News and comment on the US, UK and Middle East, White House coverage
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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“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.)
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?
A tent has been set up at White House gates to take reporter’s temperatures. No open events until 5:30pm briefing today.
| DAILY GUIDANCE AND PRESS SCHEDULE FOR SUNDAY, MARCH 22, 2020 In-Town Pool Wires: AP, Reuters, Bloomberg Wire Photos: AP, Reuters, AFP, NYT TV Corr & Crew: FOX Print: USA Today Radio: VOA EDT 2:30PM In-House Pool Call Time THE PRESIDENT has no public events scheduled. Briefing Schedule 4:30PM Members of the Coronavirus Task Force hold a press briefing James S. Brady Briefing Room On Camera ### |
Senate Lockdown to Hammer out Mammoth Trillion Dollar Stimulus Package
Tax, healthcare, small business, and impacted industries are the focus of negotiations for a trillion dollar stimulus deal. Senators haggled over Trump’s one time $1200 check to individuals earning $75,000 or less. Scaling would occur $99,000 and below and nothing would be sent to anyone over that income. Democrats demanded unemployment insurance expansion.
Stabilization funds for states to use if their economies decline due to the virus are a debate point with Democrats asking for $750 billion . Small business would get $350 billion.
“We’ve got a deadline,” the delay has come to expand the stimulus package according to Sen. Chuck Grassley (R-Iowa) as the Senate went past 5pm Saturday. The President assured that the bill would be passed Monday.
Majority Leader Mitch McConnell (R-Ky) sent a midnight Friday night deadline to reach an ‘in-principle’ bipartisan deal on major legislation after a 12 hour session..
Confirmed Covid-19 case in the US have reached 24,000, with 285 deaths. The Dow has dropped 9000 points in march.
Coronavirus Task Force Press
“Part of the American dream is having a home.”president has authorized the immediate cessation of foreclosure and eviction. FHFA has done the same for 60 days. Asked various services of mortgage loans to exercise forbearance. Asked people to contact the loan provider. HUD does not have authority to mandate that eviction does not occur, petitioning congress to enforce, utmost of the PHAs are run by people who care about actual people. People are stepping up. Section 8 April vouchers will go out next week, May vouchers are being worked on. In contact with stakeholders in low income housing. We have extended deadlines for healthcare and multi family requirements until April 30.
It’s a lot easier for us to take these measures so we don’t destroy a very excellent system. if you don’t spend the money and deal with this now it will cost a whole lot more to build this up again.
Pete: FEMA HHS, together assisting local, tribal under the nationwide emergency 100 million allocated. Supplies, critical supply requests must go through channels. order supplies from regular vendors and open market and we will reimburse you, buy abroad and we will reimburse, go to FEMA for tests, hospital capacity tests, masks, ventilators, from local county state to DC FEMA.
Whole of government locally state managed and supported works best.
When you talk about the kinds of mitigation issues, there are two dynamic forces that go on at the same time.. You have the infection outbreak. You have mitigation strategies to dampen that. We can’t quantitate the rate now. we come back to you every day. Baseline for everyone throughout the country, but the mitigation gets ratcheted up in impact areas. Testing, we are getting to the solution that everyone in the country is looking for. not every single person needs to be tested. an unintended consequence of the desire to test is you are consuming personal protective equipment which are high priority for those who have to offer services to infected. We will increase these, but we don’t want personnel endangered because the
please put off, cancel elective procedures, these consume personal protective equipment and possibly ventilators we need.
FEMA Pete Gaynor, ”
Tests plus results dramatic curve.
We are transitioning into large scale testing into mainstream of American testing. Currently 91 public health laboratories are up and running. This only accounts for CDS, state and public health laboratories and American clinical laboratories. This does not account for the hospital based labs who are testing.
There are priorities for testing. Those hospitalized or in ICU, health care workers, symptomatic people in long term care facilities, symptomatic individuals over 65, symptomatic individuals with underlying health issues, testing is ramping up but we still have priorities.
CBT sites are popping up these are state managed and locally executed. These are weak up , drive throng, or geared to healthcare workers, but these are not federal but state and local.
Mike Pence,
6 days into 15 days, we have an opportunity to ‘slow the spread.’ ‘We are all in this together.’ For most Americans the risk is low, but we don’t want to expose people who are vulnerable.
Procuring more supplies and allocating through FEMA. Continue to ask for conservation.
Hundreds of millions of N-95 masks coming. Asked to postpone elective medical procedures to make medical care available.
Progress is being made on a bi-partisan bill look to pass Monday in house and senate.
Member of my staff has tested positive, he’s well and had a day 1/2 of mild symptoms and no direct contact. did contact tracing. no reason to believe Pence exposed. He and his wife will be tested later this afternoon.
We are working hour by hour through FEMA to work through with states.
195,000 + Americans with symptoms have been tested, not including health care labs and community hospitals. 19,343 are positive.
“If you don’t have symptoms, don’t test.”
“not a whole of government approach, but a whole of America responsibility.” Americans are acting with “commonsense, compassion, generosity”
10s of millions are putting into practice 15 days to slow the spread.
“We are currently at 6 of 15 days.”
For every American this is what you can do over the next week and a few day…slow the spread.”
Almost overwhelmed by the outpouring of support from small businesses
Millions of surgical masks.
Thanks faith for suspending services and continuing to support food banks
Trump:
Calls with representatives of hospitals, doctors, nurses.
Calls with business roundtable-CEOs US and global companies. Doug MacMillan Walmart, business is more than a clip of Christmas, extra staff, no empty shelves, restaurants fast food, grocery stores, groups of retailers, G7 meeting, almost all governors on conference cals, religious leaders. Signed legislation for paid sick leave and family leave, free testing,
relief to small business, disbursements to workers and families being negotiated on Hill.
Moved Tax day April 15 to July 15 no penalties, no interest.
HUD with FHA insured mortgages 60 days of relief from eviction
Standardized testing: Dep of Ed drop waived standardized testing for the current school year.
Student Loans: Interest and ‘other things being discussed’ to suspend student loan payments for at least 60 days.
Defense Production Act: Federal government can push needed supplies: Executive Order Defense Production Act for supplies.
Call to private sector. produce and supply masks swabs ventilators etc. Haines retrofitting manufacturing to produce masks.
FDA authorized therapeutics: FDA taking steps to make available to use. and possibly get a number of potential therapeutics out.
Alcohol repurpose to make hand sanitizer Pernod-Ricard.
Level One Response center
FEMA involved nationwide
Tele-health expanded so can see a doctor without leaving home
“I think we are going to change the way our country behaves medically.”
“Every American has a role to play in defending our nation from this invisible horrible enemy”
“Stay at home and save lives.”
“…a time of shared national sacrifice”
‘We are going to be celebrating a great victory in the not too distant future.”
Health Security Covid-19 My Notes on Covid-19
Cornerstone of US/UK Approach to Covid-19
US officials relied on this report from Imperial College London, which projected up to 2.2 million American deaths and 510,000 British deaths from Covid-19. Initially Britain sought herd immunity. After the report was published, both countries began Flatten the Curve. CDC now forecasts 21 million will need hospitalization, 1.7 million deaths. Estimated US is 1-2 weeks behind Italy’s 31,500 cases, 2500 deaths.
Shelter-in-Place Policy follows March 3 community transmission stage
New York State on Pause Plan, Gov Andrew Cuomo Stay at Home Order effective Sunday 22 March 8pm. Stay home except for solitary exercise. All nonessential gatherings of individuals banned. Special Services grocery trips. 6 foot distance in public. Mass Transit operational, food delivery, pharmacy, clinics, gas, police.
New York expects it will not be able to meet health system capacity
Illinois Stay at home order 3-21-4/7
Oregon
New Jersey 9 pm 3/22, some towns began last week
PA closes non-essential business
CDC report compiled by Johns Hopkins says New jersey, Colorado, Florida, Louisiana on similar trajectory to New York
Early testing may have skewed negative results before exposure in some states
China used lockdowns and were able to enforce them. Wuhan is now reopening schools. 3200 deaths, 81,000 infections
South Korea mass testing rollout, managed early to flatten the curve
. Questioning infected populations remoteness, concerns it will reactivate. Tremendous contact tracing, widespread testing.
Iran hid
Italy’s strict stay in policy arrived late in disease progression. Now beginning to write a selective treatment policy, considering excluding elder patients from care.
