'This system is doomed': Doctors, nurses sound off in NBC News coronavirus survey

CORONAVIRUS IS THE ULTIMATE CRISIS OF CAPITALISM

A hospital nurse in Michigan says she and her colleagues have discussed bringing in bleach to make their own disinfectant wipes. A pregnant nurse in Ohio says she has no choice but to tend to critically ill patients without a specialized N95 mask. And a health care worker in Georgia has resorted to scouring local hardware stores in an effort to secure the protective masks.

© Provided by NBC News Medical workers wearing their PPE, personal protective gear.

These are just some of the stories told to NBC News by more than 250 health care providers on the frontlines of the coronavirus pandemic, including many who work in major hospitals.

The accounts were solicited through an NBC News survey, pushed out on social media, about access to personal protective equipment (PPE), a broad term for the gear, such as masks, glasses, gowns and respirators, donned by healthcare workers to protect against the transmission of germs.

Nearly all who responded said there were shortages of PPE in the hospitals, outpatient clinics and offices where they worked.

Many reported being forced to ration or reuse supplies, including surgical and N-95 masks, for fear of running out. Many also said they were facing shortages of basic sanitary supplies, including hand sanitizer and disinfectant wipes.

© via social media A nurse in Illinois shared a photo of her N-95 mask she keeps in a bag labelled with her name. Many healthcare workers are being asked to ration their personal protective equipment.

NBC News was not able to independently verify each account. But where possible, the facilities were contacted and given an opportunity to respond.


The nurse in Michigan, who is based in Flint and works primarily with immunocompromised patients, said that nurses at her hospital have been rationed one N95 mask each and are being required to store them in a bag and reuse them, against manufacturer guidelines. Nurses on her floor, she added, have also been unable to obtain enough disinfectant wipes.

"We ordered five containers the other day and we only got one," she said. Like many medical professionals who spoke to NBC News, she asked to remain anonymous for fear of losing her job. "One container of bleach wipes for 42 beds."

"I don't feel like my hospital is failing us," she said. "It's the whole system that's failing us."

"We certainly would not ask a firefighter to fight a fire with a spray gun," said Deborah Burger, president of National Nurses United, the nation's largest nurses' union. Burger, who has been a registered nurse for 45 years, said that neither the government nor the private sector are acting fast enough to get critical supplies to those that need them.

"It is a moral obligation of our government and our employer to provide safety equipment to those of us on the front line," she said.

"We are unable to protect ourselves"

The overwhelming majority of the medical professionals across the country who responded to the NBC News survey expressed concerns about a lack of N95 masks, which offer more protection than surgical masks.

A health care worker at a hospital in Indiana described a Kafkaesque scenario: medical staffers can only get the masks when a patient has tested positive for the virus, but the facility has no way to confirm a case.

"There are many possible exposures in my hospital but are not equipped with the testing devices in order to confirm the cases," the worker wrote. "We are then not allowed to wear proper PPE because they are not 'positive' and because our hospital is short on the PPE. We are also told that we are expected to keep the N-95 masks for several days and several patients and that they can be disinfected with Sanicloth wipes."

"We do not have N95 masks, so we are being asked to intubate patients (which exposes us to entire airway) with normal masks," wrote the pregnant nurse from Ohio. "It is unacceptable. We are supposed to treat every patient as suspected positive but we are unable to protect ourselves."

The N95 mask filters out airborne particulates and aerosols, and the Food and Drug Administration advises that neither N-95 masks, nor surgical masks, should be used more than once.

But in response to growing shortages of PPE, the Centers for Disease Control and Prevention has loosened its guidelines on proper use and reuse of masks. On Thursday, the agency advised that bandanas and scarves could be used by healthcare workers in place of a mask as a last resort.

"The fact that a recommendation like that came out from the Centers for Disease Control is mind boggling to me," said Dr. Adam Friedlander, an emergency physician working in Atlanta, GA.

"There was a time when a recommendation came from the CDC we knew that it was evidence-based guidelines for how we could protect ourselves from becoming sick with a potentially fatal illness. Now we know the recommendations are coming from a place of desperation, acknowledging that these supplies are unavailable."

A nurse who works at a major hospital in Massachusetts and spoke to NBC News on the condition of anonymity, said that medical staff have been told they must reuse their N95 masks five times before they are able to get a new one.

"It's scary to have to reuse the mask," she said. "At the same time it's like, what are you supposed to do if there's none to be had?"

"A nationwide problem"

The U.S. Department of Health and Human Services said in a statement this week that the agency has been steadily deploying PPE to areas in need from the Strategic National Stockpile, the nation's supply of pharmaceutical and medical supplies, intended for use during a severe public health emergency.

"We have been transparent that more supplies are needed - hence the request to Congress for additional funding so we could procure more and scale up production," the statement said. "The role of the SNS is to fill the gap temporarily until states and localities working with the private sector can respond to the state and local needs."

The survey responses reveal the scope of the shortages, as many medical professionals pleaded for the government to step up delivery of supplies.

"We have no proper PPE," wrote one survey respondent, who works in a hospital in New York City. "We are being told to come to work even if you had a COVID exposure...This system is doomed for failure without immediate help from the military. We need PPE, vents, staffing, more hospital beds, more tests."

In the meantime, health care systems and staff are being forced to improvise.

One doctor, who works at a rural health clinic in Virginia, said that clinics are increasingly being asked to fill the gap and send their PPE supplies to hospitals, where the need is greater.

But that, of course, leaves clinics—and the patients they serve—exposed.

"There simply isn't enough stock," said the doctor, who spoke to NBC News on condition of anonymity. "We have no N-95s or gowns. We have limited surgical masks."

"This is a nationwide problem, even on the private side," he added. "No clinic in this country, or hospital for that matter, is going to have enough equipment."

The limited supply of PPE has forced some hospitals to take the extraordinary step of asking the community for help. Seattle Children's Hospital in Washington has received thousands of donated protective equipment and is currently accepting curbside drop-off of additional masks, gowns and gloves.

"Thanks to members of the local and international community, to date we have received 15,100 isolation masks, 1,200 N95 respirator masks and 400 surgical masks from donations," a hospital spokesperson said.

"I am so scared"

Three survey respondents reported that they were asked to work with patients who tested positive for the virus without adequate protective gear. Others reported that they faced disciplinary action for using PPE outside of specified circumstances.

A memo distributed this week to Monmouth Medical Center Southern Campus in New Jersey, part of RWJBarnabas Health Facilities, informed staff that PPE must be worn in all rooms containing individuals with suspected or confirmed cases, but that staff could be disciplined for wearing masks, gloves and gowns outside patient rooms.

"RWJBarnabas Health facilities, including Monmouth Medical Center Southern Campus, are concerned about the possibility of a potential shortage of PPE including masks, eye shields and gowns," a spokesperson told NBC News. "We are carefully managing current inventory of items to ensure adequate supply of materials to protect our staff and the community.

Dr. Robert Morin, a plastic surgeon who works in emergency rooms in major hospitals in New York City and New Jersey, said that such policies, put into place in response to shortages, put healthcare workers at risk. "We don't need hospital administrators going out of the way to make us sick," he said.

Dr. Morin said that he has been exposed to patients with positive cases while working in an operating room without proper PPE. "I don't feel like we're getting the support we need," he said.

"The chaos, the lack of supplies, the lack of equipment," he added. "The numbers are just going to keep going up."

Some survey respondents and others who spoke to NBC News reported searching for PPE at local stores or on websites, like Ebay.

A doctor in Philadelphia, who is married to a doctor who works in a major hospital in the city, told NBC News that her husband searched for an N-95 mask at four hardware stores before his shift yesterday but could find none.

"He says, "It's my duty,'" she said. "He is proud of doing all that he is able to do right now, which I am also proud of, but I am so scared. I can't even begin to tell you."

