Proactive MD Preparations for Coronavirus (COVID-19)

Things are moving quickly as the COVID-19 outbreak continues. At Proactive MD, we are monitoring these developments, as we continue to provide care without compromise to our patients. We want to make sure that our partners – patients, clients, and the broader healthcare community – have the latest information. Here’s a digest of the most recent presidential press conference, governmental guidance, and COVID-19 news.

News Round-Up

Will The Costs Of A Great Depression Outweigh The Risks Of Coronavirus?
Federal and state governments are making a massive gamble about a little-understood new virus. They may not only be betting our entire economy, but our nation’s future. Thus it’s imperative that they not make foolish choices.
We shouldn’t allow policy under a Republican president to be driven by a Democrat like Steve Mnuchin, whose overwhelming priority is reassuring Wall Street above all else. Voters don’t vote for Donald Trump to get Obama-Bush bailouts of Wall Street and welfare expansions.  (Read more)

Cuomo Orders All Hospitals To Add Beds As New York Confirms 20,000 Coronavirus Cases
New York state has confirmed 20,875 cases of the coronavirus — a jump of 5,700 cases that Gov. Andrew Cuomo says is because of his state’s aggressive approach to testing. New York can now conduct more than 16,000 tests a day, the governor said. As he announced those sobering numbers, Cuomo reiterated that New York, the U.S. epicenter of the COVID-19 pandemic, needs to sharply increase hospitals’ capacity to treat patients. The governor escalated that call Monday, saying his office is issuing an emergency order to require all hospitals in the state to increase their capacity.
“You must increase your capacity by 50%,” Cuomo said. “You must. Mandatory directive from the state. Find more beds, use more rooms.” (Read more)

‘I know, but what do you want me to do?’: Fauci’s strikingly honest review of Trump’s coronavirus response
Dr. Anthony Fauci’s interview with Science magazine began on an inauspicious note. Asked how he’s doing right now, Fauci said he was “exhausted” but “good.” “I mean, I’m not, to my knowledge, coronavirus-infected,” he said, before adding with a laugh: “To my knowledge, I haven’t been fired.”

The half-joke was a sign of things to come. What followed were several exchanges that should help people take stock of President Donald Trump’s response to the coronavirus. Repeatedly, Fauci tacitly and even openly admitted that comments made by the commander in chief are not true and are not in line with what the nation’s leading infectious disease expert is advising. (read more)

Surgeon general on coronavirus pandemic: ‘It’s going to get bad’
The Surgeon General had a grim warning Monday that the coronavirus pandemic will get worse because Americans aren’t taking the threat seriously enough. “I want America to understand this week, it’s going to get bad,” Surgeon General Dr. Jerome Adams said during an interview on NBC’s Today. “We really need to come together as a nation.”
Adams said too many people—especially those who are young—aren’t following social distancing protocols and guidance to stay at home. “Right now, there are not enough people out there who are taking this seriously,” he said. “A lot of people think this can’t happen to them.” (read more)

FDA approves rapid coronavirus test licensed by Colorado company
ENGLEWOOD, Colo. (KDVR) — Aytu BioScience, Inc. announced Monday that the company may begin the distribution of the first 100,000 COVID-19 IgG/IgM Rapid Tests throughout the country this week. The test delivers results between 2 and 10 minutes at the point of care and are for professional use only. 

Josh Disbrow Aytu BioScience’s Chief Executive Officer, said, “We are moving as quickly as we can to bring the COVID-19 IgG/IgM Rapid Test to the U.S. professional medical community. With product now in transit to our warehouse in Colorado we’re optimistic that we can have test kits ready for sale in the very near term. In the two short weeks since signing our distribution agreement, we have ordered our first 100,000 tests and have received confirmation from FDA that we may begin distribution. We are optimistic that we’re now just days away from placing these COVID-19 test kits into the hands of healthcare professionals.” (Read more)

Other news:
How Long Will the Coronavirus Lockdowns Go On?

White House Press Briefing

President Trump:

  • Public health experts are studying COVID-19, so we know when we’ve turned a corner
    • Medical experts will develop guidance so we can approve re-starting regional economies once cleared
    • Working on legislation to protect businesses both small and large
  • Proud of the America people
    • Call on Congress to act together as well
    • Expects a full economic recovery
  • FEMA just shipped 8 million N95 masks to areas with greatest need
    • New York & Washington getting shipments
    • FEMA taking donations and making masks as well
    • Cooperation between government, scientists, public and private companies
  • Clinical trials in for drugs starting tomorrow in New York,
    • Chloroquine Z-packs and other drugs being distributed
    • Believes there is a real chance these drugs can have a tremendous impact
      • Distribution starts tomorrow morning in New York
  • Postponing Real-ID requirements
    • New deadline announced soon
  • Announcing more rescues for Americans stranded abroad
  • Invoking sections of the Defense Procurement Act to prevent people from hording
    • Prevent price gouging
    • Protect resources under this act
    • Prevent people from exploiting fellow citizens
    • Federal prosecutors already taking action
      • Shutting down a site selling fake cures
  • Citizens are doing things for their neighbors – America at its best

