|From: John Koligman||11/27/2020 8:04:13 PM|
|Los Angeles issues stay-home order as coronavirus cases surge out of control|
PUBLISHED FRI, NOV 27 20206:56 PM ESTUPDATED AN HOUR AGO
The three-week order takes effect Monday. It came as the county confirmed 24 new deaths and 4,544 new cases of Covid-19. The five-day average of new cases was 4,751.Nearly 2,000 people in the county are hospitalized.The order advises residents to stay home “as much as possible” and to wear a face covering when they go out. It bans people from gathering with people who aren’t in their households, whether publicly or privately.
Employees wait for testing supplies as LAX is offering walk-up Coronavirus testing for 150 dollars in the Tom Bradley International Terminal at LAX in Los Angeles on Tuesday, November 17, 2020.
Keith Birmingham | MediaNews Group | Getty Images
Los Angeles County announced a new stay-home order Friday as coronavirus cases surge out of control in the nation’s most populous county.
The three-week order takes effect Monday. It came as the county confirmed 24 new deaths and 4,544 new cases of Covid-19. The five-day average of new cases was 4,751.
Nearly 2,000 people in the county are hospitalized.
“We know we are asking a lot from so many who have been sacrificing for months on end,” Public Health Director Barbara Ferrer said. “Acting with collective urgency right now is essential if we want to put a stop to this surge.”
The order advises residents to stay home “as much as possible” and to wear a face covering when they go out. It bans people from gathering with people who aren’t in their households, whether publicly or privately.
However, exceptions are made for church services and protests, “which are constitutionally protected rights,” the county Department of Public Health said in a statement.
Businesses are allowed to remain open but with limited capacity, and the same is true of nail salons and other personal care services.
Beaches, trails, and parks also will remain open, with safety requirements.
The order, which runs through Dec. 20, is more modest than a statewide closure order in the spring.
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|From: Glenn Petersen||11/27/2020 8:08:13 PM|
| November 27 COVID-19 Test Results|
by Calculated Risk on 11/27/2020 07:52:00 PM
Note: The data will be unusual over the holiday weekend. Stay Safe!!!
The US is now averaging over 1 million tests per day. Based on the experience of other countries, for adequate test-and-trace (and isolation) to reduce infections, the percent positive needs to be well under 5% (probably close to 1%), so the US still needs to increase the number of tests per day significantly (or take actions to push down the number of new infections).
There were 1,703,640 test results reported over the last 24 hours.
There were 194,979 positive tests.
Over 33,000 US deaths have been reported so far in November. See the graph on US Daily Deaths here.
This data is from the COVID Tracking Project.
The percent positive over the last 24 hours was 11.4% (red line is 7 day average). The percent positive is calculated by dividing positive results by the sum of negative and positive results (I don't include pending).
And check out COVID Exit Strategy to see how each state is doing.
The second graph shows the 7 day average of positive tests reported and daily hospitalizations.
The dashed line is the previous hospitalization maximum.
Note that there were very few tests available in March and April, and many cases were missed, so the hospitalizations was higher relative to the 7-day average of positive tests in July.
Posted by Calculated Riskon 11/27/2020 07:52:00 PM
Calculated Risk: November 27 COVID-19 Test Results (calculatedriskblog.com)
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|From: Savant||11/27/2020 8:15:58 PM|
|Covid synthetic peptide mini-blockers|
But David Baker, a biochemist at the University of Washington’s Institute for Protein Design, and his colleagues think they can produce an even better therapy. They have designed a synthetic peptide—a short string of amino acids, the building blocks of proteins—20 times smaller than a monoclonal antibody that is designed to bind to the infamous “spike” protein on the surface of the SARS-CoV-2 virus particle. Doing so would directly block the virus from binding to the ACE-2 receptors on human cells, functioning much like an antibody produced by an infected person’s immune system. Baker and his colleagues described these “ miniprotein inhibitors” in September in Science. Although the study only tested these synthetic proteins in the lab, mixing viral particles with monkey cells in vitro, he says that unpublished data show they can protect mice and hamsters from SARS-CoV-2 infection.
“We built these [tiny proteins] from scratch based on ‘first principles,’ using computers to model all the biochemical details of a theoretical protein that could stick to the virus,” explains Baker, who was awarded a $3 million Breakthrough Prize earlier in September for his decades of work pioneering the field of synthetic protein design. His team used computers to digitally design more than two million candidate “miniproteins,” crunched the data using algorithms, sifted out 118,000 candidate genes that encode these proteins, manufactured the proteins from scratch, and tested them directly against the virus in the lab—finding that seven designs could effectively bind to and thus disable the virus.