AI and Machine Learning Use in Covid-19
Blue Dot is an AI platform that tracks infectious disease around the world. Using their AI detection platform, they flagged Wuhan as a center of disease. 9 days after Blue Dot sent the alert, WHO released a ‘novel coronavirus’ statement. Blue Dot also studied patterns in travel to predict where the virus would go from Wuhan.
Methods
Blue Dot is currently tracking spread and forecasting, looking at movement patterns in most affected areas.
AI flagged information is sent in reports to their specialists in these areas
Temperature Detection in Public Space
Baidu Chinese tech firm used temperature detection technology in Beijing’s Qinghe Railway Station…
Cameras with computer vision infrared sensors predict people’s temperatures in public areas. 200 people screened per minute within .5 C AI flags anyone over 37.3.
AI Chest CT Scans
Chinese Technology giant Alibaba is being used in 100 Chinese hospitals to detect Covid-19 in CT Scans
Robots for Procedures, Cooking. Minimizes patient contact.
Robots automate procedures normally performed by medical staff.
Minimizes patient contact.
Robots are being used to cook rice in Chinese hospitals.
Seattle doctors use robots to communicate with and treat patients remotely.
Drones
Chinese firms use drones to deliver and spray disinfectants
Drug Research Conducted using AI
Deepmind is using its AI in the drug research race for a vaccine. Vaccines can cost a billion dollars and take 12yrs to develop. Deepmind AI research lab (Google acquired 2014) is using deep learning to learn the structure of Covid proteins. Genomes were shared on open access DBs Protein DataBank. Deepmind uses its AlphaFold system to structure predictions and form hypotheses. Researchers use computational models to predict protein structures from amino acid sequence. 3D models.
News
Therapeutics, only one showing potential for success
Hydroxychloroquine, First Trial Data France
Small trial 26 patients and 16 controls, open label, some patients dropped out (6 dropped out. 3 went to ICU, one died, another got nauseous, and the last went home and disappeared so who knows?) 15 males, 21 females. 22 presented with upper respiratory symptoms, 8 had lower respiratory symptoms. All imaging of all participants showed pneumonia.
Treatment 200mg Hydroxychloroquine 3 x day + 500mg azithromycin to deal with potential superinfection by bacteria
Potential ELISA Test Mt Sinai Critical to disease control tracking virus in healthy people
Critical to track virus in healthy people is an antibody test of blood
There is a need to track both active and past infection to trace the progression of the virus.The body keeps antibodies it has made to fight pathogens overcome
Mt Sinai Icahn School of Medicine posted a preprint SARS-CoV-2 antibody test they developed. They also posted instructions to replicate the test. Objective is to screen a few thousand people a day and get more data on the accuracy.
Test was made with an altered version of the spike protein in Covid-19. That triggers a color change on a recognized protein. 59 tests were runon serum samples banked before the outbreak showed that the test worked, as antibodies to SARS-CoV-2 bound to the test’s proteins. It showed positive results only for the COVID-19 patients and none for the control group.
Nature of the Virus
Mathematics of Epidemiology
The basic reproduction number (R0) is a central concept in infectious disease epidemiology, indicating the risk of an infectious agent with respect to epidemic spread.
Mathematics are applied to disease to understand trajectories and establish control methodology. The basic reproduction number (R0) of the COVID-19 virus. R0 is the average number of new infections generated by an infectious person in a naive population, indicating transmissibility of a virus. R0 > 1, the number infected is likely to increase, and for R0 < 1, transmission is likely to die out. R0 is factored when no one has been vaccinated, no one has had the disease before, there’s no way to control the spread of the disease. (Pronounced R naught)
R0 = 3.28 for Covid-19 (average taken across multiple studies)
(Ying Liu, Albert A Gayle, Annelies Wilder-Smith, Joacim Rocklöv Journal of Travel Medicine, Volume 27, Issue 2, March 2020, taaa021, https://doi.org/10.1093/jtm/taaa021)
R0 = 1,4-1.8 Swine Flu, H1N1
1.4 billion infected, 151,700 – 574,000 deaths according to CDC
R0 = 3-4 Spanish Flu 1918
500,000,000 infected, ¼ of the world’s population. 50,000,000 dead.
R factor Reproductive Number (Number of secondary infections transmitted) combines with Timing of onset to peak infectivity. Taken together you get the epidemic growth, allowing for a time period of contagious but asymptomatic individuals. Curves become exponential.
Center for Mathematical Modeling of Infectious Diseases (CMMID) at the London School of Hygiene and Tropical Medicine https://www.lshtm.ac.uk/research/centres/centre-mathematical-modelling-infectious-diseaseshttps://academic.oup.com/jtm/article/27/2/taaa021/5735319
| reproductive number of COVID-19 is higher compared to SARS coronavirus | Journal of Travel Medicine | Oxford AcademicIntroduction. In Wuhan, China, a novel and alarmingly contagious primary atypical (viral) pneumonia broke out in December 2019. It has since been identified as a zoonotic coronavirus, similar to SARS coronavirus and MERS coronavirus and named COVID-19.Academic.oup.com |
| Modeling study suggests 18 months of COVID-19 social distancing, much disruption | CIDRAPOn Mar 16, when White House coronavirus response coordinator Deborah Birx, MD, stood beside President Donald Trump and announced the “15 Days to Slow the Spread” campaign, she said guidance on home isolation was informed by the latest models from the United Kingdom.www.cidrap.umn.edu |
Mitigating Disease
Build Models based on mathematics and disease parameters
Approach
Viral Features
Source: Stefan Flasche German doing computer modeling mathematics and epidemiology London School of Hygiene and Tropical Medicine
Patients who are Potentially Susceptible
According to Italy’s national health authority.
* Younger people have overwhelmed Italian hospitals, but there is rumor that doctors may have prioritized younger patients and decided not to treat those over 80. It may be that doctors gave over more beds to younger people.
Prevention of Spread
Presentation in Hospital, Treatment
Requirements for Hospitals
To Perform Mechanical Ventilation
Current estimate 62,000 ventilators in US acute care hospitals. Additional ventilators stockpiled at local, state, federal level. Prior studies estimated that in a severe pandemic, 35,000 – 60,000 additional ventilators will be needed. If a facility had space and ancillary supplies as well as adequate staff, staff might still need training to use them.
Federal Government has entered stockpile to provision supplies
Strategies need to be developed to allocate Stockpiled Ventilators for Mechanical Ventilation and to re-allocate them, suggest using UPS or Amazon style logistics.
State and local planners need assistance to allocate stockpiled ventilators to healthcare facilities then move them around as needed, buy additional ventilators in the market and one great big computer model, then sell them on.
The Centers for Medicare and Medicaid Services has issued several statements recently with regard to infection control, patient care, and provider safety precautions in a variety of settings.
Tracing
Singapore Trace Together app to track infected and contact. https://www.gov.sg/article/help-speed-up-contact-tracing-with-tracetogether
| gov.sg | Help speed up contact tracing with TraceTogetherTry recalling who you met two weekends ago. Can you name everyone you met and talked to that day? Chances are, probably not. And even if you did, there’s a good chance you might not have all their contacts. These are some of the problems that come up during contact tracing after a COVID-19 case is …www.gov.sg |
South Korea, a free market model more like US reducing cases, is concerned about resurgence. Ground Zero Shincheonji Church of Jesus, a secretive, messianic megachurch
What they did well
Diagnostic capacity at scale
Expansive, organized testing program
Isolate infected people
Track, trace, quarantine infected people’s contacts. 5200 tests per million inhabitants according to the Worldometer website.
“High-risk patients with underlying illnesses get priority for hospitalization, says Chun Byung-Chul, an epidemiologist at Korea University. Those with moderate symptoms are sent to repurposed corporate training facilities and spaces provided by public institutions, where they get basic medical support and observation. Those who recover and test negative twice are released. Close contacts and those with minimal symptoms whose family members are free of chronic diseases and who can measure their own temperatures are ordered to self-quarantine for 2 weeks. A local monitoring team calls twice daily to make sure the quarantined stay put and to ask about symptoms. Quarantine violators face up to 3 million won ($2500) fines. If a recent bill becomes law, the fine will go up to 10 million won and as much as a year in jail.” ScienceMag.org
Latest News From Administration
Stimulus expected to reach agreement in Senate Monday Morning 3/23
Senate Lockdown to Hammer out Mammoth Trillion Dollar Stimulus Package
Tax, healthcare, small business, and impacted industries are the focus of negotiations for a trillion dollar stimulus deal. Senators haggled over Trump’s one time $1200 check to individuals earning $75,000 or less. Scaling would occur $99,000 and below and nothing would be sent to anyone over that income. Democrats demanded unemployment insurance expansion.