Attorney General Barr:

  • Executive Order (Section 102 of the DPA)
    • Designated scarce material
    • Once designated prevents and can prosecute from accumulating or selling in excess of market price
    • HHS will enforce:
      • No items yet designated
      • Working to identify those items
      • New task force to address hording, price gouging and supply chain problems
    • Already initiated investigations
      • Not businesses, but those trying to manipulate the market
      • Not a citizen with toilet paper, but those who have a “warehouse of masks”

Dr. Brix:

  • Thanks other countries for their mortality data
    • No child under 15 in Europe has died
    • Preexisting conditions a major factor
  • Please continue the 15 day challenge
  • Thanks Laboratory people on the front lines
    • Large commercial labs doing round-the-clock runs
    • Still getting more tests than they can process
    • Breakthrough today on self-swab tests
      • Now available
      • Emergency rooms and hospitals still a priority
      • Reminder that people should only test if they need it
  • NYC has an attack rate close to 5x the national average
    • NYC needs to self-isolate and social distance

VP Pence:

  • Recapped the call with State Governors today
    • Recent approval of CA, NY and WA disaster declarations
    • Will expedite review for other states
    • Do whatever it takes to support states
      • Locally executed, State managed, Federally supported  
  • The Administration fully supports governor’s actions
    • Discussed importance of Federal legislation being negotiated
    • Want Governors to support too (encourage their delegations
      • $3000 per family on average
      • Small business assistance
      • Hospital monetary assistance
  • Testing Updates
    • Expanding by the hour across the country
    • FDA reviewing less invasive testing
      • Self-collection of nasal swabs
      • Nasal swabs can now be collected at testing sites
      • Minimize drain on PPE
    • New guidance to commercial labs to prioritize hospital
    • All states must report to the feds by law
  • Businesses stepping up
    • N-95 masks being donated by facebook
    • 3M increasing production
  • Ventilators may now be repurposed from anesthesiologists
    • Governors can survey and repurpose
  • 8 days into the 15 days to slow the spread
    • We will beat this

Rear Admiral Polowczyk (Supply chain task force – FEMA)

