Here ’s How New York City Will Split Ventilators to Treat Covid-19

Here ’s How New York City Will Split Ventilators to Treat Covid-19

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How has the United States missed the golden 30 days of epidemic prevention and control after becoming the largest country diagnosed?
The United States has become the country with the largest number of confirmed cases of COVID-19 (referred to as Wuhan pneumonia). President Trump has been boasting that the United States has done a good job in epidemic prevention and control until last week, but he recently asked for help from South Korea. Using the “Defense Production Law” to order manufacturers such as General Motors and Kiwi to manufacture respirators and masks is tantamount to admitting that he had underestimated the epidemic. Hopkins University professor Nazo (Nuzzo) pointed out that if the United States has the ability to do more testing from the beginning, the situation will be completely different from now.

In the end, what went wrong in the United States and caused the outbreak? “New York Times” on the 28th titled “A Missed Month in the United States” as the title, published a long-form analysis report, and concluded that the United States may have been able to block the virus, but because of technical errors, regulatory obstacles and government leadership, the new crown virus Zhou Lai drives straight into the United States. The following is a summary of the highlights of the New York Times report:

Earlier, dozens of federal officials responsible for the prevention and control of the new coronavirus gathered daily in the White House Situation Room for meetings. The problems they are trying to solve are how to withdraw American consulate personnel from Wuhan, how to ban Chinese passengers from entering China, and how to withdraw Americans from Diamond Princess and other cruise ships.

Several participants recalled that during the daily meeting, the New Corona Virus Working Group usually spends only 5 to 10 minutes discussing virus detection issues, and only discusses a few sentences at the end of the meeting. At that time, the Director of the CDC assured the participants that the CDC had developed a diagnostic model and that a test package could be launched soon.

However, when the virus began to wreak havoc across the United States, the large-scale testing of suspected infected persons did not happen. What is the reason? The New York Times interviewed more than 50 current and former public health officials, government officials and senior scientists, and business executives. The answer was: there are many factors, including technical problems, regulations are also obstacles, and government units are as usual Bureaucracy, lack of leadership and many other factors. (Recommended reading: Make up for the exam, the US 5-minute fast screening will start next week, and the number of diagnoses will soar)

As a result, a whole month was wasted. The United States, the richest country in the world, with the most highly trained scientists and infectious disease experts, has wasted the best opportunity to prevent and control the spread of the virus; this lost month has allowed Americans to The severity of the disaster was ignored.

Former CDC Dr. Thomas Frieden pointed out that failure to conduct a large-scale screening before things become “too late” is a total failure of the US government. Johns Hopkins University epidemiologist Jennifer Nuzzo also pointed out that the Trump administration’s views on the potential impact of the epidemic are “unbelievably limited”. Dr. Margaret Humburg, the former director of the US Food and Drug Administration, clearly stated that this mistake caused “exponential explosion of cases.”

Scientist Dr. Anthony S. Fauci, who participated in the epidemic prevention work, frankly admitted that he could not detect it early when he testified before Congress, which was the “failure” of the government’s response to the global pandemic.

Interviewees pointed out that none of the three units of the US government responsible for epidemic prevention and control were ready when they should be prepared. Even when scientists saw the situation in China and issued warnings, the heads of the three units Nor did I feel the urgency of taking defensive actions.

The CDC Director is a renowned AIDS expert and former 68-year-old former military doctor Robert R. Redfield. He said at the outset that senior CDC scientists will soon develop the most accurate detection method for coronavirus in the world and will share it with laboratories in various states. When the problem developed by the new crown virus test tool became very obvious in February, he promised that he would solve it quickly, but then it took several weeks to solve the problem.

The CDC also strictly limits who can be tested, and is too slow to take “community monitoring” to prevent standard measures of community transmission. If the United States can start tracking the earliest movements of the virus earlier and find hidden hot spots, then it may rely on isolation , You can limit the spread of the virus.

The 60-year-old Stephen Hahn, the director of the US Food and Drug Administration (FDA), adheres to the laws and regulations that are routinely implemented, making it difficult for hospitals, private clinics and businesses to mobilize the development and production of testing tools in emergency situations. Other countries have mobilized kit manufacturers to supply reagents and conduct tens of thousands of tests every day, but the United States ca n’t do it even 100 times, leaving local health officials, parliamentarians and the public frustrated.