Dr. Nivedita Lakhera, a doctor in San Jose, Calif., said her hospital is working hard to get N-95 masks for all doctors but they are in short supply. She shared messages with NBC News from doctors she knows who are worried about their own mortality.

"The doctors are talking about making living wills and what will happen when we are faced with this," she said. "All of us are wondering which one of us will die."

LIES, DAMNED LIES AND LABOUR STATS 

Labor Department asked states to delay releasing increased unemployment numbers: report

Alicia Cohn and Naomi Jagoda

The Trump administration asked state labor officials to delay releasing exact numbers for increased unemployment claims, according to a report in The New York Times.

© Getty Images Labor Department asked states to delay releasing increased unemployment numbers: report

"States should not provide numeric values to the public," Gay Gilbert, the administrator of Labor Department's Office of Employment Insurance, wrote in a memo Wednesday that was reviewed by the news outlet.

Some states have started to report the number of unemployment claims they've seen so far this week as more and more businesses have been closing in an effort to stop the spread of the coronavirus.

The Labor Department email also asks states to only "provide information using generalities to describe claims levels (very high, large increase)" until the department releases the total number of nationwide jobless claims for this week on Thursday of next week.

The memo argues that the state reports should be delayed because the financial markets watch them closely.

Gilbert has worked at the Labor Department during both Democratic and Republican administrations, and the Times reported that there is no evidence that political appointees directed her to send the email. The news outlet reported that some states that received Gilbert's email were bothered by it.

A Labor Department spokesperson said in a statement that "state data is regularly embargoed until the national numbers are published on Thursday morning and states are asked not to share their data until that time."

"As a leading economic indicator that has the potential to impact policy decisions and financial markets, it is important to ensure the information is communicated in a consistent and fair manner," the spokesperson added.

The Times story came out after the Labor Department on Thursday reported that there was a 30 percent increase in unemployment claims last week. The number of unemployment claims is expected to increase further as the number of business closures goes up.

Cruise ships kept sailing as coronavirus spread. Travelers and health experts question why.

Beth Reinhard, Rosalind Helderman, Faiz Siddiqui, Mark Berman

It was one of the first outbreaks of coronavirus to capture global attention: For weeks in February, the cruise ship Diamond Princess was moored off the shore of Japan with hundreds of infected people aboard.

© Takashi Aoyama/AFP/Getty Images Despite a Feb. 5 quarantine, 700 people aboard the Diamond Princess eventually tested positive for the novel coronavirus. The ship is seen in Yokohama, Japan, on Feb. 21.

Then in early March, nearly 2,000 passengers had to be quarantined on U.S. military bases after infected passengers were found on the Grand Princess, a sister ship operated by Carnival Corp.-owned Princess Cruises.

By the time major cruise lines halted new voyages last Friday, at least half a dozen other ships had sailed with at least one passenger later diagnosed with highly contagious virus.


While cruise lines have seen only a small fraction of the pandemic, they have emerged as a particularly tricky battleground to fight the virus. Health experts said the industry’s initial resistance to take drastic action — coupled with a deference from government officials, who let the companies to come up with their own action plan — put more passengers at risk.

“The cruise ship response was definitely lagging behind expert opinion on how big the risks are,” said University of Chicago epidemiologist Katelyn Gostic. “It was sluggish decision-making and they should have responded earlier.”

The crisis has put the spotlight on an industry that critics say for years has skirted labor regulations, such a minimum wage, and federal income taxes by incorporating overseas. Yet when disasters strike, or when people get sick or fall overboard, federal agencies such as the U.S. Coast Guard come to the rescue.

The Trump administration is now pushing to spend billions to prop up the cruise industry and other hospitality and travel businesses that have been crushed by the pandemic.

“Through the years, a huge amount of federal staff resources have been diverted to dealing with cruise ship health outbreaks,” said Nicole Lurie, who served as a top official at the Department of Health and Human Services during the Obama administration. “Given all the demands on public health resources, it may be worth asking about the public investment we make in protecting cruise ship passengers by putting in place better strategies to prevent future outbreaks involving cruise ships.”

© Behrouz Mehri/AFP/Getty Images An initial CDC study published this week found that the virus quickly spread through food service workers aboard the Diamond Princess, particularly those cooking for other members of the crew.

Cruise line officials said operators are subject to robust inspection by U.S. and foreign regulators. And the industry defended its response to the pandemic, noting the singular nature of the crisis.

Bari Golin-Blaugrund, a spokeswoman for the Cruise Lines International Association, said “the agility and responsiveness of CLIA cruise line members has been on full display over the past two months.”

Within 24 hours of the World Health Organization’s declaration of a global health emergency, cruise line operators rapidly adopted enhanced protocols that she said “were repeatedly elevated as circumstances evolved over time.”

That, along with extensive cleaning and sanitation, helped limit the number of coronavirus cases aboard cruise lines, she said.

Roger Frizzell, chief communications officer of Carnival Corp., the world’s largest cruise operator and the owner of the line that operates the Diamond Princess and the Grand Princess, said cruise lines in January began barring passengers who had been to China in the previous two weeks. They later added recent travelers to Hong Kong, Macao, South Korea and regions of Italy to the no-sail list.

“To my knowledge, this was the first such restriction like this ever established in the cruise industry,” he said. “In reality, the cruise industry acted collectively and independently well before other industries when it came to the initial outbreak of coronavirus in China in December 2019.”

But in the weeks following the outbreak on the Diamond Princess, major cruise lines missed several opportunities to mitigate the crisis, according to health experts and passengers aboard the vessels.

After it was clear the coronavirus was spreading around the world, passenger screening was limited. Even on cruises where officials knew of positive tests, such as the Grand Princess, strict quarantines confining passengers to their rooms were not imposed immediately.

Inconsistent deboarding procedures also meant thousands of passengers who traveled on a ship that had carried a passenger who tested positive for the coronavirus went home with little or no medical screening — possibly bringing the virus back to their communities.

And companies stopped sailing only when the pandemic had reached a crisis point, with some countries closing their harbors, leaving ships with potentially sick people adrift.

Compounding the problem was a White House reluctant to crack down on cruises as the pandemic mounted, even as some top administration officials were urging a suspension of operations before the voluntary shutdown, as The Washington Post previously reported.

Vice President Pence, who leads the coronavirus task force, touted the industry’s initial plan to beef up passenger screening and quarantine protocols. “We want to ensure Americans can continue to enjoy the opportunities of the cruise line industry,” he said at a March 7 meeting with industry executives.

© Eliot J. Schechter/Getty Images Carnival Corp. chairman Micky Arison, left, is a longtime friend of President Trump’s. They are seen with their wives in Miami in 2005.

Trump has long-standing connections to the industry, including through Carnival Corp. chairman Micky Arison, a friend whose company helped sponsor Trump’s reality show franchise “The Apprentice” over the years. On Thursday, Trump said he spoke to Arison, who had offered up his ships to house non-coronavirus patients.

The president has repeatedly said he wants to help cruise lines with a financial rescue package, along with airlines and hotels.

“You don’t want to lose industries like this,” he said Thursday. “These are incredible industries. You can’t lose them.”

Meanwhile, the Centers for Disease Control and Prevention boosted its warning this week against cruising to a higher level, advising any recent travelers to isolate themselves for two weeks. It also put local health departments on notice for the first time about six ships that carried infected passengers in the last month — which have already disembarked travelers who were then not quarantined.

Some customers and their family members now say the industry held back information and should have reacted more quickly.

“To avoid a panic that might collapse the industry, the cruise lines continued to mislead their passengers,” said Ashley Ecker, whose San Diego-based parents are aboard the Costa Luminosa, which continued on a voyage across the Atlantic earlier this month after a woman, later diagnosed as positive for the virus, disembarked with breathing problems. By the time the ship reached a port in France on Thursday, five additional passengers and two crew members had flu-like symptoms.

