Coronavirus response: Ventilators for political gain

Welcome, dear readers, to the third installment of my coronavirus roundup. If you all find it helpful, I’ll post these every Friday in addition to Lost in the Sauce on Mondays. The title is a reference to the “Uneven distribution” section below, describing how Trump sent ventilators to Colorado as a political favor to a vulnerable GOP senator.

Housekeeping:

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Yet more warnings ignored

Intel reports

US intelligence agencies were tracking the coronavirus outbreak in China as early as November, offering multiple early warnings about the potential severity of the pandemic now spreading throughout the nation. Trump was informed of the threat posed by the coronavirus on January 3, when the intelligence collected by the National Center for Medical Intelligence was included in the President’s daily briefing.

“Analysts concluded it could be a cataclysmic event,” one of the sources said of the NCMI’s report. “It was then briefed multiple times to” the Defense Intelligence Agency, the Pentagon’s Joint Staff and the White House. Wednesday night, the Pentagon issued a statement denying the “product/assessment” existed.

…From that warning in November, the sources described repeated briefings through December for policy-makers and decision-makers across the federal government as well as the National Security Council at the White House. All of that culminated with a detailed explanation of the problem that appeared in the President’s Daily Brief of intelligence matters in early January…

Navarro’s memos

On January 29, President Trump’s trade adviser Peter Navarro, wrote a memo warning the White House that the coronavirus could claim more than a half-million lives because it was much more serious than the seasonal flu:

“The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,” Mr. Navarro’s memo said. “This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”

  • One day later, on Jan. 30, Trump said of the threat: “We think it’s going to have a very good ending for it. So that I can assure you.”

Then, on February 23, Navarro sent a second memo (directly addressed to Trump) that warned of an “increasing probability of a full-blown COVID-19 pandemic that could infect as many as 100 million Americans, with a loss of life of as many as 1.2 million souls.” He urged the task force, which had been meeting for nearly a month, to spare no expense to “get the appropriate protective gear and point of care diagnostics [read: rapid COVID-19 tests].”

  • Feb. 24: Trump says: “The Coronavirus is very much under control in the USA. … Stock Market starting to look very good to me!”
  • Feb. 26: Trump says, “When you have 15 people — and the 15 within a couple of days is going to be down to close to zero — that’s a pretty good job we’ve done.”

Despite Navarro’s advice to start buying personal protective equipment (PPE) and developing rapid COVID-19 testing methods, the Trump administration didn’t start making orders for bulk production of that gear until the middle of March.

During the Tuesday Trump rally Coronavirus task force briefing, Trump was asked if he read the memos at the time:

”I don’t remember that, I’ve now seen the memo. I saw it- Peter sends a lot of memo… as you know, World Health [Organization] was saying that was not correct because at the time they called it wrong… I acted as quickly- people were shocked that I acted so quickly and everybody thought I was wrong because I did act so quickly, as you know, with respect to closing the borders . With respect not only to China, but with Europe I closed the borders and I think that was very important.

  • WHO fact check: The CDC knew of the danger of the outbreak in China on Dec. 31. The first US case was reported on Jan. 21. The World Health Organization declared a global health emergency on Jan. 30.
  • Travel “ban” fact check: Trump’s travel restrictions that he describes as “closing the borders” still allowed nearly 40,000 people to fly from China into the US. Furthermore, addressing the claim that he acted early to limit travel from Europe, new research indicates that the coronavirus outbreak in New York originated mainly in travelers from Europe and was circulated in communities by mid-February. Trump instituted the China travel limits on Jan. 31 and the Italy restrictions on Feb. 29, far after the coronavirus had been introduced to the US.

Asked how the memo would have changed the steps he took if he had read it at the time, Trump replied: “I don’t think it would have changed it because I did- I basically did what the memo said and the memo was a pretty good memo from the standpoint that he talked – I guess, I didn’t see it yet… I couldn’t have done it any better because it was at about the same time and I closed it down to China.”

Not to mention…

Talking Points Memo: As recently as the end of February, the US Commerce Department was encouraging US companies to take advantage of newly relaxed Chinese import regulations to export masks, ventilators and other COVID-relevant medical supplies to China.