Next is Alex M. Azar II, who leads the Ministry of Health and Human Services. His department oversees the other two units and coordinates the government’s response to the pandemic. When the American public’s criticism of the testing problem intensified, he was very frustrated, but he was unable to urge any unit to speed up or change direction.

Hazard, 52, was originally the chairman of the New Corona Virus Task Force. In late February, Trump replaced him and appointed Vice President Mike Pence to take over. Over the past few months, Hazard has been arguing with the White House on many issues for many months. Trump’s window in the working group was Mick Mulvaney, acting director of the White House Office, who was also taken away by Trump. In this case, the development of inspection tools is worse because there is no high-level attention.

Busy politics is not busy epidemic situation Trump missed a month of gold
At the beginning of the month that was wasted and wasted, Trump was so busy dealing with the nuclear bombing that he had no time to take into account the threat that the epidemic might pose to the public health and the US economy. Until the end of that month, he also claimed that the United States is doing very well, “The virus is about to disappear. One day, miraculously, it suddenly disappeared.”

However, by the beginning of March, federal officials finally announced that they would expand inspections, but it was too late. Over time, anti-blocking is no longer an option.

Today, the number of confirmed cases in the United States has exceeded 100,000, ranking first in the world. The number of deaths is rising. Many cities are closed, closed, and the economy is stagnation. The daily life of the people is forced to be restricted. Still, there are still many people infected with the virus who cannot be detected.

He added that at Trump Under Mr. ’s leadership, the government “expanded its testing capabilities.”

Last month, he led a team of experts to China to study the mysterious new virus. The World Health Organization (WHO) senior consultant Dr. Alward pointed out that testing is “absolutely crucial” to understanding how to overcome a disease, but only through testing, In order to be able to identify the infection, the scope of transmission and find out the way of infection.

Elward said: “You must know if you are infected, you must know whether the people around you are infected, and only then can you stop it.” He warned: “If you can’t see it, You cannot stop it. “

The frustration of the United States is too shocking
The first time Redfield heard about the severity of the virus from the Chinese CDC was around New Year’s Day, when he and his family were on vacation, but he spent a lot of time talking on the phone, and his family barely saw him. What he heard made him very uneasy. A few days later, Gao Fu, the director of CDC, made a phone call, and Gao Fu cried over the phone.

Redfield never held public office before being appointed as CDC director. Before 2018, he has been engaged in combating the spread of HIV. He was more optimistic about treating diseases in Haiti or Africa. He suddenly became the focus of attention and was forced to fight the pandemic of infectious diseases.

Initially, CDC’s actions were quite fast.

On January 7, the CDC has established an “emergency management system” and recommended that Americans who travel to Wuhan take protective measures. On January 20, two weeks after Chinese scientists disclosed the virus’ genetic sequence, CDC developed its own testing tool and provided it with the first case test in the United States.

Redfield then said in an interview: “Our first priority is this matter.”

Identifying viruses is challenging. The virus is too new, scientists have little information, China provides limited data, and China refuses to send Hazard and Redfield to send US CDC experts to understand the situation. The new coronavirus causes asymptomatic transmission, a feature previously unknown to everyone, making it more difficult to understand.

In order to identify the virus, the CDC test method uses three segments of the virus’ genes, and all three segments must match to be diagnosed; this is different from the test method developed by Germany and widely used in other countries. The German method only uses two segments of genes, but The United States believes that this will reduce the accuracy of testing.

Just when the FDA approved the CDC test kit and handed it to the health department laboratory, the problem occurred. Because there is a standard for the diagnosis of the third paragraph of genes, there is a confusion of inconsistent results in practice. The CDC must find out whether it is because of contamination or a design problem. Anyway, the testing of the national laboratory was forced to stop.

The most important moment of the time tracking virus, the shocking frustration of CDC, shut down this most important work. According to data from the CDC official website, until mid-February, the United States can only test 100 samples per day.

