Mega-Thread: Democratic 2020 Primaries

[JohnBrown1917]

I get sick to my stomach knowing that we're going to be once again spending our energy defending a piece of trash politician:

[IMG]https://i.gyazo.com/a8b87bf933b954a974ecdb786680fe39.png[IMG]

Then don't defend him.

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I hope that one day I will become enlightened enough as you are to see that the politicians I disagree with are actually worse than serial killers

The likes of Trump, Obama and Biden are responsible for way more deaths than even the worst serial killer.

[Spectral]

...discussing of rationing ventilators...

Your core point is well taken, but this framing is something that's been bugging me. People seem to believe that there ever could have been more ventilators than demand and that's just not really a feasible approach to a truly widespread respiratory pathogen. Triaging ventilators was always going to be inevitable. Here, let me quote a policy paper from Johns Hopkins published in September 2019:

WHO should lead an expert-informed process to develop technical guidance to inform the clinical management of patients with highly contagious respiratory diseases during a severe outbreak. This guidance should include recommended PPE, treatment courses, disinfection guidelines, and personnel training. Additionally, health systems may need guidance for allocating scarce resources, such as mechanical ventilators and medications, if the demand exceeds available supply. Given differences in countries’ health systems, this guidance may need to be tiered for low-, medium-, and high-resource settings.

The position held by serious policy people wasn't that we need a staggering amount of ventilators for respiratory pathogen preparedness, it's that we needed clear guidance for how to allocate those ventilators. This is more or less inevitable for any sufficiently large problem - spending enough to truly cover yourself isn't actually feasible when that equipment will mostly sit around gathering dust.

[Themius]

Your core point is well taken, but this framing is something that's been bugging me. People seem to believe that there ever could have been more ventilators than demand and that's just not really a feasible approach to a truly widespread respiratory pathogen. Triaging ventilators was always going to be inevitable. Here, let me quote a policy paper from Johns Hopkins published in September 2019:

The position held by serious policy people wasn't that we need a staggering amount of ventilators for respiratory pathogen preparedness, it's that we needed clear guidance for how to allocate those ventilators. This is more or less inevitable for any sufficiently large problem - spending enough to truly cover yourself isn't actually feasible when that equipment will mostly sit around gathering dust.

Cuomo said when it came to ventilators that ny wouldn’t be hoarding them but would send them across the country to help along with doctors. That there needs to be a central point to track and send them where they’re needed nationally. So we could have enough with proper management.

We have decided to go the route of states bidding against states and federal government. Driving up prices instead.

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I get sick to my stomach knowing that we're going to be once again spending our energy defending a piece of trash politician:

I want to know more about this case. Some people are trustworthy some people are not. Ford told her story from the beginning multiple times once it happened. She also seems properly stable.

Biden camp is asking the press to investigate.

She has publicly posted quite worrying things that take away a serious chunk of reliability.

[Spectral]

Cuomo said when it came to ventilators that ny wouldn’t be hoarding them but would send them across the country to help along with doctors. That there needs to be a central point to track and send them where they’re needed nationally. So we could have enough with proper management.

We have decided to go the route of states bidding against states and federal government. Driving up prices instead.

There is literally no model of this infection that's consistent with the claim that there would be enough ventilators if only they were distributed properly. I don't know what exactly Cuomo said, but if you're under the impression that the cause of ventilator shortages is mostly distribution problems, you're not reading any primary literature on epidemiological models.

[Kasierith]

Your core point is well taken, but this framing is something that's been bugging me. People seem to believe that there ever could have been more ventilators than demand and that's just not really a feasible approach to a truly widespread respiratory pathogen. Triaging ventilators was always going to be inevitable. Here, let me quote a policy paper from Johns Hopkins published in September 2019:

The position held by serious policy people wasn't that we need a staggering amount of ventilators for respiratory pathogen preparedness, it's that we needed clear guidance for how to allocate those ventilators. This is more or less inevitable for any sufficiently large problem - spending enough to truly cover yourself isn't actually feasible when that equipment will mostly sit around gathering dust.

The issue regarding ventilators, specifically in regards to Trump's response, is that while we would never realistically have expensive and fragile medical equipment stockpiled well beyond normal demand in the case of an emergency, that this was likely coming was a known factor as far back as early February, perhaps earlier. The lesson learned in Wuhan was that deaths start piling up when there are too many cases all at once inhibiting a deterministic response for each individual case. The same lesson was repeated in South Korea and, to a catastrophic degree, Italy. The desperate need for ventilators and other medical equipment to allow extensive pulmonary care in non ICU or specialty facilities was a known factor. Despite nearly two months head start knowing this, however, the wheels are only now starting to turn.

