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“Our Country Was not Built to Be Shutdown”

Breaking: Trump says “protocols will be released to cautiously allow local communities to resume activities. Let’s get back to work. Our country was not built to be shut down.” “American will again and sooner be open for business. “We are not going to let the cure be worse than the problem.” At the end of the 15 day period a decision will be made.…see more

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Boris Johnson Addresses the Nation, puts Britain under Lockdown

“Without a huge national effort to halt the growth of this virus, there will come a moment when no health services in the world could possibly cope, because there won’t be enough ventilators, enough intensive care beds, enough doctors and nurses. And as we have seen elsewhere in other countries that also have fantastic health care systems, that is the moment of real danger. To put it simply, if too many people become seriouslyunwell at one time, the NHS will not be able to handle it. Meaning more people are likely to die, not just from coronavirus but from other illnesses as well. So it is vital to slow the spread of the disease because that is the way we reduce the number of people needing hospital treatment at any one time. So we can protect the NHS’s ability to cope and save more lives. And that is why we’ve been asking people to stay home during this pandemic. And though huge numbers are complying and I thank you all, the time has now come for us all to do more “

From this evening I must give the British people a very simple instruction. You must stay at home. Because the critical thing we must do to stop the disease spreading between households. That is why people will only be allowed to leave their home for the following very limited purposes.

Shopping for basic necessities as infrequently as possible.

One form of exercise a day, for example, a walk, a run, cycle with alone or with members of your household .

Any medical need to provide care or help a vulnerable person.

And traveling to and from work, but only where this is absolutely necessary and cannot be done from home. These are the only reasons you should be leaving home.

You should not be meeting friends. If your friends ask you to meet, you should say no. You should not be meeting family members who do not live in your home. You should not be going shopping except for essentials and medicine and you should do this as little as you can. And use food delivery service where you can. If you don’t follow the rules, the police will have the power to enforce them, including through fines and dispersing gatherings.

To ensure compliance with the government’s instruction to stay home, we will immediately close all shops selling non-essential goods including clothing and electronic stores, and other premises including libraries, gyms, and places of worship. We will stop all gatherings of more than two people in public, excluding people you live with. . We will stop all social events, weddings, baptisms, but excluding funerals. Parks will remain open for exercise, but gatherings will be disbursed.

No Prime Minister wants to enact measures like this. I know the damage that this disruption is doing and will do to people’s lives, to their business and to their jobs. And that’s why we produced a huge and unprecedented program of support both for workers and for business. And I can assure you that we will keep these restrictions under constant review. We will look again in three weeks and relax them if the evidence shows we are able to, but at present there are just no easy options. The way ahead is hard. And it is still true that many lives will sadly be lost. And it is also true hat there is a clear way through.

Day by day we are strengthening our amazing NHS. We have 7500 former clinicians now coming back to the service. With the time you buy, by simply staying at home, we are increasing our stocks of equipment. We are accelerating our search for treatments. We’re pioneering work on a vaccine. And we’re buying millions of testing kits that will enable us to turn the tide on this invisible killer.

I want to thank everyone who is working flat out to beat the virus. Everyone from the supermarket staff to the transport workers to the carers to the nurses and doctors on the frontline. In this fight we can be in no doubt that each and everyone of us is directly enlisted. Each and everyone of us is now obliged to join together, to halt the spread of this disease to protect our NHS and to save many, many thousands of lives. and I know that as they have in the past, so many times, the people The people of this country will rise to that challenge And we will come through it stronger than ever. We will beat the Coronavirus and we will beat it together. And therefore I urge you, in this time of national emergency to stay at home, protect our NHS, and save lives. Thank you.”

(NHS is the 5th latest employer in the world. A big move for the UK.)

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15 Days and America Goes Back To Work, Trump will make the call

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? 

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Morning Roundup

  1. Likely when 15 days is up, we all just go back to work and keep the vulnerable protected. Tweeted by Trump. We can’t let the cure be worse than the problem itself. Will decide at the end of 15 days. .
  2. Central Banks buying bonds to tame markets. Mortgage Bond Sales Flood Markets
  3. Fed Emergency central bank purchase of US government bond and mortgage backed security to support market function.
  4. China talks of a repaid economic rebound. Hong Kong in deep.
  5. Senate grapples to pass $1.6 trillion stimulus by end of day after Dems blocked Sunday. Debate is centered on Exchange Stabilization Fund ($500 million) prevention of layoffs. Rs say Dems are throwing in unrelated goodies including expanding collective bargaining for unions, increased fuel emission standards for airlines, wind and solar credits.
  6. US regulators ease borrowing constraints
  7. 5 GOP Senators quarantined
  8. UK non-urgent business reports delayed
  9. Lebanon Debt Insurance payout coming after committee ruling.
  10. National Guard activated by President and will bring medical supplies to New York, Cali, Washington. The Hill
  11. Louisiana, Ohio, Delaware strict-stay home orders aside from essentials, invoked
  12. Tokyo says games will not be cancelled. Canada, Australia pull out of Tokyo Olympics
  13. Retail Industry crisis letter sent by 90 business groups to White House
  14. WHO released global update report Sunday, circulated by White House
  15. Biosecurity Report says for vulnerable, reduce visits to medically necessary Integrate Medical Reserve Corps, Reduce Internal Activities, Clean and Disinfect, Use Personal Protective Equipment, gloves, gowns, face masks, fitted respirators, eye protection. Implement an dLTCF Help Line. Encourage Family to take residents home where possible.
  16. 15 Americans tested positive for Covid-19 Feb 28. Today positive tests 17,000. Real infection number predicted to be 87,000 by virologist Trevor Bedford. Defense One
  17. In Italy quarantine violators get yelled at by politicians