Several government officials pointed out that Redfield has been downplaying this issue at working group meetings, ensuring that he will resolve the issue soon.

Due to the limited amount of testing, the CDC stipulates that the qualifications of the examinees in the next few weeks are very strict. Only those who have recently visited China and those who have close contact with the diagnosed can be tested.

The lack of testing tools in the states also means that local health authorities cannot use another important tool in epidemiology: surveillance. This method allows health authorities to see where the virus can be hidden, and at the same time to detect throat swab samples from influenza patients.

The CDC announced a plan on February 14 to conduct larger-scale screenings in five high-risk cities, New York, Chicago, Los Angeles, San Francisco and Seattle. An official said that by doing so, it can provide an early signal for the parties concerned to respond to changes in strategy early.

Dr. Nuzzo of Johns Hopkins University said: “If we have done more tests from the beginning and found the cases earlier, the situation will be completely different from now.”

By the end of February, the consequences became more obvious. Seattle has been diagnosed with cases with no apparent contact history or travel history, more than a month after the first diagnosis in the United States. The researchers later concluded that the virus may have spread there and elsewhere for several weeks. Without more complete information on infected persons, public health work will not be able to track the source of infection and contact history to prevent the virus from spreading further.

In the CDC, the CDC still does not consider adopting the WHO test standards, insisting that it only believes in itself, and processes samples swarmed by the states in its own laboratory. Dr. Anne Schuchat, deputy director of the CDC, later said that the CDC had not thought about “we need someone else’s method.”

Moreover, the German-designed test method promoted by WHO is to be used in the United States, and it also needs to obtain the approval of the US regulatory agency, which takes time.

At the end of February, CDC told the state and local health departments that the CDC laboratory could finally start testing. CDC told them not to wait for CDC’s new test kit and use the old one directly, but omit the detection of the third gene.

At the same time, as the virus spread in South Korea and Italy, the agency ’s epidemiologists are increasingly worried. On February 25, Trump, who had just returned from India, listened to the briefing because the experts briefed him pointed out that there is a high possibility that the daily life of the people will be interrupted.

Later that day, Hazard tried to dilute the seriousness of the matter at a press conference. He said that the expert meant that people might not be able to start thinking about how much their lives might be affected.

After the CDC determines the testing standards, the private enterprise should logically say that it is the next stick. In other countries severely hit by the new coronavirus, the government quickly took action to speed up detection. In South Korea, for example, the regulatory agency relaxed the requirements for testing and convened 20 manufacturers to coordinate the production of test kits in early February.

However, the US Food and Drug Administration has always been conservative, has not found a supplier, and has adhered to the usual tedious procedures for approving medicines, and does not give rapid approval for testing products.

Even the public health laboratories in the United States open to the FDA for help at this time.Outside the CDC, there are so many public health laboratories. No one has diagnostic or monitoring tools,” Public Health Laboratories. Association Chief Executive Officer Becker (Scott Becker) wrote to FDA Commissioner Hahn in late February, “At this time we think a faster channel is needed.”

Although researchers across the country soon began developing tests that could diagnose Covid-19, these test products were stuck by the FDA’s approval process.

Stanford University is one of them. The school formed a research team in February, according to the sequence announced by WHO, and WHO has distributed the German version of the test package used by more than 70 laboratories around the world to prepare for development and production.

As a result, the clinical laboratory at Stanford University was not allowed to start testing coronavirus samples until early March.

French diagnostic company BioMérieux also encountered a similar situation. The company made a test tool that provided results within 45 minutes. It was also checked at the Food and Drug Administration until March 24 before it received emergency approval. “Compared to other countries, I’m sorry, I must say that the United States is really slow and chaotic,” said Mark Miller, the company’s chief medical officer.

Trump was still bragging until last Tuesday that the United States “created a new system, and now we are doing an incredibly large number of tests.” He said that the United States has been testing coronavirus in South Korea over the past 8 days compared to South Korea in 8 weeks More tests are conducted.

But on Monday, Trump called South Korean President Wen Jae-in and asked him to help him out of the 100,000 test kits produced every day in South Korea to help the United States. This is equal to the default detection energy shortage in the United States.

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