[Draco-Onis]

There is literally no model of this infection that's consistent with the claim that there would be enough ventilators if only they were distributed properly. I don't know what exactly Cuomo said, but if you're under the impression that the cause of ventilator shortages is mostly distribution problems, you're not reading any primary literature on epidemiological models.

I think the problem with the ventilators and PPE in general is the months this administration wasted because they did not take the crisis seriously. South Korea and the US had their first infections around the same time but the South Korean went defcon5 while the Trump administration wasted months playing the whole thing down. If they did take it seriously and enacted pre-plans for this kind of situation we would be in a completely different situation.

The US was ranked as the top country to handle a pandemic but Trump has spend the last 3 years destroying the federal government. Most of the vital posts needed for this crisis are empty and most heads of departments are "acting" and like Chad Wolf head of DHS are woefully incompetent at their job.

[Spectral]

The issue regarding ventilators, specifically in regards to Trump's response, is that while we would never realistically have expensive and fragile medical equipment stockpiled well beyond normal demand in the case of an emergency, that this was likely coming was a known factor as far back as early February, perhaps earlier. The lesson learned in Wuhan was that deaths start piling up when there are too many cases all at once inhibiting a deterministic response for each individual case. The same lesson was repeated in South Korea and, to a catastrophic degree, Italy. The desperate need for ventilators and other medical equipment to allow extensive pulmonary care in non ICU or specialty facilities was a known factor. Despite nearly two months head start knowing this, however, the wheels are only now starting to turn.

This critique seems basically accurate to me. My qualms are with people who seem to think that triage stems from a policy mistake rather than

I think the problem with the ventilators and PPE in general is the months this administration wasted because they did not take the crisis seriously. South Korea and the US had their first infections around the same time but the South Korean went defcon5 while the Trump administration wasted months playing the whole thing down. If they did take it seriously and enacted pre-plans for this kind of situation we would be in a completely different situation.

The US was ranked as the top country to handle a pandemic but Trump has spend the last 3 years destroying the federal government. Most of the vital posts needed for this crisis are empty and most heads of departments are "acting" and like Chad Wolf head of DHS are woefully incompetent at their job.

I don't particularly disagree, but I think it's wildly unlikely that any leadership team was going to have the cultural sway required to implement a South Korean style response.

[Lenonis]

Neither Obama nor Trump are worse than OJ, a murderer.

I'm going to type this very slowly so you can keep up.

OJ is directly responsible for murder. His entire impact was on the life of 2 people.

A president is responsible for the entire country. His entire impact is indirect, but encompasses the entire country. In this particular case Trump made deliberate decisions and made deliberate statements to confuse and downplay the situation when COVID started. He also was slow to leadership to encourage things like social distancing etc., going against the medical experts.

Because of this the initial spread of the virus was worse than it could have been and subsequently tens of thousands of people have been impacted and some of those have died.

And this is just COVID. We haven't discussed the war in the middle east, attacking the ACA, and other policy decisions he has made that have resulted in loss of life.

So you have one person directly responsible for the death of 2 people and on the other hand someone indirectly responsible for the deaths of thousands at a bare minimum.

One of the problems with Trump is you have very little to offset that to try to balance the scales.

[Draco-Onis]

I don't particularly disagree, but I think it's wildly unlikely that any leadership team was going to have the cultural sway required to implement a South Korean style response.

The social aspects is another matter but supply problems would not exist and hospitals would be more than prepared for any influx. Of course spending months making fun of the disease is not helping now as 13% of Americans think it's a hoax and a large portion of republicans are not taking it seriously still.

[Spectral]

The social aspects is another matter but supply problems would not exist and hospitals would be more than prepared for any influx. Of course spending months making fun of the disease is not helping now as 13% of Americans think it's a hoax and a large portion of republicans are not taking it seriously still.

I'm not sure what you mean by "more than prepared" - do you just mean more prepared?

With the possible exception of New York City, surge capacity is being implemented at hospitals across the country. While supply chains are likely to be strained, the operating capacity is increasing and with the exception of a few hard hit areas, the surge capacity is being established ahead the actual number of infections are present regionally. Hospitals are also improving their capacity to information share with the CDC and state agencies as well as with each other to handle regional load balancing hand-in-hand with the the improvised ICUs.