Former federal prosecutor Barbara McQuade: Bush devised a plan for pandemics like the coronavirus. Trump is ignoring it… In 2005, President George W. Bush announced the National Strategy for Pandemic Influenza, and the following year, his administration rolled out an implementation plan. The plan has been updated as recently as 2017 and provides a blueprint for the administration to act during the current outbreak. Federal command, control and coordination are covered in the plan.


Turnover and vacancies

I’ve been tracking the turnover and vacancies in the Trump administration for three years now. Although the overall number of departures has slowed down since the first year, the people who have been leaving the administration lately (whether fired or resigned) tend to be high-level officials. Particularly after Trump’s pressure campaign on Ukraine and the associated whistleblower complaint, many of these departing officials held significant positions in the intelligence sector. This specific form of “chaos” in the administration has hampered our response to the outbreak and likely led to the loss of thousands of lives.

Politico published an op-ed that brilliantly captures this aspect of the crisis:

Donald Trump’s Apprentice-style staffing bake-offs and his oft-voiced predilection for acting officials kept the U.S. government distracted, off-kilter and understaffed.

Trump is obviously not responsible for the appearance of the novel coronavirus—but he is responsible for the government’s spiraling failure to respond appropriately in a timely manner. He has ignored the hiring practices, protocols, norms and expertise that would have given him and the federal government a better shot at defeating Covid-19. Three years into his administration and with a Republican-controlled Senate ready to move nominees through to confirmation, he didn’t build the national leadership we needed. That inescapable fact is Donald Trump’s fault.

Testing bungled

Three months into the coronavirus outbreak in the US and the federal government still has not created a national strategy to test Americans for the disease, leaving states to devise their own testing systems.

While testing has accelerated now that private companies are processing samples, even the most aggressive states have tested just a small fraction of their residents. New York has tested 1,645 of every 100,000 people and Utah 1,043 of every 100,000, but Texas has tested just 297 and Georgia 381. On a per capita basis, the United States lags behind several other countries in the rate of testing.

Some Trump officials said it is too late to create a national testing strategy and that it should have been done weeks, if not months, ago. “We were a month behind on getting testing set up, and now we’re just trying to ramp up testing every single day,” said one official, speaking on the condition of anonymity to be frank. (WaPo)

In spite of this testing lag – and with the peak of the crisis expected next week – the federal government is ending its support for testing sites today: “Some local officials are disappointed the federal government will end funding for coronavirus testing sites this Friday. In a few places those sites will close as a result,” NPR reports. One of the sites that are closing in Pennsylvania tested 250 people a day, totaling over 5,000 individuals since March 21.

UPDATE: Last night, NPR reported that HHS reversed its policy after defending it all day. Now, the agency claims, “local authorities can choose whether they want to transition to running the programs themselves or continue with federal oversight and help.”

UPDATE: More details of testing failures

new report from CNN states that “over January and February, agencies within the Department of Health and Human Services not only failed to make early use of the hundreds of labs across the United States, they enforced regulatory roadblocks that prevented non-government labs from assisting.”

Federal agencies had their own plan to ramp up testing during a national health crisis, but failed to fully enact it:

The plan, which is spelled out in an April 2018 agreement between the Centers for Disease Control and three of the biggest associations involved in lab testing, called for boosting the capacity of public health labs, bringing big commercial labs into the testing process early, and making sure labs would have whatever they needed to mount a rapid, large-scale response.

…But, smothered by bureaucratic inertia and disinterest at the highest levels of the Trump Administration in pandemic preparation, that agreement, known as a memorandum of understanding, today remains far from being fully realized, scientists say. “What we needed was extremely aggressive leadership at the CDC level and at the national level to say, okay, these are all our plans… I don’t think there was really a realization of the magnitude of the problem,” said Glenn Morris, director of the Emerging Pathogens Institute at the University of Florida.

As late as January 28, in an email obtained by CNN, CDC Director Robert Redfield told state public health directors that “the virus is not spreading in the U.S. at this time and CDC believes the immediate health risk from 2019-nCoV to the general American public is low.”

