Sunday School Extra Credit 3/29/20

Also making classroom visits yesterday were Drs. Anthony Fauci, who chatted with Jake Tapper on CNN's State of the Union, and Deborah Birx, who talked with Chuck Todd on MTP, which is where we'll start.

Responding to Todd's question on the growth in the death rate (17 days or so to get to 100, nine more days to get to 1,000 and only 72 hours to get to 2,000) and "where this is headed in the next few weeks, Birx noted "this is the way pandemics work" and that

No state, no metro area will be spared. And the sooner we react and the sooner the states and the metro areas react and ensure that they've put in full mitigation, at the same time understanding exactly what their hospitals need, then we'll be able to move forward together and protect the most Americans.

She also referenced some new modeling that's available, which predicts how COVID-19 might spread. Todd wondered what the model showed, in particular if the plan to create the county-by-county risk map wasn't going to happen, since the models show no area is safe. She said the two pieces come together, and we need both of them.

One of them is ensuring that we have full capacity for full diagnosis...that is still going on, and we do have enough tests for that. The other piece of this is surveillance. So we're looking across the US for counties that do have lower case numbers right now to see what we can do in order to really put into place full surveillance, full contact tracing, and full diagnostic capacity to ensure cases are found and we contact trace while the metros and other areas go through clearly important mitigation efforts to spare as many American lives as possible. 

She also said that they're studying what's going on in New York "very carefully" - hospital needs, how to do testing better, how to keep less sick patients out of the hospital, and how to keep hospitals stocked with critical supplies, among other things. On that last part, she noted,

It's not enough for us to get materials to warehouses. We have to be working with the state and local governments comprehensively to ensure that equipment and supplies are getting to each hospital. Hospitals are so busy taking care of the people who are ill. They can't be spending time doing inventory. And so we need to help and support that. 

On supplies and competition between states and the feds, Todd asked if the feds were going to take over procurement and disbursement, and he also asked what role Birx plays in where supplies are going, vs. what FEMA is responsible for. She talked about all the things other people should be doing (know where the hospitals and surgical centers are, where the anesthesia ventilators are, how to move those things around, etc.). Which is what governors and local folks ARE doing, and they're running into problems, still. So Todd asked it again: "who should be trying to acquire new equipment, states or the federal government?"

Well, I think the federal government right now is working very hard on looking at where all the ventilators are and where production can be. But we need states at the same time to look where all of their ventilators are, including outpatient surgical centers, which is a really important place to be looking because you get staff plus ventilator. They also have the cardiac monitoring, they'll be able to monitor oxygen levels. All of that can come into the hospitals to care for patients. So both of those pieces need to come together. The government looking to increase procurements and states looking for every single option that they have.

They talked about the potential quarantine for the NY/NJ/CT area, and she said that when New York City started getting bad, the data showed more cases on Long Island and in Southern Florida, presumably because people were leaving NYC for safer areas. And, she added.

What we're trying to say to everyone is when this virus comes to your metro area, please stay in your metro area where your care can be provided because it's spreading virus more quickly around the United States. 

In the same vein, Todd asked about shutting down domestic air travel, noting it seems odd that NYC airports "are wide open for people to leave." Birx noted that air travel in and out of New York is down by 90% and by more than 90% in the NYC metro area.

And they talked about a possible extension of the 15-day guidelines, which we now know have been extended through the month of April. Her job, she said, was putting the data together to brief the president and VP. She wouldn't share her recommendation with Chuck first, she said. Silly boy. 

Over in the CNN classroom, Jake Tapper asked Dr. Fauci about the change from a quarantine in the NYC metro area to a requirement that folks "refrain from nonessential domestic travel from that area for 14 days, and whether it would help stop the spread of the virus. Fauci spoke of "very intensive discussions" with the president, and that

we made it clear, and he agreed, that it would be much better to do what's called a strong advisory. And the reason for that is that you don't want to get to the point where you're being - enforcing things that would create a bigger difficulty, morale and otherwise, when you could probably accomplish the same goal. 

Tapper asked if, based on the numbers (and an assumption that the numbers are correct), the US "is now the epicenter" of the outbreak. That led to some discussion on what things could look like, regardless of whether you call it the 'epicenter', or just "the focus of what's going on right now" which is what Fauci said it certainly is. He spoke of the difficulty of the problem, places like New York of course, but other cities like Detroit that are "starting to get into trouble."