It's not going to be enough and there's plenty of hindsight around the specifics that can and will be done. Again, I don't have any real doubt that Trump's people have not acquitted themselves well, but the decentralized response has always been the intended mechanism of action for American responses with the federal government serving in a coordinating rather than operational role. Trump's scrapping of the White House pandemic response team was pointless and shortsighted, but people are underestimating the permanence of most CDC roles and the intended role of state agencies in disease control.

[Draco-Onis]

I'm not sure what you mean by "more than prepared" - do you just mean more prepared?

With the possible exception of New York City, surge capacity is being implemented at hospitals across the country. While supply chains are likely to be strained, the operating capacity is increasing and with the exception of a few hard hit areas, the surge capacity is being established ahead the actual number of infections are present regionally. Hospitals are also improving their capacity to information share with the CDC and state agencies as well as with each other to handle regional load balancing hand-in-hand with the the improvised ICUs.

It's not going to be enough and there's plenty of hindsight around the specifics that can and will be done. Again, I don't have any real doubt that Trump's people have not acquitted themselves well, but the decentralized response has always been the intended mechanism of action for American responses with the federal government serving in a coordinating rather than operational role. Trump's scrapping of the White House pandemic response team was pointless and shortsighted, but people are underestimating the permanence of most CDC roles and the intended role of state agencies in disease control.

Our doctors are using garbage bags South Korean doctors are using hazmat suits whenever they want, that's what I mean by being prepared. The forces Trump is mobilizing now for manufacturing would have already been ready if he had taken it seriously.

[Spectral]

Our doctors are using garbage bags South Korean doctors are using hazmat suits whenever they want, that's what I mean by being prepared. The forces Trump is mobilizing now for manufacturing would have already been ready if he had taken it seriously.

I'm going to find it seriously weird if people keep holding up South Korea as though that was ever an option. South Korea's low infection total is the punch line there, not the equipment. If you have a low infection total, the equipment isn't a problem. I really don't know what to tell people if they think any leader could have convinced Americans or Europeans to have the social response that Korea did.

Head here, start clicking through a few countries and you'll pretty quickly notice that it's the same ~3 day doubling trajectory across Italy, Spain, Germany, UK, USA, France, Netherlands. Maybe Switzerland is doing a bit better, but basically everywhere else is bumping into the same thing. Critiquing that is fine and sensible, but thinking that the American response is uniquely bad just isn't consistent with what we're seeing - pretty much every country outside of China and Korea are showing the same pattern and the main differences come down to population density rather than policy.

[JohnBrown1917]

I'm going to find it seriously weird if people keep holding up South Korea as though that was ever an option. South Korea's low infection total is the punch line there, not the equipment. If you have a low infection total, the equipment isn't a problem. I really don't know what to tell people if they think any leader could have convinced Americans or Europeans to have the social response that Korea did.

Head here, start clicking through a few countries and you'll pretty quickly notice that it's the same ~3 day doubling trajectory across Italy, Spain, Germany, UK, USA, France, Netherlands. Maybe Switzerland is doing a bit better, but basically everywhere else is bumping into the same thing. Critiquing that is fine and sensible, but thinking that the American response is uniquely bad just isn't consistent with what we're seeing - pretty much every country outside of China and Korea are showing the same pattern and the main differences come down to population density rather than policy.

They can enforce it, just like South Korea did. And SK had an insane cult spreading the virus, so it was not as easy as you seem to think it was. Germany is using similar methods, and its working.

[Bodakane]

He’s literally a murderer dude. Calm down

Trump has more blood on his hands right now, then OJ. It will exponentially worse each week.

[Draco-Onis]

I'm going to find it seriously weird if people keep holding up South Korea as though that was ever an option. South Korea's low infection total is the punch line there, not the equipment. If you have a low infection total, the equipment isn't a problem. I really don't know what to tell people if they think any leader could have convinced Americans or Europeans to have the social response that Korea did.

Head here, start clicking through a few countries and you'll pretty quickly notice that it's the same ~3 day doubling trajectory across Italy, Spain, Germany, UK, USA, France, Netherlands. Maybe Switzerland is doing a bit better, but basically everywhere else is bumping into the same thing. Critiquing that is fine and sensible, but thinking that the American response is uniquely bad just isn't consistent with what we're seeing - pretty much every country outside of China and Korea are showing the same pattern and the main differences come down to population density rather than policy.

I think you are being purposely obtuse you are smart enough to know that this is a simple logistical problem. You keep focusing on the social aspect when I am talking about the things within the government's control and yes messaging would have made a huge difference as well to deny it is to be delusional.

