Sunday School 1/24/21: Extra Credit

I'm sure many of you have heard about Dr. Deborah Birx's interview with Margaret Brennan in the Face the Nation classroom. A few excerpts have been making the rounds, including this one.

I saw the President presenting graphs that I never made. So, I know that someone-- or someone out there or someone inside was creating a parallel set of data and graphics that were shown to the President. I know what I sent up and I know that what was in his hands was different from that. You can't do that.

What else did she have to say? Well, she knew, at the end of last February, that we were going to be facing a pandemic based on what she had seen from China. 

...when you overwhelm your hospitals, you have to know that you have broad-based community spread before that happens. Yet they weren't seeing it. And that really worried me because what we were looking for is people with symptoms. And so, when people were coming into the country, we were looking for people with symptoms...  This is exactly how we missed the HIV pandemic. If you're only looking for sick people, you miss a lot of the-- what is really happening under the surface...So, when we were questioning people who came into this country about symptoms rather than testing everybody who came into the country, that's when I started to get really worried. 

President Obama appointed her for the AIDS effort, but thinking about how she's going to be forever linked to president Trump doesn't sit well with her.

Well, you know, this is what worries me. If we start looking at technical civil servants as belonging to a political party, we will lose the ability for highly qualified civil servants to come and help. If we start saying if you come in and do this, you are then going to be part of the political apparatus, that is going to be very dangerous for this country.

She did say that "pandemics are always political," because to tackle them, you almost always have to change policies. But even with her experience working on AIDS, nothing prepared her for the politics of the coronavirus in the White House.

White Houses function in a pretty-- a pretty bureaucratic way, and most of the agencies function in a very predictable and bureaucratic way. But when you remove the infrastructure of the civil servants, then you end up with a lot more very quick right turns, left turns, right turns, left turns, and that-- that becomes less predictable and less able to manage that kind of response and change. 

When asked whether there were COVID deniers in the White House, she said in the White House and elsewhere, "there were people who definitely believed that this was a hoax." Partly because information was confusing, and because people saw others who got COVID and were fine, and 

When you have a pandemic where you're relying on every American to change their behavior communication is absolutely key. And so, every time a-- a statement was made by a political leader that wasn't consistent with public health needs, that derailed our response. It is also why I went out on the road because I wasn't censored on the road.

Birx noted she wasn't doing national press, and also that she wasn't "going to go outside the chain of command," and ask to go out and talk to the press if she wasn't asked to 

because there was so much leaking and so many parallel stories being leaked to the press that did not have grounding in truth that I didn't want to ever be part of that slippery slope. I know people started it with good intentions of trying to inform the American people, but then it became a way that they could silence those who didn't agree with them. And so I knew that every time I had a significant disagreement in the White House that within days a story would be planted... I think a lot of people were doing that.

She realized that speaking directly to the governors was the best way to get her information out, and that she, former FDA Commissioner Steve Hahn, former FDA chief Robert Redfield, and Dr. Fauci "would make sure we got the information out to the public one way or another." She considered quitting, "Always. I mean, why would you want to put yourself through that, every day?" That didn't get any better after the 'bleach' incident.

When you're a scientist who's grounded themselves in data and combating epidemics and working with communities and working with governments to change the future of people's lives for the better and then you get-- this is what-- when you talked about, was I prepared for that? No, I wasn't prepared for that. I didn't even know what to do in that moment.

That moment included becoming a character in an SNL skit. 

Birx agreed when Brennan asked if the "fundamental question" is whether we should leave it up to the states to handle a pandemic. They talked about some of the governors who not only had to deal with the president not wearing a mask, pushing them to keep everything open, and whatnot, but also with their own state legislators and state parties.

You needed every single level of government then to work together to ensure that, again, we're talking about behavioral change of American citizens.

About that behavior change? Birx said there were only two people at the White House who regularly wore a mask - she and the support person she had from HHS.  No one else. In trying to explain that, Birx said she thought "people believed wrongly that testing would be adequate ...that they believe that testing is a surrogate for a public health intervention." And, she said

There are multiple communications about masking. Remember when I was talking about the stream of data coming in? They were mixing data that didn't have anything to do with the relevance of masking as a public health measure to changing into masking as a personal protective measure.

Birx also said that she knew going to work at the White House to try and coordinate a pandemic response would be a "terminal event" for her career. 

I know that I wouldn't be allowed to really continue successfully within the federal government. You can't go into something that's that polarized and not believe that you won't be tainted by that experience or how people interpret you in that experience. So I knew that part of it. I didn't want that to happen.

Here's Birx's response when Brennan asked if "this will be the end of your federal career."

Yeah. I will need to retire probably within the next four to six weeks from CDC."

Her experience may keep good people from going into public service, which would be a shame.

See you around campus.

Wondering on Wednesday 12/23/20

Ready... Set... Wonder!

There's so much wondering in my head today. For example:

Who will be in the next round of pardons, clemencies and commutations? 

