the tissue repairs itself , with some luck , we can take out the breathing tube , ” Schaffner said .
“ We @ @ @ @ @ @ @ start breathing for yourself again .
You can recover.
” There are two theories as to how this drug might actually work , Schaffner said .
It may inhibit the virus ’ s attachment to cells to slow the infection .
It is also used to treat autoimmune conditions like lupus , and may help “ modulate the immune system.
” For this reason , the drug may help that overreactive inflammatory response in COVID-19 .
“ We just don ’ t know , though , ” Schaffner said .
We ’ ve @ @ @ @ @ @ @ test , not just experiment when patients are ill , Schaffner insisted .
Not everyone needs the drug or will improve on it .
“ I am a vigorous proponent of the clinical trial , ” he said .
“ This virus is not going away anytime soon .
If in October , we get another surge of infections , I would like to be more sophisticated about [ the drug ] treatment than we are now.
” And hopefully , we ’ ll be able to prevent as many people as possible @ @ @ @ @ @ @ their infection .
Experts are still learning about the novel coronavirus .
The information in this story is what was known or available as of press time , but guidance concerning COVID-19 could change as scientists discover more about the virus .
Please check the Centers for Disease Control and Prevention for the most updated recommendations .

LOADING ERROR LOADING
There’s a critical point, somewhere around the second week of coronavirus symptoms, where patients usually start to recover. Sometimes, though, they don’t. Some people can take a turn for the worse even after they’ve started to feel somewhat better. The progression of symptoms is one of the more mysterious elements of this illness.
While the symptoms can escalate quickly, the more “prolonged course” of COVID-19 makes it unlike influenza or other similar respiratory illnesses, said William Schaffner, a professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.
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“Once on a ventilator, patients also seem to be on those ventilators for longer than comparable patients who had the flu and were also seriously ill,” he said.
Why do patients who appear better suddenly get worse? And who is more susceptible to this longer progression of symptoms?
COVID-19’s Path Through The Body
To understand why some people recover at a better rate than others, we first need to understand the mechanics of how coronavirus infects the body.
As you probably know, the novel coronavirus is a respiratory virus. When an infected person coughs, sneezes or touches a surface, another person can pick up the virus when they inhale respiratory droplets or come into contact with a surface where those droplets have landed, according to Kirsten Hokeness, professor and chair of the Department of Science and Technology at Bryant University and an expert in immunology.
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Once in your nose or mouth, the virus then latches on to cells that express a protein called ACE-2; these cells can be located deep in the back of the throat and high up in the nasal passage.
“This is an important receptor in regulating blood pressure that the spikes on the surface of the virus have found a way to unlock,” Hokeness said. Once the virus “unlocks the receptor,” it can get inside the cell and use its machinery to replicate, she added.
“Once it makes its many copies, the new viruses then exit that cell and go on to infect more and more cells,” she said. “In some cases, the virus may stay more localized here, and in other cases, the virus replicates and then makes its way down into the lungs and starts to infect the lung cells, as well.”
On the way, as the virus is multiplying, it nestles into the lining of the bronchial tubes, causing inflammation and producing cough, Schaffner said.
“In the meantime, the body’s inflammatory response is revving up, becoming more active in trying to combat the virus,” he said. “We get a sore throat, cough, and fever as a manifestation of that.”
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A cough is meant to expel mucus; a fever slows the path of the virus down, making replication slower. This is still on the “milder end” of the spectrum, Schaffner said.
After a week to 10 days of fighting it out with the virus, Hokeness said many people’s immune systems will be able to overcome it.
“This is enough time for the innate and adaptive immune responses to do their job, subside and develop the memory component of the response,” she said, meaning they develop at least short-term immunity.
“If, however, the battle rages on and the virus becomes a vicious competitor that the immune system has difficulty controlling, the virus can continue to spread and involve more of the lungs,” Hokeness said.
When the virus exits the bronchial tubes and heads to the lungs, it can “disrupt the function of the lung tissue,” causing pneumonia, Schaffner added. That’s usually a sign that the virus is no longer considered “mild.”
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People can still get better when this happens, but it often takes longer. They may start to decline in week two if the virus does not subside ― even if, at some points, they seem to feel like they’re recovering. And it’s not always the virus to blame.
svetikd via Getty Images
Why People Can Get Worse In Week Two
As the virus travels to the lungs, remember that the immune response is in high gear trying to overpower COVID-19. “The army follows the enemy,” Schaffner said.