“This needs to be investigated — certainly before we even consider an industry bailout,” she said.
'They didn't want to scare anyone'

© Noah Berger/AP Passengers who boarded the Grand Princess in San Francisco on Feb. 21 were given a brief questionnaire that asked about fever, cough and recent travel to virus hotspots.

The cruise industry got an early warning of how easily the virus could spread on its massive ocean liners when the first cases emerged on the Diamond Princess in early February after it left Yokohama harbor.

Despite a Feb. 5 quarantine, 700 people aboard eventually tested positive.

An initial CDC study published Tuesday found that the virus quickly spread through food service workers, particularly those cooking for other members of the crew. “This investigation underscores the need for swift epidemiologic investigation as soon as a COVID-19 case is detected in an area or group where a large number of persons gather in a closed or crowded setting,” the study said.

On Feb. 21, as quarantined passengers were still trying to get off the Diamond Princess, Diane and Steve Houghton of Pleasant Hill, Calif., were eagerly boarding a sister ship, the Grand Princess, on the other side of the Pacific Ocean, for a 15-day cruise to Hawaii.

Steve Houghton said the passenger screening in San Francisco was limited. The brief questionnaire handed to passengers as they boarded asked about fever, persistent cough or recent travel to coronavirus hotspots like China.

His document went into a stack along with hundreds of others, Houghton said.

On his form, Houghton wrote that he coughs all the time and has difficult breathing due to chronic asthma. “No one asked any questions. They said not a single word,” he said.

The ship set sail for Hawaii with roughly 3,500 people aboard. As it passed beneath the majestic Golden Gate Bridge, passengers crammed the decks to take in the view, drinks in hand.

Several days of relaxation and merriment followed, with little or no awareness of the virus’s creep around the world, according to passengers interviewed by The Post.

“We never thought coronavirus was in America. We never dreamt of it,” said 65-year-old Howard Lewis of Wales, who said he and his wife met couples aboard who had booked the cruise to Hawaii after canceling trips to Asia.

What they didn’t know: the day before, as the ship’s previous voyage to Mexico was winding down, a passenger came into the medical center “with a six to seven day history of symptoms of acute respiratory illness,” Grant Tarling, Carnival’s chief medical officer, said in a call with reporters two weeks later.

Crew members and 62 passengers who had possibly interacted with that guest on the earlier trip remained aboard for the cruise to Hawaii, according to the cruise line.

© Chief Master Sgt. Seth Zweben/California National Guard/Associated Press Medical personnel work with CDC officials aboard the Grand Princess off the coast of California on March 5.

Frizzell, the Carnival executive, said Princess Cruises was not aware that the passenger had been hospitalized until days after the cruise had departed. Guests had been given “a general health notice with their boarding materials as additional precaution for coronavirus as part of our company’s enhanced safety and health protocol,” he said.

On March 3, health officials in Placer County, Calif., announced the former passenger had tested positive for coronavirus.

The following morning, the Grand Princess issued a “health advisory letter” to guests that said the Centers for Disease Control and Prevention was investigating a “small cluster of COVID-19 (coronavirus) cases in Northern California connected to our previous Grand Princess voyage.”

The notice said the ship was skipping a stop in Mexico and heading directly back to San Francisco. The passengers who had gone on the previous voyage were asked to retreat to their cabins until cleared by medical staff.

The coronavinus-infected former passenger died that day, becoming the state’s first fatality from the virus. California Gov. Gavin Newsom (D) declared a state of emergency.

But the vast majority of the approximately 2,400 Grand Princess passengers were not quarantined in their cabins until the afternoon of March 5.

Health experts say cruise ships are fertile ground for infectious diseases because they pack thousands of people into close quarters for days at a time, encouraging them to eat and socialize together. Cruises also cater to the elderly, who are particularly vulnerable.

Amesh Adalja, an infectious disease doctor who serves as senior scholar at the Johns Hopkins University Center for Health Security, said that the positive test on March 3 should have led to a more serious response.

“The confirmed case should have triggered social distancing measures at that point,” Adalja said. “Because of the high consequences of this infectious disease and attention to it in light of what happened with the Diamond Princess in Japan, they really should have been prepared for what could happen.”

Frizzell said passengers “were alerted within hours” about the positive coronavirus test.

“Upon being alerted of the issue, the Grand Princess looked closely to the CDC and health officials for direction,” he added.

© Noah Berger/AP Health officials in California announced a former Grand Princess passenger had tested positive for coronavirus on March 3. The following morning, the ship issued a “health advisory letter” to guests. It wasn’t until the afternoon of March 5 that passengers were quarantined in their cabins.

Passengers said performances and activities were canceled on the evening of March 4 and the following morning, but they continued to mingle at the bar and move freely around the ship.

The buffet was still open at about 1:45 p.m. on March 5, according to Keane Li of San Francisco, who was keeping close tabs on his parents on the ship and posting updates to Twitter.

“Given what happened on the Diamond Princess, there should’ve been a contingency plan for this,” said Li, whose father, Wai Li, was diagnosed with covid-19 after disembarking the ship last week. “I get that they didn’t want to scare anyone, but they should’ve acted sooner.”

Kailee Higgins Ott, a high school junior from the Bay Area, said she was eating lunch in the main dining room on March 5 when the captain announced that people needed to stay six feet away from each other and then retreat to their staterooms.

“I mean, when he said social distancing, everyone like started to laugh because we were sitting in a dining room and obviously we couldn’t be six feet away from everyone,” she said.

On March 6, Captain John Harry Smith assured passengers he would keep them informed, according to announcements shared by a passenger with The Washington Post. An update came later that day, but not from the captain.

In a news conference at the White House that afternoon, Pence said that 46 people had been tested from among the more than 3,500 people on board. Among them, 21 had tested positive, 19 of them crew members.

© Noah Berger/AP Passengers aboard the Grand Princess celebrate as they arrive in Oakland, Calif., on March 9.

Passengers learned there were confirmed coronavirus cases on board at the same time the public did. Smith came back on the loudspeaker.

“We apologize, but we were not given advance notice of this announcement by the U.S. federal government,” the captain said. “It would have been our preference to be the first to make this news available to you.”

Carolyn Wright, 63-year-old from Santa Fe, said, she was “hearing things on the news that were affecting us directly that were never communicated to the passengers being affected. It was the most frustrating, helpless feeling.”

“When all control over your personal life is taken from you and you're not even told what's going to happen to you or why or anything, the stress level is incalculable,” she added.

After Pence’s announcement, Carnival relaxed its policies to allow guests to cancel or postpone cruises because of potential worries about coronavirus.

The Grand Princess used a stricter protocol for distributing food and fresh towels to quarantined passengers than the Diamond Princess, which had allowed crew members wearing masks and gloves to make deliveries in person. On the Grand Princess, passengers said they were asked to wear masks when they opened their doors to retrieve meals left on the floor and said they never saw crew members.

“The stewards, the ones that came and delivered things to you, they all had their masks on,” said Amy Horowitz, a New Yorker celebrating her 59th birthday on the ship with family. “They would just bang on your door to let you know they left something at your door and run away as fast as you could.”

© Kate Munsch/Reuters Grand Princess passengers wait to board a chartered flight at Oakland International Airport in California on March 11.

On March 9, the ship was allowed to dock in Oakland. Lewis and his wife flew home to Wales, as did other passengers from around the world, while the American passengers were sent to military bases for quarantine.

As of Thursday, more than 870 evacuees from the ship who were taken to four U.S. military bases had been tested, according to the Department of Health and Human Services. Another 674 had declined to be tested.

Including passengers and crew who were tested while still aboard the ship, U.S. officials said they were aware of 40 people from the Grand Princess who have so far tested positive for the coronavirus, a number that is expected to increase in the coming days, according to an HHS spokeswoman.

Houghton said he and his wife have been feeling fine and have declined testing while confined to Travis Air Force Base, stewing about the cruise line’s handling of the situation.

“Princess Cruise Lines filling our ship and sailing with sick people on board was unforgivable,” he said.