Why is the United States considering offering immunity to Prince Mohammed bin Salman, the Saudi royal who's such a good What's App friend of Jared Kushner, for his role in the murder of Jamal Khashoggi?

Who will be the next target that the president will attack, now that he's gone after the #2 Republican in the Senate? Any guesses?

Why are people all of the sudden worried about foreign policy? Why haven't they been complaining all along? And why are reporters and politicians lying about it?

Why did the president decide, suddenly, to be interested in the pandemic spending bill once it had been approved, after not paying attention - for months?

If you don't put out cookies for Santa Claus, does he get free returns on your stuff? And does he keep all those receipts? 

How many Bed, Bath and Beyond coupons do you think they get at the North Pole, anyway? And, of course, while I'm typing this, a BB&B coupon landed in my inbox... 

We've been listening to our collection of Christmas CDs (we're old - we don't stream) and my husband said that the "Mayhem Steamroller" tunes would be coming up soon... and can't you just picture THAT Allstate commercial? 

How do we get out of the mess, all of this stuff I posted yesterday?

Why are people STILL so concerned about the House Speaker's ice cream habit? And why do people think that she could fund the stimulus with it? And am I a bad person for buying craft ice cream myself?

How many people will follow the applicable COVID restrictions where they live? How many of the three million+ people who've moved through TSA airport screening checkpoints around the country are going to quarantine when they get off the plane? 

How much does Dr. Deborah Birx regret travelling with multiple generations of her family?

News is breaking that the president has vetoed the National Defense Authorization Act, the $740B military spending plan, mostly (he's said in the past) because it allows for renaming military bases, and because it doesn't remove protections for Twitter and Facebook, which have aggressively labelled his posts as fake news - and, really on both, what do they have to do with the military? 

How long will it take for his veto to be over-ridden? Probably not long.  And does Trump know he's the first to not sign the bill in nearly sixty years? And does he consider being the first another notch in his #winning  hair spray bottle? 

Should pandemic-denying Republican members of the House and Senate be getting the vaccine ahead of front line health care providers, the elderly, essential workers, and folks of all ages with pre-existing conditions? Are they really that much more valuable or that much more worthy of the protections than, say, my 90-year-old-with-a-heart-condition Mom?

What are you wondering about?

Sunday School 12/6/20: Extra Credit

In this week's Sunday School, we talked to Republicans about the election. For your Extra Credit, let's talk with some of the pandemic experts, starting with Dr. Deborah Birx, who visited the Meet the Press classroom.

Chuck Todd wondered what Birx would say to frustrated healthcare workers, what with the new CDC guidelines on indoor mask wearing, and at the same time we've got a boatload of parties being thrown by the president and others in the administration.

I think it's really important that every single person understands that the way this virus is spread is if you're with anyone indoors without a mask, that's a viral spreading opportunity. If you're outdoors and hugging and kissing individuals, that is a viral spreading opportunity... And we have to listen right now to what we know works, which is mask, physical distancing, washing your hands. But not gathering. You cannot gather without masks in any indoor or close outdoor situation.

And, she's frustrated, too, with people making the arguments that mask don't work, we need herd immunity, that gatherings don't turn into superspreaders, and with the many areas where leaders aren't putting in the necessary restrictions. 

... this fall/winter surge is combining everything that we saw in the spring with everything that we saw in the summer, plus the fall surge going into a winter surge. And I think that's why Dr. Redfield made this absolute appeal to the American people. This is not just the worst public health event. This is the worst event that this country will face, not just from a public health side. Yet, we know what behaviors spread the virus and we know how to change those behaviors to stop spreading the virus.

She said that all states are trying to get things under control, but they all need to do more, including "critically informing their state population that the gatherings we saw in Thanksgiving will lead to a surge" and we can't have a 'it doesn't apply to me" attitude.

... You cannot gather with your mask off. You cannot hug and kiss people outside. We won't have a vaccine for even the most vulnerable Americans -- I'm thrilled with the vaccine. But we won't have them for the most vulnerable Americans until February. So we need to do this now.

Christmas travel is dangerous "because it mixes households" and because we don't know who the asymptomatic carriers are. She said  we need to increase testing of asymptomatic people, to identify people with the virus so we can stop them from spreading it. That's a huge change from how we test now, and would antagonize the president if he were paying attention.

And, of course, everything she's saying we need to do is being ignored by the president and members of his cabinet, or contradicted by them, including HHS Secretary Alex Azar, who visited the Fox News Sunday classroom.

Wallace played a clip of CDC Director Robert Redfield saying, "The reality is December and January and February are going to be rough times. I actually believe they're going to be the most difficult time in the public health history of this nation," and asked Azar if this was the result of "a massive failure by president Trump and his administration?" 

Azar blamed the weather. Well, the weather and something else. 

It's about behavior and cold weather. People are going indoors. They're not minding the three Ws. They're not wearing their face coverings. We're engaged in indoor behaviors where we let our guard down.  We need people to renew their commitment. 

