A sad situation at the Hunter Holmes McGuire VA Medical Center – TTG

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Colonel Lang sent me an eye opening link last night concerning the Hunter Holmes McGuire VA hospital in Richmond. Here are some excerpts from the Richmond Times-Dispatch article.

————

As of Thursday, 23 employees at the 4,000-employee VA hospital,  had tested positive, according to an update the hospital director emailed to employees. Another 45 employees are home awaiting test results. The hospital declined to say how many of the employees who are positive or are awaiting results are nurses, or name which parts of the hospital they work in. 

Three VA nurses said they were given N95 respirators for several days early in the crisis in March, but after that they were given surgical masks, which provide less protection from the coronavirus. Another nurse reported wearing only a surgical mask the entire time caring for coronavirus patients. The nurses, who work in a unit that treats COVID-19 positive patients or patients awaiting test results who are suspected to be positive, spoke on condition of anonymity because they were not authorized to speak to news media and their job security could be at risk if they spoke publicly.

The hospital had 73 confirmed coronavirus cases among patients as of Friday, and four inpatient deaths. "Currently every health care system is taking steps to conserve PPE. VA is no different," Hodge wrote in a series of responses by email to questions. Hodge also said that the hospital is issuing surgical masks to all staff who work in non-COVID-19 units. “Those staff are provided one surgical mask weekly to assist in protecting high-risk patients who are asymptomatic,” he wrote.  (Richmond Times-Dispatch)

———

I’m not surprised by the numbers. Richmond, itself, is a virus hot spot although that is mostly due to several deadly assisted living/nursing home outbreaks. What shocks me is the PPE situation. The fact that nurses have to treat known Covid-19 patients with hospital masks rather than the N95 respirators is only moderately better than third world conditions in my view. Hospital masks offer the wearer no protection against the aerosolized virus. If the patients were wearing those masks, it would be more helpful than the nurses wearing them. 

Here’s a tip. If you can still smell odors like onions or bacon while wearing the mask, the aerosolized virus can get into your lungs. Hospital masks and other improvised masks protect those around the wearer, not the mask wearer. The concept behind the universal wearing of such masks is mutual protection. For any of you who spent time in the infantry, it’s the same concept behind the DePuy fighting positions where you are not defending yourself. You are forming interlocking fields of fire to protect your comrades to the left and right of you. Protecting those around you actually provides the best protection for all of you. We wear masks in grocery stores and other such places to protect the entire community, not just our own sorry asses. 

But back to the situation at McGuire. In the early days of the pandemic in America, the hospital instituted a screening program at the hospital entrances consisting of temperature and health interview. We were told to expect delays and to be given a mask for wear in the hospital. Not long after that, we were called to reschedule our appointments to May or beyond. By mid-April, this was the COVID-19 testing situation.

Since the number of COVID-19 tests are limited nationwide, there is no COVID-19 testing capability at our CBOC locations. Please call your provider to determine whether you would be a candidate for testing. If so, then you may proceed to the Hunter Holmes McGuire VA Medical Center in Richmond, Virginia where Monday – Friday, 8:30 a.m. – 1:00 p.m., a Drive-Thru Clinic is available for screening and testing (if you need it); you will be triaged according to your symptoms. Also, Monday – Friday, 8:00 a.m. – 4:00 p.m., you may be directed to be seen in the medical center’s High Consequence Infections (HCI) Clinic. Last, depending on your symptoms, you may go to the hospital’s Emergency Department or to an Urgent Care Center or Emergency Department in your area.   

McGuire seems to have had all its ducks in a row. It’s what I expect. This VA medical center is well run. The professionalism, pride and morale among the staff is astoundingly high. It shows among us broke down old vets who show up for care. We are proud of McGuire. That this fine facility is now forced to ration out PPE to its staff is a travesty. The VA dropped the ball. The federal government dropped the ball… for several administrations. PPE should have been stockpiled at all levels and those stockpiles should have been replenished by a push logistics system. 