Other passengers from around the world who chose to be tested are now learning their results. In Wales, Lewis and his wife found out last weekend that they were infected.

“With hindsight I suppose you could say they should have quarantined us earlier, though I am not sure it would have made a difference,” Lewis said. “People will learn a lot from this hopefully.”

Seeking a port

© Daniel Cole/AP The Costa Luminosa arrives in Marseille, France, on Thursday after a journey across the Atlantic Ocean.

On March 5, the same day that Grand Princess passengers were being quarantined to their rooms, another cruise ship, the Costa Luminosa, set sail from Fort Lauderdale, on an itinerary through the Caribbean and onto Europe. The ship carried 1,400 passengers, including 233 Americans.

Ecker, 41, said her parents Jeffrey and Kathryn Bitner were nervous about going on the trip. But she said they were assured by cruise authorities that there was no need for concern — and also warned that they would not be reimbursed if they canceled.

“So they believed them,” she said, “and they left.”

Passengers did not know that during a previous voyage of the Costa Luminosa, an Italian man had complained of heart trouble and was taken off the ship in the Cayman Islands on Feb. 29, according to Carnival-owned Costa Cruises, which operates the ship. He later tested positive for the coronavirus and died.

On the current voyage, an Italian woman disembarked March 8 in Puerto Rico complaining of breathing troubles and then tested positive for the virus. So did her husband traveling with her, the company has since said.

While it awaited test results, the cruise line did not initially tell passengers about the sick woman who got off the ship, even though she was hospitalized, relatives of current passengers said.

Instead, the ship continued toward its next port-of-call, Antigua. After authorities there denied the ship docking because of the ill woman who had disembarked in Puerto Rico, it headed out for the multiday trip across the Atlantic Ocean.

Only then, on March 9, were passengers told about the sick woman, according to a letter delivered on board, a copy of which was obtained by The Post.

© Chris S via Reuters A view of the interior of the Costa Luminosa on Thursday.

Those aboard the ship continued to mingle and eat communally. By the time the Costa Luminosa reached the Canary Islands, off the coast of northwest Africa, three more passengers had coronavirus-like symptoms. They were allowed to disembark, but the Spanish government would not allow others to come ashore because Spain has closed its ports, the company said.

On March 13, the cruise company said it was told that the Italian man on the ship’s previous voyage had tested positive. The following day, March 14, it learned that the woman hospitalized in Puerto Rico and her husband also had tested positive.

One more day passed before passengers were isolated in their rooms, according to people aboard. A full week had passed since the sick woman disembarked in Puerto Rico.

“Other measures had already been implemented in the days before, including isolation of the close contacts of the suspect cases and the cancellation of several on board activities,” Rossella Carrara, a Costa Cruises vice president, said in an email.

“The health and safety of guests, crew member and of the destinations is of the utmost importance,” she added.

By the time the ship docked in Marseille early Thursday morning, five passengers and two crew members had flu-like symptoms, the company said. After French health authorities came aboard to do health checks, 386 passengers disembarked, most of them French, Canadian and U.S. citizens, the company said.

A chartered airplane carrying U.S. citizens landed in Atlanta on Friday morning, where additional health screenings were expected to take place. According to passengers, some were coughing during the trans-Atlantic flight.
Clearance to disembark

© Lynne Sladky/AP The MSC Meraviglia, right, was docked in Miami this week. As the ship was underway on a cruise last week, the cruise line learned that a passenger on the previous journey had tested positive for the virus.

On March 8, the State Department and the Centers for Disease Control and Prevention warned U.S. citizens, particularly those with medical issues, not to travel by cruise ship. The move panicked industry officials, who scrambled to pull together an action plan and get ahead of further government action, according to people familiar with the situation, who spoke on the condition of anonymity to describe private discussions.

Around 6 p.m. that day, the MSC Meraviglia pulled out of Miami for a scheduled eight-day cruise to the Caribbean.

Four days later, the MSC cruise line was informed by Canadian authorities that a passenger on the ship’s previous journey had tested positive for the coronavirus, according to the cruise line. Some crew members and guests who had traveled with that passenger had remained on board for the subsequent voyage.

Passengers received notices the next day that seven crew members who may have been in contact with the virus-infected former guest were quarantined, according to a copy reviewed by The Post. It did not mention possible contact with other passengers.

The ship continued, making a stop Saturday at an MSC-owned island in the Bahamas.

Jeffrey Cleary, 55, said passengers had their temperatures taken before reboarding the ship. But when they arrived back in Miami on Sunday, no one checked their temperatures, he said.

Nearly 3,900 passengers streamed off the ship — many headed to the airport to fly to homes around the world.

“Not one piece of screening was done,” Cleary said. “Off we went.”

© Florent Serfari/Reuters A passenger who returned from a cruise aboard the MSC Meraviglia on Sunday said passengers’ temperatures were checked after an island visit but not as passengers streamed off the ship at the end of the cruise.

The cruise line had been carefully monitoring the health of crew and passengers, and none were experiencing symptoms associated with covid-19 as the cruise ended, according to the company.

“The ship received clearance from the CDC and [the United States Coast Guard] on Sunday, March 15 after they reviewed all the necessary documentation regarding the health of passengers and crew on board on Sunday and throughout the cruise,” the company said in a statement.

CDC spokeswoman Kristen Nordlund said the federal agency had been aware of the positive test before the ship was allowed to dock and responded by sending a notice to local health departments to alert them to the “medium risk” posed by the disembarked passengers.

“As the situation in the United States changes, both with increasing COVID-19 cases and the number of cruise ships coming in to port over the next few days, CDC is continuing to reevaluate how we approach returning cruise ships,” Nordlund said.

Thousands of cruise ship passengers are now slated to return home in the coming days from ships whose voyages began before the industry’s temporary halt.

Many of those that remain at sea have had difficulty finding countries that will allow them to dock, even those with no identified cases aboard.

The Norwegian Jewel, for instance, which departed Sydney on Feb. 28, had been sailing toward Honolulu after being prevented from docking in several South Pacific ports.

Marilee Perkal, whose daughter and son-in-law are on board, said they have been told there are no signs of passengers with symptoms. She said that her daughter recently sent a photo of her and her husband lounging by the pool.

As a precaution, her daughter told her, the ship has had no buffets since the start of its cruise. Guests are not even allowed to touch the salad dressing bottles. “That has been a comfort,” she said.

On Wednesday, however, Hawaii announced that no additional cruise ships will be allowed to dock. Passengers had not yet been informed of a new plan for disembarking, Perkal said.

Tom Hamburger, Julie Tate, Hannah Sampson and Jonathan O’Connell contributed to this report.

TRUMP IS AN IDIOT
Analysis: Seven days as a ‘wartime president’: Trump’s up-and-down command of a pandemic
Philip Rucker, Ashley Parker 

President Trump was reeling from one of his worst weeks ever: The novel coronavirus was killing Americans, wrecking the economy and subsuming him and his presidency.

But in the pandemic, Trump saw an opportunity to cast himself in a new role: “Wartime president,” as he later dubbed it. Aides noted that Trump was punctual for last Saturday’s White House task force meeting, donning a navy “USA” cap and — instead of simply watching as Vice President Pence and the assembled health officials briefed the public that afternoon, as he’d initially planned — joining them at the rostrum.

All week, Trump reveled in his newfound character — that of a crisis commander steering his skittish nation through battle with what he called an “invisible enemy.” He parried questions, barked orders and stood stoically by as he accepted praise, day after day, from his underlings for his “strong leadership” and “decisive actions.”

But on Friday, Trump faltered. He argued based on “just a feeling” that, despite no scientific evidence yet, an anti-malaria drug could cure the coronavirus. He complained that he has not been credited for fixing a nationwide testing system that clearly is still broken. And when asked what message he had for Americans who were scared, he lashed out.