He tried to change the subject, but Wallace stayed on topic, mentioning President-elect Biden's plan to ask for a 100-day mask-wearing commitment, as opposed to  president Trump saying back in April that he wouldn't be wearing a mask, and that it was voluntary, not necessary

This is when Azar referred to 'Vice President Biden,' and where he ignored two corrections by Wallace on that point. And this is where he tried to convince us that Trump is doing enough, and that all of his top advisors tell people to wear masks. Wallace refreshed Azar on Trump's maskless behavior, including his Georgia rally just the night before.

Chris, our advice is always the same, wash your hands, watch your distance, wear face coverings when you can't watch your distance and be especially careful of those settings like overcrowded indoor bars and restaurants or multi-family household gatherings where you're going to let your guard down and take that face covering off. So, Chris, our advice is the same, regardless of the setting.

It's hopeless, trying to get these folks to admit the president is unhelpful, or doing the wrong thing, or not saying the right thing. It's hopeless.

And here's the contradiction with Birx on mitigation efforts. Wallace asked about lockdowns, which Azar said were not necessary.

Chris, our community mitigation efforts have to be based in science and evidence or we lose public support and compliance for them. We know that our workplaces, our universities, our K-12 schools, flying on airplanes are not major vectors of disease transmission. It's overcrowded indoor restaurants and bars, it is multi-household indoor gatherings where we let our guard down. These are the things we need to protect against. If we go too far - and we defer to governors on the steps they need to take. It's their call. But we -- if we go beyond science and evidence, we will undermine public support... 

We won't get a unified voice, from the president on down, from this administration, but I expect we will from the next one.. 

Finally, the head of Operation Warp Speed, Dr. Moncef Slaoui, was in the CNN SOTU classroom. Tapper asked when we might see results from the vaccine, such as improvements in our death and hospitalization numbers. 

The vaccine efficacy, as we have seen it, actually starts reasonably quickly after the first dose of vaccine, and then is further maintained with the second dose. And, therefore, I am hopeful that, by the end of the month of January, we should already see a quite a significant decrease in the mortality and severe morbidity associated in the elderly population. 

He also said we don't know whether a person who's vaccinated will still be able to spread the virus, even if they're now no longer at risk. He thinks most folks will "control the virus" and not be infectious to others.

That work, we may have a first answer to it somewhere in February/March from the trial that we have conducted already, further analysis and some analysis in blood and things like that. But there are also -- we're discussing clinical trials where we may be able to assess whether people actually, on a daily basis, shed virus or stop shedding the virus when they have been immunized and exposed to this -- to the infection. 

Similarly, we don't know for sure on how long immunity will last, or if this'll become a seasonal vaccine we need.

...based on science and experience I have, this vaccine effectiveness will be long-lasting, because one of the hallmark of our immune system is, it has memory. It remembers everything we learned. It learned. And when it sees the virus again, it responds to it much, much faster than when it sees it the first time. I think that process of memory is likely to prolong our protection for probably a few years, and maybe many, many years. 

Tapper mentioned polling showing that "less than half of black Americans say they will get a coronavirus vaccine if one were available today." Slaoui said they've been working with everyone -- "NIH leadership, with the surgeon general, with all the leaders that we could" to engage the minority population, including to get clinical trial participants. And he said

Nobody is being used as a guinea pig. Unfortunately, this virus is impacting the African-American population and the Hispanics two and four times more than it does to the Caucasian part of our country. And we have to stop that. It's really very, very important that people take the time to listen to the data, listen to the people they trust that have some expertise. Please don't make your opinion outside of having listened to the data and to experts you trust. When that happens, I feel confident you will agree to be immunized. And that can help save your life.

As they closed the interview, Slaoui said he expects the FDA advisory panel to approve the Pfizer vaccine when it meets later this week.  

Masks on, folks, and I'll see you around campus. But you won't catch me in a plane anytime soon, I can assure you.

Sunday School 8/2/20

Here are your highlights from Sunday morning classrooms.

First up? Dana Bash and Dr. Deborah Birx on CNN's State of the Union, starting with whether we're in a new phase of the virus.

What we are seeing today is different from March and April. It is extraordinarily widespread. It's into the rural as equal (to) urban areas. And to everybody who lives in a rural area, you are not immune or protected from this virus. And that is why we keep saying, no matter where you live in America, you need to wear a mask and socially distance, do the personal hygiene pieces... This epidemic right now is different, and it's wide -- it's more widespread. 

On whether we need a federal government 'reset'; it's been suggested by folks at Johns Hopkins, who said "The United States is not currently on course to get control of the epidemic. It's time to reset." 

Well, I think the federal government reset about five to six weeks ago, when we saw this starting to happen across the South. And that is why we have done these very -- rather than generic federal framework, we have gone to very specific state and local, city by city, county by county, showing out which counties and which cities are under a particular threat and what mitigation has to be done.