OVER THE COURSE OF 3.5 BILLION YEARS EVOLUTION HAS PRODUCED AN INCREDIBLE ARRAY OF PROTEINS AND PEPTIDES. IN RECENT YEARS BIOCHEMISTS HAVE TRACKED DOWN AND USED SOME OF THESE TO CREATE NEW DRUGS, SUCH AS EPTIFIBATIDE, AN ANTIPLATELET DRUG ADMINISTERED TO PREVENT HEART ATTACKS WHOSE ACTIVE INGREDIENT IS EXTRACTED FROM THE VENOM OF THE SOUTHERN PYGMY RATTLESNAKE. THE PROTEIN DATA BANK, AN ONLINE REPOSITORY OF PROTEIN SEQUENCES AND EDUCATIONAL TOOLS, CONTAINS THE AMINO ACID SEQUENCES AND FULL 3-D STRUCTURES FOR MORE THAN 160,000 PEPTIDES AND PROTEINS—BUT THE NATURAL WORLD CONTAINS HUNDREDS OF MILLIONS OF PROTEINS.
“It’s very challenging to discover in nature a peptide that does exactly what you want it to do,” explains Gaurav Bhardwaj, also a biochemist at the Institute for Protein Design, but who was not involved in the Science study. He is trying to design a bespoke peptide that would prevent SARS-CoV-2 from replicating within human cells. “Now we can computationally explore the possible design configurations for a peptide in order to perform the exact functions that we want.”
Every protein’s function depends on its structure. Interactions between the atoms of the protein’s amino acids cause these chains to self-assemble in less than a second into a complex array of spirals and pleats. As the chain of amino acids grows, these helices and rippled sheets stack on top of and around one another into a dizzyingly complex series of folds, and it is these folds that give proteins their shape and function. Yet figuring out how one amino acid sequence turns into a specific fold has been a torturously difficult task, and it was only in the 1990s—with ever expanding databases of protein information—that scientists could begin to link sequence to form.“We can make up completely new proteins that have never been seen in nature because we now understand the nature of protein folding,” Baker says. “Our ability to use computers to design ‘de novo’ proteins has really only come into its own in the last few years–we might not have been able to apply ourselves to COVID-19 if the pandemic had happened five years ago.”Many organizations, including the Gates Foundation, the Open Philanthropy Foundation, and most recently, the committee of the Breakthrough Prize, have supported this work. Although monoclonal antibodies for SARS-CoV-2 are already in clinical trials, Baker says his miniprotein inhibitors have even greater potential to tackle the pandemic because they are 20 times smaller and thus would be cheaper to produce quickly and consistently.SYNTHETIC PEPTIDES SHOW ENORMOUS POTENTIAL TO BE SCALED UP AT LOW COST TO PRODUCE ROBUST, BESPOKE TREATMENTS, SAYS SAREL FLEISHMAN OF THE WEIZMANN INSTITUTE OF SCIENCE IN ISRAEL, WHO WAS NOT INVOLVED IN THE STUDY. BUT THEY ARE STILL IN UNCHARTED TERRITORY, PUTTING THEM AT A DISADVANTAGE IN THE RACE FOR A CURE, HE SAYS. “THE MAJOR ADVANTAGE OF MONOCLONAL ANTIBODY TREATMENTS IS THAT THEY ARE COMPLETELY ‘HUMAN,’ MEANING THEY ARE ALREADY COMPATIBLE WITH OUR IMMUNE SYSTEMS. SO THEY CARRY A LOT LESS RISK THAN SYNTHETIC PROTEINS,” HE SAYS. CROSSING REGULATORY HURDLES WILL BE A LOT MORE STRAIGHTFORWARD WITH MONOCLONAL ANTIBODIES, HE SAYS, BECAUSE REGULATORS WILL ALREADY UNDERSTAND WHAT THEY ARE DEALING WITH COMPARED WITH A NEW AND UNPROVEN TECHNOLOGY.
Although synthetic peptides have enormous potential, we need to be cautious about being overly optimistic, adds biochemist Erik Procko of the University of Illinois, who worked as a postdoctoral researcher in Baker’s team, but was not part of this specific study. “The pharmacokinetics of miniproteins”—the ways the human body can metabolize, absorb and excrete them—“will be a barrier to their usefulness as drugs,” Procko says. “Eli Lily’s antibody drug persists in the body for a month; it will be challenging for a small designed miniprotein to match that stability in the blood.”