“I say that you’re a terrible reporter,” Trump answered to NBC News correspondent Peter Alexander. “That’s what I say.”

Trump’s past seven days at the helm of the coronavirus effort illuminated his mercurial nature and underscored his difficulty overseeing the national response to a global catastrophe largely out of his — or any other leader’s — control.

Trump — whose moods often determine policy and are almost directly correlated to the vagaries of 24-hour news cycles — has been lapsing into his self-destructive ways even when aides stress the importance of steady leadership during a national emergency.

Fixated on his portrayal in the media, Trump has used this past week to try to rewrite history in hopes of erasing the public’s memory of him dismissing the severity of threat and bungling the early weeks of the administration’s response.

“I’ve felt that it was a pandemic long before it was called a pandemic,” Trump said Tuesday. Only five days earlier he had declared, “It’s going to go away,” and two days before that he had said, “It will go away. Just stay calm.”



1/5 SLIDES © Jabin Botsford/The Washington Post

After the coronavirus was first detected in China and swept across Europe, and even after the first reported case in the United States on Jan. 21, Trump tried to wave off the danger. He was then in the throes of the impeachment battle and distracted by the Democratic presidential primaries. The president accused the media of perpetuating a hoax, arguing that news organizations were drumming up hysteria over the growing public health crisis as a way to hurt his presidency.

The nadir for Trump came March 6, when he visited the Centers for Disease Control and Prevention headquarters in Atlanta and appeared to make a mockery of the scientists’ warnings. He then decamped for the extended weekend to Palm Beach, Fla., where he played golf and hung out with friends at his Mar-a-Lago Club, which itself turned into a coronavirus petri dish.

Trump’s public posture began to shift, however, once the financial markets started to plummet. He was particularly taken with the numbers — not just the cratering Dow Jones industrial average but also the briefings he received from Vice President Pence, multiple times a day, with fresh data and figures showing how the virus could devastate the nation if left unchecked.

A new study released earlier this week by the Imperial College London — which projected that 2.2 million would die in the United States alone if no steps were taken to curb the outbreak — was particularly influential among Trump’s inner circle.

Trump also was influenced by his conversations with business leaders and wealthy supporters, who lit up the presidential phone line with angst and alarm over the Wall Street meltdown. Their message: Get it together. The world’s collapsing and you’re flaunting that you don’t care.


Trump then took a series of steps in quick succession to try to gain control over the spiraling crisis. He delivered a prime-time address to the nation. He banned travel from Europe. And he declared a national emergency.

Though Trump claims his Jan. 31 restrictions on travel from China as evidence that he always has taken the coronavirus seriously, one senior White House official said his March 11 announcement prohibiting most travel from countries in the European Union — a critical diplomatic ally and trade partner — helped truly underscore for Trump the severity of the crisis.

Trump was angry that his error-riddled prime-time Oval Office address to the nation, in which he announced the Europe ban, was widely panned, and frustrated that so few allies defended him on television the next day. But on March 13, a news conference in the Rose Garden — at which he announced a new testing website and new testing locations, both of which were half-baked at best — buoyed his spirits because he finally felt he had at least the illusion of control, aides said.

Officials also pointed to Hope Hicks — Trump’s former communications director and close confidante who recently returned to the White House after a stint in Los Angeles — as a calming presence who helped focus Trump.

Each day after the task force meets and before members present their latest message to the public, a small group retreats to the Oval Office to strategize about the news conference. The group includes whatever officials are speaking that day, as well as Pence, Hicks, White House chief of staff Mark Meadows, the vice president’s chief of staff Marc Short, and Trump’s son-in-law and senior adviser Jared Kushner. Hicks often offers tonal suggestions, helping steer Trump toward the sort of more measured language that his advisers have long been pushing.

On Monday, Trump adopted the far more serious tone that his advisers had encouraged. He echoed the guidance of infectious disease experts and offered direction about what people should and shouldn’t do. He advised against gatherings of more than 10 people, as well as discretionary travel, and urged whoever could work from home to do so. He even hit the pause button on his various feuds with Democrats and the media.

“My focus is really on getting rid of this problem — this virus problem,” he said Monday. “Once we do that, everything else is going to fall into place.”

Trump spoke of the coronavirus as if it were a foreign adversary at war, drawing parallels between the ways Americans are adapting their lives to adhere to social distancing guidelines to the sacrifices citizens made during World War II. Speaking about his own leadership, Trump said Wednesday, “I view it as, in a sense, a wartime president.”

Historian Michael Beschloss said Trump’s conception of himself as a wartime leader is potentially apt.

“The war metaphor is actually a good one if what it means is that the president is acting as a commander in chief does, which is trying to orchestrate all of the power of the federal government to solve the problem and to level with the American people,” Beschloss said. “But this is not a war against a foreign enemy. It is not military. Waging a war is not the same thing as fighting an illness.”

The president’s resolve, however, did not last. Trump has never demonstrated the ability to sustain discipline or message control over an extended period — frequently following fleeting periods of calm with bursts of seeming self-sabotage — and this week was no different.

On Thursday, Trump snapped at a reporter who began a question by stating that “the economy is essentially ground to a halt.”

“Thanks for telling us — we appreciate it,” Trump said, before adding, “Everybody in the room knows that.”

By Friday, Trump was in full tirade mode. Seemingly desperate for a miracle medicine, he kept on pushing an anti-malarial drug as a potential cure-all, prompting Anthony S. Fauci, the director for the National Institute of Allergy and Infectious Diseases, to gently offer a more nuanced view.

But even the normally placid-faced Fauci could barely contain himself when Trump referred to “the State Department or, as they call it, the ‘Deep State’ Department.” Fauci, standing just behind Trump’s left shoulder but still on camera, smirked and touched his fingertips to his brow to cover his face as he struggled to suppress a chuckle.

Other moments were less humorous. When Alexander, the NBC reporter, asked Trump what message he had for “Americans who are watching you right now who are scared,” Trump angrily attacked him as “a terrible reporter” and called it “a very nasty question.”

When Alexander later posed the same question to Pence, it was Trump’s No. 2 who offered the words one might ordinarily expect from a wartime president: “Don’t be afraid. Be vigilant.”


 

 Analysis: Trump's coronavirus claims haven't matched response reality

WASHINGTON — To hear President Donald Trump tell it, there is a website where you can find out if you need to get tested for coronavirus, and millions of testing kits available for anyone who needs one. There is an approved treatment, a vaccine coming soon, plenty of protective masks in circulation, and a ship that will be off the coast of New York next week to help patients.

But the president's description of the state of measures being taken by his administration stands in sharp relief to the reality being described by the experts on the ground involved in the response. And so the president, who was criticized early in the crisis for downplaying the risk posed by the virus while health officials were sounding the alarm, now faces claims that he is overplaying the available assistance.

While Trump has given overly optimistic timelines and overstated his accomplishments throughout his time in office, in the case of the coronavirus pandemic, his alternate version of events threatens to create unnecessary confusion among the public, potentially leading to a false sense of security, drawing criticism from public health experts and political opponents.

"Memo to Donald Trump: take a day off from the briefing room where you hype cures that aren't proven, promise websites that don't exist, and talk about tests that aren't being given -- and let @CDCgov talk," Ron Klain, a longtime adviser to Democratic presidential contender Joe Biden who led the Obama administration's response to the Ebola outbreak, said Thursday in a tweet.

The president has gone further than government experts on multiple fronts, including available treatment.

On Thursday — during a news conference which Trump had described a day earlier as being held to announce "very important news from the FDA concerning the Chinese Virus!" — he said a decades-old malaria drug had been approved to treat COVID-19 and could be a "game changer." Moments later, the FDA said the drug was still going through the approval process to determine if it was safe and effective for coronavirus patients.

When Trump was pressed by NBC's Peter Alexander on Friday about whether this claim was giving Americans false hope, he testily defended his positive spin. "I feel good about it, that's all, just a feeling, smart guy," Trump said. "I feel good about it, and you are going to see soon enough."