On whether it's possible we could see 300,000 deaths by the end of the year, as has been suggested by former FDA head Scott Gottlieb:

-- you know, public health is called public health because it has a public component. And we need all of the public to help us get control of this virus. If we still are going to parties at home, even though the bars are closed, if we are creating interactions where we know it's not safe, because there's multiple people there, and you don't have masks on, and you're not socially distanced, you can assume...  It's not super-spreading individuals. It's super-spreading events. And we need to stop those. We definitely need to take more precautions.

I think I have to agree with many who've suggested that she's converted from scientist to apologist and cheerleader for the administration. Either that, or she's been learning howto not answer questions from Mike Pence.

Over in NBC's Meet the Press classroom, Chuck Todd and Adm. Brett Giroir, the testing guy for the White House Coronavirus Task Force, chatted about things, including whether we're "ever going to be able to get this testing strategy right":

...we've increased our testing by 32,000%. We're completing over 80% of our tests within three days, almost 90%t within five days. Of course, we're going to improve that. We're continuing to improve that. By September, we'll have over 23 million point-of-care tests, so we are improving that. But I do want to get the opportunity to put testing in context. And I think that's very important. How we use it, how we rely on it, and how we fix the outbreak right now by using testing selectively the way we're doing it in all the southern states.

On whether we're doing selective testing (based on defined risk or symptom criteria, rather than "if you want a test, you can get a test") because we don't have capacity, and if that's the case, why aren't we using the Defense Production Act (DPA):

We look every day for opportunities to use the DPA or other investments. And when it's possible to do that, we do that... The DPA is not a magic wand. It can't create something out of nothing. It can be used as an effective tool, and that's the way we're doing it. But testing is a part of the strategy. We don't test our way out of this. We do smart policies with testing as an adjunct... And you know what that is. Wear a mask, avoid crowded indoor places, use good hygiene, and avoid crowds. And if we do those things, that will reduce the overall outbreak to levels that will go down significantly. And that's what we're seeing across the South.

On whether the Task Force is recommending "partial shutdowns" in the red zone states:

 ...both for the red zone states and the emerging yellow states, we have really good data now... that if you do simple measures like avoid the indoor crowded places, and a lot of times that are indoor bars, but you can't have a hundred people at your house either. Do less indoor dining, because that's another place. Wearing a mask is incredibly important, but we have to have like 85% or 90% of individuals wearing a mask and avoiding crowds. That is essentially -- gives you the same outcome as a complete shutdown. 

And on whether hydroxychloroquine is a danger to public health:

... at first hydroxychloroquine looked very promising. There were not the definitive studies. At this point in time, there has been five randomized controlled, placebo-controlled trials that do not show any benefit to hydroxychloroquine. So, at this point in time, we don't recommend that as a treatment. There's no evidence to show that it is... Right now, hydroxychloroquine, I can't recommend that.

...hydroxychloroquine needs to be prescribed by a physician. There may be circumstances, I don't know what they are, where a physician may prescribe it for an individual. But I think most physicians and prescribers are evidence-based and they're not influenced by whatever is on Twitter or anything else. And the evidence just doesn't show that hydroxychloroquine is effective right now. I think we need to move on from that and talk about what is effective.

That would be hand-washing, mask-wearing, social distancing, and the like. And some better treatment protocols, too. But not hydroxychloroquine.

And our last drop in? That was the Face the Nation hall, where John Dickerson talked with Neel Kashkari, the head of the Minneapolis Fed, where the first question was what Kashkari saw inside the horrible Q2 GDP numbers:

The US personal savings rate has taken off. Before the crisis, it was around 8%. Now it's around 20%. Now, let me tell you what's going on. Those of us who are fortunate enough to still have our jobs, we're saving a lot more money because we're not going to restaurants or movie theaters or vacations. That actually means we have a lot more resources as a country to support those who've been laid off. And so while historically we would worry about racking up too much debt, we're generating this savings ourselves. That means Congress has the resources to support those who are most hurting.

On whether racking up debt will be something we have to deal with eventually: 

It's simply not an issue because we're not having to go abroad to fund these extra- the extra money for the CARES Act or whatever is to come. So that provides a lot of relief right now. And if you look over the long term, our inflation has been very low. Inflation continues to be low. Inflation expectations continue to drift lower. Right now, the US can fund itself at very, very low rates. Congress should use this opportunity to support the American people and the American economy. I'm not worried about it. We- if we get the economy growing, we will be able to pay off the debt.

On whether he's seen any evidence that supports the Republican argument that the $600 bonus unemployment is keeping people at home instead of working:

Well, not right now, not when 20 million people are out of work relative to February. There's just so many fewer jobs than there are workers available. At some point it'll be an issue. When we get the unemployment rate eventually back down to 5% and we want to get it back down to 4% or 3.5% where it was before, yes, that disincentive to work becomes material. But right now, it's simply not a factor in the macro economy that we have in the US because we have so many millions of Americans out of work.