Baker acknowledges that both Fleishman and Procko are correct: “our miniproteins will have to go through the same scrutiny of clinical trials as monoclonal antibodies,” he says, “though it is worth noting that regulatory bodies like the FDA have vast experience with all sorts of drug and therapeutic modalitiesBoth Procko and Baker note that miniproteins will very likely need to be administered directly to the lungs by inhalation. Researchers at the University of California, San Francisco, have designed just such an aerosol formulation. The technology, called “AeroNabs,” would be administered by an inhaler or nasal spray. Roughly three times larger than Baker’s miniproteins, the U.C.S.F. ones are modeled on “nanobody” particles found in the immune systems of animals such as llamas, and function similarly: they bind to SARS-CoV-2’s “spike” protein and prevent it from fusing with the ACE-2 receptor on human cells.
“Monoclonal antibodies are unlikely to reach the airway spaces of the lungs when given as an injectable drug,” explains Aashish Manglik of U.C.S.F., part of the team that developed AeroNabs. He and his colleagues described their innovation in the preprint database bioRxiv in August. Only 2 percent of monoclonal antibodies injected into the bloodstream tend to reach the pulmonary spaces, the regions of the lungs through which the virus gains entry in most people—but a drug delivered via aerosol would be able to reach these air sacs, and thus could serve both as a therapeutic and a prophylactic, Manglik says. “We see this as being useful with patients who are in the early stages of infection, or with people at high risk of becoming infected, such as frontline and healthcare workers,” he says. “However, from a technical perspective, what Baker has been able to pull off—designing everything prospectively and not based on an existing structure in nature—is just phenomenal. It’s an exciting time in protein science.”
BEAT CHRISTEN OF THE INSTITUTE OF MOLECULAR SYSTEMS BIOLOGY IN ZURICH, WHO WAS NOT INVOLVED IN BAKER’S OR MANGLIK’S RESEARCH, AGREES IT IS AN EXCITING TIME. “SYNTHETIC BIOLOGY IS PROGRESSING VERY FAST IN DEVELOPING VACCINES AND THERAPEUTICS—IN A VERY SHORT TIME FRAME WE HAVE SEEN MANY THINGS PUSHED TO THE FOREFRONT, AND THE CORPORATE WORLD IS REACTING WITH MANY SPINOFFS AND STARTUPS THAT HAVE PIVOTED TO THIS FIELD,” HE SAYS.
With an increase in corporate interest, however, may come a decrease in public trust—as happened with genetically modified food two decades ago. The technology was largely seen as expensive and unnecessary, driven by corporate profit motives rather than public need. Synthetic peptides—many entirely “unnatural” and “never seen before on earth”—risk falling into the same trap.“But with COVID-19, there is a clear, huge challenge facing humanity,” Christen says, “and if synthetic biology can contribute with new solutions and new therapies, people will easily see the need for it.”
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|From: marcher||11/27/2020 9:26:02 PM|
|Employers given broad discretion on whether to report worker deaths to Osha – and many have simply chosen not to.|
...Even after Covid-19 struck in mid-March and cases began spreading through the government-run facility in Park Forest, Illinois, which serves nearly 350 adults with developmental disabilities, Walter was determined to go to work, Carlene said. Staff members were struggling to acquire masks and other personal protective equipment at the time, many asking family members for donations and wearing rain ponchos sent by professional baseball teams. All Walter had was a pair of gloves, Carlene said.
By mid-May, rumors of some sick residents and staffers had turned into 274 confirmed positive Covid tests, according to the Illinois department of human services Covid tracking site. On 16 May, Walter, 53, died of the virus. Three of his colleagues had already died, according to interviews with Ludeman workers, the deceased employees’ families and union officials... But facility officials did not deem the first staff death on 13 April work-related, so they did not report it. They made the same decision about the second and third deaths. And Walter’s...
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|From: marcher||11/27/2020 9:55:16 PM|
|More than 2.5 million vulnerable people in England will be offered free Vitamin D supplements this winter.|
The vitamin, which helps to keep bones, teeth and muscles healthy, will be delivered to people who are clinically extremely vulnerable, and care homes.