Trump's recent assurances about the scope of medical supplies on the way for health care workers also hasn’t matched what has been available on the ground.

As hospitals have scrambled to get the protective supplies they need, Trump has repeatedly expressed confidence the U.S. will have the supplies needed. Over the past week, Trump has said the U.S. had “massive numbers of ventilators” and plenty of protective masks for health care workers while assuring that more supplies were on the way.

“The masks are being made by the millions,” Trump said on March 14. “Millions and millions. We have plenty now, but we're ordering for the millions. We're ordering worst-case scenario.”

But a few days later, Trump had to call on the military to rush out protective supplies, as hospitals said they had to start reusing masks, making their own and asking the public for donations.

When Trump was asked at a press briefing Thursday about the gap between his own claims and what health care providers say they are experiencing, he denied over-hyping. “I’m hearing very good things on the ground," he said.

To make sure the U.S. has the supplies it needs, Trump said Wednesday he was turning to the Defense Production Act, to get the private sector to ramp up production, similar to the effort in WWII when factories adapted their capabilities to make military equipment. But Trump declined to specify on Friday what steps, if any, he had taken under the act to require companies to ramp up production of needed supplies.

For patients confused about whether they need testing and how to get it, Trump announced last week that Google was developing a coronavirus testing website that was going to be “very quickly done, unlike websites of the past.” Vice President Mike Pence said Americans would be able to use the website “very soon” to find out if they needed testing and where to go to get it.

But the website being developed by Google sister company Verily has ended up being much more limited in scope than what the White House promised. Verily did launch a website this week similar to the one Trump described, but said in a statement to NBC News that the site is in the “early stages of development” and only being tested in two California counties.

While Pence clarified the day after the White House announced the site that it would just be for the San Francisco Bay Area, “with the goal of expanding to other locations,” Trump denied there was any miscommunication, saying the head of Google called to apologize, without elaborating on what that apology was allegedly for, and accused the media of putting out false information, without specifying what the inaccuracies might be.

To address growing concerns by hospitals that they would soon run out of beds for patients, Trump said at a Wednesday press conference that the Navy was sending a medical ship to New York and another to the West Coast to help treat patients. Trump said the ships “are in tip-top shape. They soon will be.” On timing, he said “they can be launched over the next week or so, depending on need.”

Defense Secretary Mark Esper gave a less optimistic timeline later that day. During an interview on CNN, he said the ship to be sent to New York, which is currently undergoing maintenance, wouldn’t be ready for “a couple weeks plus” and the one on the West Coast “should be ready in a week and half, two weeks, definitely before the end of the month.” He said the ships still needed to be staffed with medical personnel, and only then moved to their locations.

Esper also clarified that the ships, built to deal with wartime trauma, wouldn’t be used to treat those infected with the coronavirus, but rather to take care of other patients to free up hospital operating rooms.

And as concern has mounted in the general public over exposure and diagnosis, Trump has repeatedly overplayed the availability of testing. He said on March 6 that anyone who needed a test was able to get one, reiterating that claim when asked about it at a press conference last week. On March 9, Vice President Mike Pence said that 1 million tests had been distributed, and 4 million more were expected to be sent by the end of the week, predicting on March 13 that 15,000 to 20,000 tests would be performed a day.

The testing availability has been changing rapidly and more labs are coming online daily, but roughly eight weeks after the first confirmed cases, roughly 112,000 tests have been conducted, according to researchers at the COVID Tracking Project. Doctors have continued to say they struggle to obtain testing and results for patients they believe should be tested.

On Friday, Trump said again that the administration was not getting proper praise for the actions he had taken. "We haven’t been given the credit we deserve," the president told reporters. "That I can tell you."

Goldman Sachs CEO gets 19% raise, bumping his pay to $27.5 million

IMAGINE IF A UNION ASKED FOR A 19% RAISE FOR ITS MEMBERS

THE HOWLING OF WALL ST. AND BAY ST. WOULD BE DEAFENING

Goldman Sachs releases 2019 compensation numbers

Goldman Sachs CEO David Solomon received a 19% raise for his work in 2019, a filing issued on Friday shows.

The increase bumps his pay to $27.5 million for 2019, up from $23 million for his work in 2018.

Solomon's 2019 compensation includes a $1.9 million base salary, a $7.7 million cash bonus, and a $17.8 million stock bonus, according to the filing.

Goldman Sachs said in the filing that Solomon "successfully executed on his priorities in his first full year as Chairman and CEO," and "demonstrated a strong commitment to improved transparency," among other "performance achievements."

Solomon became CEO of Goldman Sachs in 2018, replacing Lloyd Blankfein.

A spokesperson for Goldman Sachs was not immediately available for comment.

California earthquake: Massive 5.2 quake rocks US striking just off the coast

A MASSIVE earthquake has rocked the US, just off the Californian coast, with a 5.2 Richter scale reading.

By REBEKAH EVANS PUBLISHED: Thu, Mar 19, 2020

The news follows a March forecast which predicted California could experience a big earthquake within weeks.

A "major seismic hazard" - the Rose Canyon fault - has been recorded beneath California's San Diego, which was estimated at the time to cause $38 billion of damage.

The Richter scale, used to measure the strength of earthquakes, was developed by US seismologist Charles F. Richter in 1935.

The reading was first recorded by the United States Geological Survey - a scientific agency of the US government.

The San Andreas fault line lies along California, causing regular quakes (Image: GETTY)

At the time, the Earthquake Engineering Research Institute warned of the fault lines.
They said: "San Diego could suffer major geologic ground failure and ground shaking hazards resulting in severe seismic damage consequences."

This particular earthquake only sent shockwaves to mainland America.

But it could be a sign of developments to come.

READ MORE: California earthquake: Is Big One coming? ‘Major hazard’ threat

The earthquake registered at 5.2 on the Richter Scale (Image: USGS)

The National Weather Service’s Tsunami Warning System said there was no risk of a tsunami from the earthquake last night.

According to the US Geological Survey, Wednesday’s quake had its epicenter under the Pacific Ocean about 35 miles southwest of Eureka and fewer than 10 miles offshore.

Almost 100 Eureka resident had posted online reports to the Geological Survey saying they’d felt shaking.

It comes after another quake on March 8, which was measured at a magnitude of 5.8, with an epicenter 70 miles southwest of Eureka.

Shockwaves reached mainland USA (Image: USGS)

During this earthquake, the epicenter was more than a mile deep beneath the Pacific Ocean and about 70 miles southwest of Eureka, the agency reported.

It had earlier reported the magnitude as 5.9, but downgraded it slightly later on Sunday night.

The National Weather Service’s US Tsunami Warning System said there was no danger of a tsunami from the temblor.

This is because it was centered west of Petrolia, a town about 45 miles south of Eureka

California is often struck by earthquakes.

This is because the state is home to the San Andreas fault line, which is overdue another Big One.

The last Big One struck on April 18, 1906, off the northern California coast.

It is believed to have killed 3,000 people.

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COVID-19 PIC OF THE DAY

L’Oréal Announces Plans to Produce Hand Sanitizer in Response to the Shortage

SO FAR IT IS ALL FRENCH PERFUMERS AND AN IRISH GIN COMPANY,

WHERE IS COTY, AVON, REVLON, AND OTHER AMERICAN COMPANIES?

Kaleigh Fasanella

© Getty Images

As a direct result of the COVID-19 outbreak, hand-sanitizing products are becoming increasingly difficult to come by. In response to the shortage, L'Oréal Group, one of the world's biggest beauty producers, has announced it will use its manufacturing facilities to make hand sanitizer and hydroalcoholic gel to distribute throughout Europe, reports Women's Wear Daily.

