Which states had the best pandemic response?

“Few states have a record as unblemished as Vermont.

The odds could have been stacked against the state. The virus arrived in Vermont during the first wave sweeping the country. It shares borders with some of the hardest-hit states and has the third-oldest population in the country.

But Vermont swiftly flattened its initial wave and has since gone weeks at a time without any new confirmed infections. Fewer than 60 people have died, giving the state the second-fewest deaths per capita behind Alaska, which has seen surging caseloads in recent weeks. If the country as a whole had the same per capita death rate as Vermont, the nationwide death toll would be 30,000 instead of more than 215,000.”

“While health experts say the state has likely benefited from its rural geography, other sparsely populated areas of the country that let their guard down were overwhelmed by the virus this spring and summer. That sense of complacency never took hold in Vermont, where a moderate Republican governor and a Democratic-led Legislature helped defuse partisan tensions that hampered the response elsewhere.

“Any state that’s going to succeed against Covid has got to have the compliance of the population, because every single thing you do is telling people to alter their personal behavior,” Mark Levine, Vermont’s health commissioner, said in an interview.”

“Vermont reopened slowly. The lockdown it put in place in late March is still gradually being lifted, restaurants and bars are still limited to 50 percent indoor capacity and even outdoor gatherings are still subject to a 150-person limit.”

“Local governments have authority to set their own stricter rules. Burlington, the state’s most populous city, reduced its outdoor gathering limit to 25 in late August when college students began returning to nearby campuses.”

“The state is also strict about visitors, requiring a two-week quarantine for people arriving from places with higher infection rates. And it invested early in testing and contact tracing and implemented a state-wide mask mandate early on.”

” Vermont’s experience has some similarities to Alaska, another predominantly rural state that until recent weeks kept the virus at bay through one of the country’s most proactive testing regimes and a strictly enforced quarantine requirement for travelers. But unlike Alaska, Vermont is just a few hours’ drive from New York City, the outbreak’s early epicenter, and that makes its performance even more noteworthy.”

“Washington state shows larger urban centers can mount an effective defense against the virus with rapid coordination and an early focus on vulnerable populations.

“Washington was the tip of the spear,” Riley said. “They were the first and had to make decisions really fast.”

The state in late January reported the nation’s first case of Covid-19, and the pathogen’s tear through a Seattle-area nursing home was the first indication of how thoroughly the facilities would soon be devastated nationwide. But the state quickly got its act together.”

“The state’s success stems from extensive data sharing, which helped health officials better target their response measures once state restrictions and business closures during the initial lockdown were eased. That meant a better view into where the virus was still lurking and knowing where to direct critical resources like testing, protective equipment and hospital surge capacity.”

“Washington health authorities understood early the need to protect the elderly, identifying people living in nursing homes and assisted living communities as particularly vulnerable clusters.

When Congress gave states a 6.2 percent bump to their federal Medicaid funds in March, Washington was among a handful of states that largely used the windfall to provide targeted aid to nursing homes, helping them pay for additional staffing, equipment and hazard pay. New York was not.”

The New York Times Recoils at the Predictable Consequences of the Mandatory COVID-19 Precautions It Supports

“If COVID-19 precautions are mandatory, they must at some point be legally enforced, with all the risks that entails, including violence and racial discrimination. The public health payoff might justify those risks in certain contexts—if a dense crowd happens to gather in Central Park, for instance, or if subway riders refuse to wear masks (although that was the situation in the video that the Times cites as evidence of overkill). But the risks cannot be eliminated if voluntary compliance is less than perfect, as it always will be.”

How masks helped Hong Kong control the coronavirus

“New York City, with a population of about 8.4 million, has had over 28,000 coronavirus deaths as of May 18. Meanwhile, Hong Kong has officially recorded only four Covid-19 deaths, despite having 7.5 million residents.
One reason that could help explain the stark disparity: In Hong Kong, nearly everyone wears a face mask in public.

If any city in the world was likely to experience the worst effects of the coronavirus, Hong Kong would have been a top candidate. The urban area is densely populated and heavily reliant on packed public-transit systems, and it has very few open spaces. Moreover, a high-speed train connects Hong Kong to Wuhan, China, where the coronavirus originated.

Hong Kong, it seemed, was doomed.

But almost as soon as the outbreak first began in the city, millions of residents started wearing masks in public. One local told the Los Angeles Times that the government didn’t have to say anything before 99 percent of the population put them on.

Experts now say widespread mask usage appears to be a major reason, perhaps even the primary one, why the city hasn’t been devastated by the disease.