Hokeness compares it to a see-saw: the balance of “a good immune response and a damaging” one.
“Viruses that are aggressive or pathogenic, like COVID-19, test the immune capacity,” she said. Sometimes, the immune system fights with a lot of vigor, and manages not to cause damage to the person’s body. That usually takes a little over a week, on average.
But with this virus, which no human has encountered before, it is not always as simple as 10-day fight. Because the immune system weakens with age, people who are older have a higher risk of getting seriously ill. Those who have underlying chronic conditions ― like diabetes, cancer, autoimmune illnesses or high blood pressure ― also have compromised immune systems that leave them more vulnerable to the body’s surging inflammatory response. Sometimes, unfortunately, it can be a mystery; even young, healthy people can get very ill at this phase.
“Around week two is when the immune system should be resolving, and the virus should be just about cleared,” Hokeness said. “For those that have underlying conditions, or who are older and whose immune system may not be functioning properly, they may not be able to handle this balance. There may initially be some relief, but then the virus escapes and persists and the immune response goes somewhat out of control.”
As the immune response is “reenergized” to keep fighting the virus, “you get collateral damage,” Schaffner said. “You get an over-response. The response is not like a rifle that just targets the virus. It is more like a shotgun, and as you get those shotgun blasts, the inflammatory response can damage its own tissue.”
Similar distress can happen in other areas of the body outside of the lungs, as well. A study in medical journal The Lancet noted that COVID-19 is also capable of causing damage to other organs, like the heart, liver and kidneys.
This is a pivotal time where there is a delicate balance between a good immune response and a damaging one, Hokeness said. “If the virus can be controlled and the immune response can subside, individuals will begin to recover. If the scales are tipped, and a damaging immune attack begins, this is when things get critical.”
According to a recent study, this second week and second wave of symptoms often prompts patients who will likely need ICU care to head to the hospital.
Patients in the intensive care unit often develop Acute Respiratory Distress Syndrome (ARDS), which is when “inflammation and fluid begin to accumulate in the spaces around the air sacs,” Hokeness said.
“If immune cells keep causing damage and producing more pro-inflammatory chemicals, the fluid can’t drain normally, and the air sacs then fill with fluid,” she explained. This frequently causes a “drowning feeling” in patients, and the blood’s oxygen levels to drop. The need for a ventilator can arise quickly after admission to the hospital, sometimes within a day.
kupicoo via Getty Images
How Can Critical Patients Be Helped?
Schaffner said all the supportive care a person gets in the ICU is meant “to tide you over while the inflammatory response fights the virus and dies down.” This includes supplemental oxygen or intubation, if needed. “Then, as the tissue repairs itself, with some luck, we can take out the breathing tube,” Schaffner said. “We can discontinue that treatment and you can start breathing for yourself again. You can recover.”
In the meantime, researchers are looking into what sorts of added treatments might be effective ― including plasma therapy, where COVID-19 patients can receive infusions of antibodies from those who have fought off the virus and recovered. This is now being tried in places like New York and Texas.
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Schaffner said that clinical trials of drugs will be important, too. Take hydroxychloroquine, for example, which has been in the news a lot lately as a possible treatment down the road.
There are two theories as to how this drug might actually work, Schaffner said. It may inhibit the virus’s attachment to cells to slow the infection. It is also used to treat autoimmune conditions like lupus, and may help “modulate the immune system.” For this reason, the drug may help that overreactive inflammatory response in COVID-19. “We just don’t know, though,” Schaffner said.
Right now, the research on hydroxychloroquine’s effectiveness is extremely mixed, though the drug has been shown potentially effective in a lab setting and doctors treating COVID-19 have observed some success in using it. The drug also comes with side effects like heart rhythm disturbances, which may prove problematic for those with underlying conditions, Schaffner said.
On top of that, there are people who need this drug for conditions like lupus and rheumatoid arthritis, who will run into shortages if everyone believes it’s a miracle cure for COVID-19, and at this point, there is no evidence of that.
There are many questions researchers need to interrogate in coming weeks and months. “If we want to treat this virus with a drug, when is the best time to administer it?” is one Schaffner is keen to see answered.
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“It’s being used, and we are giving this to people who are very sick,” he said. “But is that the stage of the illness where it is effective? Or is it past the time? Should we treat them early, at an earlier stage, to prevent intensive care? We won’t do this until we do rigorous clinical trials.”