The Foundation L’Oréal also announced its plans to donate one million euros to the associations that are working around the clock to help the disadvantaged during these unprecedented (and uncertain) times. According to WWD, this involves distributing money to several associations, as well as offering the beneficiaries, social workers, and volunteers who work at those associations hygiene kits and hydroalcoholic gel to help prevent furthering the spread.

The beauty brand's chairman and chief executive officer, Jean-Paul Agon, told WWD: "In this exceptional crisis situation, it is our responsibility to contribute in every possible way to the collective effort. Through these gestures, L’Oréal wishes to express its appreciation, support, and solidarity with all those who mobilize with extraordinary courage and abnegation to fight against this pandemic."

In addition, L'Oréal is putting a hold on all debts owed to them by small and medium-sized businesses as a result of the situation. And for the businesses that are experiencing the most devastation, it will set up a personalized payment system that reflects their specific situation.

L'Oréal isn't the only beauty company putting forth efforts to help those impacted by the coronavirus crisis. LVMH, the French giant behind luxury brands like Louis Vuitton and Givenchy, recently announced it would use all of its perfume and cosmetics facilities to manufacture and distribute hand sanitizer during this time.

"Given the risk of shortage of hydroalcoholic gel in France, Bernard Arnault has instructed the LVMH Perfumes and Cosmetics business to prepare its production sites to manufacture substantial quantities of hydroalcoholic gel to be provided to public authorities," said the company in a statement obtained by WWD.

SEE
https://plawiuk.blogspot.com/2020/03/iconic-distilleries-turn-to-hand.html
https://plawiuk.blogspot.com/2020/03/loreal-announces-plans-to-produce-hand.html
https://plawiuk.blogspot.com/2020/03/from-vodka-and-gin-to-hand-sanitizer.html
https://plawiuk.blogspot.com/2020/03/dior-and-givenchy-to-use-perfume.html
https://plawiuk.blogspot.com/2020/03/he-has-17700-bottles-of-hand-sanitizer.html
https://plawiuk.blogspot.com/2020/03/new-yorks-solution-to-hand-sanitizer.html

TRUMP LIES
Fauci throws cold water on Trump's declaration that malaria drug a 'game changer'

Trump on malaria drug for COVID-19: ‘I feel good about it’

A day after President Donald Trump declared an anti-malaria drug a “game changer” in the fight against the novel coronavirus, the nation’s top infectious disease expert downplayed any role it might play in the fast-moving pandemic and said signs of the drug’s promise were purely “anecdotal.”

Fauci’s statements at a White House briefing Friday amounted to clinical cold water thrown on the president’s repeated upbeat assessments on the U.S. fight against the virus, also known as COVID-19.

Trump has falsely declared in recent weeks that anyone who wants a test could get one, despite limited access in parts of the country that continued through this week.

On Thursday, Trump declared an anti-malaria drug called chloroquine a “game changer” in the effort to develop a coronavirus treatment and announced the drug had been “approved.”

Chloroquine, or hydroxychloroquine, has been approved to treat and prevent malaria since 1944. But no drug has been approved to treat COVID-19, and a vaccine is estimated to remain at least a year away.MORE: Chloroquine, an old malaria drug, may help treat novel coronavirus, doctors say 

© Jim Watson/AFP via Getty Images Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during a briefing on the latest development of the coronavirus outbreak in the U.S. at the White House, March 20, 2020, in Washington.When asked if the drug was promising Friday, Fauci, standing next to Trump, said “the answer is no” because “the evidence you’re talking about … is anecdotal evidence.”

“The information that you’re referring to specifically is antecdotal,” he added. “It was not done in a controlled clinical trial. So you really can’t make any definitive statement about it.”

Trump then stepped forward to add: “We’ll see. We’re going to know soon.”

The president then repeated his assessment that the drug was potentially a “game changer” and said: "We have millions of units ordered.”

MORE: Trump announces potential 'game changer' on drugs to treat novel coronavirus, but FDA says more study is needed 

When asked if he was giving the nation a false sense of hope, Trump said no.

“It may work, it may not work,” he said. “I feel good about it.”

On chloroquine, U.S. health officials say it’s possible that doctors could try the drug to treat coronavirus symptoms if it’s already on the market. Clinical trials are under way.

But the FDA says it wants to study the potential of the drug before recommending its use, in part so that patients and their doctors don’t waste critical time on a drug that might not work.

On testing, Fauci said it’s true that not everyone who wants a test can get one.

He said access to tests has improved in recent days noticeably, with the private sector having jumped on board.

But, he added, he continues to hear from people unable to determine if a patient has been infected – a serious problem when trying to mitigate the spread.

“I understand and empathize with the people who rightfully are saying I’m trying to get a test and I can’t,” Fauci said.

A reporter asked: “So is that another way of saying we are not at a point where we are meeting the demand pressure?”

“The answer is yes … We are not there yet because otherwise people would never be calling up saying they can’t get a test,” he said.

Fauci and Trump agreed that people without symptoms don’t need to tested. And Fauci said even without testing, communities can respond to the outbreak by limiting social contact.

“Testing is important. It would be nice to know. And there are certain things you could do” with results, Fauci said. “But let’s not conflate testing with the action we have to take,” which includes social distancing and washing hands.

TRUMP IS AN IDIOT
Virus Drug Touted by Trump, Musk Can Kill In Just Two Grams
China recommended chloroquine for coronavirus a month back

Within days, it cautioned against severe side effects

‘It’s not going to kill anybody,’ Trump says at White House

Research still examining safety, effectiveness of chloroquine

(Bloomberg) -- The drug touted by the U.S. President Donald Trump as a possible line of treatment against the coronavirus comes with severe warnings in China and can kill in dosages as little as two grams.

China, where the deadly pathogen first emerged in December, recommended the decades-old malaria drug chloroquine to treat infected patients in guidelines issued in February after seeing encouraging results in clinical trials. But within days, it cautioned doctors and health officials about the drug’s lethal side effects and rolled back its usage.

This came after local media reported that a Wuhan Institute of Virology study found that the drug can kill an adult just dosed at twice the daily amount recommended for treatment, which is one gram.

As the drug hasn’t been approved by the U.S. Food And Drug Administration to treat the disease known as Covid-19, the Chinese experience may be useful as the American regulator studies the medication which has been endorsed by Trump as well as Tesla Inc. chief executive officer Elon Musk.

© Photographer: Barcroft Media/Barcroft Media An employee checks the production of chloroquine phosphate, resumed after a 15-year break, in a pharmaceutical company in Nantong city in east China's Jiangsu province Thursday, Feb. 27, 2020.

The pandemic, which has sickened more than 235,000 globally and killed over 9,800 people, has triggered growing anxiety across the U.S. as states say they lack testing kits and medical equipment. California instituted a state-wide lockdown on Thursday to slow the outbreak.

Chloroquine was among the first group of therapies Chinese scientists identified as being effective in curbing the new coronavirus. Clinical trials on about 130 patients demonstrated the drug’s ability to reduce the severity of the illness and speed up virus clearance, according to China’s Ministry of Sciences and Technology.

Chroloquine phosphate was officially recommended on Feb. 19 in the Covid-19 treatment guidelines published by China’s National Health Commission, along with a few other drugs such as AbbVie Inc.’s Kaletra and flu drug arbidol as antiviral treatments for patients. The commission recommended no more than a 10-day course of chloroquine for adult patients at 500mg -- half a gram -- twice a day.

The Search for New Drugs for Coronavirus Faces Long Odds

As hundreds of clinical trials are launched to study potential Covid-19 treatments, stocks of drugmakers and biotechnology companies have racked up big gains on the hope that the industry will see a windfall. But the history of previous viral outbreaks like Ebola and Zika show little success in producing viable treatments. Some potential drugs were developed only after the epidemics already waned through containment measures.
Closely Watched

China’s recommendation to use chloroquine in treatment was quickly followed by a warning.

