Back to Work , Trump will decide before Sunday on Back to Work call.
Trump is shifting. He sees the economic disaster and is listening to business pressure. His previous guides were more medical and scientific. Pence has pushed the full 15 days and the President seems willing to stick to that. Economic concerns are now more at the forefront. The rest period was meant to mobilize resources and get set up to preserve healthcare. American business may not make it two weeks.
Trump does not want to run an ER.
The administration’s thought process in calling to flatten the curve was based on the Imperial report. The policy became Flatten the Curve to get the medical system ready to handle 21 million predicted cases and up to 2.2 million deaths and slow the charge. The objective was both to prepare and save the healthcare sector. The healthcare system may crash anyway under lost revenues.
The administration bought some time to get public and private sectors to rally together to address issues. At this time however, the cost to healthcare of no longer operating is equally devastating. The industry is putting off elective procedures set in March to summer and shifting to delaying services and delaying screenings, that further delay treatments. US is uniquely positioned versus other nations. Italy is nationalized medicine. The income value of a knee operation is greater than the value of giving oxygen. Respiratory assistance bills at $9000-$20,000 and requires purchase orders of equipment that at the end of the epidemic is useless excess. When an out-patient procedure of high level expertise can net $20,000 a flooded hospital of Pneumonia presentations is not helpful to revenue.
New York failed to flatten. In part they refused shelter in place orders and had a cumbersome large vector population under 50 in Manhattan and some bad luck, such as the super spreader lawyer who infected 31 in New Rochelle in large and active church community. It may also be that the US has more super spreaders in a highly mobile free society. We are looking at New York hitting a need for 115,0000 IC beds and having only 50,0000 on the current disease model. They are not flat enough to continue current policy to the detriment of the economy. New York will be the guinea pig for the rest of the states but with a predicted 70% infection rate possible already in Manhattan, they may be able to return to work. States will also need revenues.
Economically, business can’t work from home. the design of 5% of workforce out works well, over that it gets sticky. Business leaders and organizations are calling for bailouts, assistance, and end to quarantine. Even Apple is struggling.
After 15 Days America will be told to go back to work, then it will be up to States and communities to decide over shelter orders and mitigations strategies with a federal and private sector helpline in place.
It will be a brief moment that Cuomo can remain center stage and call for what he thinks NY needs. That program is not going to run very long, particularly with haggling in the senate over recovery bills. If that relief bill is not passed right away, there is no shelter program. Low income workers need the money.
We predicted 21,000,000 ER visits and 2.2 million deaths. There will be peripheral additional deaths too of those who can’t get timely diagnosis and treatments and after shocks that might be much higher. During ‘08 cancer rates climbed for example.
Supply
Most of the predictions we can make about what the need will be and where it will occur is based in math. You can take the number of patients current and the R(0) of the virus and you know a lot about what happens next. You know the number of existing IC beds, doctors, can predict doctors who are well or ill, protective gear needs and predict what supplies are needed next based on all of those things.
Example I have harped on about is tubes for respirators, a disposable goods sold in only three global locations and in short supply. These attach to respirators. Italians reported to 3 d printing, great idea, they are about to be sued over it. S Korea is one hub. These tap into ventilators. A month ago it was test kits (test kits will be abandoned I predict and have limited use for people who are hypoxic or being discharged.) Last week it was masks and swabs, now suits, next up is tubes in a few weeks when supply runs out. You can assume that whatever people are screaming about now is old news and past thinking.
Soon we will have good numbers and see how it is handled in the test case NYC to build predictions of how it goes elsewhere.
Figure that staff will have an infection rate too so if there is a back to work allowance, then firms will operate with limited staff anyway for a 12 week period of infection cycles. it may be 15% then 30% then top out. Again it is a math question.
In Italy they are already acting on not caring for elder patients, so soon they may put that in writing. We are going to see selective care. We may also see people break the quarantine and defy orders.After 15 days of this, most people would rather drop dead than stay home.
Plotting Infection Rates
We have the Elisa antibody test on open source as developed by Mt Sinai. That should or may be rolled out to determine plotting the virus as well as return to work in other states who are earlier in the process. This is cheap and easy stuff both to produce and to do, not like the swabs that have loads of requirements. We should get to being able to test at select pharmacies or with a lab phlebotomist and get results and certificates for employers on a phone and reduce staff at home.
This week the political call to get everyone tested should subside. It is a waste of resources. An uninfected person today is infected tomorrow. Tests should only be given to folks that are blue or leaving hospital. Protocol is two tests to be let out.
New Problem Set Supply Chain
The entire project in my view is a supply chain problem and that is data driven and a lot of companies will want in on a national medical supply market. It has a national security components too so gov will buy in. This will be a discussion point this week. It is being talked about already, but it may take shape over the next few days.
We should resource ourselves to that project.
Specific Supply shortages
So we need specific items for which demand has risen exponentially, like tubes and vents. And the need is temporary. We should predict a hoarding problem People buy up potentially needed goods, medical centers will want to retain supplies during shortages. We have doctors writing names on N-95s to protect themselves. It will be dog eat dog. That will be part of the supply chain solution whereby new deliverable go to less affected under the promise that their goods ship to NYC now for example.
Items needed for doctors
Respirators
eye shields
hand cleaner
N95 Masks The only American manufacturer of N95 masks, based in Texas, has quadrupled production to one million per day.
Protective suits
Specialized kits required to run tests for the virus (Swab, reagent for testing, both in shortage)
Form-fitting respirators have been particularly short because critical components are made only in Asia and supply chains have been disrupted by the pandemic.
Healthy people have rushed to buy and exhausted supplies of masks for example.
There is a grassroots supply system going on too. Communities are supplying each other, locals donate N-95 to hospitals etc.
We see local, state, national interventions. Everyone needs logistics.
Building a National Medical Exchange
The future of Covid-19 is going to move to elegant supply chain. It is going to be let loose. It will need a national organization to oversee an market exchange. Run by private sector with a backbone of national security. Loads of dough in that for somebody.
The hoarding aspect can be mitigated too. Bu allowing new deliveries to go to Arkansas, Arkansas can sell to New York now.
There is a healthcare budgeting element to this too Healthcare has a cost associated with having a poor exchange of good and a lack of exchange of services. This pushes up the cost of doing business for medical centers.
Future Issues are Legal and Insurance
Finally massive legal battles over the week off work and deliverables on the way internationally where there have ben orders. And maybe insurance too. What is an act of God?