The United States had months to prepare this is what they should have done. South Korea has a low infection rate because they did take it seriously massive ramp up of testing and quarantine of infected individuals and contact tracing. It happened because they took it seriously and the US is not the only country who did not take it seriously in time. The fact that other countries messed up doesn't absolve them of anything.

- Travel ban on China - Trump refused because trade deal.
- Ramp up production of needed goods - The federal government has a stockpile of PPE and ventilators well start stockpiling this is an administration with record breaking deficits so lol costs is a bad excuse.
- Figure out testing either take the WHO tests or make tests that work - Months were wasted here, tests were faulty, testing standards were too high and now we are at rationing tests. This was because Trump wanted to keep the numbers low because he thought it would go away.

Notice most of the things I am saying are things Trump is doing now months after the intelligence briefings and the warnings. Even 7 days ago Trump was refusing to use the full powers of the federal government because SOCIALISM VENEZUELA. There's frankly no excuse for his response he failed badly and people are dying because of it. Would it have been a perfect response? no would it have been better than this complete shit show? absofuckinglutely.

[Levelfive]

I'm not sure what you mean by "more than prepared" - do you just mean more prepared?

With the possible exception of New York City, surge capacity is being implemented at hospitals across the country. While supply chains are likely to be strained, the operating capacity is increasing and with the exception of a few hard hit areas, the surge capacity is being established ahead the actual number of infections are present regionally. Hospitals are also improving their capacity to information share with the CDC and state agencies as well as with each other to handle regional load balancing hand-in-hand with the the improvised ICUs.

It's not going to be enough and there's plenty of hindsight around the specifics that can and will be done. Again, I don't have any real doubt that Trump's people have not acquitted themselves well, but the decentralized response has always been the intended mechanism of action for American responses with the federal government serving in a coordinating rather than operational role. Trump's scrapping of the White House pandemic response team was pointless and shortsighted, but people are underestimating the permanence of most CDC roles and the intended role of state agencies in disease control.

Much of what you've said on this is wrong: It was meant to be centralized; the federal government was to have an operational role; the intent was to have 10s of thousands on hand specifically to deal with a flu-type pandemic; and it was, indeed, a policy failure stretching back to Bush's, through Obama's, and into to Trump's administration:

"Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators.

The breathing-assistance machines tended to be bulky, expensive and limited in number. The plan was to build a large fleet of inexpensive portable devices to deploy in a flu pandemic or another crisis.

Money was budgeted. A federal contract was signed. Work got underway.

And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.

That failure delayed the development of an affordable ventilator by at least half a decade, depriving hospitals, states and the federal government of the ability to stock up. The federal government started over with another company in 2014, whose ventilator was approved only last year and whose products have not yet been delivered.

Today, with the coronavirus ravaging America’s health care system, the nation’s emergency-response stockpile is still waiting on its first shipment. The scarcity of ventilators has become an emergency, forcing doctors to make life-or-death decisions about who gets to breathe and who does not.

The stalled efforts to create a new class of cheap, easy-to-use ventilators highlight the perils of outsourcing projects with critical public-health implications to private companies; their focus on maximizing profits is not always consistent with the government’s goal of preparing for a future crisis.

“We definitely saw the problem,” said Dr. Thomas R. Frieden, who ran the Centers for Disease Control and Prevention from 2009 to 2017. “We innovated to try and get a solution. We made really good progress, but it doesn’t appear to have resulted in the volume that we needed.”

The project — code-named Aura — came in the wake of a parade of near-miss pandemics: SARS, MERS, bird flu and swine flu.

Federal officials decided to re-evaluate their strategy for the next public health emergency. They considered vaccines, antiviral drugs, protective gear and ventilators, the last line of defense for patients suffering respiratory failure. The federal government’s Strategic National Stockpile had full-service ventilators in its warehouses, but not in the quantities that would be needed to combat a major pandemic.

In 2006, the Department of Health and Human Services established a new division, the Biomedical Advanced Research and Development Authority, with a mandate to prepare medical responses to chemical, biological and nuclear attacks, as well as infectious diseases.

In its first year in operation, the research agency considered how to expand the number of ventilators. It estimated that an additional 70,000 machines would be required in a moderate influenza pandemic.

The ventilators in the national stockpile were not ideal. In addition to being big and expensive, they required a lot of training to use. The research agency convened a panel of experts in November 2007 to devise a set of requirements for a new generation of mobile, easy-to-use ventilators.