Two days after the treatment guideline update, health authorities in Hubei province -- China’s worst-hit region where the outbreak started and which accounted for majority of its over 80,000 patients -- asked hospitals to closely watch for, and immediately report, any adverse side effects of chloroquine phosphate, according to a report in local media outlet The Paper.

The drug is known to have short-term side effects such as nausea, diarrhea and tinnitus while long-term use can irreversibly impair eyesight. It’s forbidden for pregnant women as it can cause congenital defects in babies.

China Health Commission revised the dosage in a Feb. 29 notice tightening chloroquine use. The drug cannot be given to pregnant women, those with heart disease, terminal liver and renal disease, retina and hearing loss and patients on antibiotics such as azithromycin and steroid.

It can now be given only to patients between 18 to 65 years of age for a seven-day treatment course. Patients weighing over 50 kilograms (110 pounds) can take 500mg twice a day -- the usual dose -- while those weighing less will be administered the drug just once a day after two days of use, according to the latest guidelines.

A woman in Wuhan proved how lethal chloroquine can be when it’s taken beyond the recommended dose. On Feb. 25, Shanghai-based The Paper reported that she took 1.8 grams of the drug she ordered online after suspecting she had the coronavirus. She did not, but the drug caused her to develop malignant cardiac arrhythmia, which can cause sudden death, and she was admitted to the intensive care unit.
©2020 Bloomberg L.P.

TRUMP IS AN IDIOT
Trump Touts Drug That FDA Says Isn’t Yet Approved for Virus 

By Anna Edney March 19, 2020

‘It’s not going to kill anybody,’ Trump says at White House

Research still examining safety, effectiveness of chloroquine

Trump Says Malaria Drug Approved to Treat Coronavirus

The Food and Drug Administration has been told by President Donald Trump to see if it can expand the use of a decades-old malaria drug as an experimental treatment for coronavirus patients.

The drug, chloroquine, hasn’t yet been approved for treatment of Covid-19, the disease caused by the new coronavirus. While it’s been available for decades for malaria, it’s not clear whether it will work against the new illness. A March 10 review of existing research found there’s little solid proof one way or the other.

During an at-times-confusing White House press conference, Trump said that chloroquine was approved for use and that he wanted to “remove every barrier” to test more drugs against Covid-19 and “allow many more Americans to access drugs that have shown really good promise.”

“Normally the FDA would take a long time to approve something like that, and it’s -- it was approved very, very quickly and it’s now approved by prescription,” Trump said.

An FDA spokesperson said the drug hadn’t been approved for use in Covid-19 patients. However, U.S. doctors are legally able to prescribe a drug for any illness or condition they think is medically appropriate.

More than a dozen generic drugmakers, including Teva Pharmaceutical Industries Ltd., Mylan NV and Novartis AG’s Sandoz unit, manufacture chloroquine, also called hydroxychloroquine. It comes with few major known side effects, is relatively inexpensive and is widely used around the world. It’s also been touted by Tesla Inc. Chief Executive Officer Elon Musk as a potential treatment, and China has been testing it as well.

Mylan said in a statement Thursday it would immediately ramp up manufacturing of hydroxychloroquine pills at its West Virgina facility to meet expected high demand if the medication is shown to be effective against the disease. The generic-drug giant expects to be able to supply the drug by mid-April, ultimately providing 50 million tablets to potentially treat more than 1.5 million patients.

Other drugmakers are also developing experimental treatments and vaccines for Covid-19, with results from a Gilead Sciences Inc. drug, remdesivir, expected next month.

Gilead shares closed down 1.1% at $78.55 in New York, after earlier rising as much as 8.2%.

Press Conference

Trump has called for rules to be relaxed and government authority to be expanded to respond to the coronavirus outbreak, which has resulted in more than 200,000 confirmed cases and at least 9,000 deaths around the globe. Cities have been locked down and economies brutalized as governments try to prevent the spread.

At Thursday’s press conference, Trump and FDA Commissioner Stephen Hahn appeared to differ substantially about the status of the drugs being tested.

Trump said chloroquine had been approved and could be given to patients by doctors with a prescription.

“It’s been around for a long time, so we know that if things don’t go as planned it’s not going to kill anybody,” Trump said.

Shortly thereafter, Hahn said that use of the drug would be in a controlled trial to find out whether or not it works, and if so, what dose would be safe and effective.

“We want to do that in a setting of a clinical trial,” Hahn said.

There was similar confusion over Gilead’s drug, which Trump said was “essentially approved.”

Hahn said afterward that remdesivir is “going through the normal process” and isn’t yet available to patients.


The FDA has increasingly stepped back from its regulatory role in the middle of the crisis, announcing that it would let states regulate tests to diagnose the virus in order to speed their rollout. It has also said it is temporarily halting inspections of drug plants in the U.S. and abroad.

The agency’s standard for drugs is to look at the risk posed by side effects compared with how effective treatments are. But the growing number of coronavirus cases in the U.S., and the lack of any proven therapy or vaccine, may have tilted that balance.
Drug Pipeline

Gilead’s remdesivir was originally developed for use against the Ebola virus. The drugmaker is expected to report early results of tests of the experimental medicine in April.

Regeneron Pharmaceuticals Inc. said Tuesday its development efforts for a drug to treat the virus are ahead of schedule and it could start testing in humans this summer. Several vaccines are also in development.

Even those in Trump’s inner circle have cautioned against equating early research on drugs with proof that they work.

Deborah Birx, a member of the president’s coronavirus task force, said during Wednesday’s White House briefing that Trump had asked for a briefing on potential treatments for the virus. Birx said that even evidence a drug works in animals doesn’t mean it will work in people.

“Of course, there’s always anecdotal reports, and we’re trying to figure out how many anecdotal reports equal real scientific breakthroughs,” Birx said.

A small percentage of people die from infection by the coronavirus, and the vast majority get better on their own as their immune system battles the pathogen. That can make it more challenging to determine whether experimental drugs are effective.

— With assistance by Riley Griffin

(Adds information about Mylan manufacturing in seventh paragraph. An earlier version of this story corrected the number of cases around the globe.)


Early Coronavirus Drug Trials Yield Mixed Results 

By Jason Gale March 19, 2020, 1:04 AM MDT

HIV drug combination shows no benefit in severe patients 
Fujifilm medicine linked to materially faster viral clearance


Coronavirus Vaccine Test Open
Drug trials on coronavirus patients in China yielded mixed results, with an HIV pill showing little benefit and a flu medication made by Fujifilm Holdings Corp. resulting in faster clearance of the virus.

The combination of lopinavir and ritonavir, marketed by AbbVie Inc. as Kaletra, didn’t improve the condition of severe Covid-19 patients or prevent them from dying more than standard care in a randomized, controlled trial of 199 patients. The research was published Wednesday in the New England Journal of Medicine.

A separate study of 80 patients receiving Fujifilm’s favipiravir, or Avigan, found it helped clear the virus from patients a week earlier than the HIV medicine and was associated with improved chest symptoms shown on CT scans.

The favipiravir study, which wasn’t randomized, was conducted in a different group of patients and at a later time point when doctors might have discovered better ways to care for patients, Evercore ISI analyst Umer Raffat said in a note.

Avigan influenza tablets.Photographer: Akio Kon/Bloomberg

The clinical research on favipiravir augers well for another anti-viral, Gilead Sciences Inc.’s experimental drug remdesivir, which is also undergoing clinical trials in China, Tyler Van Buren, an analyst with Piper Sandler said. Results of the remdesivir study are yet to be published.

“If successful, it could be approved for broad use in the coming months considering it’s safe, the bar for efficacy in the context of the ongoing global pandemic is low,” he said.

Patients in the lopinavir and ritonavir trial were also found to show more gastrointestinal side effects such as vomiting and diarrhea than those not given the drug in the comparison group. Nearly 14% of those taking the drug were unable to finish the 14-day therapy, mostly because of the gastrointestinal disorders.

— With assistance by Michelle Fay Cortez, Cristin Flanagan, and Dong Lyu