Stabilization funds for states to use if their economies decline due to the virus are a debate point with Democrats asking for $750 billion . Small businesses would get $350 billion.
“We’ve got a deadline,” the delay has come to expand the stimulus package according to Sen. Chuck Grassley (R-Iowa) as the Senate went past 5pm Saturday. The President assured that the bill would be passed Monday.
Majority Leader Mitch McConnell (R-Ky) sent a midnight Friday night deadline to reach an ‘in-principle’ bipartisan deal on major legislation after a 12 hour session..
Confirmed Covid-19 cases in the US have reached 24,000, with 285 deaths. The Dow has dropped 9000 points in march.
Notes from Coronavirus Task Force White House Press Conference Brady Room with Trump 21/3/20
“Part of the American dream is having a home.”president has authorized the immediate cessation of foreclosure and eviction. FHFA has done the same for 60 days. Asked various services of mortgage loans to exercise forbearance. Asked people to contact the loan provider. HUD does not have authority to mandate that eviction does not occur, petitioning congress to enforce, utmost of the PHAs are run by people who care about actual people. People are stepping up. Section 8 April vouchers will go out next week, May vouchers are being worked on. In contact with stakeholders in low income housing. We have extended deadlines for healthcare and multi family requirements until April 30.
It’s a lot easier for us to take these measures so we don’t destroy a very excellent system. if you don’t spend the money and deal with this now it will cost a whole lot more to build this up again.
Pete: FEMA HHS, together assisting local, tribal under the nationwide emergency 100 million allocated. Supplies, critical supply requests must go through channels. order supplies from regular vendors and open market and we will reimburse you, buy abroad and we will reimburse, go to FEMA for tests, hospital capacity tests, masks, ventilators, from local county state to DC FEMA.
Whole of government, locally, state managed and supported works best.
When you talk about the kinds of mitigation issues, there are two dynamic forces that go on at the same time.. You have the infection outbreak. You have mitigation strategies to dampen that. We can’t quantitate the rate now. we come back to you every day. Baseline for everyone throughout the country, but the mitigation gets ratcheted up in impact areas. Testing, we are getting to the solution that everyone in the country is looking for. not every single person needs to be tested. an unintended consequence of the desire to test is you are consuming personal protective equipment which are high priority for those who have to offer services to infected. We will increase these, but we don’t want personnel endangered because the
please put off, cancel elective procedures, these consume personal protective equipment and possibly ventilators we need.
FEMA Pete Gaynor,
Tests plus results dramatic curve.
We are transitioning into large scale testing into mainstream of American testing. Currently 91 public health laboratories are up and running. This only accounts for CDS, state and public health laboratories and American clinical laboratories. This does not account for the hospital based labs who are testing.
There are priorities for testing. Those hospitalized or in ICU, health care workers, symptomatic people in long term care facilities, symptomatic individuals over 65, symptomatic individuals with underlying health issues, testing is ramping up but we still have priorities.
CBT sites are popping up these are state managed and locally executed. These are weak up , drive throng, or geared to healthcare workers, but these are not federal but state and local.
Mike Pence,
6 days into 15 days, we have an opportunity to ‘slow the spread.’ ‘We are all in this together.’ For most Americans the risk is low, but we don’t want to expose people who are vulnerable.
Procuring more supplies and allocating through FEMA. Continue to ask for conservation.
Hundreds of millions of N-95 masks are coming. Asked to postpone elective medical procedures to make medical care available.
Progress is being made on a bi-partisan bill expected to pass Monday in house and senate.
Member of my staff has tested positive, he’s well and had a day 1/2 of mild symptoms and no direct contact. did contact tracing. no reason to believe Pence exposed. He and his wife will be tested later this afternoon.
We are working hour by hour through FEMA to work through with states.
195,000 + Americans with symptoms have been tested, not including health care labs and community hospitals. 19,343 are positive.
“If you don’t have symptoms, don’t test.”
“not a whole of government approach, but a whole of America responsibility.” Americans are acting with “commonsense, compassion, generosity”
10s of millions are putting into practice 15 days to slow the spread.
“We are currently at 6 of 15 days.”
For every American this is what you can do over the next week and a few days…slow the spread.”
Almost overwhelmed by the outpouring of support from small businesses
Millions of surgical masks.
Thanks faith for suspending services and continuing to support food banks
Trump:
Calls with representatives of hospitals, doctors, nurses.
Calls with business roundtable-CEOs US and global companies. Doug MacMillan Walmart, business is more than a clip of Christmas, extra staff, no empty shelves, restaurants, fast food, grocery stores, groups of retailers, G7 meetings, almost all governors on conference calls, religious leaders. Signed legislation for paid sick leave and family leave, free testing,
relief to small business, disbursements to workers and families being negotiated on Hill.
Moved Tax day April 15 to July 15 no penalties, no interest.
HUD with FHA insured mortgages 60 days of relief from eviction
Standardized testing: Dep of Ed drop waived standardized testing for the current school year.
Student Loans: Interest and ‘other things being discussed’ to suspend student loan payments for at least 60 days.
Defense Production Act: Federal government can push needed supplies: Executive Order Defense Production Act for supplies.
Call the private sector. produce and supply masks, swabs, ventilators etc. Haines is retrofitting manufacturing to produce masks.
FDA authorized therapeutics: FDA taking steps to make available to use. and possibly get a number of potential therapeutics out.
Alcohol repurpose to make hand sanitizer Pernod-Ricard.
Level One Response center
FEMA involved nationwide
Tele-health expanded so can see a doctor without leaving home
“I think we are going to change the way our country behaves medically.”
“Every American has a role to play in defending our nation from this invisible horrible enemy”
“Stay at home and save lives.”
“…a time of shared national sacrifice”
‘We are going to be celebrating a great victory in the not too distant future.”
WHO recommended actions
Highest priority:
Secondary priority: Participate in routine surveillance systems to monitor disease trends, impacts, and virus evolution; periodically share isolates with referral laboratories following WHO guidance.
Highest priority
Secondary priority
Establish metrics and monitoring evaluation systems to assess effectiveness of measures. Document lessons learned to inform on-going and future preparedness and response activities.
Prepare for regulatory approval, market authorization and post-market surveillance of COVID-19 products (e.g. laboratory diagnostics, therapeutics, vaccines), when available.
Training: OpenWHO Infection prevention and control (IPC) for novel coronavirus (COVID-19).
| Recommended in all situations. | • Hand hygiene• Respiratory etiquette• Masks for symptomatic individuals.• Isolation and treatment of ill individuals.• Monitoring symptoms of healthy contacts.• Traveler health advice• Environmental cleaning |
| Consider, based on local and/or global evaluation. | • Avoid crowding (i.e. mass gatherings).• School closures and other measures.• Public transportation closures, and/or• Workplace closures and other measures.• Public health quarantine (asymptomatic contacts) and/or isolation (ill individuals). |
Additional Equipment
Carnival Cruise Lines has offered to turn its cruise ships into makeshift hospitals
Adrian Rosebrock, where he tried to create an automatic COVID-19 detector using the COVID-19 X-ray image dataset (curated by Dr. Joseph Cohen)along with normal X-Ray Images from theKaggle’s Chest X-Ray Images (Pneumonia) dataset.
Response
Health and Human Services waive privacy requirements to allow doctors to telecommunicate with patients
National Guard
Guardsmen continue to assist with food delivery, logistics and cleaning services in the previously identified “containment area.”
In addition, guardsmen, including Army National Guard combat medic specialists and Air National Guard medical technicians, are “assisting state officials with the collection of samples” at drive-thru testing locations, the official added.
Other
Covid Data Resource Hubhttps://www.tableau.com/covid-19-coronavirus-data-resources
EU Data
WHO Predictive Modeling Wuhan
WHO Situation Report
WHO’s strategic objectives for this response are to:
Impact
From Axios Logos:
Antitrust cases slowed against Google FB
Remote Work; Cloud based work tools are great, but companies were only prepared to use it for a smaller percentage of works, not all workers. VPN needed for all employees, often in a small organization only a few and require an outside vendor to to upgrade their equipment, takes two weeks. Government regulations and security requirements from clients or data exchange partners are a hurdle. Apple was unable to access work tools for unreleased products WSJ.
Small business free ads, Yelp providing 25 million in free ads. FB providing 100 million.