“If not for universal masking once we depart from our home every day, plus hand hygiene, Hong Kong would be like Italy long ago,” K.Y. Yuen, a Hong Kong microbiologist advising the government, told the Wall Street Journal last month.”

“Starting last spring, pro-democracy activists took to the streets of Hong Kong to protest a set of laws that would give mainland China — which isn’t supposed to have full control over the city until 2047 — more power over Hong Kong. To protect themselves from police tear gas and avoid the city-state’s ubiquitous surveillance cameras, millions of protesters donned masks.

In an effort to quash the movement last October, Hong Kong’s China-backed government banned the wearing of face masks in public. The hope was that forcing demonstrators to show their faces would make them stay home instead.

Just a few months later, the coronavirus happened.

As the coronavirus first hit the city, Hong Kong Chief Executive Carrie Lam fumbled her response, not wearing a mask during a press conference and, eventually, wearing one incorrectly in public. She also asked government employees not to wear masks.

By April, public health experts in Hong Kong were calling on the government to not only repeal the mask ban but also to mandate the wearing of masks in public as a means of curbing the coronavirus’s spread.

But by then, almost everyone was already wearing them, ban be damned. Indeed, the fact that the government seemed to advocate against masks may have helped make them more popular. Almost in protest, residents started wearing masks in large numbers and helping the most vulnerable communities obtain them.”

“The city has faced pandemics before, including the 1968 flu, which began in Hong Kong and killed about 1 million people worldwide. When SARS came to Hong Kong from mainland China in 2003, residents took it seriously and nearly everyone wore a mask. Partly as a result, the city lost only 300 people during that crisis.

Experts say that instilled a sense among the people of Hong Kong that masks are vital to thwarting a pandemic. That sense was reignited when the coronavirus hit. Now they’re everywhere.”

“Despite Hong Kong’s mask ban officially remaining in place, some of the government’s health officials now praise the citizenry for organically putting the coverings on without being told to do so.”

“It’s worth noting that Hong Kong also implemented a strong testing, tracing, and isolation program, in addition to strengthening travel rules and closing bars at the end of March. Those moves, perhaps just as much as masks, have helped keep Hong Kong’s coronavirus death toll low.

But the masks, research shows, are still very important.”

Dr. Fauci Has Been Dreading A Pandemic Like COVID-19 For Years

“At the time, I didn’t find this quote particularly earth-shattering. It seemed like a reasonable concern, but not newsworthy. After all, Americans have lived through multiple pandemic scares — SARS, MERS, swine flu — and we largely dodged each bullet. This part of the interview was off-topic for the series I was making, and I left it on the cutting room floor.
Reading the transcript almost a year later, I am struck by how clearly Fauci described this current pandemic. Our nation’s top public health officials have known that this outbreak, or something like it, was a serious possibility, and they haven’t been keeping this information to themselves. But it’s hard to find the collective will to prepare for — and stop — a theoretical threat. COVID-19 may be unprecedented, but it wasn’t unpredictable.”

America doesn’t want another Tea Party

“Trump’s approach to the pandemic has been to crow about his administration’s imaginary successes while blaming governors for everything that’s gone wrong.
On Friday, he escalated his message, endorsing the anti-stay-at-home protests cropping up across the country — specifically the protests in battleground states run by Democratic governors.

Moments after Fox News aired a segment on the rallies, Trump tweeted their rally cry against their governors: “LIBERATE.””

“Fox News is trying to convince Americans that there’s a groundswell of opposition to these important measures, attempting to make small rallies look big and fringe attitudes look mainstream.

On air, they’ve displayed images that make the protests seem significant. A first glance at the map below makes it look like a huge number of rallies have already happened, but they haven’t. It’s a double-whammy: The movement looks large and Fox encourages viewers to join.”

” The same images were used in the early days of the Tea Party, when Fox trumped up the rallies, describing them as part of a “revolution” and urging viewers to join.”

“Conservative groups are playing an important part, too. Three pro-gun groups are behind the largest Facebook group encouraging the protests, according to an investigation by the Washington Post.

In Michigan, a group funded by Trump ally Education Secretary Betsy DeVos helped get out the word.

And the same Tea Party groups that were successful a decade ago are eager to join in. “

400,000 cases later, Trump defends his February claim that the coronavirus was going away on its own

“It’s true that by February 23, Trump had restricted travel from China. But the virus was already spreading within the United States. And Trump’s public statements belie the revisionist history he’s now offering about how he took the coronavirus seriously from the beginning.
For instance, during a news conference on February 26, Trump said, “when you have 15 [coronavirus cases], and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”

But instead of going down “close to zero,” the United States now has nearly 400,000 cases less than two months out from Trump uttering those words. During Tuesday’s briefing, a reporter pressed him on this point.