5-minute test

Last weekend, Trump praised Abbott Laboratories’ 5-minute coronavirus testing machines, saying “That’s a whole new ballgame. I want to thank Abbott Labs for the incredible work they’ve done.” The president claimed that “Abbott will be providing 50,000, or more, tests per day starting on April 2nd, with the first shipments out already.”

However, FEMA and the Department of Health and Human Services (HHS) later revealed that the federal government only ordered enough tests for 5,500 people – far below what would be needed to achieve widespread testing:

all 50 state health departments, as well as some local health departments, would each receive 10 to 15 devices for a total of 780 devices distributed nationwide. Each lab would also be receiving 100 coronavirus tests — a total of 5,500 tests across the country

Abbott said by the end of today, the company will have shipped more than 190,000 rapid tests. Where will the ~184,500 tests go? HHS spokesperson said those will be “for hospitals and other healthcare providers to purchase through the commercial sector.” In other words, the vast majority of the 5-minute tests will end up being sold in the same eBay-like bidding war between the states and hospitals, driving up the price and generating profit for Abbott Labs.

Maryland Gov. Larry Hogan (R) said in an interview that his state needs at least 100,000 more tests than it has right now. “We’ve talked to Abbott. They’re shortly supposed to have a small amount of testing machines out to the states. No governor in America has received any yet,” Hogan said. “They’ve said they are available. They are not yet available. They say, ‘Get on the phone, governors can get all these things.’ I just got off the phone with all the governors, no governors have these things.” (WaPo)

  • Further reading: 538 “Why We Still Need To Test Widely For Coronavirus,” Stat News “Covid-19 testing: overcoming challenges in the next phase of the epidemic,” USA Today “Labs are testing 100,000 people each day for the coronavirus. That’s still not enough.”
  • Trump fact check: CNN: President Donald Trump has falsely claimed four times since last week that he inherited a faulty coronavirus test — which was, in reality, developed this year… he faulty initial test for the coronavirus was created during Trump’s administration, in early 2020, by the Centers for Disease Control and Prevention. Since this is a new virus that was first identified this year, the tests couldn’t possibly be “old” or “obsolete.”

Using the Defense Production Act to retaliate

Last week, Trump invoked the Defense Production Act (DPA) to prevent the export of surgical masks and gloves outside of the country, singling out 3M in particular to require all US-made N95 masks be kept for the US market. “You could call it retaliations. Because that’s what it is. It’s a retaliation,” Trump said last Saturday.

“Ceasing all export of respirators produced in the United States would likely cause other countries to retaliate and do the same,” a 3M statement warned. “If that were to occur, the net number of respirators being made available to the United States would actually decrease.”

…”The company was reluctant to accept the White House request on legal and humanitarian grounds, as medical workers across the region would be deprived of protection,” a source told the Financial Times. “3M executives did commit to exporting a similar number of masks to the US from a plant in China but that did not stop the White House from publicly attacking the company.”

Trump’s export ban frustrated and infuriated some Canadians, with PM Trudeau warning that Canada’s relationship with the United States is a “two-way street” – a reference to the Canadian healthcare workers that cross into Michigan each day.

On Tuesday, Trump announced his administration had “reached an agreement, very amicable, with 3M for the delivery of an additional 55.5 million high-quality face masks each month.” Those respirators are intended to be delivered from 3M’s Chinese factories while 3M will be allowed to continue exporting its US-made respirators.

How to actually use the DPA

In the face of mounting pressure from the national-security community and both Republican and Democratic lawmakers, Trump has nominally embraced the statute, but for the limited purpose of singling out companies for undefined deficiencies.

How is the DPA supposed to be used? It is a complicated statute, “not a big stick that forces results from otherwise uncooperative manufacturers, but a set of assorted authorities that enable the executive branch to take on the central-strategist role that no other entity has the information, resources, or mandate to execute.”

The DPA offers a blueprint for bridging those gaps. Title III of the statute authorizes the president to design an array of financial incentives that, with the right appropriations from Congress, would enable private industry to assist in the national defense effort, including loans, loan guarantees, direct purchases, and purchase commitments. The point is to expand domestic production capacity “to avert an industrial resource or critical technology item shortfall that would severely impair national defense capability.”

Another part of the statute that went unaddressed in the executive order, Title VII, empowers Trump to turn relevant portions of the competitive market into a cooperative one, which is crucial for stimulating production in the face of complicated supply bottlenecks.