On what role fear plays in Kashkari's assessment of our economic behavior, particularly given our consumer-driven economy:

Oh, fear's a huge factor. You can see this around the world. Some countries that didn't lock down officially based on public policy had a similar economic response because their own citizens were afraid and they said, no, I'm not taking that risk. I'm going to shelter at home. And so we all - many of your viewers, the American people, are paying close attention to what's happening to the virus. And you're seeing a similar economic behavior around the country, regardless of local public policy.

So fear is a huge driver, and that's why they need to have confidence that they will be safe, their families will be safe, their kids will be safe. And until we have that real confidence, not just wishful thinking, but in the data, real evidence that it's safe, we're not going to have a meaningful economic recovery.

Do you agree? At some point, do we just need to stop being afraid? And what data will it take for us to get there? Kids going back to school safely?  I'm not sure... 

Whether you're afraid or not, be sure you're doing your part, and remember what Admiral Giroir says:

Wear a mask, avoid crowded indoor places, use good hygiene, and avoid crowds. 

Stay safe; I'll see you around the virtual campus. 

TGIF 6/19/20

Oh, what a week it was... Here's just a slice.

Take John Bolton. Liar, or teller of the most secrety of our secrety stuff? Money-hungry man without a conscience, or money-hungry man without a conscience? A would-be do-gooder, if only there'd been a subpoena, or a man who doesn't really give a rat about our country and protecting it from the Trumpeters?

Could he be all of those rolled into one? Seems like the answer is yes, or sorta kinda maybe. Here's one take on it, from The Atlantic. The author, Thomas Wright, gives a litany of reasons (and likely not a full list, it sounds) of why he's no fan of Bolton, only to land here:

But I have to acknowledge that Bolton behaved honorably as national security adviser when he told his staff to report illegality to the White House lawyers. He also defended those who served under him against Trump loyalists. He is right to publish his book. If he gives a full accounting of what he saw as national security adviser—and from a recent article in The New York Times and an excerpt in The Wall Street Journal, it seems he might have—he deserves credit for it regardless of what he did or did not do during the impeachment hearings and trial. He will have done the nation a service.

ABC's Martha Raddatz has Bolton exclusively, Sunday night; check your local listings.

And speaking of John Bolton, Mick Mulvaney - remember him, the acting chief of staff who was exiled to Ireland to serve as chief groundskeeper or something at Trump's golf course?  Among other things, Mulvaney said something to the effect that no one else who was in The Room Where it Happened mentioned anything inappropriate. And I had to laugh at that - as if Mulvaney, Pompeo, or others still in Trump's universe would recognize anything as being in appropriate? I mean, they thought an obvious quid pro quo was nothing other than a perfect phone call, for Pete's sake.

And speaking of Pete's sake, here's the question NBC's Peter Alexander asked at the presser today.

Why does the president keep hiring people who are dumb as a rock, overrated, way over their heads, whack' and incompetent?

The answer, from Press Secretary Kayleigh McEnany? Trump likes "countervailing opinions" and likes to balance his own opinion with those who disagree with him, similar to Lincoln's Team of Rivals model. Except that the words Alexander used in his question are Trump's words, used to describe former staffers - and they did actually apply to Bolton, she added.

And, McEnany went on to say that even the FAILING NEW YORK TIMES!!! which is often FAKE NEWS!!! and which NOBODY READS ANYWAY!! because they're losing subscribers left and right has criticized Bolton. Except, I have to correct the part about the Times losing subscribers left and right - because they didn't have any 'right' ones, right? I mean left? Or something?

Mulvaney, for his part, felt safe in saying that the president isn't good at hiring people.

And speaking of the president, he's having his love-fest tomorrow in Tulsa OK, against the advice of Drs. Anthony Fauci and Deborah Birx, according to this NBC News report. I guess the docs are part of the 'team of rivals' on the White House Coronavirus Task Force?  Anyway, a couple of days ago, Fauci said he would not ("of course not") attend any of Trump rallies, being in a high-risk category, and he added

outside is better than inside, no crowd is better than crowd, and crowd is better than big crowd.

And speaking of crowds (sheesh, this whole post reads like an ad for Segues, doesn't it?), the president had this to say about what might happen in Tulsa.

And, now we learn how it will be "a much different scene" - some 250 National Guard soldiers will be there, unarmed except for shields, batons, and pepper spray, to help keep the peace. Of course, it could have been a very much different scene entirely, but the Oklahoma Supreme Court refused to issue an injunction keeping the rally from going on as planned, saying there was no law requiring masks or physical distancing.

And speaking of the National Guard, it seems some of the folks who were called to duty helping out with coronavirus efforts will be one day short of the 90-day deployment requirement for benefit eligibility.

The issue arose after the administration decided to end federal deployment orders for National Guard members on June 24. The decision would leave some who were placed under federal orders in late March just short of reaching a 90-day threshold that would allow them to collect retirement benefits early, before turning 60. The date also would cut short access to some GI Bill benefits, though that could be earned later.