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|From: John Koligman||11/27/2020 10:30:02 PM|
|Judging by the lines I see on video at Black Friday store sales, I don't know if what Osterholm says will actually get through to the Covidiots out there.|
"The public does not realize how dire the situation is, Dr. Osterholm said, and may respond only “when people are dying, sitting in chairs in waiting rooms in emergency rooms for 10 hours to get a bed, and they can’t find one, and then they die.”
Covid Overload: U.S. Hospitals Are Running Out of Beds for Patients
As the coronavirus pandemic surges across the country, hospitals are facing a crisis-level shortage of beds and staff to provide adequate care for patients.
Tracey Fine was waylaid on a gurney in an emergency room hallway in Madison, Wis., where hospitals are overwhelmed with Covid patients and staff are stretched thin. Credit...Lauren Justice for The New York Times
By Reed Abelson
Nov. 27, 2020Updated 6:34 p.m. ET
In excruciating pain with lesions on her face and scalp, Tracey Fine lay for 13 hours on a gurney in an emergency room hallway.
All around her, Covid-19 patients filled the beds of the hospital in Madison, Wis. Her nurse was so harried that she could not remember Ms. Fine’s condition, and the staff was slow to bring her pain medicine or food.
In a small rural hospital in Missouri, Shain Zundel’s severe headache turned out to be a brain abscess. His condition would typically have required an operation within a few hours, but he was forced to wait a day while doctors struggled to find a neurosurgeon and a bed — finally at a hospital 375 miles away in Iowa.
From New Mexico to Minnesota to Florida, hospitals are teeming with record numbers of Covid patients. Staff members at smaller hospitals have had to beg larger medical centers repeatedly to take one more, just one more patient, but many of the bigger hospitals have sharply limited the transfers they will accept, their own halls and wards overflowing.
In the spring, the pandemic was concentrated mainly in hard-hit regions like New York, which offered lessons to hospitals in other states anticipating the spread of the coronavirus. Despite months of planning, though, many of the nation’s hospital systems are now slammed with a staggering swell of patients, no available beds and widening shortages of nurses and doctors. On any single day, some hospitals have had to turn away transfer requests for patients needing urgent care or incoming emergencies.
And rising infection rates among nurses and other frontline workers have doubled the patient load on those left standing.
There is no end in sight for the nation’s hospitals as the pandemic continues to hammer cities and rural areas across the country, totaling 13 million cases so far this year. And public health experts warn that the holidays may speed the already fast-moving pace of infection, driving the demand for hospital beds and medical care ever higher.
A record number of Americans — 90,000 — are now hospitalized with Covid, and new cases of infection had been climbing to nearly 200,000 daily.
Health care systems “are verging on the edge of breaking,” Dr. Michael Osterholm, a member of President-elect Joseph R. Biden Jr.’s Covid-19 advisory council, said in a podcast this month.
The public does not realize how dire the situation is, Dr. Osterholm said, and may respond only “when people are dying, sitting in chairs in waiting rooms in emergency rooms for 10 hours to get a bed, and they can’t find one, and then they die.”
When Ms. Fine went to UW Health’s University Hospital in Madison, she found doctors there overwhelmed and distracted. “They just parked me in a hallway because there was no place for me to go,” said Ms. Fine, 61, who was eventually found to have a severe bout of shingles that threatened her eyes.
She had missed her annual checkup or a shingles vaccination because of the pandemic.
Medical workers at University Hospital in Madison, Wisc., pleaded for help in an open letter. “Without immediate change our hospitals will be too full to treat all of those with the virus and those with other illnesses or injuries,” they warned.Credit...Lauren Justice for The New York Times
Admitted to a makeshift room with curtains separating the beds, Ms. Fine watched the chaos around her. A nurse did not know who she was, asking if she had trouble walking or heard whooshing in her ears. She “was just completely frazzled,” Ms. Fine recalled, though she added that staff members were “kind and caring and did their best under horrifying conditions.”
Workers at the hospital issued a plea last Sunday, published as a two-page ad in The Wisconsin State Journal, asking state residents to help prevent further spread of the virus.
“Without immediate change, our hospitals will be too full to treat all of those with the virus and those with other illnesses or injuries,” they warned. “Soon you or someone you love may need us, but we won’t be able to provide the lifesaving care you need, whether for Covid-19, cancer, heart disease or other urgent conditions. As health care providers, we are terrified of that becoming reality.”