…The DPA is not an authoritarian alternative to good corporate citizenship. It empowers the government to spur and synchronize what would otherwise amount to inadequate, piecemeal efforts to equip the country to fight the pandemic. Using the statute does not mean giving up on American ingenuity in an emergency but competently maximizing it—and recognizing that the energy must come from the top.

There’s more…

Politico: President Donald Trump’s administration stands accused of effectively hijacking shipments of masks and additional crucial supplies meant for other countries, including U.S. allies, and strong-arming private firms to prioritize America over other parts of the world… Multiple reports emerged this week in which foreign officials accused Americans — including U.S. government representatives — of essentially commandeering shipments of medical supplies meant for other countries, among them generally well-off U.S. allies in Europe.


What stockpile?

Investigation

You may recall my earlier post detailing Jared Kushner’s incorrect claim that the Strategic National Stockpile belongs to the federal government and that states are not supposed to be using it. The Homeland Security Committee and Oversight Committee are now investigating Kushner’s role, seeking “all communications between any FEMA employee and Jared Kushner regarding the acquisition, distribution of, or federally directed sale of any form of PPE or of medical supplies and equipment to be used for the diagnosis or treatment of COVID-19,” according to the letter.

“We are troubled by reports that Mr. Kushner’s actions — and those of outside advisers he has assembled and tasked — may be ‘circumventing protocols that ensure all states’ requests are handled appropriately,'” they wrote. “We are particularly troubled that Mr. Kushner’s work may even involve ‘directing FEMA and HHS officials to prioritize specific requests from people who are able to get Kushner on the phone.'”

Stockpile empty amid mismanagement

report released by the House Oversight Committee on Wednesday revealed that HHS staff admitted that the federal stockpile of personal protective equipment (PPE) is depleted and states will not be receiving any more shipments. Chairwoman Carolyn Maloney released a statement saying:

“The document the Oversight Committee is releasing today shows that the federal government has distributed just a fraction of the personal protective equipment and critical medical supplies that our hospitals and medical first responders urgently need… Now that the national stockpile has been depleted of critical equipment, it appears that the Administration is leaving states to fend for themselves, to scour the open market for these scarce supplies, and to compete with each other and federal agencies in a chaotic, free-for-all bidding war.”

The report reveals that “only 11.7 million N95 respirator masks have been distributed nationwide—less than 1% of the 3.5 billion masks that the Trump Administration estimated would be necessary in the event of a severe pandemic.” Additionally, “only 7,920 ventilators have been distributed from the stockpile, even though a recent survey of 213 mayors—which did not include New York City, Chicago, or Seattle—identified a total estimated need of 139,000 ventilators.”

Furthermore, HHS sent all states at least three shipments of PPE and supplies, which were not based on states’ requests. Instead, the federal government used 2010 Census population data to determine a proportional amount that was sent in the first two shipments, then sent all states roughly the same amount of supplies in the third “final push” shipment. As an example of the inequities of the final push: “both Vermont and Texas received 120,900 respirators. Based on 2010 Census data, that is equivalent to roughly 193 respirators for every 1,000 residents in Vermont, but fewer than 5 respirators per 1,000 residents in Texas.”

It gets worse…

The Inspector General for the Dept. of Health and Human Services issued a report on Monday detailing “severe shortages” facing hospitals dealing with the pandemic, largely as a result of Trump’s policies. The data for the report was collected between March 23-27, before the worst of the crisis hit the US.

Hospital administrators expressed uncertainty about availability of PPE from Federal and State sources. Some hospitals noted that at the time of our interview they had not received supplies from the Strategic National Stockpile, or that the supplies that they had received were not sufficient in quantity or quality.

… One health system reported that it received 1,000 masks from the Federal and State governments, but it had been expecting a larger resupply. Further, 500 of the masks were for children and therefore unusable for the health system’s adult staff. One hospital reported receiving a shipment of 2,300 N95 masks from a State strategic reserve, but the masks were not useable because the elastic bands had dry-rotted.

When asked about the IG report, Trump attacked the IG, claiming “politics entered into” the conclusions in the report: “It’s just wrong. Did I hear the word ‘inspector general,’ really? It’s wrong,” Trump said.