That’s the long term screw up. In the more immediate term, the federal government should have been acquiring that PPE and forcing industry to massively produce supplies back in January. Trump should have invoked and used the Defense Production Act robustly in January rather than waiting until March and April to weakly wield that executive authority. Every hospital and every first responder should have had all the PPE needed. Every household could have been sent a dozen disposable masks with a note from President Trump telling us to keep these in case we need them. What a galvanizing message that would have sent across the nation. Even if Covid-19 proved to be a non-problem, it would have been a message of Churchillian defiance in the face of a potential threat. A missed opportunity for both the American people and Trump.

TTG

https://www.richmond.com/special-report/coronavirus/at-mcguire-va-hospital-in-richmond-nurses-fear-the-masks-they-wear-dont-protect-them/article_6da49ed3-84c7-52a6-b052-32ca3cd305b9.html?utm_source=RTD&utm_medium=referral&utm_campaign=Breaking%20News

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50 Responses to A sad situation at the Hunter Holmes McGuire VA Medical Center – TTG

  1. Avatar Terence Gore says:

    Sorry to read your post and hope everyone fares well. Many nursing homes may be in the same situation.
    https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/uchicago-medicine-doctors-see-truly-remarkable-success-using-ventilator-alternatives-to-treat-covid19
    “The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it’s been fascinating and wonderful to see,” Spiegel said.”
    Possibly positive news.

  2. Avatar Laura Wilson says:

    Thank you, our veterans and American residents ALL deserve a better response. This in formation is horrifying because the federal government has ALL the responsibility for veterans care…no pushing it off on governors or private companies.

  3. Avatar Pj20 says:

    It isn’t just the VA, hospitals all over the country are short of PPE. And that is one of the problems with opening up the country too soon. Unprotected staff in suddenly flooded hospitals become ill themselves risking the viability of local health systems.

  4. Avatar turcopolier says:

    All
    https://en.wikipedia.org/wiki/Hunter_McGuire He amputated Stonewall Jackson’s arm on the battlefield at Chancellorsville.

  5. Avatar turcopolier says:

    All
    Everyone who wants to blame Trump for the shortage of PPE ought to sober up long enough to think about how vast the Executive Branch of the federal government is and how many improvements Trump has made in the system of VA medical care. Do the people who have run VA medical not responsible for what they did not stockpile and what about the Chinese who ran around the world buying up PPE AFTER they knew the virus had escaped?

  6. Avatar Fred says:

    “The federal government dropped the ball… for several administrations.”
    Pray tell how that is now Trump’s fault? What were the experts of the federal government doing since January of 2016 when he was inaugurated. Were Sally Yates, James Comey, LTC Vindman, “The super secret only Schiff knows his name whistleblower” et. al. just anomalies and all the other federal employees on the ball; except for the ones who dropped the ball – like NOT ordering PPE or NOT budgeting for PPE “for several administrations.”?
    “Trump should have invoked and used the Defense Production Act robustly in January …”
    Based on what, the impeachment hearing, the Speaker of the House showing great courtesy and concern by ripping up the SOTU speech transcript or just Fauci, who said just what? Oh, no need for a travel ban and his counterparts were saying – in that very timeframe – there was nothing to worry about.
    “Every household could have been sent a dozen disposable masks with a note from President Trump …”
    Well that would have induced either some fatal cases of laughter or a panic, but by all means tell us just how you would have managed all this without the information that is avialable on April 24th but with only the infromation available in January, when it would have been politically impossible to do what you propose.