Apple faces supply chain problems
Youtube lowered streaming resolution along with Netflix -pressure form EU
CivicScience: Grocery delivery target markets for AMazon and Walmart are young and wealthy. People are still going to stores to get groceries.
Amazon, GOogle, FB eager to keep existing products functioning provide accurate info fight misinfo help in fight against corona
CORE
Global Case Count DashboardJohns Hopkins CSSE
ProMED-mailISID
Resources for State, Local, Territorial and Tribal Health DepartmentsCDC
Disaster Lit Coronavirus ResourcesNIH NLM
Novel Coronavirus (2019-nCoV)WHO
Morbidity and Mortality Weekly ReportCDC
MCMi Novel Coronavirus PageFDA
Coronavirus InfectionsMedline Plus
Novel Coronavirus ResourcesASM
Coronavirus Information Guide2019-nCoV, MERS-CoV and SARS NIH
PubMed 2019-nCoV CitationsNIH NLM
Severe Respiratory Disease Associated with a Novel Infectious Agent – Hong Kong Centre for Health Protection
3 Feb2019 Novel Coronavirus Strategic Preparedness and Response PlanWHO
Information for Healthcare ProfessionalsCDC
Information for Public Health ProfessionalsCDC
Healthcare Professional Preparedness Checklist For Transport and Arrival of PatientsHealth Security March 21 2020
Covid-19 https://academic.oup.com/jtm/article/27/2/taaa021/5735319
Link toImperial College Report Influenced US and UK Policy. Provides models for disease dissemination and mitigation to flatter the curve.
AI and Machine Learning Use in Covid-19
AI platform tracks infectious disease around the world, flagged Wuhan . 9 days later WHO released ‘novel coronavirus’ statement. They studied patterns in travel to predict where the virus would go from Wuhan.
Blue Dot are currently tracking spread, looking at movement patterns in most affected areas. Blue Dot forecasts spread.
AI flagged information is sent in reports to their specialists in these areas
Geographic Infosystems
Spatial Data Analytics
Data visualization
Computer science
Medical experts infectious disease
Travel and tropical medicine
Public health
Baidu Chinese tech firm used temperature detection technology in Beijing’s Qinghe Railway Station…
with cameras with computer vision infrared sensors to predict people’s temperatures in public areas. 200 people screened per minute within .5 C Ai flags anyone over 37.3.
Alibaba Chinese tech used in 100 Chinese hospitals
AI system detects coronavirus in Chest CT scans
96% accuracy according to developers. They trained on data from 5,000 cases. Takes 20 second (usually 15mins for a person) It can differentiate Covid-19 from flu pneumonia.
Robots
Renmin Hospital Wuhan University Wuhan EndoAngel Medical Technology Company, China University of Geosciences
AI for chest scans trained on 45,000 anonymized scans Published on medRxiv. Performance of Ai in detection is as good as an expert.
Robots automate procedures normally performed by medical staff or to cook rice. Minimizes patient contact.
Seattle doctors use robots to communicate with and treat patients remotely
Drones
Chinese firms use drones to deliver and spray disinfectants
AI in drug researchDeepmind race for vaccine
Vaccines can cost a billion and take 12yrs Deepmind AI research lab (Google 2014) is using deep learning to learn the structure of Covid proteins
Genomes were shared on open access DBs Protein DataBank
AlphaFold system structure predictions hypothesis
Researchers use computational models to predict protein structures from amino acid sequence. 3D models
Mathematics of Epidemiology
Center for Mathematical Modeling of Infectious Diseases (CMMID) at the London School of Hygiene and Tropical Medicine https://www.lshtm.ac.uk/research/centres/centre-mathematical-modelling-infectious-diseaseshttps://academic.oup.com/jtm/article/27/2/taaa021/5735319
Elements of Disease Control and Modeling in Mathematics
R factor Reproductive Number, Number of secondary infections transmitted
Timing of onset to peak infectivity
Taken together you get the epidemic growth, allow for time period of contagious but asymptomatic.
isolate symptomatic individuals
Contact trace to build the model, to control disease, quarantine their contacts
individuals who will die
individuals who will become ill and recover
Those who will need IC, intubation, respiration, home self-care, asymptomatic
| reproductive number of COVID-19 is higher compared to SARS coronavirus | Journal of Travel Medicine | Oxford AcademicIntroduction. In Wuhan, China, a novel and alarmingly contagious primary atypical (viral) pneumonia broke out in December 2019. It has since been identified as a zoonotic coronavirus, similar to SARS coronavirus and MERS coronavirus and named COVID-19.academic.oup.com |
| Modeling study suggests 18 months of COVID-19 social distancing, much disruption | CIDRAPOn Mar 16, when White House coronavirus response coordinator Deborah Birx, MD, stood beside President Donald Trump and announced the “15 Days to Slow the Spread” campaign, she said guidance on home isolation was informed by the latest models from the United Kingdom.www.cidrap.umn.edu |
Trace Together Singapore, app to track infected and contact. Huge help in disease control https://www.gov.sg/article/help-speed-up-contact-tracing-with-tracetogether
| gov.sg | Help speed up contact tracing with TraceTogetherTry recalling who you met two weekends ago. Can you name everyone you met and talked to that day? Chances are, probably not. And even if you did, there’s a good chance you might not have all their contacts. These are some of the problems that come up during contact tracing after a COVID-19 case is …www.gov.sg |
Stimulus expected to reach agreement in Senate Monday Morning 3/23
Senate Lockdown to Hammer out Mammoth Trillion Dollar Stimulus Package
Tax, healthcare, small business, and impacted industries are the focus of negotiations for a trillion dollar stimulus deal. Senators haggled over Trump’s one time $1200 check to individuals earning $75,000 or less. Scaling would occur $99,000 and below and nothing would be sent to anyone over that income. Democrats demanded unemployment insurance expansion.
Stabilization funds for states to use if their economies decline due to the virus are a debate point with Democrats asking for $750 billion . Small businesses would get $350 billion.
“We’ve got a deadline,” the delay has come to expand the stimulus package according to Sen. Chuck Grassley (R-Iowa) as the Senate went past 5pm Saturday. The President assured that the bill would be passed Monday.
Majority Leader Mitch McConnell (R-Ky) sent a midnight Friday night deadline to reach an ‘in-principle’ bipartisan deal on major legislation after a 12 hour session..
Confirmed Covid-19 cases in the US have reached 24,000, with 285 deaths. The Dow has dropped 9000 points in march.
Notes from Coronavirus Task Force White House Presser with Trump 21/3/20
Coronavirus Task Force Press
“Part of the American dream is having a home.”president has authorized the immediate cessation of foreclosure and eviction. FHFA has done the same for 60 days. Asked various services of mortgage loans to exercise forbearance. Asked people to contact the loan provider. HUD does not have authority to mandate that eviction does not occur, petitioning congress to enforce, utmost of the PHAs are run by people who care about actual people. People are stepping up. Section 8 April vouchers will go out next week, May vouchers are being worked on. In contact with stakeholders in low income housing. We have extended deadlines for healthcare and multi family requirements until April 30.
It’s a lot easier for us to take these measures so we don’t destroy a very excellent system. if you don’t spend the money and deal with this now it will cost a whole lot more to build this up again.
Pete: FEMA HHS, together assisting local, tribal under the nationwide emergency 100 million allocated. Supplies, critical supply requests must go through channels. order supplies from regular vendors and open market and we will reimburse you, buy abroad and we will reimburse, go to FEMA for tests, hospital capacity tests, masks, ventilators, from local county state to DC FEMA.
Whole of government locally state managed and supported works best.
When you talk about the kinds of mitigation issues, there are two dynamic forces that go on at the same time.. You have the infection outbreak. You have mitigation strategies to dampen that. We can’t quantitate the rate now. we come back to you every day. Baseline for everyone throughout the country, but the mitigation gets ratcheted up in impact areas. Testing, we are getting to the solution that everyone in the country is looking for. not every single person needs to be tested. an unintended consequence of the desire to test is you are consuming personal protective equipment which are high priority for those who have to offer services to infected. We will increase these, but we don’t want personnel endangered because the
please put off, cancel elective procedures, these consume personal protective equipment and possibly ventilators we need.
FEMA Pete Gaynor,
Tests plus results dramatic curve.
We are transitioning into large scale testing into mainstream of American testing. Currently 91 public health laboratories are up and running. This only accounts for CDS, state and public health laboratories and American clinical laboratories. This does not account for the hospital based labs who are testing.