UW Health declined to comment directly on Ms. Fine’s experience, but acknowledged the strains the pandemic has imposed. While patients were sometimes boarded in the emergency room even before the new coronavirus surge, occupancy is now “super high,” said Dr. Jeff Pothof, the group’s chief quality officer.
UW Health is “starting to do things it hasn’t done before,” he said, including enlisting primary care and family doctors to work in the hospital treating seriously ill patients. “It works, but it’s not great,” he said.
Covid in the U.S.: Latest Map and Case CountA detailed county map shows the extent of the coronavirus outbreak, with tables of the number of cases by county.
Hospitals in St. Louis have been particularly hard-hit in recent weeks, said Dr. Alexander Garza, the chief community health officer for SSM Health, a Catholic hospital group, who also serves as the head of the area task force on the virus. Over the last month, SSM Health turned away about 50 patients that it could not immediately care for.
And nurses — already one of the groups most vulnerable to infection — are adding more and more hours to their shifts.
Hospitals are reassigning nurses to adult intensive care units from pediatric ones, doubling up patients in a single room, and asking nurses, who typically care for two critically ill patients at a time, to cover three or more, he said.
“If you’re not able to dedicate as much time and resources to them, obviously they’re not getting optimal care,” Dr. Garza said.
Consuelo Vargas, an emergency room nurse in Chicago, says patients linger for days in emergency rooms because I.C.U.s are full. The nursing shortage has a cascading effect. It “leads to an increase in patient falls, this leads to bedsores, this leads to delays in patient care,” she said.
Personnel, available beds and protective equipment are fundamentally scarce. At a news conference held by National Nurses United, a union, Ms. Vargas said there was still not enough protective equipment like N95 masks, forcing her to buy her own.
Some hospitals have joined in sounding the alarm: Supplies of testing kits, masks and gloves are running low.
The country never quite caught up from the earlier shortages, Dr. Osterholm said. “We’re just going to run into a wall in terms of P.P.E.,” he said.
Even if hospitals in some cities appear to have enough physical space, or can quickly build new units or set up field hospitals, staff shortages offset any benefit of expansion.
“Beds don’t take care of people; people take care of people,” said Dr. Marc Harrison, the chief executive of Intermountain Healthcare, a sprawling system of hospitals and clinics based in Salt Lake City.
“We’re out here by ourselves,” said Tony Keene, chief executive of a rural hospital in Missouri with 25 beds. “We don’t have a larger system pumping money into us or something like that.”Credit...Kathryn Gamble for The New York Times
At any given time in recent weeks, a quarter of Intermountain’s nurses were out — sick, quarantining or taking care of a family member felled by the virus. Nursing students have been granted temporary licenses by the state to fill gaps, and the hospital system is scrambling to latch onto travel nurses who are in high demand across many states and expensive to hire.
To relieve pressure on its big hospitals, Intermountain is keeping more patients at its smaller centers, monitored virtually by specialists at the larger hospitals who consult with the local doctors via remote links.
Smaller hospitals are under significant stress. “We don’t have intensive care units,” said Tony Keene, the chief executive of Sullivan County Memorial Hospital, a rural hospital licensed for 25 beds in Milan, Mo. “We don’t perform surgeries or anything like that here. When we have Covid cases, it very much taxes our ability.”
His tiny hospital usually has no more than a half-dozen patients on a busy day, but may now treat twice that number. About a fourth of the hospital’s 100 employees, including Mr. Keene, have come down with the virus since March.
“It is sometimes a daily and hourly struggle to make sure we have adequate staff in the hospital,” he said. The hospital’s nurses, who typically work three 12-hour shifts a week, are taking as many as five or six shifts each week.
“We’re out here by ourselves,” Mr. Keene said. “We don’t have a larger system pumping money into us or something like that.” The hospital used federal Covid aid to invest in medical gas lines so patients could be given oxygen.
The sickest patients still must be transferred, but the larger hospital 35 miles away is awash in its own heavy volume of Covid patients and is reducing staff levels.
Even when hospitals in a community are talking weekly, if not daily, to discuss how to handle the overall spikes in admissions, few have room to spare in areas where numbers keep climbing. Many have reduced or even stopped providing elective surgeries and procedures.
“We’re all concerned about the surges we’re seeing now,” said Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association. Patients who need special medical attention normally can be sent to a nearby urban area, but “many times those referral centers are full or nearly full,” she said.