  7. Avatar JoeC100 says:

    TTG –
    I read a while back that the key supply chain issue with N-95 masks is that their essential core material is a synthetic spun fiber that we are completely reliant on China for sourcing. In addition. the machines that make this fiber are complex, quite expensive and there is no capability to quickly and significantly ramp up their production. Further they are challenging to set up and operate.
    And for perspective, of the 200 million masks China currently makes a day, only 600,000 are N95 standard masks, used by medical personnel,
    So yet another “essential supply chain” item for a critical health system need that simply can’t be ramped up out of this air.
    Hopefully some one in the Federal system is looking for all similar needs and working on a plan to facilitate onshore manufacturing.
    Full (scary/sobering) details are at: https://www.npr.org/sections/goatsandsoda/2020/03/16/814929294/covid-19-has-caused-a-shortage-of-face-masks-but-theyre-surprisingly-hard-to-mak
    I see this as a long term “lack of US preparedness” problem vs. something that could have been easily addressed if the administration had moved a couple on months earlier..

  8. Avatar JohninMK says:

    We have the same problems here in the UK. With people, mainly it seems like in the MSM, blaming the Government’s leadership for the supply issues.
    Ignoring totally the management of our respective national health organizations who knew, at the latest in mid January, that there was probably a nasty contagious problem coming down the tracks, that would, based on already clear Chinese actions, need more PPE than was on their shelves.
    Bear in mind that, in the UK at least, hundreds of these NHS bureaucrats earn twice what a Government minister earns and a few twice the PM’s salary. In both nations they have failed their people dismally, seemingly like rabbits trapped in the headlights. None will be punished of course for failure, they are just pleased that the Government steps up and takes the blame.
    Then we have the academics and think tank personnel. All accepted as impartial and offering honest opinions based on state of the art models. Again the Governments take what they are offered as gospel and acts on it. Only to discover that the models are more of the garbage in garbage out variety, not fit for purpose. Then we find how much funding the impartial academics are receiving from potentially very interested parties, as there are $Bs at stake. In the UK there was a Pandemic 2016 exercise to check things out. Result everything in NHS under control. In the real world under four years later, a shambles. Did you have a similar last autumn?
    The real heroes and heroines in this saga are the doctors, nurses and their support and ancillary staff who are actually at the sharp end. Many working in appallingly unsafe conditions. Hats off to them.

  9. Avatar turcopolier says:

    JoeC100
    The Administration? What about the giant highly complex federal bureaucracy? Do you really think you can effectively administer that from the WH? Have you ever worked for the US federal government at the executive level??

  10. Avatar JoeC100 says:

    Col Lang –
    I was just responding to what I took as TTG’s suggestion/implication that if Trump had acted earlier he could have alleviated this shortage (at least to some extent). And I have seen enough public bureaucracy to understand it would be impossible to effectively administer much of anything from the WH.

  11. Avatar turcopolier says:

    joeC100
    I took that as a political ad from TTG. He has a right to political opinions that I do not share. From my experience it is very difficult to get the government to; change directions, shut down the economy, confine people in virtual house arrest, seize control of industry under the DPA for something less than an announcement from God that you had better do it.

  12. Avatar turcopolier says:

    All
    BTW, I am entitled to and registered for VA medical care and have never used it. SWMBO and I are well taken care of without depriving needier people of available VA resources.

  13. Avatar mcohen says:

    Direct action attack on world supply chain would naturally start in China.The domino effect is now quite evident.Expect the next outbreak in China early June.covid 20 will flatten the bump.

  14. Avatar Bobo says:

    For 200 plus years our hospitals utilized laundries to cleanse their medical protection gear (PPE) until the advent of synthetic PPE. The present generation is taught to utilize the N95 mask and other gear once and then trash it. This was derived as a manner in reducing Sepsis and MRSA in hospitals and an effective one though those diseases are still present.
    Our hearts went out to these young medical personnel without the plastic masks and gear as they were working outside of what they were taught and they were much more susceptible to the Covid-19.
    Now we all saw every Chinaman walking around Wuhan with a N-95 mask in January and unfortunately those were our masks that were re-routed to the Chinese people. Hopefully we have now learned a very hard lesson that Just in Time Inventory does not work for medical diseases or viruses and that the USA needs to manufacture all PPE and medicine in the USA amongst other things.
    Regarding the political implications I can only say that the guy in the hot seat made things happen when the chips were down something his predecessors nor his competitor had/have the ability to do in a timely manner. Coercion worked.