There are priorities for testing. Those hospitalized or in ICU, health care workers, symptomatic people in long term care facilities, symptomatic individuals over 65, symptomatic individuals with underlying health issues, testing is ramping up but we still have priorities.
CBT sites are popping up these are state managed and locally executed. These are weak up , drive throng, or geared to healthcare workers, but these are not federal but state and local.
Mike Pence,
6 days into 15 days, we have an opportunity to ‘slow the spread.’ ‘We are all in this together.’ For most Americans the risk is low, but we don’t want to expose people who are vulnerable.
Procuring more supplies and allocating through FEMA. Continue to ask for conservation.
Hundreds of millions of N-95 masks coming. Asked to postpone elective medical procedures to make medical care available.
Progress is being made on a bi-partisan bill look to pass Monday in house and senate.
Member of my staff has tested positive, he’s well and had a day 1/2 of mild symptoms and no direct contact. did contact tracing. no reason to believe Pence exposed. He and his wife will be tested later this afternoon.
We are working hour by hour through FEMA to work through with states.
195,000 + Americans with symptoms have been tested, not including health care labs and community hospitals. 19,343 are positive.
“If you don’t have symptoms, don’t test.”
“not a whole of government approach, but a whole of America responsibility.” Americans are acting with “commonsense, compassion, generosity”
10s of millions are putting into practice 15 days to slow the spread.
“We are currently at 6 of 15 days.”
For every American this is what you can do over the next week and a few day…slow the spread.”
Almost overwhelmed by the outpouring of support from small businesses
Millions of surgical masks.
Thanks faith for suspending services and continuing to support food banks
Trump:
Calls with representatives of hospitals, doctors, nurses.
Calls with business roundtable-CEOs US and global companies. Doug MacMillan Walmart, business is more than a clip of Christmas, extra staff, no empty shelves, restaurants fast food, grocery stores, groups of retailers, G7 meeting, almost all governors on conference cals, religious leaders. Signed legislation for paid sick leave and family leave, free testing,
relief to small business, disbursements to workers and families being negotiated on Hill.
Moved Tax day April 15 to July 15 no penalties, no interest.
HUD with FHA insured mortgages 60 days of relief from eviction
Standardized testing: Dep of Ed drop waived standardized testing for the current school year.
Student Loans: Interest and ‘other things being discussed’ to suspend student loan payments for at least 60 days.
Defense Production Act: Federal government can push needed supplies: Executive Order Defense Production Act for supplies.
Call to private sector. produce and supply masks swabs ventilators etc. Haines retrofitting manufacturing to produce masks.
FDA authorized therapeutics: FDA taking steps to make available to use. and possibly get a number of potential therapeutics out.
Alcohol repurpose to make hand sanitizer Pernod-Ricard.
Level One Response center
FEMA involved nationwide
Tele-health expanded so can see a doctor without leaving home
“I think we are going to change the way our country behaves medically.”
“Every American has a role to play in defending our nation from this invisible horrible enemy”
“Stay at home and save lives.”
“…a time of shared national sacrifice”
‘We are going to be celebrating a great victory in the not too distant future.”
Viral Features
Source: Stefan Flasche German doing computer modeling mathematics and epidemiology London School of Hygiene and Tropical Medicine
Patients
Serious athletes are immunocompromised-marathon training
Smokers, vapers
Diabetics
Italy deaths
According to Italy’s national health authority.
Younger people have overwhelmed Italian hospitals, but there is rumor that doctors may have prioritized younger patients and decided not to treat those over 80. It may be that doctors gave over more beds to younger people.
Prevention of Spread
Cost of patient treatment $9000-$20000 have seen $35,000
VA got 1bn of 45bn Covid budget, for testing etc across VA
Presentation in Hospital, Treatment
Requirements for Hospitals
To Perform Mechanical Ventilation
Current estimate 62,000 ventilators in US acute care hospitals. Additional ventilators stockpiled at local, state, federal level. Prior studies estimated that in a severe pandemic, 35,000 – 60,000 additional ventilators will be needed. If a facility had space and ancillary supplies as well as adequate staff, staff might still need training to use them.
Federal Government has entered stockpile to provision supplies
Strategies need to be developed to allocate Stockpiled Ventilators for Mechanical Ventilation and to re-allocate them, suggest using UPS or Amazon style logistics.
State and local planners need assistance to allocate stockpiled ventilators to healthcare facilities then move them around as needed, buy additional ventilators in the market and one great big computer model, then sell them on.
The Centers for Medicare and Medicaid Services has issued several statements recently with regard to infection control, patient care, and provider safety precautions in a variety of settings.
WHO recommended actions
Highest priority:
Secondary priority: Participate in routine surveillance systems to monitor disease trends, impacts, and virus evolution; periodically share isolates with referral laboratories following WHO guidance.
Highest priority
Secondary priority
Establish metrics and monitoring evaluation systems to assess effectiveness of measures. Document lessons learned to inform on-going and future preparedness and response activities.
Prepare for regulatory approval, market authorization and post-market surveillance of COVID-19 products (e.g. laboratory diagnostics, therapeutics, vaccines), when available.
Training: OpenWHO Infection prevention and control (IPC) for novel coronavirus (COVID-19).
| Recommended in all situations. | • Hand hygiene• Respiratory etiquette• Masks for symptomatic individuals.• Isolation and treatment of ill individuals.• Monitoring symptoms of healthy contacts.• Traveler health advice• Environmental cleaning |
| Consider, based on local and/or global evaluation. | • Avoid crowding (i.e. mass gatherings).• School closures and other measures.• Public transportation closures, and/or• Workplace closures and other measures.• Public health quarantine (asymptomatic contacts) and/or isolation (ill individuals). |
Additional Equipment
Carnival Cruise Lines has offered to turn its cruise ships into makeshift hospitals
South Korea, a free market model more like US reducing cases, concerned about resurgence
Ground ZeroShincheonji Church of Jesus, a secretive, messianic megachurch
What they did well
Diagnostic capacity at scale
Expansive, organized testing program
Isolate infected people
Track, trace, quarantine infected people’s contacts. 5200 tests per million inhabitantsaccording to the Worldometer website.
“High-risk patients with underlying illnesses get priority for hospitalization, says Chun Byung-Chul, an epidemiologist at Korea University. Those with moderate symptoms are sent to repurposed corporate training facilities and spaces provided by public institutions, where they get basic medical support and observation. Those who recover and test negative twice are released. Close contacts and those with minimal symptoms whose family members are free of chronic diseases and who can measure their own temperatures are ordered to self-quarantine for 2 weeks. A local monitoring team calls twice daily to make sure the quarantined stay put and to ask about symptoms. Quarantine violators face up to 3 million won ($2500) fines. If a recent bill becomes law, the fine will go up to 10 million won and as much as a year in jail.” ScienceMag.org
Adrian Rosebrock, where he tried to create an automatic COVID-19 detector using the COVID-19 X-rayimage dataset (curated by Dr. Joseph Cohen)along with normal X-Ray Images from theKaggle’s Chest X-Ray Images (Pneumonia) dataset.
Response
Health and Human Services waive privacy requirements to allow doctors to telecommunicate with patients
National Guard
Guardsmen continue to assist with food delivery, logistics and cleaning services in the previously identified “containment area.”
In addition, guardsmen, including Army National Guard combat medic specialists and Air National Guard medical technicians, are “assisting state officials with the collection of samples” at drive-thru testing locations, the official added.
Hydroxychloroquine, First Trial Data France
Small trial 26 patients and 16 controls, open label, some patients dropped out (6 dropped out. 3 went to ICU, one died, another got nauseous, and the last went home and who knows?) 15 males, 21 females. 22 presented with upper respiratory symptoms, 8 had lower respiratory symptoms. All imaging of all participants showed pneumonia.
Treatment 200mg Hydroxychloroquine 3 x day + 500mg azithromycin to deal with potential superinfection by bacteria
Potential ELISA Test Mt Sinai
Critical to track virus in healthy people is an antibody test of blood
There is a need to track both active and past infection to trace the progression of the virus.The body keeps antibodies it has made to fight pathogens overcome
Mt Sinai Icahn School of Medicineposted a preprint SARS-CoV-2 antibody test they developed. They also posted instructions to replicate the test. Objective is to screen a few thousand people a day and get more data on the accuracy.
Test was made with an altered version of the spike protein in Covid-19. That triggers a color change on a recognized protein. 59 tests were runon serum samples banked before the outbreak showed that the test worked, as antibodies to SARS-CoV-2 bound to the test’s proteins. It showed positive results only for the COVID-19 patients and none for the control group.