It putters along a while, and then it just goes way up. And when it does that, you're really in full mitigation. It's difficult to do containment, So we want to strongly do mitigation in those areas like NYC and the surrounding metropolitan area, at the same time that we don't neglect other areas of the country where it looks like there are just relatively few infections, because we have a window of opportunity there... to get out there and test. 

He and Birx were pretty much in lockstep on that messaging, about doing contact tracing and containment to prevent the need for massive mitigation efforts. Tapper asked how many cases Fauci thought we could have, "a million cases, 10 million cases? Or are these - we - or do we not even have any idea?" Fauci was refreshingly honest.

You know, Jake, the honest - to be honest with you, we don't really have any firm idea. 

But don't worry - we've got those models that Birx mentioned, and they use assumptions, and you get a best case and a worst case scenario, and Fauci says the answer is usually somewhere in the middle. And those scenarios are only as good as the assumptions, he cautioned.

So, when you use numbers like a million, a million-and-a-half, two million, that almost certainly is off the chart. Now, it's not impossible, but very, very unlikely. So, it's difficult to present.

I mean, looking at what we're seeing now, I would say between 100,000 and 200,000 cases. But I don't want to be held to that, because it's -- excuse me -- deaths. I mean, we're going to have millions of cases.

And, he said, we don't really need to be making projections, "when it's such a moving target, that you can so easily be wrong and mislead people." 

They also talked about how much longer social distancing guidelines would remain in place, and of course we know his overarching recommendation was to let the virus tell the politicians what to do. And, he said, if you do it, you need to have tools in place to keep an eye on things, to make sure you continue testing, contact tracing, and so on, 

Because if you release the restrictions before you have a good eyeball on what's going on there, you're going to get in trouble. So, I'm not against releasing the restrictions. I'm actually for it in an appropriate place. But I don't recommend it unless we have the tools in place in real time to do the things I just said. 

Tapper asked if we have the tools, quoting the VP's figures on testing - there had been more than 600,000 tests across the country, which is certainly an improvement from where we were a month ago. But there are 330 million Americans; 660,000 or 600 -- whatever the number is -- 600,000-plus - and asked "how many tests need to have been done, need to be done before you will feel comfortable knowing where the hot spots are, so then some restrictions can be loosened in the future?"

Jake, I don't think it's the quantitatively -- how many tests you need. I mean, obviously, you want to get tests out there that one can get a test easily, in real time, with a result right away... So, right now, if you compare a couple of weeks ago to where we are right now, we have an amazingly larger number of tests than we had before.

But what I want to see and I want to be satisfied is that those tests are being implemented on the ground where we need them. That's the connection I want to make sure, not just tests out there, but are the tests being able to be implemented? If we can do that, Jake, I think we could reasonably, with the safety of the American people in mind, pull back on some of the restrictions.

But you got to have all the players and all the material in place. That's what we're trying to do.

And, he said, in some places everything is in place, but in other places, they're not.

It still is not a perfect situation, because I'm sure people will be calling up and saying, I needed to get a test, and I couldn't get it. Hopefully, that's much, much less frequently than we saw a week or two ago.

Fauci also said when we get the rapid tests, the ones that let you know if a matter of minutes whether or not someone's infected, and you can get them out of circulation, we'd be closer to being able to lift the restrictions. It's good to know that's the kind of stuff he's bringing to the task force table.

On other subjects, he said based on his experience, he tends to believe my Sonofa Gov, so when he said he needed 30,000 ventilators, again there's the potential issue of accessibility to existing ventilators, but if he says he needs more, give him more.

One way or the other, he needs the ventilators that he needs. And, hopefully, we will get him the ventilators that he needs. They may be closer to him than is realized. But if they're not, we will get them there. And if they are, we will try to help him get access to the ones that are there. 

Bottom line, he's got to have the ventilators, period.

The last question was about Trumpian rhetoric, his saying that people are not being appreciative of him, the Army Corps, FEMA, and so on, and whether the American people will get what they need from the federal government regardless of whether or not their governors are "appreciative enough of the federal help or flattering enough of the Trump Administration?

Jake, I think the reality, not the rhetoric, but the reality is that the people who need things will get what they need. There's the reality and the rhetoric. I think that -- I mean, I know the spirit of the task force, and when we talk about, when people need things, doesn't matter who they are. We try to get them what they need.

Three cheers for having an adult in the room, right? 

See you around the virtual campus.