We’ve got to put potential treatments to the test, not just experiment when patients are ill, Schaffner insisted. Not everyone needs the drug or will improve on it. “I am a vigorous proponent of the clinical trial,” he said. “This virus is not going away anytime soon. If in October, we get another surge of infections, I would like to be more sophisticated about [the drug] treatment than we are now.” And hopefully, we’ll be able to prevent as many people as possible from getting sicker in the course of their infection. Experts are still learning about the novel coronavirus. The information in this story is what was known or available as of press time, but guidance concerning COVID-19 could change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.


huffpost--2020-04-24--Does Deep Breathing Really Help With Coronavirus Symptoms?

Cuomo said he changed his approach to include deep breathing .
“ You have got to do the things to beat the virus , you have got to breathe deep when it hurts and it hurts , ” he said on his show .
In the video , Munshi demonstrates how to breathe in deeply , hold one ’ s breath for five seconds at the top of the inhale , and then breathe out .
He recommends two cycles of six breaths , where you complete a big cough on the sixth breath .
Munshi also recommends laying on @ @ @ @ @ @ @ improve lung function .
The idea is to open up your lungs ’ air sacs .
Deep breathing can help lung function when you ’ re sick .
When your lungs are inflamed , whether from COVID-19 or another condition , some of the air sacs that exchange oxygen and carbon dioxide are replaced with fluid and debris , according to Vandana Patel , a board-certified pulmonologist at Bon Secours Mercy Medical Group in Portsmouth , Virginia , and clinical adviser for Cabinet Health .
When you practice the deep breathing technique like @ @ @ @ @ @ @ are pushing air into your lungs , Patel said .
As you hold your breath at the end of the exhale , you are “ splinting open the air sac , increasing the surface area for gas exchange within your lungs , ” she explained , adding that this helps to open collapsed air sacs in the lungs and improve oxygen levels in the body .
The technique also helps with anxiety and control during a scary situation .
“ What I think this video is saying is , ‘ Hey , if @ @ @ @ @ @ @ breathing exercises may help you , ’ ” Desai said .
“ A lot of feeling better is managing anxiety .
If you are anxious , you are going to be short of breath.
” Deep breathing exercises help to manage stress for the same reason .
Not only can the practice bring your mind into the present moment , but it can also physically signal your nervous system to calm down .
That can be useful in worrisome situations like dealing with the coronavirus .
Desai said a lot of these pulmonary @ @ @ @ @ @ @ very ill in the hospital .
But she does not think it is a magic bullet that will stop COVID-19 from progressing .
“ With this disease , there is a sense of everyone lacking control over this situation , ” Desai said .
“ If people want to do this and it makes them feel better , great .
But it won ’ t prevent you from COVID and it won ’ t necessarily help you recover.
” ( Just like a ventilator doesn ’ t necessarily cure a coronavirus patient , @ @ @ @ @ @ @ to ease coronavirus symptoms at home .
It is also important to practice anxiety-reducing self-care , Desai noted .
If you are anxious about having shortness of breath , that anxiety will only exacerbate the feeling that you can ’ t breathe .
Deep breathing exercises can help with that .
“ If you can ’ t breathe , nothing else matters and you won ’ t be able to think about anything else , ” Desai said .
Since COVID-19 symptoms can last a long time , it is really critical to @ @ @ @ @ @ @ as your body .

LOADING ERROR LOADING
Earlier this month, CNN anchor Chris Cuomo was in an active fight against the novel coronavirus. He described a relentless fever, wild dreams and difficulty breathing. Then a pulmonary expert told him he needed to “fight” back by stretching his torso and breathing in deeply.
Cuomo said he changed his approach to include deep breathing. “You have got to do the things to beat the virus, you have got to breathe deep when it hurts and it hurts,” he said on his show.
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The CNN journalist wasn’t the first person to adopt a deep breathing regimen. Just days earlier, “Harry Potter” author J.K. Rowling shared a video where physician Sarfaraz Munshi from Queens Hospital in the U.K. detailed a breathing technique he said may keep COVID-19 patients from developing secondary pneumonia.
After coming down with COVID-19 symptoms, Rowling explained that her husband had advised her to follow the steps in the video. “I’m fully recovered & technique helped a lot,” she tweeted.
In the video, Munshi demonstrates how to breathe in deeply, hold one’s breath for five seconds at the top of the inhale, and then breathe out. He recommends two cycles of six breaths, where you complete a big cough on the sixth breath. Munshi also recommends laying on the stomach instead of the back to improve lung function. The idea is to open up your lungs’ air sacs.