Other
Covid Data Resource Hubhttps://www.tableau.com/covid-19-coronavirus-data-resources
EU Data
WHO Predictive Modeling Wuhan
WHO Situation Report
WHO’s strategic objectives for this response are to:
Impact
From Axios Logos:
Antitrust cases slowed against Google FB
Remote Work; Cloud based work tools are great, but companies were only prepared to use it for a smaller percentage of works, not all workers. VPN needed for all employees, often in a small organization only a few and require an outside vendor to to upgrade their equipment, takes two weeks. Government regulations and security requirements from clients or data exchange partners are a hurdle. Apple was unable to access work tools for unreleased products WSJ.
Small business free ads, Yelp providing 25 million in free ads. FB providing 100 million.
Apple faces supply chain problems
Youtube lowered streaming resolution along with Netflix -pressure form EU
CivicScience: Grocery delivery target markets for AMazon and Walmart are young and wealthy. People are still going to stores to get groceries.
Amazon, GOogle, FB eager to keep existing products functioning provide accurate info fight misinfo help in fight against corona
CORE
Global Case Count DashboardJohns Hopkins CSSE
ProMED-mailISID
Resources for State, Local, Territorial and Tribal Health DepartmentsCDC
Disaster Lit Coronavirus ResourcesNIH NLM
Novel Coronavirus (2019-nCoV)WHO
Morbidity and Mortality Weekly ReportCDC
MCMi Novel Coronavirus PageFDA
Coronavirus InfectionsMedline Plus
Novel Coronavirus ResourcesASM
Coronavirus Information Guide2019-nCoV, MERS-CoV and SARS NIH
PubMed 2019-nCoV CitationsNIH NLM
Severe Respiratory Disease Associated with a Novel Infectious Agent – Hong Kong Centre for Health Protection
3 Feb2019 Novel Coronavirus Strategic Preparedness and Response PlanWHO
Information for Healthcare ProfessionalsCDC
Information for Public Health ProfessionalsCDC
Healthcare Professional Preparedness Checklist For Transport and Arrival of PatientsCDC
Directory of Local Health DepartmentsNACCHO
RESEARCHERS
2019-nCoV SequencesGenBank
NEWS/MEDIA
Coronavirus News in Past HourGoogle
Coronavirus Gov Updates Past 24 HoursGoogle
Coronavirus Custom Search EngineGoogle
Articles by Helen BranswellSTAT
Latest on CoronavirusHarvard
NYT Live UpdatesNY Times
Coronavirus NewsAssociated Press
CoronavirusScience
Reuters Coronavirus CoverageReuters
SOCMED
Coronavirus WatchTwitter List
READING + RESOURCES
COVID-19 Expert Reality CheckGlobal Health NOW
Understanding pandemics: What they mean, don’t mean, and what comes next with the coronavirusSTAT
If the coronavirus outbreak grows, can a strained US health care system keep up?BOTAS
Global Tracker: Travel Restrictions on China Due to COVID-19Think Global Health
Defining the Epidemiology of Covid-19 — Studies NeededNEJMNEW
PERSONAL PREPAREDNESS
Pandemic PreparednessReady.gov
Preventing nCoV Infection from Spreading in Homes and ResidencesCDC
Travel AdvisoriesState Dept
Myth-BustersWHO
Look Out for Coronavirus-Related Investment Scams – Investor AlertSEC
HIPAA Privacy and Novel CoronavirusHHS
Get Your Household Ready for Pandemic FluCDC
Report a Fraudulent 2019-nCoV ProductFDA
How to Avoid Phishing Emails Exploiting Coronavirus FearsJBSA.mil
Coronavirus: Scammers Follow the HeadlinesFTC
AT WORK
Prep and Protection for First RespondersIAFF
Pharmaceutical Cargo Security Initiative Supply Chain Survey Healthcare Ready
Guidance for Environmental Cleaning in Non-Healthcare Facilities Exposed to SARS-CoV-2ECDC
Interim Guidance for Businesses and Employers to Plan and Respond to COVID-19
Key OSHA Standards for COVID-19Dept of Labor
Human Resources Flexibilities Available for Federal Employees Impacted by the 2019 Novel CoronavirusOPM
Classroom Cleaning Tips for TeachersWA DOH
Novel Coronavirus Guidance for Air Carriers and CrewFAA
Interim Guidance for Ships on Managing 2019 Novel CoronavirusCDC
Strategies for Optimizing the Supply of N95 RespiratorsCDC
COVID-19 Guidance for ShipsCDC
Tulane National Primate Research Center (TNPRC) is establishing a COVID-19 research program to develop a vaccine and test treatments against the virus. First, researchers will create a nonhuman primate model to study the disease’s clinical progression, how it is transmitted through the air and how it specifically affects aging populations. Investigators hope to answer many of the unknowns about the disease, including why older individuals are more susceptible to complications and death from it.
Earlier this year, TNPRC mobilized to become one of the first research facilities in the country to obtain approval from the Centers for Disease Control to receive samples of the novel coronavirus, called SARS-CoV-2. TNPRC is the only National Primate Research Center with a Regional Biocontainment Laboratory (RBL) onsite that is capable of the high level of biocontainment required to study an emerging infectious disease like COVID-19. It also has the nation’s largest capacity for studying the transmission of infectious agents in nonhuman primates at this level of biocontainment, which is critical as public health responders rush to understand and thwart disease spread.
Rappaport will lead a team of collaborators from the center with unique expertise in aerobiology, virology, immunology, pulmonology, and veterinary medicine. All work will be conducted in the RBL under the highest, most stringent safety and quality standards and overseen by Tulane Director of Biosafety Angela Birnbaum, a nationally certified biosafety expert.
Birnbaum leads a national working group that will launch a collaborative research program on COVID-19 among the National Primate Research Centers (NPRCs). The group will work to develop vaccines and evaluate treatments against the disease using a nonhuman primate model. It will release research findings to scientists and collaborators in real time to accelerate progress to find successful treatments and preventions against the disease.
Virologist Bob Garry
In Pictures: DoD Airlifts Swabs for COVID-19 Testing from Italy to Memphis
Approximately 500,000 testing swabs and supplies were flown by Air Mobility Command on March 19-20 from Aviano Air Base, Italy, to the FedEx hub in…
Tulane https://www.eurekalert.org/pub_releases/2020-02/tu-tmp021820.php
James “Mac” Hyman, the Evelyn and John G. Phillips Distinguished Professor in Mathematics at Tulane University, is using mathematical models to better understand and predict the spread of COVID-19 and to quantify the effectiveness of various efforts to stop it.
The goal of Hyman’s work in “mathematical epidemiology” at the Tulane School of Science and Engineering, is to help the public health community understand and anticipate the spread of the infection and evaluate the potential effectiveness of different approaches for bringing it under control.
Hyman and colleagues at Georgia State University and the Public Health Agency of Canada recently had a paper on COVID-19 accepted by the journalInfectious Disease Modelingand theJournal of Clinical Medicine.
Infectious disease modelling
Use mathematical equations
Importance of contact tracing
Ebola 1/10 of 1% of Spanish Flu
Contact Tracing quantify the variability in the number of secondary infections allows to quantify transmission risk for novel pathogens
Reproduction number of an epidemoc R0 is expected number of secondary cases produced by primarcy case during the infectious perios
Metric to decide transmisibility
If R0 less than 1 it dies
President Approved New York Disaster Declaration
President’s Daily Schedule
12:00 briefing in Brady Room from Corona task Force
2pm call Trump Veterans Organizations
VA got 1bn of 45bn Covid budget, for testing etc across VA
FEMA
Cost of patient treatment $9000-$20000
Carnival Cruise Lines has offered to turn its cruise ships into makeshift hospitals
Reproductive Rate of Virus 2.6
Expected Problems
IC Bed shortages
Ventilators
Staffing
Protecting Healthcare workers, suits
Training Workers
Other Countries
Singapore TraceTogether Mobile App (apple, googleplay) Created by Government Technology Agency (GOvTech) in collaboration with MOH Ministry of Health. Uses short distance mobile signals exchanged over Bluetooth to help MOH determine who was within 2m of an infected person within a 30minute time bracket. Beats contact interviews. (SNGDO MOH, Smart Nation, Digital Gov Office)
Suspension of mass events
Leave of absence for staff who travelled in March
Safe Distancing for retail and Food and Beverage outlets
Border lockdowns
US NAtional Gueard
3300 Guardsmen women 27 states activatedhttps://www.militarytimes.com/news/coronavirus/2020/03/18/heres-the-latest-national-guard-mobilizations-by-state/
All 50 states have issued emergency declarations, a critical step before mobilizing National Guard resources.