Which stinks, especially when "we love the military." I can't imagine that no one knew that picking this specific date - a seemingly random Wednesday - would ensure that so many folks who put themselves on the line when asked to, who were away from their families helping protect the country from an invisible Chinese enemy, were going to be treated this way.

I'll leave you with this closing thought. My Sonofa Gov, Andrew Cuomo, is ending his daily coronavirus briefings. No word on whether he's also ending his participation in the Cuomo Brothers show on CNN.

TGIF, everyone.

Sunday School Extra Credit 5/3/20

In our Sunday School post this week, we heard from five governors In this Extra Credit post, we'll give the medical folks their turn.

First up? Dr. Deborah Birx, who talked with Chris Wallace on Fox News Sunday. Now Birx has been a regular on the shows, replacing Dr. Fauci as the face of Trump's medical and household disinfectant task force, so we'll move here stuff pretty quickly. (As an aside, I miss Dr. Fauci.)

• She thinks the gating criteria and the phased reopening guidelines are a "pretty firm policy" even though no state has met them and many are reopening anyway. And she said that states have been asked to make all of their data public, including where they are with the gating criteria. She pointed to Florida, a state that has had issues around reporting COVID-19 data, as a example of a state doing that right.
• Protesting without masks is "devastatingly worrisome" to her personally, and people need to protect each other while voicing discontent. We'll have to see if that happens; it seems unlikely based on what we've seen so far.
• On paper, at least, it's possible there'll be a vaccine by January of 2021, by moving forward with multiple candidates and compressing the phases without sacrificing safety. But, "it's whether we can execute, and execute around the globe."  

Next up we have Dr. Tom Inglesby talking with Chuck Todd on MTP. Inglesby's from the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. He expressed some concern about states moving forward, while recognizing that they're not all the same from a COVID-19 standpoint. He focused on areas being able to "rapidly isolate and trace contacts" and diagnose everyone who has symptoms of the virus as being the 'least risky" places to begin reopening. He said it's going to be two or three weeks before we'll know the impact of the reopening, due to the incubation period of the virus.

He said that "it's like a patchwork across the country" in terms of access to and "the operations around" testing, in contrast to what the White House has maintained. He noted in some places the percentage of people testing positive is very low, while in others it's very high, and said "that's worrisome." And more diagnostic testing is important because we're not capturing the mildly or moderately sick folks now, so we "can't break their chains of transmission."

Finally, on whether he's worried about a "bad fall outcome" if we don't see advancements on treatment or a vaccine, Inglesby is worried even before we get to fall. 

Nothing has changed in the underlying dynamics of this virus. If we stop social distancing all together tomorrow, we would recreate the conditions that existed in the country in February and March. So what we need to do is continue, to our best possible effort, all the individual efforts we're making around social distancing...the extent to which we're able to do that over the next couple of months will dictate how we do as states and as a country.

Because, as he reminded us, in the fall we'll still have COVID and we'll have the flu, at the same time, and together they'll impact hospitalizations, and

...I don't think people should think that there will be a lull. That just because the summer's coming we're going to have a lull before the fall. It'd be wonderful if that happens. But I don't think we should at all assume that at this point given the nature of this virus. 

Dr. Ingelsby was not the only expert sitting down with Chuck; he also talked with Dr. Scott Harris from the Alabama Department of Public Health and Dr. Joneigh Khaldun, who's with the Michigan Department of Health and Human Services.

Harris said that they reopened in Alabama in a very gradual way, not a full 'phase 1' thing like was in the WH guidelines, given how things were going there. He also said that testing is "really unevenly distributed" with folks in rural areas facing more barriers, such as transportation or access to a health care provider.

In Michigan, Dr. Khaldun said, they have seen burdens on hospitals, capacity not being where it needs to be and testing also falling a little short. He's "cautiously optimistic" but they "need to be very careful." They're looking at regional data on a daily basis, tracking outbreaks, and also paying attention to hospital capacity and what not - basically, every region of the state is different.

Chuck asked them if they were feeling pressure to move things along and speed things up. While Khaldun said no, Harris said the pressure is "significant," noting that lots of folks in his state don't have an option to make a living now, and they need to try and "balance the health of the economy with the health of average Alabamians." He agreed that, with Georgia being more aggressive with reopening, they have to be careful and he plans to watch what happens there closely. And, he said,

...we certainly will consider dialing things back if we see an increase in cases... I think that's the approach - that probably all states would want to take.

And finally, Chuck had Sir John Bell, from Oxford University to talk about a vaccine that's being tested there that shows some promise - and is ahead of some of the other vaccine projects. Referring to a colleague saying there was an 80% chance their vaccine would be "at least somewhat successful, in the next year," Bell was a little bit more circumspect. He said that was high, but the likelihood of success goes up every day.

They're looking to start some human trials, so they need to be able to test where there are outbreaks. Bell said there's no shortage of disease in the UK, and they've already given the vaccine to around 1,000 people, but they want to ramp up quickly.