Seems like simple solutions to complex symptoms, right? Here’s what doctors want you to know about the technique.
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Catherine McQueen via Getty Images Voluntary breathing exercises have long been useful for people with different pulmonary conditions.
Deep breathing can help lung function when you’re sick.
When your lungs are inflamed, whether from COVID-19 or another condition, some of the air sacs that exchange oxygen and carbon dioxide are replaced with fluid and debris, according to Vandana Patel, a board-certified pulmonologist at Bon Secours Mercy Medical Group in Portsmouth, Virginia, and clinical adviser for Cabinet Health.
“These areas are now less functional for the work of gas exchange,” she said.
When you practice the deep breathing technique like in Munshi’s video, you are pushing air into your lungs, Patel said. As you hold your breath at the end of the exhale, you are “splinting open the air sac, increasing the surface area for gas exchange within your lungs,” she explained, adding that this helps to open collapsed air sacs in the lungs and improve oxygen levels in the body.
Ventilators perform a similar function in patients who are not healthy enough to breathe efficiently on their own, Patel said.
Voluntary breathing exercises have long been useful for people with different pulmonary conditions, added Nikita Desai, a pulmonologist at Cleveland Clinic.
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“If you have a chronic lung disease, like asthma or COPD, breathing can be helpful in getting control of that chronic condition,” she said. “Exercise programs are called pulmonary rehabilitation. For patients, we often recommend things like pursed lip breathing to control breath.”
Desai said this often slows breathing to get more air into the lungs.
The technique also helps with anxiety and control during a scary situation.
Desai said deep breathing may focus a patient’s energy and offer a sense of control over their care, which may, in turn, improve outcomes, especially when used in conjunction with other at-home care tactics.
“What I think this video is saying is, ‘Hey, if you are at home, these deep breathing exercises may help you,’” Desai said. “A lot of feeling better is managing anxiety. If you are anxious, you are going to be short of breath.”
Deep breathing exercises help to manage stress for the same reason. Not only can the practice bring your mind into the present moment, but it can also physically signal your nervous system to calm down. That can be useful in worrisome situations like dealing with the coronavirus.
“Any kind of deep breathing, or a 10-minute meditation, or moment of mindfulness, may be extremely beneficial,” Desai said.
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“A lot of feeling better is managing anxiety. If you are anxious, you are going to be short of breath.” - Nikita Desai, pulmonologist
Don’t expect deep breathing to cure COVID-19.
All that said, take this deep breathing technique with a grain of salt when it comes to the coronavirus.
Desai said a lot of these pulmonary regimens may be done when patients are very ill in the hospital. But she does not think it is a magic bullet that will stop COVID-19 from progressing.
“With this disease, there is a sense of everyone lacking control over this situation,” Desai said. “If people want to do this and it makes them feel better, great. But it won’t prevent you from COVID and it won’t necessarily help you recover.” (Just like a ventilator doesn’t necessarily cure a coronavirus patient, either.)
Petri Oeschger via Getty Images “Any kind of deep breathing, or a 10-minute meditation, or moment of mindfulness, may be extremely beneficial,” says pulmonologist Nikita Desai.
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There are other ways to ease coronavirus symptoms at home.
If you or a loved one comes down with COVID-19 symptoms and you can manage them at home, Patel recommends deep breathing as part of a greater symptom-treatment regimen.
Clinically, it is “a proven method to help improve lung function,” Patel said, noting that it may allow more air to infiltrate the lung tissue, easing some symptoms.
Desai is certainly not opposed to the technique — but only if it makes you feel better. “If the deep breathing makes you dizzy or lightheaded, then it’s too much,” she said.
It is also important to practice anxiety-reducing self-care, Desai noted. If you are anxious about having shortness of breath, that anxiety will only exacerbate the feeling that you can’t breathe. Deep breathing exercises can help with that.
“If you can’t breathe, nothing else matters and you won’t be able to think about anything else,” Desai said. Since COVID-19 symptoms can last a long time, it is really critical to pay attention to your mind as well as your body.
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Beyond that, make sure to “rest and drink plenty of fluids,” Patel noted. “Even a warm shower or having a humidifier nearby can help manage symptoms. Pain relievers such as acetaminophen and cough suppressants can help, as well.”
