Sunday, April 05, 2020

Federal Purchasing Contracts Show How The US Wasted Months Before Acting Against Pandemic; Trump Praises Billy Graham's Son (Who Says Virus Is Punishment From God) As "An Extraordinary Person"


U.S. "Wasted" Months Before Preparing For Virus Pandemic
Michael Biesecker, Associated Press, April 5, 2020
As the first alarms sounded in early January that an outbreak of a novel coronavirus in China might ignite a global pandemic, the Trump administration squandered nearly two months that could have been used to bolster the federal stockpile of critically needed medical supplies and equipment.

A review of federal purchasing contracts by The Associated Press shows federal agencies largely waited until mid-March to begin placing bulk orders of N95 respirator masks, mechanical ventilators and other equipment needed by front-line health care workers.

By that time, hospitals in several states were treating thousands of infected patients without adequate equipment and were pleading for shipments from the Strategic National Stockpile. That federal cache of supplies was created more than 20 years ago to help bridge gaps in the medical and pharmaceutical supply chains during a national emergency.

Now, three months into the crisis, that stockpile is nearly drained just as the numbers of patients needing critical care is surging. Some state and local officials report receiving broken ventilators and decade-old dry-rotted masks. ...

As early as mid-January, U.S. officials could see that hospitals in China's Hubei province were overwhelmed with infected patients, with many left dependent on ventilator machines to breathe. Italy soon followed, with hospitals scrambling for doctors, beds and equipment.

Because of the fractured federal response to COVID-19, state governors say they're now bidding against federal agencies and each other for scarce supplies, driving up prices.

"You now literally will have a company call you up and say, 'Well, California just outbid you,'" Gov. Andrew M. Cuomo, D-N.Y., said Tuesday. "It's like being on eBay with 50 other states, bidding on a ventilator."

For nearly a month, Trump rebuffed calls from Cuomo and others to use his authority under the Defense Production Act to order companies to increase production of ventilators and personal protective equipment. ...

Trump spent January and February playing down the threat from the new virus. He derided warnings of pandemic reaching the U.S. as a hoax perpetrated by Democrats and the media. As the World Health Organization declared the outbreak a global public health emergency on Jan. 30, Trump assured the American people that the virus was "very well under control" and he predicted "a very good ending."

His administration was so confident that Secretary of State Mike Pompeo announced on Feb. 7 that the government had airlifted nearly 18 tons of donated respirator masks, surgical masks, gowns and other medical supplies to China. ...

Trump accused some Democratic governors of exaggerating the need and derided those that criticized the federal response as complainers and snakes.

"I want them to be appreciative," Trump said on March 27.

Exclusive: Pressed By Trump, U.S. Pushed Unproven Coronavirus Treatment Guidance
Marisa Taylor and Aram Roston, Reuters, April 4, 2020:
In mid-March, President Donald Trump personally pressed federal health officials to make malaria drugs available to treat the novel coronavirus, though they had been untested for COVID-19, two sources told Reuters.

Shortly afterward, the federal government published highly unusual guidance informing doctors they had the option to prescribe the drugs, with key dosing information based on unattributed anecdotes rather than peer-reviewed science. ...

The episode reveals how the president's efforts could change the nature of drug oversight, a field long governed by strict rules of science and testing. Rarely, if ever, has a U.S. president lobbied regulators and health officials to focus their efforts on specific unproven drugs.

"The president is short-circuiting the process with his gut feelings," said Jeffrey Flier, a former dean of Harvard Medical School. "We are in an emergency and we need to rely on our government to ensure that all these potential therapies are tested in the most effective and objective way." ...

The first official action came March 21, at the height of the president's efforts, when the CDC prepared a document, Information for Clinicians on Treatment Options for COVID-19 Patients, that included a section on the antimalarial drugs.

The document describes possible prescription information for coronavirus patients, while at the same time proposing hydroxychloroquine and chloroquine as an option in coronavirus treatment. It was the first time the federal government's disease control agency had officially floated the idea.

"Although optimal dosing and duration of hydroxychloroquine for treatment of COVID-19 are unknown," the document says, "some U.S. clinicians have reported anecdotally" about different hydroxychloroquine doses. The document does not name the clinicians, say whether their treatment was successful or explain the paper's sourcing.

Dr. Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University, says she was surprised to read the document guidance, after Reuters pointed it out to her. "Geez!" she said. "No references, no nothing! Why would CDC be publishing anecdotes? That doesn't make sense. This is very unusual." ...

The CDC declined to detail the interactions of its director, Dr. Robert Redfield, with President Trump. ...

The CDC would not disclose the identities of the authors who prepared the document, nor detail its sourcing. ...

Trump's push for action came after Fox News on March 16 reported on a small French study highlighting the effectiveness of one of the drugs, hydroxychloroquine. ...

On March 19, Trump [said:] "And that’s where the FDA has been so great. They – they've gone through the approval process; it's been approved. ..."

In fact, the drug had not gone through an FDA review process ...

How Tea Party Budget Battles Left the National Emergency Medical Stockpile Unprepared for Coronavirus
Yeganeh Torbati and Isaac Arnsdorf, Propublica, April 3, 2020
Dire shortages of vital medical equipment in the Strategic National Stockpile that are now hampering the coronavirus response trace back to the budget wars of the Obama years, when congressional Republicans elected on the Tea Party wave forced the White House to accept sweeping cuts to federal spending.

Among the victims of those partisan fights was the effort to keep adequate supplies of masks, ventilators, pharmaceuticals and other medical equipment on hand to respond to a public health crisis. Lawmakers in both parties raised the specter of shortchanging future disaster response even as they voted to approve the cuts. ...

"It's really easy to second-guess and suggest we didn't do as much," [Denny Rehberg, a retired Republican congressman from Montana who chaired the appropriations subcommittee responsible for overseeing the stockpile in 2011] said. ...

There were, in fact, warnings at the time: A 2010 Centers for Disease Control and Prevention-funded report by the Association of State and Territorial Health Officials urged the federal government to treat public health preparedness "on par with federal and state funding for other national security response capabilities," and said that its store of N95 masks should be "replenished for future events."

But efforts to bulk up the stockpile fell apart in tense standoffs between the Obama White House and congressional Republicans ... Had Congress kept funding at the 2010 level through the end of the Obama administration, the stockpile would have benefited from $321 million more than it ended up getting, according to budget documents reviewed by ProPublica. During the Trump administration, Congress started giving the stockpile more than the White House requested. ...

Even in the aftermath of the swine flu pandemic, the stockpile wasn't a priority then. Without a full committee markup, Rehberg introduced a bill that provided $522.5 million to the stockpile, about 12% less than the previous year and $132 million less than the administration wanted. ...

During the Trump administration, the White House has consistently proposed cutting the CDC and the HHS Office of the Assistant Secretary for Preparedness and Response, which took over stockpile management from the CDC. Congress approved more stockpile funding than Trump's budget requested in every year of his administration, for a combined $1.93 billion instead of $1.77 billion, according to budget documents.

The White House budget request for 2021, delivered in February as officials were already warning about the dangerous new coronavirus, proposed holding the stockpile's funding flat at $705 million and cutting resources for the office that oversees it.
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