  15. Fred,
    “The federal government dropped the ball… for several administrations.”
    “Pray tell how that is now Trump’s fault?”
    That’s easy. Who led the last two administrations? Obama and Trump. Given the 2009-2010 H1N1 pandemic, Obama should have definitely improved our readiness in remaining six years in office. Trump had three years to fix what I’m sure he would view as one of Obama’s failures. He didn’t. Hence, they both dropped the ball.

  16. Avatar Terence Gore says:

    “Maybe there is a beast… maybe it’s only us.” “Ralph wept for the end of innocence, the darkness of man’s heart, and the fall through the air of the true, wise friend called Piggy.”

  17. Avatar steve says:

    Obama did have longer to refill the stockpile, but the economy was much, much worse under Obama. Trump has lead us to the best economic performance in US history so we should have been able to afford to refill the stockpile during the last 3 years.
    We decided early that there wasn’t going to be much access to extra PPE for quite a while. The US can tramp us production very much. No company is going to open up a new factory to make PPE for just year or two. Foreign countries will want to keep the PPE they can make, at least for a while. So we invented our own mask sterilizer. We are sterilizing our masks plus those of the local nursing homes and some of our local first responders.
    Steve

  18. Avatar Fred says:

    TTG,
    What is “The Resistance” and how did that affect Obama’s terms in office and how is it effecting Trump’s?

  19. Fred,
    The resistance? You mean the Republican movement to ensure that Obama failed in everything he did announced by Limbaugh at the 2009 CPAC and implemented by McConnell in his fervent desire to deny Obama a second term? That did set a precedent that haunted the Republicans for the last three years.

  20. Avatar BillWade says:

    TTG and JoeC100, Just wondering, what was more egregious:
    President Trump comes into office and does not know of an inventory deficiency of N95 masks and similar.
    President Bush comes into office and does not know of a planned attack on the United States of America.

  21. Avatar optimax says:

    Much of the federal stockpile of PPE sent to the states had passed their expire dates, 2010 for some, and was either useless or had to be repaired. I blame the failure on the person, or persons, charged with monitoring the wharehoused stockpiles. The president only knows what he’s told. He can’t micromanage the nation. He needs Jack Webb directing him to stick with the facts.
    We have two groups of psychopaths vying for political power.
    https://time.com/5815652/national-stockpile-medical-supplies-unusable/

  22. Avatar elaine says:

    I read somewhere the V.A. ordered the masks but F.E.M.A expropriated
    them on the directions of Jared Kushner, who will later decide who
    receives the masks…something about the National Emergency Stockpile…what a mess.

  23. Avatar Jose says:

    Trump should have invoked and used the Defense Production Act robustly in January rather than waiting until March and April to weakly wield that executive authority. TTG
    And if Obamacare did not impose a medical device tax maybe all these things would still be made in America.
    Also, why did Obama-Biden-Fauci send $3.7 million to Wuhan to study Corona viruses, Fort Detrick, John Hopkins, Harvard-MIT, Satnford-UCSG-Berkely were to busy or not good enough?

  24. Avatar Philip Warren says:

    The Chinese Communist Party in January bought up all the PPE they could find in the US, Europe and Australia. My friend’s wife is a manager at the Home Depot in the Bronx and she she witnessed this first hand. The PPE was manufactured in the PRC, and they knew exactly where it was going abroad. They took this action not only for their own needs, but also to make it harder for the West to protect its medical community. The goal of this is to try they get their economy open while the rest of the world is locked down. Many people may not be interested in Chinese communists, but they are interested in you and your N95 masks.
    https://nationalfile.com/video-chinese-woman-brags-about-buying-truckloads-of-facemasks-from-us-supermarkets/
    https://en.wikipedia.org/wiki/Unrestricted_Warfare

  25. Avatar JohninMK says:

    Optimax, very valid points but the only reason I can see why a polypropylene or similar mask, probably in sealed packets, bulk packed in cartons, has an expiry date at all is to enable the manufacturer to sell more. In an emergency why dump them when there is little of no inbound replacement stock.
    This is the wrong mindset at work.