“When Peter Navarro did circulate those memos, you were still downplaying the threat of coronavirus in the US,” the reporter said. “You were saying things like, ‘I think it’s a problem that is going to go away within a couple of days —’”

“Which I’m right about,” Trump interjected.

The reporter continued: “You said ‘within a couple of days the cases will be down to zero.’”

Given the current magnitude of coronavirus cases in the US, you might think Trump’s comment about coronavirus going away on its own would be too much even for him to try and defend. You’d be wrong.

“Well, the cases really didn’t build up for a while,” Trump replied.”

“Navarro’s memo recommended significant immediate federal investment in personal protection equipment (PPE) for health care workers. But federal agencies largely held off on such expenditures until mid-March, when the crisis was already spinning out of control. Trump’s line on that point has been that states should’ve done more to help themselves.

If Trump really didn’t learn of Navarro’s memo until media reports about it in recent days, it’s an indictment of his administration — after all, you’d expect a top official’s conclusion that as many as 2 million Americans could die from a deadly disease would be worth bringing to his attention. But if he did see it and not only didn’t act but told the public that the coronavirus would go away “like a miracle” as he did on February 27, then in some ways that’s even worse.

What we do know is that, for whatever reason, Trump was indulging in wishful thinking during a critical period in which more proactive measures could’ve saved lives. And as a result, the goalposts have now moved to a point where Trump is preparing to tout as many as 100,000 American deaths as a win.”

The WHO isn’t to blame for Trump’s disastrous coronavirus response

“The SARS-CoV-2 virus that causes the disease swept across the globe not because of the WHO’s errors but because of a “very fragmented, chaotic, state-centric response,” according to Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
And now, with over 2 million reported cases and 125,000 deaths worldwide, countries “failing in their response have decided WHO is the culprit,” says Ashish Jha, a professor at the Harvard T.H. Chan School of Public Health.”

“Most experts agree there are some legitimate criticisms of how the agency has handled the Covid-19 global health crisis, particularly in how it responded to China’s initial delays and suppression of key information. Other critiques, they say, are less founded.”

“On January 22, just three weeks after first being notified of the virus’s existence, WHO Director-General Tedros Adhanom Ghebreyesus convened an emergency meeting to determine if the outbreak qualified as a public health emergency of international concern (PHEIC), the agency’s term for an “extraordinary event” that requires a coordinated international response — like SARS, H1N1, and Ebola outbreaks in 2014 and 2019. The experts couldn’t agree and decided to meet again. After the director-general traveled to Beijing to meet with Chinese President Xi Jinping in Beijing on January 29, a PHEIC was declared on January 30.

This declaration activated WHO measures to “address travel, trade, quarantine, screening, treatment” as well as national measures in countries that have tied their pandemic response plans to WHO declarations. “I called for WHO to do it a little earlier,” says Gostin, “but it had no impact on the epidemic.” Jha agrees. “I think they could have called it when they initially met, but it wouldn’t have made a big difference,” he says.”

“all the experts Vox interviewed agreed that the US government’s lack of preparation for Covid-19 was not a result of WHO delays.”

“ABC News reports US intelligence agencies warned the White House and the Pentagon of the disease as early as November. In January, trade adviser Peter Navarro warned the White House that the novel coronavirus could kill half a million Americans. In February, the US lost valuable weeks failing to develop effective testing. As late as February 27, Trump told a press briefing the virus would “disappear.” The next day, the first American died of Covid-19.

“WHO is not responsible for America not heeding the warnings of its own scientists and security apparatus — for two months,” says Jha. “That’s laughable.””

“WHO has offered little criticism of governments’ responses.”

“More than 430,000 people traveled from China to over 17 American cities after the virus was discovered but before the ban; another 40,000 people arrived to the US from China after the ban went into place.”

“Although the WHO has not publicly criticized the American travel ban, it doesn’t recommend travel or trade restrictions during disease outbreaks, both because they often don’t work and because they can make disease response more difficult. Kamradt-Scott recalls firsthand his difficulty in trying to get from Australia to West Africa during the 2014 Ebola outbreak, when all but two commercial airlines had stopped flying there. “It’s not simply that it causes economic damage, but that it impedes responses,” he says. ”

“Kamradt-Scott, however, is on the fence. He has just completed a literature review, looking at travel and trade restrictions, and his view is that travel bans “may have helped delay the arrival of the virus.” He predicts that eventually Covid-19 research will cause the WHO to revisit some of its guidelines. “It’s rather fraught. It does create economic problems, but if it can help countries by giving them time to prepare, perhaps it can be justified on that ground.”