Just make sure to be a label-reader when you are taking over-the-counter medications. Don’t forget that cough suppressants and cold and sinus medications can contain acetaminophen, too — which you might forget if you don’t regularly read the active ingredient label.
“In most doses you might take acetaminophen, you’ll be OK. But if you do that plus a cold medication with acetaminophen, you could overdose or cause harm,” said Desai. “There is so much as too much of an otherwise benign thing.”
If you’re concerned about what OTC medication doses are right for you, call your primary care physician or a pharmacist for guidance. And just in general, it’s always a good idea to stay in touch with your doctor as you monitor your symptoms.
Experts are still learning about the novel coronavirus. The information in this story is what was known or available as of press time, but it’s possible guidance around COVID-19 could change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.
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huffpost--2020-03-19--Trump Says It’s Up To States To Supply People Masks And Ventilators

Pressed by a reporter Thursday on the dire shortage of medical supplies and testing to deal with the coronavirus , @ @ @ @ @ for the crisis and instead put the burden on governors .
Speaking at what ’ @ @ @ @ @ House press briefing on the pandemic , Trump insisted that states should take the lead @ @ @ @ @ medical equipment and protective items , despite the federal government ’ s vastly greater resources @ @ @

Pressed by a reporter Thursday on the dire shortage of medical supplies and testing to deal with the coronavirus, President Donald Trump deflected responsibility for the crisis and instead put the burden on governors.
Speaking at what’s become a daily White House press briefing on the pandemic, Trump insisted that states should take the lead in supplying the badly needed medical equipment and protective items, despite the federal government’s vastly greater resources and capabilities.


huffpost--2020-03-25--We Found The Secret Ventilator Stockpile. It’s Still Not Enough.

AXEL HEIMKEN via Getty Images A ventilator is pictured during an instruction of doctors at the Universitaetsklinikum Eppendorf in Hamburg , on March 25 , 2020 .
- Currently ten Covid-19/ Corona patients are treated in the hospital .
( Photo by Axel Heimken / POOL / AFP ) ( Photo by AXEL HEIMKEN/POOL/AFP via Getty Images ) The stockpile was started in 1999 primarily to prepare for attacks against Americans using weapons of mass destruction .
Once an obscure government initiative , it has been shoved into the spotlight as state officials and hospital administrators search for every available @ @ @ @ @ @ @ of hospitalizations as U.S. coronavirus cases crested 50,000 on Tuesday with no signs of slowing .
Still , the totals of ventilators ticked up , to more than 8,000 in 2010 and eventually the 16,600 that are in the stockpile now , Amber Dukes , a health communications specialist who works in the stockpile ’ s operations branch at HHS , said in an email .
Like many details of the stockpile , the total number of ventilators has been the subject of secrecy recently , as officials point to national security concerns @ @ @ @ @ @ @ figure .
“ All of a sudden that number has become protected infrastructure information for some reason , ” said Richard Branson , a respiratory therapist and professor at the University of Cincinnati Medical Center who has helped federal officials plan how to allocate stockpile resources in emergencies .
Branson said he doesn ’ t think it ’ s really about national security , but rather officials trying to control media reports about the stockpile and manage public concerns about equipment shortages .
Of the three models of ventilators currently in the stockpile @ @ @ @ @ @ @ since 2006 , and the manufacturer stopped servicing the machines in 2011 .
A 2018 study jointly run by the CDC and the U.S. Food and Drug Administration found that , aside from some battery life concerns , the machines seemed to be functional , although the ventilators in the stockpile have suffered through another two years of deterioration .
While the nation ’ s medical system may have about 160,000 ventilators overall , many of them may already be in use .
In Illinois , for example , there are 1,467 ventilators @ @ @ @ @ @ @ WGN-TV in Chicago , but 1,093 of them are already being used .
That leaves only 374 available .
And even if the stockpile had hundreds of thousands more ventilators , hospitals may not have the staff to operate that many more .
A 2015 study by federal government researchers concluded that only about 50,000 new people could safely be put on ventilators because of limitations in medical experts and ventilators .
That number could be increased — if corners are cut , and doctors eschewed some normal precautions meant to prevent infections @ @ @ @ @

A ventilator is pictured during an instruction of doctors at the Universitaetsklinikum Eppendorf in Hamburg, on March 25, 2020. - Currently ten Covid-19/ Corona patients are treated in the hospital. (Photo by Axel Heimken / POOL / AFP) (Photo by AXEL HEIMKEN/POOL/AFP via Getty Images) AXEL HEIMKEN via Getty Images
This story is from the Center for Public Integrity, a nonprofit, nonpartisan investigative media organization in Washington, D.C.