  26. Avatar JJackson says:

    In 2005 the reality that influenza’s came in many different levels of severity and that the 1918 pandemic was far from a worst case scenario was forced on consciousness of policy makers by H5N1. Everyone busily developed pandemic plans and with typical human short term-ism within a few years let them lapse and the progress made evaporate. The WHO got an influx of funds to create a rapid response team but by the time it was need for Ebola in West Africa those funds had dried up and the teams and equipment disbanded. This is the reality of emergency healthcare funding. Now we will have money for all kinds of research which will produce vaccines and therapeutics for this outbreak but few, if any, will be available for this epidemic. The funds for all the buoys deployed for Tsunami detection have dried up and they are not being repaired and replaced. We seem to have the attention span of a gadfly.
    Tsunami’s have not gone away, Avian influenzas are doing very nicely, SARS-3 will be along shortly as will other zoonotic disease. The only thing more certain than these is that we will not be ready for them when they do. Pick a gear and stay in it.

  27. Avatar Fred says:

    TTG,
    The ever accurate wiki doesn’t seem able to come up with that equality between political oppositions, sir. Why there is zero mention of an inaguration day protest by millions or an ongoing investigation by the FBI into collusioin by the Obama campaign with foreign governments. I wonder why that didn’t get into the public eye by leak after leak. Even the protests in public don’t apprear to be the same.
    https://en.wikipedia.org/wiki/Protests_against_Barack_Obama#2009
    2009[edit]
    April 15 – Tea Party protests against high taxes and big government in Lafayette Park.
    May 17 – the University of Notre Dame’s selection of President Barack Obama as its commencement speaker led to a gatherin the day before of around 100 anti-abortion rights activist to protest against his invitation.[2] The ceremony itself took place peacefully with the few hecklers shouted down and Obama receiving several standing ovations.[3]
    July 4 – About 2,000 small-government advocates gathered for Tea Party Day to protest the economic stimulus plan and health care initiative of the Obama administration and Congress.[4][5]
    Oooh, 2,000 people! That seems to rather timid compared to the :
    January 21, Women’s Marches – A series of political rallies known as Women’s Marches took place in locations around the world.[291][292] Estimates suggest between 3.3 and 4.6 million people took part, making it the largest protest in United States history.[293]
    https://en.wikipedia.org/wiki/Timeline_of_protests_against_Donald_Trump#Protests_during_Trump's_campaign.

  28. Avatar Fred says:

    JJackson,
    “Pick a gear and stay in it.” The healthier a person appears to be, the more dangerous they are, better obey the government. Meanwhile survival stats from the health experts commenting in public, or commenting here, appear to be zero. The only settled science is climate change; and the political science observation by jledell’s comment about the Kavanaugh hearings – ‘it’s just politics’.

  29. Avatar optimax says:

    johnmk
    The article said some suffered dry rot. I don’t know why. the rotted elastic bands are replaceable but I don’t know why ventilators would deteriorate over time, but maybe they were defective to begin with or have rubber washers. Whatever a country, company or individual stockpiles should be checked every once in a while. It’s common sense. Why wait until an emergency?