He later took to Twitter: “Why didn’t the I.G., who spent 8 years with the Obama Administration (Did she Report on the failed H1N1 Swine Flu debacle where 17,000 people died?), want to talk to the Admirals, Generals, V.P. & others in charge, before doing her report. Another Fake Dossier!”

The following day Trump admonished a female reporter for asking about the testing failures highlighted in the IG report, dismissed the report because the IG wasn’t appointed by him, and called another report “third-rate” for not mentioning in his question that the IG worked in the Obama administration.

  • Fact check: The HHS IG is actually a woman (not a man, as Trump thought) and her name is Christi Grimm. She is a career official who has worked at HHS since 1999. She served during the Clinton, Bush, Obama and Trump administrations.
  • Noah Bookbinder, the executive director of Citizens for Responsibility and Ethics in Washington, pointed out that under the system put into place after Watergate, inspectors general are supposed to do more than just highlight abuses and wrongdoing. “Much of what they spend their time doing is making constructive recommendations to facilitate more effective government functioning,” Bookbinder told me. “The current president is so intent on stifling anything that could reflect negatively on his administration that he is undercutting a system that helps the government do a better job, which in the current crisis could save lives.”

Uneven distribution

As we saw in the stockpile segment above, HHS admits to not tailoring distributions from the stockpile to states based on need. However, the actual reports from the states indicates that the distribution is more tainted by political bias and simple chaos than the House Oversight report reveals.

For instance, in early March Washington state requested 233,000 N95 respirators and 200,000 surgical masks, but the Strategic National Stockpile sent them less than half that amount. Days later, on March 11, Florida asked for 430,000 surgical masks, 180,000 N95 respirators, and other equipment. The full order arrived three days later. The state received a second full shipment less than two weeks later with a third on the way.

One White House official said Trump is attuned to the electoral importance of Florida in November, giving added weight to the arguments DeSantis has made to the administration that his state’s economy should reopen as soon as possible. “The president knows Florida is so important for his reelection, so when DeSantis says that, it means a lot,” said the official, who spoke on the condition of anonymity to be frank. “He pays close attention to what Florida wants.”

We saw another instance of this political favoritism this week. For weeks, Trump ignored Colorado’s Democratic Governor’s repeated pleas for ventilators. Gov. Jared Polis eventually reached a deal with a private company for 500 ventilators, but FEMA stepped in to prevent the sale and buy the machines instead. It wasn’t until vulnerable GOP Sen. Cory Gardner asked for the machines that Trump decided to send them, announcing on Twitter that they were being sent in Gardner’s name.

Rep. Diana DeGette (D-CO) called out the deal with Gardner as a “political favor.” DeGette said in an interview: “I was totally outraged… Nowhere did it say if a Republican senator calls up the President they can get it,” noting Gardner then took “all kinds of credit on national TV.”

Sen. Elizabeth Warren on her home state’s difficulties getting a hold of supplies: “now he’s focused on how Donald Trump is going to get reelected. That invades every decision that he makes…. How can it be that Kentucky and Florida get 100 percent or 100 percent-plus of what they need while Massachusetts doesn’t? I think anyone would look at that and say it’s Donald Trump playing politics once again.”


Feds seizing from states

The federal government is seizing medical supply orders from hospitals and clinics across the nation, “leaving medical providers across the country in the dark about where the material is going and how they can get what they need to deal with the coronavirus pandemic.” The LA Times (pastebin) reports that healthcare networks in seven states have had their orders seized: In Florida, a large medical system had an order of thermometers taken away; in the Pacific Northwest, a multi-state hospital system had a shipment of testing supplies seized.

“Are they stockpiling this stuff? Are they distributing it? We don’t know,” one official said. “And are we going to ever get any of it back if we need supplies? It would be nice to know these things.”

The New York Times compiled similar reports: In Massachusetts, state leaders said a large order of PPE was seized; in Kentucky, a broker pulled out of an agreement to deliver medical gear to a hospital system after “the supplies were commandeered” by FEMA.