We've consolidated a phase one and two programs because we are pretty confident that the vector itself is safe because it's been used in about 5,000 people already up to now. So that's allowed us to really accelerate the phase one program, and we hope that there would be enough disease that we would get evidence that the vaccine has efficacy by the beginning of June.

Chuck wondered if there was any chance their drug could be used as a therapeutic if it doesn't work as a vaccine, or how helpful the therapeutics like remdesivir are in terms of developing a vaccine.
Bell said remdesivir works completely differently than what they're doing, so there's probably no connection between them, but "both could be helpful steps" to get the virus under control.

On whether everyone's going too fast, and if safety protocols could be overlooked and what's being done to prevent that, Bell said that the efficacy of the vaccine, to generate "strong antibody responses" is good, but "the real question is whether the safety profile's going to be fine." And that's what the clinical studies focus on. They did all the preclinical work, he said, including "mouse, ferret, primate" tests which it sounds like some others might not have done.

And now, we're being very careful in the clinic to try and monitor exactly what's happening. But, you know, that doesn't mean there won't be safety signals, because there may well be. And we'll be on the alert to see if we can see them.

He said that there'll be data on the primate tests this week, referring to it as "an important milestone." After that, they'll look to see whether the vaccine worked to "largely eliminate" the disease in test group compared to a placebo group. 

...we'll probably get a signal based on current levels of the disease. We'll probably get a signal in early June. We're ready to move trials overseas if the disease peters out in the U.K. So we've got sites already in play in other bits of the world where it's active. So we're pretty sure we'll get a signal by June about whether this works or not.

And whether this will be like the annual flu vaccine, or just used to protect against this particular coronavirus, Bell said

... I suspect we may need to have relatively regular vaccinations against coronaviruses going into the future. That... of course remains to be seen, but that's my bet at the moment, is that this is likely to be a seasonal coronavirus vaccine.

 So, there you have it, from a host of experts:

• reopening is going to happen (hopefully carefully and with respect the relevant regional data), whether we're ready for it or not;
• we're not going to see a national policy on who can do what when, all we have are the guidelines we've already been given;
• there's a chance we'll see a vaccine sooner than later, although we don't know what kind it is; and
• we must continue to practice social distancing for the foreseeable future. 

You know the drill - wash your hands, cover your face, keep your distance - and I'll see you around the virtual campus.

Sunday School 4/26/20

Holy moly, the classrooms were packed today! I'll fit in what I can, and the rest will flow over into an Extra Credit post, sound good?

Stacey Abrams, the woman who has made it clear she wants to be Joe Biden's veep. was on with Chuck Todd on Meet the Press, as was Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.  Here are highlights of those discussions, starting with Abrams.

If she were governor of Georgia, it seems clear she would not have reopened until there was more testing and a reduced infection rate; she said reopening before those were in place "wrongheaded," noting the state's "14th highest infection rate and 7th slowest testing rate."  In response to Todd's question on how she'd "launch a national testing strategy" if she were in charge of the federal government. She likes what Congress is doing with the investment in testing, and funding for folks in the trenches,

But I would also be encouraging states like Georgia and the other southern states and Midwestern states that have refused to expand Medicaid to do so immediately. Part of testing is making sure people trust that they can go and be tested. And right now, there is an inadequate equipment, an inadequate strategy. We should increase production. We should make certain it's not simply the testing that's available but the mechanics, the swabs, the vials. And that we are funding people on the front-lines to do this work, to put themselves in harm's way, to make sure we can test, trace and track.

After some discussion on what skills a Biden VP should have, or what that person should bring to the table, she was asked if she thought it'd be a mistake if Papa Joe didn't pick a woman of color.

I think President, a President Biden will do what he has always done, which is respect and value communities of color. I think he understands that black communities and people of color are vital to the success of the Democratic Party. And I think he's going to pick the right person. I, of course, think that a woman of color can bring certain attributes. We have to lift up marginalized communities, communities that do not trust that they will be served because they’ve been the hardest hit by this pandemic.. And so, yes, having a woman of color on the ticket will help promote not only diversity, but trust. But I trust Joe Biden to pick the person he thinks is the right running mate for him.

And yes, of course, she's still interested in the position. 

Moving on to Osterholm, there was a lot of talk about testing. He said that "our government is not working with private sector companies," that "we have the wild wild west for testing right now. The FDA has all but given up its oversight responsibility," and that, "if you were to test for antibody in most places in the US, over half the tests would be false positives."

So what we need is a major, new initiative on testing that gets away from every day just saying how many people get tested. We're missing the mark in a big way right now.

Using the Defense Production Act to force companies to make what we need to be able to use the available testing capacity is part of the answer, but "we're competing against the world for the reagents" and we've not been clear what we want or need. We have "too much happy talk" and we need a "strategic plan that lays out why we are going to use the test, how we are going to use the test, when will it be available?" And finally, on which will come first, herd immunity or a vaccine, he said we'll have the former if we don't get the latter, but that he thinks "we have a better chance of a vaccine than some." 