  30. Avatar confusedponderer says:

    TTG,
    may the PPE supply be fixed soon. COVID-19 is a bad thing and it will be some times with us, until we get a not national exclusive vaccine or, in the bad case, that herd immunity is achieved in two or so years after many many more deaths. So, good luck and respect for the hospital staff.
    That written, it may have been worse if Trump’s choice Ronny Jackson (the candy man) was now head of the VA – even though then the hospital likely would not be short of chloroquin, bleach, viagra, ketamin, prozac, morphine, aspirin, paracetamol, speed or valium and other essential medicine, which IMO is not a comfort.
    But then, according to Trump it was totally Jackson’s decision to withdraw from the job application. Naturally. Just like injecting or drinking antiseptic medicine or bleach is a ‘very interesting idea’ not in my mind. I propose self experiment here to get the surely very interesting, perhaps final, experience.

  31. Avatar optimax says:

    johninmk
    From the California Department of Public Health:
    Q: What is the shelf life of an N95 respirator?
    A: The standard shelf life of N95 respirators is a maximum of five years from production date and if it has been stored in the original packaging. Storage conditions can also affect shelf life.
    https://www.cdph.ca.gov/Programs/EPO/Pages/Wildfire%20Pages/N95-Respirators-FAQs.aspx

  32. Avatar harry says:

    Good piece, and i totally agree.

  33. Avatar JohninMK says:

    Thanks Optimax.

  34. Avatar steve says:

    JohninMK-
    No, they actually do dry rot. An entire order we received from FEMA was no good due to that.
    Steve

  35. Avatar JamesT says:

    A lot of governments dropped the ball on this. Thirteen years ago the province of Ontario stockpiled 55 million n95 masks in the aftermath of the SARS outbreak to protect healthcare workers during a future pandemic (we did not handle SARS well and studied what went wrong).
    But n95 masks expire, they expired years ago, and they were not replaced. Did we jump on acquiring such masks early on in this pandemic – nope.

  36. Avatar mcohen says:

    Developed in n.k released in wuhan,k-pop sure is popular around the world.

  37. Avatar Fred says:

    Optimax,
    You make to much sense and provide too much clarity on what supply chain person in the hospital field would be doing. An individual at a hospital would be tasked with cycling the inventory in a FIFO manner, just like they would do with N2 or O2 cylinders.

  38. Fred, Optimax, et al.,
    Your comments about managing supply chains and rotating stockpiles hit on the reason this situation irked me so. My last active duty position was as the mobilization planner for Fort Jackson. In conjunction with the South Carolina STARC mobilization planning office, I wrote and managed the writing of Fort Jackson’s mobilization and contingency plans. I oversaw the management of various stockpiles to support these plans. The maintenance and rotation of those stocks was important enough to be briefed to the installation commander and staff as well as SC state and National Guard leadership on a regular basis. We conducted various exercises throughout the year to ensure the plans and stockpiles would be ready. I know the importance of these efforts and the degree of attention higher levels of military and civilian leadership should pay to those efforts.
    Recent events indicate proper attention to detail was/is lacking in our national emergency response plans and preparations. Even though the Obama administration upgraded plans and organization for pandemic contingencies since the last major pandemic to hit us in 2009-2010, it is clear the national stockpiles were not properly replenished or managed. The Trump administration did not remedy these shortfalls. The planning and organization for such contingencies appear to have also deteriorated in the last three years. I don’t expect the president to personally inventory, maintain and rotate stocks in the national stockpiles, but I do expect him to ensure that it is done.

  39. Avatar elaine says:

    Philip Warren, I first noticed this buying in bulk of masks, etc
    @ a Home Depot & the clerk even admitted the buyer, a foreign national, bragged they were sending them out of the country. I
    alerted a higher up in state gov to no avail. Makes you wonder…
    The video you posted is not the only one circulated, that woman
    was only 1 of many. This was well organized & I doubt anything will
    be done about it either. This behavior was documented as early as
    the beginning of February.

  40. Avatar A.I.S. says:

    Concerning Surgical masks:
    They actually do something. Generally speaking, a considerable proportion of viral material will not be just a small virus that easily gets through a surgical masks on account of being small, but will be bound to droplets of other stuff. Said droplets can well be large enough to be blocked by surgical masks. You typically dont get infected by a “single virus”, essentially, how many initial viruses you get considerably impacts the probpability of actually getting infected. You could kind of equate this in military terms to the probability of the viral troops succesfully establishing a beachhead or not, which is considerably defined by the number of viral tropps who initially get in.
    Still, not having realy protective masks is a disgrace, although the US is hardly alone in this. Germany fucked up too.