About a fourth of the 100 employees at Mr. Keene’s hospital, Sullivan County Memorial, have come down with Covid-19 since March.Credit...Kathryn Gamble for The New York Times
Mr. Zundel’s case was a matter of life or death. He had a debilitating headache and “was not able to function at all,” he said. A larger hospital nearby was inundated with patients, so his wife, Tessa, took him to a small hospital in rural Missouri to be seen quickly. The doctors there recognized that he had a brain abscess, but could not immediately find a medical center to treat him.
“He was dying,” his wife said. Some hospitals had beds, but no available neurosurgeon. Staff members spent a full day trying to find somewhere he could get an operation.
“They just worked the phone until they found a solution,” she said. “They didn’t give up.”
Mr. Zundel, 48, was finally flown to the University of Iowa Hospitals and Clinics, where Dr. Matthew Howard, a neurosurgeon, performed an operation.
But Iowa is also turning away patients, Dr. Howard said. “Early in the crisis, we were being hammered by limitations in P.P.E. Now, the problem is the beds are full,” he said.
Dr. Dixie Harris, a critical care specialist at Intermountain, had volunteered in New York City during the height of the pandemic last spring. Doctors are now better able to treat the virus and predict the course of the disease, she said.
But they are also stretched very thin, caring for Covid patients in addition to their regular patients. “Almost nobody has had a real vacation,” she said. “People are really tired.”
And readmissions or the lingering health problems of Covid “long haulers” have compounded the intensified regimen for medical care. “Not only are we seeing the tsunami coming, we have that back wave coming,” Dr. Harris said.
Some health care workers say they feel abandoned. “Nurses have been crying out for months and months that this has been a problem, and we really have not gotten rescued,” said Leslie McKamey, a nurse in Bismarck, N.D., and a member of National Nurses United.
“We’re working overtime. We’re working several different jobs,” she said. “We’re really feeling the strain of it.”
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|From: John Koligman||11/27/2020 11:20:29 PM|
|Dr. Céline Gounder, Adviser to Biden, on the Next Covid Attack Plan|
Schools are essential while restaurants are not, said Dr. Gounder. And manufacturers may soon be ordered to produce protective gear for health workers.
Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center and assistant professor at the New York University Grossman School of Medicine.Credit...Amr Alfiky/The New York Times
By Apoorva Mandavilli
Published Nov. 16, 2020Updated Nov. 17, 2020
When President-elect Joseph R. Biden Jr. takes office in January, he will inherit a pandemic that has convulsed the country. His transition team last week announced a 13-member team of scientists and doctors who will advise on control of the coronavirus.
One of them is Dr. Céline Gounder, an infectious disease specialist at Bellevue Hospital Center and assistant professor at the New York University Grossman School of Medicine. In a wide-ranging conversation with The New York Times, she discussed plans to prioritize racial inequities, to keep schools open as long as possible, and to restore the Centers for Disease Control and Prevention as the premier public health agency in the world.
The incoming administration is contemplating state mask mandates, free testing for everyone and invocation of the Defense Production Act to ramp up supplies of protective gear for health workers. Indeed, that will be “one of the first executive orders” of the Biden administration, she said.
Below are edited excerpts from our conversation.
Tell us about Mr. Biden’s Covid advisers. Who is doing what?The coronavirus task force is the team the vice president leads within the current administration. I’m a part of the Biden-Harris advisory board. Then there’s the internal transition team, which is much bigger. The transition team has been developing a Covid blueprint, the nuts and bolts of the operations, and this is something they’ve been working on for months.
The purpose of the advisory board is really to have a group of people who think big, creatively and in interdisciplinary ways — to be a second set of eyes on the blueprint they’ve come up with, and also to function as a liaison with state and local health departments.
How often will you meet with Mr. Biden and the Vice President-elect Kamala Harris?
A virtual meeting of the Covid advisory council last week. President-elect Joseph R. Biden Jr. and Vice President-elect Kamala Harris are “asking very insightful questions, very thoughtful questions,” Dr. Gounder said.Credit...Amr Alfiky/The New York Times
We’re going to have, at a minimum, a weekly meeting as a group. But in addition to that, we may be asked to brief members of the transition team and the president-elect and vice president-elect. I’ve already been on two of those briefings.
They’re asking very insightful questions, very thoughtful questions, which demonstrate that they are sensitive to who has really been hit hard, who has suffered. In terms of awareness of the technologies, they understand more than I ever thought a politician would understand. Like asking what would be the appropriate timing and target populations for monoclonal antibodies. For somebody who doesn’t follow these things, that is a really good question.