Arkansas, Arizona, California, Colorado, Delaware, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Montana, New Jersey, New York, North Dakota, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, Washington and Wisconsin have all activated Guard components.
Puerto Rico is the first and only U.S. territory to also activate guardsmen thus far.
Guardsmen continue to assist with food delivery, logistics and cleaning services in the previously identified “containment area.”
In addition, guardsmen, including Army National Guard combat medic specialists and Air National Guard medical technicians, are “assisting state officials with the collection of samples” at drive-thru testing locations, the official added.
According to the governor, New York State has 2,382 positive cases of COVID-19, including 1,000 new cases and 549 hospitalizations, as of Wednesday morning.
What are CSTs Natl Guard
National response Framework
US Stockpile Program Dipped into -Masks
DW, Stefan Flasche German doing computer modeling mathematics and epidemiology London School of Hygience and Tropical Medecine
Results so far. 2.6 R
And 10-30% transmission from flks with no symptoms
For first death in your country you have approx 100 additional infescted two weeks prior and by time of death you have 1000 infected people
Presidenet oand FDA
Defense Production Act to help facilitate distribution of essential supplies if necessary. We’re working with Congress to provide major additional relief to the workers, small businesses, and the hardest-hit industries.
So we slashed red tape to develop vaccines and therapies as fast as it can possibly be done — long before anybody else was even thinking about doing this. And, as you know, earlier this week, we began the first clinical trial of a vaccine candidate for the virus, and that was launched in record time. It was just a few weeks. And that would have taken years to do, not so long ago.
The FDA Commissioner — Stephen Hahn,
Right to Try
The FDA has also approved compassionate use for a significant number of patients. You know what that means. We’re also reviewing drugs that are approved abroad or drugs approved here for other uses.
Now, a drug called chloroquine — and some people would add to it “hydroxy-.” Hydroxychloroquine. So chloroquine or hydroxychloroquine. Now, this is a common malaria drug. It is also a drug used for strong arthritis. If somebody has pretty serious arthritis, also uses this in a somewhat different form. But it is known as a malaria drug, and it’s been around for a long time and it’s very powerful. But the nice part is, it’s been around for a long time, so we know that if it — if things don’t go as planned, it’s not going to kill anybody.
When you go with a brand-new drug, you don’t know that that’s going to happen. You have to see and you have to go — long test. But this has been used in different forms — very powerful drug — in different forms. And it’s shown very encouraging — very, very encouraging early results. And we’re going to be able to make that drug available almost immediately. And that’s where the FDA has been so great. They — they’ve gone through the approval process; it’s been approved. And they did it — they took it down from many, many months to immediate. So we’re going to be able to make that drug available by prescription or states.
So, Regeneron, again, and — is some — is a company that’s done fantastically well, as I understand, with Ebola and some other things. Great company. And they’re looking at some very promising events also. So you have remdesivir and you have chloroquine and hydro- — hydroxychloroquine. So those are two that are out now, essentially approved for prescribed use.
We have 10,000 scientists, doctors, and others, and more than that working around the clock to aid the American people in this fight against the coronavirus. And those words are very much appreciated, sir. Thank you.
Contract Tracing in Epidemicshttps://www.medrxiv.org/content/10.1101/2020.02.10.20021725v1.full.pdf
CDC
Directory of Local Health DepartmentsNACCHO
RESEARCHERS
2019-nCoV SequencesGenBank
NEWS/MEDIA
Coronavirus News in Past HourGoogle
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Articles by Helen BranswellSTAT
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Understanding pandemics: What they mean, don’t mean, and what comes next with the coronavirusSTAT
If the coronavirus outbreak grows, can a strained US health care system keep up?BOTAS
Global Tracker: Travel Restrictions on China Due to COVID-19Think Global Health
Defining the Epidemiology of Covid-19 — Studies NeededNEJMNEW
PERSONAL PREPAREDNESS
Pandemic PreparednessReady.gov
Preventing nCoV Infection from Spreading in Homes and ResidencesCDC
Travel AdvisoriesState Dept
Myth-BustersWHO
Look Out for Coronavirus-Related Investment Scams – Investor AlertSEC
HIPAA Privacy and Novel CoronavirusHHS
Get Your Household Ready for Pandemic FluCDC
Report a Fraudulent 2019-nCoV ProductFDA
How to Avoid Phishing Emails Exploiting Coronavirus FearsJBSA.mil
Coronavirus: Scammers Follow the HeadlinesFTC
AT WORK
Prep and Protection for First RespondersIAFF
Pharmaceutical Cargo Security Initiative Supply Chain Survey Healthcare Ready
Guidance for Environmental Cleaning in Non-Healthcare Facilities Exposed to SARS-CoV-2ECDC
Interim Guidance for Businesses and Employers to Plan and Respond to COVID-19
Key OSHA Standards for COVID-19Dept of Labor
Human Resources Flexibilities Available for Federal Employees Impacted by the 2019 Novel CoronavirusOPM
Classroom Cleaning Tips for TeachersWA DOH
Novel Coronavirus Guidance for Air Carriers and CrewFAA
Interim Guidance for Ships on Managing 2019 Novel CoronavirusCDC
Strategies for Optimizing the Supply of N95 RespiratorsCDC
COVID-19 Guidance for ShipsCDC
Tulane National Primate Research Center (TNPRC) is establishing a COVID-19 research program to develop a vaccine and test treatments against the virus. First, researchers will create a nonhuman primate model to study the disease’s clinical progression, how it is transmitted through the air and how it specifically affects aging populations. Investigators hope to answer many of the unknowns about the disease, including why older individuals are more susceptible to complications and death from it.
Earlier this year, TNPRC mobilized to become one of the first research facilities in the country to obtain approval from the Centers for Disease Control to receive samples of the novel coronavirus, called SARS-CoV-2. TNPRC is the only National Primate Research Center with a Regional Biocontainment Laboratory (RBL) onsite that is capable of the high level of biocontainment required to study an emerging infectious disease like COVID-19. It also has the nation’s largest capacity for studying the transmission of infectious agents in nonhuman primates at this level of biocontainment, which is critical as public health responders rush to understand and thwart disease spread.
Rappaport will lead a team of collaborators from the center with unique expertise in aerobiology, virology, immunology, pulmonology, and veterinary medicine. All work will be conducted in the RBL under the highest, most stringent safety and quality standards and overseen by Tulane Director of Biosafety Angela Birnbaum, a nationally certified biosafety expert.
Birnbaum leads a national working group that will launch a collaborative research program on COVID-19 among the National Primate Research Centers (NPRCs). The group will work to develop vaccines and evaluate treatments against the disease using a nonhuman primate model. It will release research findings to scientists and collaborators in real time to accelerate progress to find successful treatments and preventions against the disease.
Virologist Bob Garry
In Pictures: DoD Airlifts Swabs for COVID-19 Testing from Italy to Memphis
Approximately 500,000 testing swabs and supplies were flown by Air Mobility Command on March 19-20 from Aviano Air Base, Italy, to the FedEx hub in…
Tulane https://www.eurekalert.org/pub_releases/2020-02/tu-tmp021820.php
James “Mac” Hyman, the Evelyn and John G. Phillips Distinguished Professor in Mathematics at Tulane University, is using mathematical models to better understand and predict the spread of COVID-19 and to quantify the effectiveness of various efforts to stop it.
The goal of Hyman’s work in “mathematical epidemiology” at the Tulane School of Science and Engineering, is to help the public health community understand and anticipate the spread of the infection and evaluate the potential effectiveness of different approaches for bringing it under control.
Hyman and colleagues at Georgia State University and the Public Health Agency of Canada recently had a paper on COVID-19 accepted by the journalInfectious Disease Modelingand theJournal of Clinical Medicine.