  41. Avatar turcopolier says:

    TTG
    I seem to remember that Obama was in office until 2017.

  42. Avatar Fred says:

    TTG,
    Yes, the President is not directly responsible for the conduct of lawyers at the DOJ, but is indirectly responsible. BTW did you hear about the DOJ lawyer who fabricated evidence in FISA warrents? Some obscure congressional committee had hearings about that and it was written about in some obscure blog you might have perused. Remember who was president when that criminal conduct occurred? Yeah, we can’t criticize that guy and those are completely different circumstances than some WG-7 in a warehouse not doing their job, why that’s impeachable not supervising that person – indirectly – in all the links in the chain that gets you to the President; unless it is a third party warehouse, then it’s contracting fraud. Yep, better get on the phone to Adam Schiff.

  43. Avatar JP Billen says:

    4-ply microfiber cleaning cloth is the best material for homemade masks per an Army Times article.
    https://www.armytimes.com/news/your-army/2020/04/24/army-researchers-say-this-is-the-best-material-for-a-homemade-face-mask-theyve-found-so-far/
    They are available as cleaning cloths in autoparts stores & most hardware outlets. I’m not talented enough to make my own mask, so I just wear a surgical mask over one to hold it in place.

  44. Avatar ked says:

    New Rule: The Buck Always Stops Somewhere Else.

  45. Avatar optimax says:

    Fred. TTG,
    After the 2009-2010 pandemic, The Feds replenished their supply of N95 masks and then forgot about them, and this was done with only a one time money procurement from congress. No thought of possible future pandemics or the expiration dates of PPE.
    After replenishing the N95 supply, they could cycle out FIFO, as Fred suggested, and instead of throwing them out, sell them at cost to hospitals, and give them to VA and rural/inner city clinics for nothing. The masks would still be one to three years from expire date, and the cost to the Feds would be minimal. The funds to do so would have to be renewed every couple years.
    Also, the states need to prepare better for pandemics by having at least six month to a year supply of PPE and depend on the fed as a last resort. But it is easier to blame someone else for not not being prepared. Both the feds and states lack foresight.

  46. Fred,
    It is not some WG-7 who is responsible for maintaining the Strategic National Stockpile (SNS). The Assistant Secretary for Preparedness and Response (ASPR) under HHS is currently responsible for maintaining and replenishing the Strategic National Stockpile (SNS). The ASPR reports periodically to President’s NSA on status of the SNS. Of course we’re all aware of the turmoil at that level of White House management over the last several years. I doubt Bonkers Bolton ever gave a rat’s ass about the SNS and Robert O’Brien was only in the NSA position a few short months before the virus hit the US.
    The possibility of a major pandemic hitting the US was not totally ignored by the Trump administration. In July 2019, a blue ribbon committee including the ASPR proposed a “Manhattan Project for Biodefense.” Also in 2019, Senator Burr re-introduced the All-Hazards Preparedness and Advancing Innovation Act. A similar bill failed to get through Congress the previous year. The 2019 bill was passed and sent to Trump for his signature on 13 June 2019. In September 2019, Trump issued an executive order requiring the government to modernize influenza vaccines and technologies.
    But the readiness of the SNS suffered for years under both Obama and Trump. Olga Khazan addressed this subject in a recent “The Atlantic” article. It’s a pretty good article in my opinion. “Officials bought millions of N95 masks and other flu-type preparations with supplemental congressional funding that trickled in from 2005 to 2007, says Greg Burel, who was the director of the stockpile from 2007 until January 2020. But then that supplemental money dried up.”
    “Since then, other changes to the stockpile might have made it less capable to handle crises like the one we’re living through. In 2018, the stockpile was moved out of the jurisdiction of the CDC and into a different domain of the Health and Human Services Department—the [ASPR]. While some of the experts I spoke with saw this as a harmless change, most worried that institutional memory was lost in the process. The CDC, they say, was better at doing operational things like mobilizing a stockpile. Having it at the CDC “puts everybody who’s working on different aspects of being prepared and able to respond together,” Levy said.” Levy oversaw the SNS as acting Division Director for the CDC in 2013 and 2014.
    https://www.theatlantic.com/health/archive/2020/04/why-were-running-out-of-masks-in-the-coronavirus-crisis/609757/
    Fred, I don’t understand why you insist that Trump was no more than an innocent and impotent bystander for the last three years. He even controlled both houses of Congress for two of those years. Yet the best he can do is whine “No, I don’t take responsibility at all.” I will say that even if the SNS was fully stocked with brand new gear, we’d still face a crisis. Even the “god-emperor” Trump couldn’t wave his tiny hands and keep the virus away from our shores, nor did he bring it to our shores. But he could have done better and he should do better from this point on.
    I await your response, if you desire to write one. After that I’ll close comments. I’m reminded of Jerry Clower’s story of the coon hunt. “Just shoot in amongst us! One of has got to get some relief!”