In 2008, the government requested proposals from companies that were interested in designing and building the ventilators.

The goal was for the machines to be approved by regulators for mass development by 2010 or 2011, according to budget documents that the Department of Health and Human Services submitted to Congress in 2008. After that, the government would buy as many as 40,000 new ventilators and add them to the national stockpile."

Much more here: https://www.nytimes.com/2020/03/29/b...-shortage.html

[Spectral]

Much of what you've said on this is wrong: It was meant to be centralized; the federal government was to have an operational role; the intent was to have 10s of thousands on hand specifically to deal with a flu-type pandemic; and it was, indeed, a policy failure stretching back to Bush's, through Obama's, and into to Trump's administration:
<snip>

I think what you mean to say is that some experts wanted to centralize it and took steps to do so, but didn't succeed in getting much of anywhere with that. The reality, as laid bare in that article, is that there was never the political will or institutional capacity to pull that off. When I say "decentralized response has always been the intended mechanism", I don't mean that there wasn't anyone that wanted to centralize responses and improve federal institutional capacity; the liked Johns Hopkins policy paper from earlier focuses on some of those exact topics. What I mean is that there was never actually an effective push to do so and no one in the past few decades has show any interest in burning political capital to federalize these responses to any meaningful extent.

I guess you can quibble about whether that constitutes "intent" or not, but the reality was always going to be a decentralized response for exactly the sorts of coordination-related reasons laid out in the NYT article you linked.

[Levelfive]

I think what you mean to say is that some experts wanted to centralize it and took steps to do so, but didn't succeed in getting much of anywhere with that. The reality, as laid bare in that article, is that there was never the political will or institutional capacity to pull that off. When I say "decentralized response has always been the intended mechanism", I don't mean that there wasn't anyone that wanted to centralize responses and improve federal institutional capacity; the liked Johns Hopkins policy paper from earlier focuses on some of those exact topics. What I mean is that there was never actually an effective push to do so and no one in the past few decades has show any interest in burning political capital to federalize these responses to any meaningful extent.

I guess you can quibble about whether that constitutes "intent" or not, but the reality was always going to be a decentralized response for exactly the sorts of coordination-related reasons laid out in the NYT article you linked.

No, I said exactly what I meant to say--you were wrong on nearly every assertion you made. When "some experts" do it on behalf of the federal government for a decade and a half, we call that public policy. As a matter of fact, the problem as laid out specifically in the article was outsourcing to a private company:

"Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.

Some Newport executives who worked on the project were reassigned to other roles. Others decided to leave the company.

“Up until the time the company sold, I was really happy and excited about the project,” said Hong-Lin Du, Newport’s president at the time of its sale. “Then I was assigned to a different job.”

In 2014, with no ventilators having been delivered to the government, Covidien executives told officials at the biomedical research agency that they wanted to get out of the contract, according to three former federal officials. The executives complained that it was not sufficiently profitable for the company.

The government agreed to cancel the contract. The world was focused at the time on the Ebola outbreak in West Africa. The research agency started over, awarding a new contract for $13.8 million to the giant Dutch company Philips. In 2015, Covidien was sold for $50 billion to another huge medical device company, Medtronic. Charles J. Dockendorff, Covidien’s former chief financial officer, said he did not know why the contract had fell apart. “I am not aware of that issue,” he said in a text message.

Robert J. White, president of the minimally invasive therapies group at Medtronic who worked at Covidien during the Newport acquisition, initially said he had no recollection of the Project Aura contract. A Medtronic spokeswoman later said that Mr. White was under the impression that the contract had been winding down before Covidien bought Newport.

It wasn’t until last July that the F.D.A. signed off on the new Philips ventilator, the Trilogy Evo. The government ordered 10,000 units in December, setting a delivery date in mid-2020."

[Themius]

There is literally no model of this infection that's consistent with the claim that there would be enough ventilators if only they were distributed properly. I don't know what exactly Cuomo said, but if you're under the impression that the cause of ventilator shortages is mostly distribution problems, you're not reading any primary literature on epidemiological models.

Would be easier to handle it wasn’t that it would be perfect but you don’t need 20k ventilators in a state using 3k. So concentrate them where the worst outbreak is.

[Draco-Onis]

Would be easier to handle it wasn’t that it would be perfect but you don’t need 20k ventilators in a state using 3k. So concentrate them where the worst outbreak is.

Let's not forget the worse stat at the time where South Korea was doing 10K per day the US had done a grand total of 5K.