Infectious disease modelling
Use mathematical equations
Importance of contact tracing
Ebola 1/10 of 1% of Spanish Flu
Contact Tracing quantify the variability in the number of secondary infections allows to quantify transmission risk for novel pathogens
Reproduction number of an epidemoc R0 is expected number of secondary cases produced by primarcy case during the infectious perios
Metric to decide transmisibility
If R0 less than 1 it dies
President Approved New York Disaster Declaration
President’s Daily Schedule
12:00 briefing in Brady Room from Corona task Force
2pm call Trump Veterans Organizations
VA got 1bn of 45bn Covid budget, for testing etc across VA
FEMA
Cost of patient treatment $9000-$20000
Carnival Cruise Lines has offered to turn its cruise ships into makeshift hospitals
Reproductive Rate of Virus 2.6
Expected Problems
IC Bed shortages
Ventilators
Staffing
Protecting Healthcare workers, suits
Training Workers
Other Countries
Singapore TraceTogether Mobile App (apple, googleplay) Created by Government Technology Agency (GOvTech) in collaboration with MOH Ministry of Health. Uses short distance mobile signals exchanged over Bluetooth to help MOH determine who was within 2m of an infected person within a 30minute time bracket. Beats contact interviews. (SNGDO MOH, Smart Nation, Digital Gov Office)
Suspension of mass events
Leave of absence for staff who travelled in March
Safe Distancing for retail and Food and Beverage outlets
Border lockdowns
US NAtional Gueard
3300 Guardsmen women 27 states activatedhttps://www.militarytimes.com/news/coronavirus/2020/03/18/heres-the-latest-national-guard-mobilizations-by-state/
All 50 states have issued emergency declarations, a critical step before mobilizing National Guard resources.
Arkansas, Arizona, California, Colorado, Delaware, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Montana, New Jersey, New York, North Dakota, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, Washington and Wisconsin have all activated Guard components.
Puerto Rico is the first and only U.S. territory to also activate guardsmen thus far.
Guardsmen continue to assist with food delivery, logistics and cleaning services in the previously identified “containment area.”
In addition, guardsmen, including Army National Guard combat medic specialists and Air National Guard medical technicians, are “assisting state officials with the collection of samples” at drive-thru testing locations, the official added.
According to the governor, New York State has 2,382 positive cases of COVID-19, including 1,000 new cases and 549 hospitalizations, as of Wednesday morning.
What are CSTs Natl Guard
National response Framework
US Stockpile Program Dipped into -Masks
DW, Stefan Flasche German doing computer modeling mathematics and epidemiology London School of Hygience and Tropical Medecine
Results so far. 2.6 R
And 10-30% transmission from flks with no symptoms
For first death in your country you have approx 100 additional infescted two weeks prior and by time of death you have 1000 infected people
Presidenet oand FDA
Defense Production Act to help facilitate distribution of essential supplies if necessary. We’re working with Congress to provide major additional relief to the workers, small businesses, and the hardest-hit industries.
So we slashed red tape to develop vaccines and therapies as fast as it can possibly be done — long before anybody else was even thinking about doing this. And, as you know, earlier this week, we began the first clinical trial of a vaccine candidate for the virus, and that was launched in record time. It was just a few weeks. And that would have taken years to do, not so long ago.
The FDA Commissioner — Stephen Hahn,
Right to Try
The FDA has also approved compassionate use for a significant number of patients. You know what that means. We’re also reviewing drugs that are approved abroad or drugs approved here for other uses.
Now, a drug called chloroquine — and some people would add to it “hydroxy-.” Hydroxychloroquine. So chloroquine or hydroxychloroquine. Now, this is a common malaria drug. It is also a drug used for strong arthritis. If somebody has pretty serious arthritis, also uses this in a somewhat different form. But it is known as a malaria drug, and it’s been around for a long time and it’s very powerful. But the nice part is, it’s been around for a long time, so we know that if it — if things don’t go as planned, it’s not going to kill anybody.
When you go with a brand-new drug, you don’t know that that’s going to happen. You have to see and you have to go — long test. But this has been used in different forms — very powerful drug — in different forms. And it’s shown very encouraging — very, very encouraging early results. And we’re going to be able to make that drug available almost immediately. And that’s where the FDA has been so great. They — they’ve gone through the approval process; it’s been approved. And they did it — they took it down from many, many months to immediate. So we’re going to be able to make that drug available by prescription or states.
So, Regeneron, again, and — is some — is a company that’s done fantastically well, as I understand, with Ebola and some other things. Great company. And they’re looking at some very promising events also. So you have remdesivir and you have chloroquine and hydro- — hydroxychloroquine. So those are two that are out now, essentially approved for prescribed use.
We have 10,000 scientists, doctors, and others, and more than that working around the clock to aid the American people in this fight against the coronavirus. And those words are very much appreciated, sir. Thank you.
Contract Tracing in Epidemicshttps://www.medrxiv.org/content/10.1101/2020.02.10.20021725v1.full.pdf
The agenda is to deliver the opening offer of a discussion between Israel and the Palestinians in a Middle East Peace process. The plan will be announced at 12pm January 28 in the East Room of the White House . Mr Trump says that Bibi worked out the plan with his opponent. The President remarked, “they say it’s probably the most difficult deal anywhere and of any kind to make.”
Prime Minister Netanyahu said, “the deal of the century is the opportunity of the century.” He turned to the president and said, “You’ve been the the greatest friend that Israel has had in the White House, and I think tomorrow we can continue to make history.”
in Q&A with press, the President said the plan is something the Palestinians should want. He suggested they may not want it initially, but in the end they will, “it’s overly good to them.” He talked about cutting off aid to the Palestinians.
The President closed by saying that at 12 the proposal will be made, calling it a “suggestion” to by Israel to the Palestinians.
Jared Kushner has been working on the “Vision for Peace.” Netanyahu’s previously published map appears to be a revised version of the Allon Plan removing access to the Jordanian border, annexing territory, implementing Palestinian self-rule, but removing the possibility of an independent Palestinian state.
There’s been a serious Maritime accident today in the Kerch Strait between a Russian Coast Guard ship and a Ukrainian navy tugboat. Ukraine was transferring three navy ships, including two warships, from Odessa in the Black Sea to Mariupol when the collision occurred. Ukraine says the Russian ship rammed the tug in “openly aggressive actions” off the Moscow-annexed Crimean Peninsula, damaging its engine, shell plating, and guard rail. In response to the incident, Russia has closed the Kerch Strait to merchant vessels, which may have been her intent. The Kech Strait connects the Black Sea to the Sea of Azov. It is an important merchant shipping and fishing zone.
The collision builds on tensions that have been growing since May when it was reported that Russia began detaining merchant ships, sometimes for days, heading to Ukrainian ports, inflicting economic losses on Ukraine. At the time of the maritime collision, Ukraine was transferring the three vessels to the Sea of Azov to increase security. The Azov is ‘patrolle’d by roughly 56 Russian vessels including war ships from her Black Sea Fleet and Caspian Flotilla. Ukraine has responded to Russian patrols by running troops and weapons along its southeast coast, increasing security from Mariupol to Berdyansk. They’ve conducted military exercises with attack helicopters.
Russia seems to intend to exert economic pressure on Ukraine to destabilize the strategic southeast region without an obvious military aggressive act, which would lead to Western sanctions.
Ashore, Mariupol is a city of 500,000 with a critical industrial port. In spring 2014, Russian separatists briefly held the city until Ukrainian battalions pushed them out.
In the nearby occupied area of the Ukraine, there are serious water shortages where Ukraine introduced a ban on the water supply. Vegetation maps show a rapid decline in vegetation growth. It is possible that today’s Russian pressure is intended to ease the water ban.
Russia built a $3.7 billion Crimean Bridge in May 2018, connecting occupied Ukraine to southern Russia across the Kerch Strait which led to Western sanctions against Russia. As the bridge was nearly completed, Russia detained a Crimean fishing vessel for illegally sailing under a Russian flag. In May, Russian border guards are reported to have arrested a Ukrainian fishing vessel and crew for illegally fishing in its exclusive economic zone. When the bridge was completed, Russia sent warships to create security for the bridge. 148 Ukrainian vessels have been detained by Russia since then, according to Ukrainian authorities, port authorities, and local merchant shipping firms. The bridge is of a low height with a 33 meter clearance which means ships can’t clear the bridge to reach Mariupol. Ukraine says this has resulted in a 30 percent loss in port revenues.
Because of a 2003 agreement signed by Vladmir Putin and President Kuchma to cooperate and share the use of the Sea of Azov and the Ketch Strait in joint control, Russian action is technically legal, but Russia has used the deal to create a blockade, according to Ukraine. Mariupol is a lucrative fishing area that employs 20,000 local area residents to make their income, and an important port for Ukraine to ship steel and grain. Ukraine could scrap the agreement but won’t.
Ukraine must respond with added security to avoid a further drop in merchant shipping to the port. She can’t overemphasized and draw too much attention to security issues which would further reduce merchant shipping out of fear of coming in to Mariupol.