  47. Optimax,
    Yes, that’s exactly how it should work.

  48. Avatar Fred says:

    TTG,
    So “managing supply chains and rotating stockpiles ” is the responsibility of the The Assistant Secretary for Preparedness and Response. How many WG 7’s report to the GS whatever supervisor that reports to that SES employee.
    “Fred, I don’t understand why you insist that Trump was no more than an innocent and impotent bystander for the last three years.”
    I fully agree with “not soon enough”. I look forward to the House “Not soon enough” impeachment. I also look forward to the house funding for all that gear for the next thing the WHO tells us not to worry about.
    “He even controlled both houses of Congress for two of those years.”
    Oh, he was a dictator and Paul Ryan took his orders, during the Russia Investation by Mueller? That doesn’t seem to be what happened. Please feel free to point out the Senator Warner and Kaine sponsored legislation to do what you wish had been done and maybe point to the congressman in your district as well.
    “even if the SNS was fully stocked with brand new gear, we’d still face a crisis.”
    Thanks to Communist China and a corrupt WHO with a giant assist from incompetent or corrupt civil servents. Jerry Pournelle’s Iron Law of Bureaucracy seems to be in play.

  49. Avatar A.I.S. says:

    I think you are massively overstating how much influence someone like Trump, or for that manner Obama, actually has.
    General speaking, if you are in a position of authority, you can pretty strongly influence 1 layer below you, and effectively influence 2 layers below you. Anything more, well, basically forgetaboutit.
    People whose main portfolio is how much masks there are are not, to my knowledge, within 2 levels of hierarchy from the president of the united states.
    What could have been done is to build up mask supplies, and draft plans for mask supply (as well as ventilation apparate supply, as well as making an inventory of ventilator trained nurses who are currently not nurses and who could be rehired as nurses with a risk bonus).
    These type of planning is staff work and fairly cheap because you only invest man hours of quite probably federally employed planners. Add figuring out how to rapidly create spare hospital or quarantine station capacity. This is also a plannable thing.
    It is also waht the US did in the runup to WW2. The amazing logistical feats achieved by the US (including highly important lend lease) where based on solid staff work which started prior to the outbreak of hostilities.
    Someone dropped the ball on not having such staff work prepared and ready.
    In Germany, the health ministry epically derped essentially (appropriate planners came up with a proposal to increase the mask supply in january, basically a German mask producing firm was explicitly asking the Health ministry if it shouldnt rather sell 1 million masks to it instead of the Chinese, and was explicitly told that Germany does not need masks), which essentially resulted in the more common sensical and more hard assed interioer ministry taking over.

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