But, he adds, “Trump implemented travel restrictions but then did nothing to prepare the country, so again, that really comes back to his administration.””

Coronavirus vs. Governors: Ranking the Best and Worst State Leaders

“On March 14, Stitt tweeted a picture of his family eating at a restaurant, as if he deserved an award for defying the coronavirus panic. “It’s packed tonight!” he enthusiastically shared, but facing blowback, later deleted the post.

The next day, Stitt declared a state of emergency. Then, the day after that, the governor’s spokesman said, “the governor will continue to take his family out to dinner and to the grocery store without living in fear, and encourages Oklahomans to do the same.” Stitt still has not issued a statewide stay-at-home order. In the absence of one, major Oklahoma cities have imposed their own over the past few days.

Two weeks later, Oklahoma’s rate of infection is intensifying, and testing is minimal. Stitt is not the only governor who has hesitated to implement stiff restrictions, but he may become a case study of the pitfalls of glib social media use in a time of crisis.”

Trump Slowly Enlisting More Agencies in ‘Whole of Government’ Response to Virus

““We need the federal government to play its role,” Gov. Andrew M. Cuomo of New York said Monday. “The federal government has tremendous capacity.”

Much of that capacity is untapped. Hospital ships are at port. The Department of Veterans Affairs, legally designated as the backup health care system in national emergencies, awaits requests for help. The veterans department has a surplus of beds in many of its 172 hospital centers and a robust number of special rooms for patients with breathing disorders.

The sprawling system of emergency doctors and nurses ready to be deployed by the Department of Health and Human Services — known as the National Disaster Medical System — is also still waiting for orders, other than to staff locations where passengers offloaded from cruise ships are being quarantined.

And the Defense Department, home to 1.3 million active-duty troops and a civilian and military infrastructure that has made planning for national emergencies almost an art form, has yet to be deployed to its fullest capabilities. Senior Pentagon officials say they are ready to assist in any way that is ordered, but they also caution that much of the military’s emergency medical care is designed for combat trauma or natural disasters, and not mass quarantine for infections.

The last time a big infectious disease epidemic emerged, President Barack Obama dispatched nearly 3,000 American troops to Liberia to build hospitals and treatment centers to help fight Ebola. The Pentagon opened a joint command operation at a hotel in Liberia’s capital, Monrovia, to coordinate the international effort to combat the disease, and the American military provided engineers to help construct additional treatment facilities and sent people to train health care workers in West Africa to deal with the crisis.”

“Defense Secretary Mark T. Esper said on Tuesday that the Pentagon will make available to the Department of Health and Human Services up to 5 million N95 masks, which can be used to help protect health workers and vulnerable people against the virus. The first 1 million, he said, would be available immediately.

The Pentagon is also making available 2,000 ventilators for hospitals, a number that would likely fall far short of the expected need. “When you look at how many people who may need it”

“Field hospitals and the hospital ships Comfort and Mercy are designed for trauma wounds, not viruses, and doctors would have to be assigned from elsewhere to staff them. The ships, each with a 1,000-bed capacity, have helped in natural disasters like tsunamis, hurricanes and earthquakes, not quarantines.

Defense Department officials said that one possibility for the Comfort would be to station in New York Harbor and absorb non-coronavirus patients in New York, which could free up hospital beds in Manhattan to attend to infectious cases.”

“Oregon sent a letter to Vice President Mike Pence on March 3 asking for 400,000 N95 masks. For days, it got no response, and only by March 14 received its first shipment, of 36,800 masks. But there was a problem. Most of the equipment they got was well past the expiration date and so “wouldn’t be suitable for surgical settings,” the state said.

New York City also put in a request for more than 2 million masks and only received 76,000; all were expired, said Deanne Criswell, New York City’s emergency management commissioner. The city is also requesting additional beds for intensive care units and medical teams to staff a convention center that may be turned into a temporary medical facility.”

“FEMA officials said the Department of Health and Human Services remains in charge of the federal response, and it too is waiting for orders from the agency before it moves to ramp up assistance.”

“In previous national emergencies, FEMA would be responsible for finding out where to obtain masks, ventilators, hospital beds and tents from either the military or the private sector and ensuring the supplies are delivered to states, according to Michael Chertoff, the secretary of homeland security under President George W. Bush who oversaw the response to Hurricane Katrina.

“They have relationships and know where to look for things,’ Mr. Chertoff said. “Without that it’s not clear to me who would be doing the coordination and facilitation function.””