Next up? Senator Amy Klobuchar, talking with George Stephanopoulos on This Week. She supports what Minnesota's governor is doing as far as stating to reopen things, as he's "been very careful and listened to the doctors and scientists" and they still have stay-at-home orders in place. And, like others who made the rounds today, she lamented the lack of a national strategy and "that there is an absence of national leadership." 

She said Dems are going to keep pushing for funds for state and local governments which are being hit so hard with all of this.  Short term, the goal is to get the state/local money; long term, it's "how we're going to make a steady economy so we can once again lead in the world. And we're not going to do it with this president."

And, does she think Minnesota is in play for November? 

No, I don't think Minnesota is in play because we want a real leader in the White House, and I am -- you know, the whole Midwest, when you look at what's happening with our biofuel plants, with our commodities, with what's happening with our poultry, this is not a good situation, and the president, in my mind, has never done enough when it comes to rural America, and now as they would say, the chickens coming home to roost and you have seen some real problems with people having to kill their chickens literally, because of what is going on right now with our rural economy. 

And finally, Dr. Deborah Birx and Jake Tapper on CNN's State of the Union. Their conversation started on testing, and why it's "taking so long" to fix things such as the shortage of nasal swabs, not enough people or equipment at labs, and so on.

Birx said in the beginning, there was only one platform for the labs, but now there are "six or seven platforms that they have to integrate" in order to use the capacity we have. Tapper asked about how our capitalist system - he's "glad we have it" - there isn't any financial incentive for companies to "do things out of the goodness of their hearts" and can't we use the DPA here to make sure the testing supplies get made?

Like others in the administration, Birx said that Trump has used the DPA, but didn't specify how it was being used here. Instead, she focused on what the FDA is doing behind the scenes to "unlock capacity day after day after day." (Trump himself has often tweeted about 'invoking the D but it in fact it's been used more as leverage than as a directive, which is what folks have asked for.)

She also noted that so much of what we need, from PPE to ventilators to testing supplies are not made in the USA,

And I think this is really a wakeup call for all of America to really ensure that we have internal capacity, because everybody's supply chains are very stressed right now... And so there's amazing positives, but there's also a real analysis of, after we move through this into the summer months, to really ensure that we have more vibrant internal, at least Northern Hemisphere and North America, supply chains that we can count on.

On concerns about seeing a surge in cases and deaths in states that are relaxing their stay-at-home orders but aren't following the Administration's guidelines. she said she's "always concerned" and said that's why they put out "key, key gating criteria" which included a focus on protecting health care workers and hospital capacity, and other things too. Basically, she gave a very detailed response which illustrated the point of Tapper's question - and he was not shy about pointing that out, either.

He said it seems like the states are on their own, and mentioned a CDC web site that's still not up and running with critical information on contact tracing, and asked if she thought states are ready to do what they're doing. given there's little evidence that they're meeting the gating criteria.

Her answer? Well, in a nutshell, CDC is doing more, but more importantly she spoke to all the ways that state and local officials are doing more, too. And they're sharing information with each other, and with CDC, and everyone is learning together.

We have never had to do this before as a country. And so we're learning, as a federal government, how to better support the states, and the states are learning how to share critical information about how we work through this together.

Not sure anyone should feel more confident about the states jumping early, without even meeting the case, death, and hospitalization metrics, much less the rest of it. But maybe it's just me.

They also talked about antibodies, and what we don't know about immunity; Birx said that the WHO is being cautious when they talk about that stuff. She thinks that all the data that's being collected by CDC, which is studying antibodies, and by the hospitals that are using plasma from recovered patients, the data is what's going to tell us what we need to know about antibodies.

I think what WHO was saying, we don't know how long that effective antibody lasts. And I think that is a question that we have to explore over the next few months and over the next few years. But I think everything that the WHO said should be happening, we're doing here in the United States to help the American people.

And finally, Tapper asked her "what should Americans know about disinfectants and the human body?" She defended the president, point to a "dialogue" he was having with the DHS guy, but that she made it clear to Trump - and he understood - that "it was not a treatment." She pointed to the DHS study as being important, and helpful in our understanding "how we can effectively create decontamination in different environments."

What bothered her about all of this - the scurrying to issue statements to protect Americans who might have acted on what the president was musing about - was not what he said, or that he said it. Rather, she's concerned that people are still taking about that, and not talking about all of the things that we're seeing that other countries didn't see - she mentioned a few of them - and that we need to have information so we can protect ourselves and each other. She wants us to move on,

to be able to get information to the American people that can help them protect each other and also help them understand how devastating this virus is to different age groups and different symptoms and different comorbidities.

If he would only let the task force do that, and if he wouldn't argue with his experts on camera, and if he wouldn't provide support to people who are ignoring his own guidelines, we might be at exactly the place Dr. Birx wants us to be in.

Lots to digest here, and I can assure you it's better digested from a safe social distance with nice clean hands.

See you around the virtual campus. 

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.