What’s the plan to help communities that have been hit hardest?Race disparities are definitely going to be a through line for all the plans — for example, with respect to testing, making sure that you are locating testing facilities in communities of color. They have not been adequately served, and the lines to wait to get tested, the turnaround times, have not been equitable.
Another area that is really of interest is Indigenous people. They are often misclassified in terms of their race and ethnicity, and that makes it very difficult to do analyses to figure out what are the trends in those communities and to target interventions accordingly. Being really attentive to detailed data surveillance, and using that to inform how we address these disparities, is going to be very, very central.
What’s the thinking on school reopenings?
Desks sat empty in a classroom in Eden, N.C., in August.Credit...Pete Kiehart for The New York Times
If you have widespread community transmission, there may come a tipping point where you do need to go back to virtual schooling. But I think the priority is to try to keep schools open as much as possible, and to provide the resources for that to happen.
From an epidemiologic perspective, we know that the highest-risk settings are restaurants, bars, gyms, nail salons and also indoor gatherings — social gatherings and private settings.
I would consider school an essential service. Those other things are not essential services. The smarter we are about being very responsive to trends in transmission — to closing indoor restaurants sooner — the longer you’re likely to be able to keep schools open.
We know that the risk of transmission in schools is not zero, but they’re not amplifying transmission the way some of these other places are.
We need to be supporting those businesses, whether it’s the restaurant owners and the people working in those restaurants, because it is not fair that they are bearing a very heavy brunt of the economic fallout from this.
Mr. Biden has said he would invoke the Defense Production Act to get companies to manufacture protective gear.From the beginning we have been — and I’ve seen it firsthand — in a rationing mode. And now things are getting worse again, so that is a very high priority. I think that’s going to be one of the very first executive actions that Mr. Biden would be taking.
What role do you see the C.D.C. playing in this pandemic and in the future?
The Centers for Disease Control and Prevention in Atlanta. Credit...Audra Melton for The New York Times
The approach is going to be much more along the lines of giving control back to the C.D.C. There’s recognition that the C.D.C. is the premier public health agency in the world. And while their role has been diminished during this current crisis, they play a very important role in all this.
It’s really going to be about rebuilding public health infrastructure. Since 2008, there have been massive budget cuts, staffing losses. And so some of it will be around that, and some of it will be around tech infrastructure and building more robust surveillance systems and dashboards.
Rural areas are particularly unequipped to deal with outbreaks. How do you plan to help them?I have myself worked on Indian reservations in the Southwest, and I know some of my colleagues are really struggling right now. Once things really start to trend up again, they simply don’t have the I.C.U. beds — not just on the reservation, but in any kind of proximity in the state — to transfer people to. And once your hospital capacity gets saturated, case fatality rates shoot up.
I don’t have a good answer for you right now as to what we can do right away. But it’s definitely on the radar.
Mr. Biden has talked about making testing available to all. Is the plan to provide rapid antigen tests?The issue with the antigen test is how well it performs in asymptomatic people. What we’ve seen in some cases is that the performance characteristics are just not that great, so I think that needs to be better assessed and studied.
You do also need separate regulatory pathways, one for a public health surveillance kind of test, one for a clinical diagnostic test. The sensitivity of the surveillance test does not need to be as high, especially if it’s cheap, and something you can be doing frequently, repeatedly.
What are your thoughts about vaccine distribution?Your local doctor’s office is not going to have the deep-freeze capability that, at least for the Pfizer vaccine, you’re going to need. They’re not necessarily going to have the tech systems to track and call people back to make sure they get their second doses.
That kind of capacity really resides either in public health departments or in the private commercial sector, like CVS and Walgreens. So it’s really going to require collaboration with them.
The White House has not permitted access to information about Operation Warp Speed or any other Covid plans. How big a problem is that?That’s clearly a frustration. The normal way of doing business has not been the case for the entire administration. So why start now?
I do think it’s important to remember, though, that you have very experienced, seasoned people on the Biden team. These are not people who are new to federal government.
It’s not just about the federal government. So much of public health happens at the state and local level, so a lot of the communication in the coming weeks is going to be with governors, state and local public health officials. For things like tests and diagnostics, the monoclonal antibodies and vaccines, those are really conversations with the private sector.
So yes, it is an obstacle. It’s rather unfortunate, but the team really does still plan to be prepared to jump right in on Day 1 and address the crisis.
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