  • Focused on PPE & Ventilators (see attached org chart)
  • Focused effort on the following areas for supplies
    • preservation
    • availability
    • reallocation
    • expansion
  • Q: Heard from your Surgeon General that this is going to get really bad?
    • Trump: Want Americans to know that, but we are doing what we can to make this much less bad
      • Taking steps to ensure that closing borders, etc.
  • Q: What happens in a week to reconcile need to keep social distancing with desire to reopen the economy?
    • Trump:  We can do two things at once, have learned a lot
      • Different areas of the counties (Iowa, Nebraska, etc.) may be handled differently
      • Sending a ship to New Yok to help more affected areas
  • Q for Dr. Brix: Do you share the optimism of the president?
    • Trump: I didn’t say in a week, but it won’t be 3 -4 months either.
  • Q for Dr. Brix: Are you worried that the cities and states that haven’t had outbreaks are lagging indicators, and we will start to see cases?
    • Dr. Brix: Your question raises important issues, tests had to be focused on hospitals for diagnosis. Now that we have more platforms for testing we can be more precise.
      • Areas have moved through their curves (China and South Korea) in approximately eight weeks.
      • Each state is going to be its own curve, Washington State is about two weeks ahead of New York in its curve.
    • Trump: We have learned a lot, we can do a few things at once – doing something for the workers as well as mitigating. We are having a flu season, and car accidents that claim a lot of victims as well. We’ll be doing things to restart the economy.
  • Q: Regarding the guidelines on testing, Sen. Paul has tested positive – but he was not in contact and didn’t have any symptoms.
    • Dr. Brix: That’s why these recommendations are important, and each person has to be responsible. Assume anyone you interact with may be positive, and hard surfaces transmit the virus. We can’t say for sure Sen. Paul had no symptoms
  • Q: You have said that you don’t want the cure to be worse than the disease?
    • Trump:  We’ll be watching this very closely, but we need to reopen the country as we win the battle.  Responsibility to people, their jobs. We can do both things: combat the virus and open the economy.  We are doing a lot of things – watching the hotspots very closely, watching seniors, and we can do that as we open the economy.
  • Q: Do you think the cure has been worse than the problem?
    • Trump: I think the cure has been very tough.  We are learning a lot and have improved the broken system.
  • Q: You’ve said the virus may be with us through July, are you changing that timeframe now?
    • Trump: We’ve learned a lot. This country has learned about shaking hands, and social distancing that will stay long after the virus has gone.  This is a severe medical situation that may go far beyond the medical.
  • Q:  Weeks not months before easing restrictions?  Have the Doctors conformed that?
    • Trump:  Doctors would shut the country down or years if it was up to them. We can’t do that with the #1 economy in the world. As we open up the country we’ll do both: may quarantine some areas, but leave others open. Closing the NYSE and NASDAQ would be extreme.  We’ll be setting guidelines and deadlines soon
  • Q: Have the doctors on your team endorsed those guidelines?
    • Trump: Not endorsed, but we talk. We haven’t set a date, but it’s a shorter than expected
  • Q: Kudlow, your economic advisor, said there would be difficult tradeoffs?
    • Trump:  Sure, lifestyles will be different. You won’t just be able to jump in the subway, some things will change forever.
  • Q: There is an uptick in Latin America, will there be a new travel ban?
    • Trump: No, Not really.
  • Q: You said in your statement that you would take care of the Asian-Americans?  Has there been something that happened?
    • Trump: Yes, I’m hearing that some people are saying nasty things – and I’m not going to let that happen to these great Americans.
  • Q:  With schools closing across the country, some for the rest of the year, how are parents supposed to work and educate their children?
    • Trump: The governors of the states will have a lot of leeway when we open up.
  • Q: Why is a $2 Trillion stimulus needed if you are going to restart the economy in weeks not months?
    • Trump: We are giving the economy a kick to help the workers and the small businesses who have been hurt very badly.  Need to make sure companies and workers are strong – and hopefully the Republicans and Democrats can get to a deal.
  • Q: But is $2 Trillion too much then?
    • Trump: Airlines and cruise lines are a priority. We need to work with and save Boeing – numbers have to reflect that. 
  • Q for Dr. Birx: How confident are you in the start date for each curve in each area?
    • Dr. Birx:  Great question – we can back into that data.  We will review the pandemic plans as a result of this. The new testing will allow us to simultaneously do mitigation and contact testing allowing us to be appropriately focused on each little bell shaped area.
  • Q: When will the antibody tests come online and become available?
    • Dr. Birx:  Will have to go back and check.  We want to blunt the curve this season, in case the virus comes back.  Want a finger prick approach and we need to go back to check with the companies – some developed in Singapore, and we are looking at those.
    • Trump:  I have a question for Dr. Birx: Will we ever go back to the days when the media room was full of reporters almost on top of each other?
    • Dr. Birx:  I don’t know, depends on the respiratory factor I think. 
  • Q for Dr. Birx: Can you comment on the new restrictions from other countries? For example, Germany doesn’t wasn’t groups of two or more, unless they’re family.
    • Dr. Birx: We are looking at all the data to inform our decisions and recommendations. Italy may be doing things now that have an impact. There is a lot of data to go through – everyone is adapting to their data.
  • Q: Dr. Birx: Are you ok with President Trump’s decision to reopen the country?
    • Dr. Birx: The President asked us to use all the data and our opinion to advise the president.  I will never speculate on the data.  We are looking at mortality rates, which vary greatly, based on location, age and other factors.
  • Q: Help us understand what you mean by higher death rates, do you mean economic depression?
    • Trump: No, I’m talking about people suffering, depression, suicide, etc.  The good news is if they pass the bill we’ll take care of them.  The country will come back, but come back faster when they pass the bill.  I’ve learned a lot from Dr. Fauci, Dr. Birx and others. We can do two things at once, and we will, but be very vigilant.
  • Q: Doesn’t announcing that you’re going to reopen the economy undermine the 15 Days to Stop the Spread Campaign?
    • Dr. Birx:  It should underscore it – encourage Americans to continue their sacrifice so we can evaluate and hopefully move faster, 
  • Q: (referring to this article) Where is Dr. Fauci?
    • Trump: He’s working on other things, will be back at the briefings soon.  He’s a good man.
  • Q: Ultimately, will you take Dr. Fauci’s recommendation on reopening the economy?
    • Trump: He’s very important, important to me.  I’ll be listening to him, be listening to Dr. Birx, other experts.  Ultimately, it’s a balancing act.
  • Q: Who are you listening to with respect to the economy as we start Quarter 2?
    • Trump: Listening to many people,  very complimentary to Mike (Pence), he’s got great advice and thoughts.  The Fed Chair (Jerome Powell) is catching up too, he’s got more arrows in the quiver.  Very happy with his job.
  • Q: When can we expect to hear from the Secretary of Education?
    • Pence: Very soon. The Department has created waivers for testing, distance learning, and they’re setting up guidelines and web based resources for K-12 too.  She’ll be coming to present on that soon, this week.
  • Q: When will the swab tests be available and where will they be going?
    • Pence: Dr: Hahn can speak more to that, but my understanding is that they’ll be ready soon, and they will be, I’m fairly confident, straight to market. Right to the labs across the country.
  • Q: Have you instructed Secretary Mnuchin to accommodate the Democratic Parties concerns to get. A deal?
    • Trump: Thought we had a deal last night and the Speaker changed it.  Will work with anyone on the deal.
  • Q: Who will hold Treasury accountable on the $500 million fund?
    • Trump:  I will be the oversight.  We’re going to make good deals, even if it’s a simple loan, but we can do better than that.  That money will keep these companies going.
  • Q: Do you have any second thoughts or regret about how you’ve handled the crisis?
    • Trump: Everyone has regrets, but I’m looking forward.  Want to get people back to the good jobs – looking out for the American people.
  • Q: Should Governor DeSantis have closed the beaches in Florida?
    • Trump:  That’s the Governor’s decision.  He’s a great governor, doing a good job, but I’m leaving that decision to him.