Only 16,600 ventilators.
That’s the total number of breathing machines that sit in the Strategic National Stockpile, the government reserve meant to fortify overwhelmed hospitals in a crisis. It’s a small supplement to the U.S. medical system’s estimated 160,000 or so ventilators — many already in use — and not nearly enough to help patients survive a severe outbreak of coronavirus infections, health experts say.
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The previously unreported stockpile number, confirmed by a U.S. Department of Health and Human Services official who works with the reserve program, shows just how few ventilators are available to a national health system bracing for the full impact of the coronavirus.
The U.S. could have as many as 742,000 patients who need ventilators in a severe outbreak similar to the 1918 Spanish flu, according to a study by the Center for Health Security at Johns Hopkins University, and more than 64,000 in a moderate outbreak.
New York City alone has said it needs an extra 15,000 ventilators, with Mayor Bill de Blasio tweeting at billionaire Elon Musk begging for his company to start making the medical devices — a sign of the desperation for the breathing machine crucial for combating a virus that targets lungs. New York state had more than 25,000 confirmed cases of the coronavirus as of Tuesday.
As hospitals prepare for a flood of patients that could overwhelm them, some are going to desperate lengths to find additional breathing machines. For example, a hospital in Spokane, Washington, borrowed a ventilator from a veterinary hospital in Portland, Oregon, 350 miles away, a spokesperson for the DoveLewis Emergency Animal Hospital said.
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The stockpile was started in 1999 primarily to prepare for attacks against Americans using weapons of mass destruction. Once an obscure government initiative, it has been shoved into the spotlight as state officials and hospital administrators search for every available breathing machine ahead of the expected wave of hospitalizations as U.S. coronavirus cases crested 50,000 on Tuesday with no signs of slowing.
The ventilator shortage may be particularly dire in hospitals in rural and low-income areas. While there’s little data tracking the location of ventilators, the machines are expensive — costing around $25,000 for a basic model — and many small hospitals in remote areas are already under severe financial strain.
For example, Washington County in Kansas, home to 5,700 residents, has two hospitals — but no ventilators at all. The county in 2018 had a median household income of $48,889, more than 20 percent below the national average.
In severe cases of COVID-19, patients’ lives will depend on ventilators. The coronavirus can destroy the small air sacs in the lungs, preventing them from passing oxygen to the blood — suffocating patients from the inside. Ventilators take over for weak lungs, forcing air and oxygen into the body.
Without a ventilator, said Lisa Shultis, a respiratory therapist who teaches at Long Island University, patients would need someone pumping air into their lungs by hand, via a plastic manual resuscitator bag.
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“You would have to be right there, squeezing that bag,” she said. “And how long can you do that? We really need these mechanical ventilators.”
Shultis is already training her students how to operate ventilators in the stockpile. On Monday, the National Guard transported her school’s 13 ventilators for use in the makeshift hospital set up inside New York City’s Javits Center.
While states have been turning to the federal government asking for the breathing machine, those familiar with the federal repository say there’s little that can be done.
“The reality is the stockpile could never have enough money to be the immediate fallback for everybody, and nobody does anything themselves,” said Greg Burel, who spent a dozen years until January as the director of the stockpile.
NEW MISSION, TOUGH TRADE-OFFS
In 2009, amid growing fears about the H1N1 flu outbreak that would eventually claim more than 12,000 American lives, Congress pushed through $7.7 billion in special funding, including billions for the stockpile, and tasked Burel with preparing for “pandemic influenza,” a catchall term for a range of viruses that target the respiratory system.
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At the time, the stockpile only had about 4,000 ventilators spread around a handful of secret warehouses, according to a report written by a Centers for Disease Control and Prevention researcher in 2008. The funds bolstered stockpiles of masks and other equipment that would help fight infectious disease outbreaks, although about a quarter of the supplies were immediately consumed on combating H1N1.
Burel said Congress never set aside funds specifically for pandemic influenza again. Working with a government oversight committee, he was forced to squeeze funds from other areas of the stockpile’s mission, including supplies for illnesses caused by a chemical, biological, radiological or nuclear weapon.
Every year, Burel would review a list of items the experts wanted to have in the $8 billion stockpile, and every year the $500 million to $600 million he’d receive from Congress would only cover about half of those items. That meant making tough choices about what to stock, he said.