This is speculation, but it’s hard not to think that something a bit shady is going on here. Are the supplies being given to private companies to sell at a profit? Or are the seized supplies being directed to Trump’s allies and swing states that he needs to win for re-election? We don’t know… yet.

  • Further reading: The incredible lengths that states are forced to go to: The federal government kept seizing PPE ordered by Massachusetts. In desperation, Gov. Charlie Baker (R) created a backchannel to the Chinese ambassador to the UN and had the New England Patriots send a jet to pick the PPE up and finally get it to Massachusetts hospitals. Also: One of the lone Republican governors who has been critical of Trump, Larry Hogan of Maryland, asked his Korean immigrant wife to appeal to South Korean officials for help in securing COVID-19 tests – Multiple South Korean companies “immediately” agreed to send tests.

Airbridge to profit

The House Oversight Committee is also investigating “Project Airbridge,” in which medical supplies are flown in from other countries for use in the US. However, last week we learned that the federal government is not taking control of the supplies and is instead allowing the private sector to sell the majority in a bidding war between the states, hospitals, and other healthcare facilities.

Illinois Gov. Pritzker confirmed that the Trump administration is assisting private companies in profiting off the crisis:

“We’re bidding, unfortunately, for all of these items of equipment against the federal government and against the other states and against other countries, because what the White House has done is created—you know, they call this the air bridge, where they’re bringing stuff back from China to the United States, and then they’re delivering it to private companies in the United States, not to the states,” said Pritzker. “And they’re letting all of us bid against each other for those goods that are owned by the private companies.”

  • Note: There was a popular comment/post a few days ago that linked a GOP fundraiser to the airbridge project. Mike Gula left the political field to open a coronavirus-supply business. To be clear, there is no evidence that Gula is involved in the selling of airbridge materials. However, it is obvious that corruption and profiteering would flourish in this scheme.

Additional reading

Republican leadership:

  • ProPublica: How Tea Party Budget Battles Left the National Emergency Medical Stockpile Unprepared for Coronavirus. Fiscal restraints imposed by Republicans in Congress in the early years of the Obama administration left the U.S. less prepared to respond to the coronavirus pandemic today.
  • WaPo: Decades of conservative governance has worsened the coronavirus crisis. From tax cuts to slashing government, conservatives ideas have left the Trump administration ill-equipped to handle the pandemic

Fact checks:

  • TPM: Trump Claimed The Feds Have ‘Built 18 Hospitals.’ FEMA And Army Records Say Otherwise
  • Factcheck: Trump Falsely Claims He Inherited ‘Empty’ Stockpile
  • Politifact: Trump blames past administrations for a flawed COVID-19 test. The test couldn’t have existed earlier. Mercury News: Trump has falsely claimed four times since last week that he inherited a faulty coronavirus test — which was, in reality, developed this year.
  • AP: As pandemic deepens, Trump cycles through targets to blame. And an op-ed in CNN: The coronavirus blame game: It’s not just Trump.
    • Guardian: Trump scapegoating of WHO obscures its key role in tackling pandemic

Supplies:

  • CNN: 600 million facemask order won’t help fight coronavirus epidemic at its peak
  • ProPublica: A Company Promised Cheap Ventilators to the Government, Never Delivered and Is Now Charging Quadruple the Price for New Ones. Royal Philips N.V. agreed in September to sell 10,000 ventilators to the U.S. for $3,280 each. It did not deliver. But the Dutch company just announced a new deal with the government. This time, it’s charging roughly $15,000 each.
    • Note that an earlier article on the topic said Philips was negotiating the higher price with Jared Kushner.
  • TPM: Trump Claims Hospitals Are In ‘Great Shape’ With Ventilators Because Hannity Said So
  • Vox: You can’t use ventilators without sedatives. Now the US is running out of those, too.
  • Rep. Katie Porter has released a report showing that mask and ventilator exports from the U.S. increased dramatically in early 2020

Reopening the country:

  • Wired: To End the Pandemic, Give Universal Testing the Green Light [important read]
  • WaPo: Bill Gates: Here’s how to make up for lost time on covid-19
  • NPR: CDC Director: ‘Very Aggressive’ Contact Tracing Needed For U.S. To Return To Normal
  • ABC News: Could a simple blood test for COVID-19 antibodies help reopen the economy?
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