“It’s always a hard trade off, and there’s never a right answer,” Burel said.
When pressed, the experts running the stockpile moved to buy obscure pharmaceuticals likely to go out of production without a big government purchase. They left off items such as ventilators and masks, which sell to medical systems anyway.
The stockpile was meant as a bridge, with the expectation that hospitals would have their own backup supplies. But with funding tight, many hospital systems have moved to a “just in time” supply system where they maintain few reserves, Burel said.
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Still, the totals of ventilators ticked up, to more than 8,000 in 2010 and eventually the 16,600 that are in the stockpile now, Amber Dukes, a health communications specialist who works in the stockpile’s operations branch at HHS, said in an email. Like many details of the stockpile, the total number of ventilators has been the subject of secrecy recently, as officials point to national security concerns over letting the public know the total figure.
“All of a sudden that number has become protected infrastructure information for some reason,” said Richard Branson, a respiratory therapist and professor at the University of Cincinnati Medical Center who has helped federal officials plan how to allocate stockpile resources in emergencies. Branson said he doesn’t think it’s really about national security, but rather officials trying to control media reports about the stockpile and manage public concerns about equipment shortages.
PROBLEMS BEYOND THE NUMBERS
One concern about the stockpile is that some machines have been sitting for years or, in some cases, decades.
Of the three models of ventilators currently in the stockpile, one hasn’t been manufactured since 2006, and the manufacturer stopped servicing the machines in 2011. A 2018 study jointly run by the CDC and the U.S. Food and Drug Administration found that, aside from some battery life concerns, the machines seemed to be functional, although the ventilators in the stockpile have suffered through another two years of deterioration.
While the nation’s medical system may have about 160,000 ventilators overall, many of them may already be in use. In Illinois, for example, there are 1,467 ventilators in the state, health officials told WGN-TV in Chicago, but 1,093 of them are already being used. That leaves only 374 available.
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Hospitals are hoping to get extra ventilators from the Strategic National Stockpile, pictured here, but there may not be enough to meet the needs of COVID-19 patients. (Courtesy of Assistant Secretary for Preparedness and Response)
Burel and the experts who made the buying decisions for the stockpile knew that the total number of ventilators they had would never be enough for a major flu or coronavirus outbreak.
And even if the stockpile had hundreds of thousands more ventilators, hospitals may not have the staff to operate that many more. A 2015 study by federal government researchers concluded that only about 50,000 new people could safely be put on ventilators because of limitations in medical experts and ventilators. That number could be increased — if corners are cut, and doctors eschewed some normal precautions meant to prevent infections, among other complications.
That challenge could be especially difficult in rural hospitals.
Under normal circumstances, America’s smallest hospitals transfer their most severe patients to bigger urban hospitals with more resources. Many rural hospitals don’t have the staff and expertise and organizational setup to care for patients on ventilators for extended periods of time and then wean them off successfully, said David Wallace, a doctor who studies critical care medicine at the University of Pittsburgh.
“If we expect patients to remain in those locations, that’s going to put new stresses and strains on those hospitals,” he said. “Those challenges will create even more problems.”
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If he were running a small, rural intensive care unit during this pandemic, Wallace said, he’d be “scared.”
Branson, the respiratory therapist at the University of Cincinnati Medical Center, took part in meetings with federal officials who wanted to more than double the stockpile’s inventory of ventilators.
To boost its stockpile, the government tapped Philips Respironics, awarding the division of the global electronics giant a $13.8 million contract in 2014 to develop a new model of ventilator for the stockpile. The contract included a $32.8 million option to buy 10,000 units of a new Advanced All Hazard Stockpile Ventilator, but Branson said the ventilators haven’t been manufactured. Dukes, the HHS official, listed three types of ventilators currently in the inventory, which did not include a Philips Respironics model.
Around the world, doctors are exploring ways to jury-rig ventilators to help more people. Shultis at Long Island University is teaching her students to keep two patients alive on a single ventilator.
An HHS spokesperson, Stephanie Bialek, said the agency could not list states that had requested ventilators, as those who manage the stockpile are “in the middle of an ongoing response.”
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Even well-funded hospitals are desperate to find more machines.
In Baltimore, Johns Hopkins Hospital has a large stock of ventilators and has ordered more. But it still might also request some from the stockpile, said R. Scott Stephens, the doctor who manages an intensive care unit there.