On a normal day in America about 8,000 people die. When the coronavirus pandemic hits its peak—probably in late April—it will likely claim about 4,000 lives per day. For a week or two, our national death rate will increase by 50 percent from its normal level.
But there’s also another way of looking at this. We would normally expect about 3 million people to die this year. If the coronavirus pandemic kills 150,000 people, that’s a 5 percent increase in our normal death rate.
Or this: the population of the United States is 330 million. If the pandemic kills 150,000 people, that’s a death rate of 0.05 percent.
Pick your poison. Are you a glass-half-empty or a glass-half-full kind of person?
This is currently the issue that has a stranglehold on the back of my mind:
Peru tried to do everything right. Officials declared an early national lockdown — and backed it up with 16,000 arrests. Yet confirmed cases of the novel coronavirus are surging, up nearly 60 percent since last weekend. In Egypt, observers say a repressive government is vastly undercounting the infected. In Brazil, where the president has dubbed Latin America’s largest outbreak a “fantasy,” numbers are skyrocketing.
….Epidemiologists and other public health experts say the coronavirus is poised to spread dangerously south, engulfing developing nations already plagued by fraying health-care systems, fragile governments and impoverished populations for whom social distancing can be practically impossible. They warned of an amplified global crisis in the coming weeks, striking nations that can least afford it at a time when wealthy countries are likely to be too preoccupied with outbreaks of their own to offer the kind of assistance they’ve extended during episodes of disease that were confined to the developing world.
I don’t know why the coronavirus initially took hold in the temperate regions of the northern hemisphere. If we’re lucky, it really does have something to do with our cool climate, which might mean that the virus will spread less quickly in hotter tropical regions. But I don’t know if I’d count on that. One thing we know for sure is that once a single person dies, it means the virus has settled in enough that it can’t be stopped without strict and universal countermeasures.
Economically, I think the global north can weather the coronavirus pandemic. We are not undergoing a normal recession, after all, where recovery is slow because nobody knows for sure when it’s really over. On the contrary: the day will come, eventually, when we can declare victory. In the meantime, the months of lockdown have acted as something of a forced savings regime. When the crisis is over, there will be huge pent-up demand and the economy should rebound quickly.
But that’s treating the northern hemisphere like an island. It’s not. We are connected to the rest of the world, and if the rest of the world turns into an economic disaster area it will have a big effect on us. There will be ongoing supply chain disruptions. There will be bond defaults. There will be currency crises. There will be stock market crashes.
This will be devastating for the countries at the epicenter, but it will probably also be devastating for us. In the worst case, it could turn a temporary regional recession into a whopping global depression.
Anyway, that’s what’s in the back of my mind. What’s in the back of yours?
Last year around this time, my biggest worry was how the inclusion of the Trump administration’s proposed citizenship question would depress participation in the decennial census. Thankfully, our Supreme Court victory means there is no citizenship question on the census. Now, I have a new worry: a global pandemic and the health of my loved ones. As it turns out, the 2020 Census plays a role here too, as it will have enormous implications on our health care for decades to come.
Specifically, the census will determine the allocation of $300 billion dollars of federal aid for the states’ health care — money for programs like Medicaid, which covers low-income individuals, families, and persons with disabilities; the Children’s Health Insurance Program, which helps uninsured, low-income children; and other programs that help assure vulnerable people, including immigrants, can get health care when they need it.
As I shelter in place in New York, the epicenter of America’s COVID-19 pandemic, the potential impact is tangible. Even before “self-isolation” and “shelter in place” became part of our country’s lexicon, New York was in danger of an undercount. According to the Census Bureau, New York City’s all-important initial response rate is projected to be 58 percent — woefully short of the 2010 national average of 66.5 percent. But across the country, there are safe ways to practice social distancing and fill out the census — online, by the phone, or by mail (just don’t lick the envelope).
These worrying trends were exacerbated by the Trump administration’s unlawful attempt to include a citizenship question on the census. While my organization, the New York Immigration Coalition, amongst other partners including the ACLU, successfully argued against the inclusion of the question, participation in the census by immigrant populations became less and less likely each passing month. Just the threat of this question, coupled with increasingly aggressive targeting of our communities by Immigration and Customs Enforcement, have forced immigrants nationwide into the shadows and made participation in the census highly suspect.
Now immigrants stand on the frontlines of COVID-19 — nursing our elderly, cooking and delivering our meals, and driving us back and forth from the hospital, with even fewer protections. In short, our immigrant communities are keeping us functioning, and we must ensure that they don’t lose deserved resources and representation. As the COVID-19 pandemic creates a different kind of fear among immigrants, it’s more vital than ever before that every state gets its fair share of federal funding to ensure our hospitals and our entire infrastructure — from libraries to schools to roads — are better prepared for the next crisis.
But we can draw on the lessons we learned fighting the President’s attempts to exclude immigrants. To that end, we are deploying several tools to ensure an accurate count of everyone in the United States — using text-banking, virtual phone banking, Zoom trainings for community-based organizations, and multilingual messaging.
There is no doubt that the challenge before us is monumental. After all, even the Spanish Influenza of 1918 took place in a non-census year. Nonetheless, we are working hard with every social distancing tool at our disposal to ensure that every immigrant and everyone in the U.S., from all backgrounds, are fully represented in the nation’s once-in-a-decade count of its populace. At stake is billions of dollars for local schools, hospitals, libraries, businesses, and the health and well-being of everyone in our country.
Since the days of Adam Smith, capitalists have been arguing that unfettered markets are the best way to organize the economy. Smith famously said that the rich are “led by an invisible hand” to, “without knowing it, advance the interest of the society.” The rise of the welfare state in the wake of the Great Depression tempered such magical thinking for a few decades, but the ascent of neoliberalism in the last half century has brought a resurgence in market fundamentalism, in both theory (very much including the pages of the New York Times and Washington Post) as well as practice.
Yet none of the steady stream of articles from these outlets attesting to heartbreaking shortages of medical equipment in coronavirus-ravaged areas in the US—“A NY Nurse Dies. Angry Co-Workers Blame a Lack of Protective Gear” (New York Times, 3/26/20), “Unprotected and Unprepared: Home Health Aides Who Care for Sick, Elderly Brace for Covid-19” (Washington Post, 3/24/20), “NY May Need 18,000 Ventilators Very Soon. It Is Far Short of That” (New York Times, 3/17/20), or “The Hardest Questions Doctors May Face: Who Will Be Saved? Who Won’t? “ (New York Times, 3/21/20), for instance—have stopped to ask why the laws of supply and demand have so catastrophically failed in this crisis.
I could feign surprise at this elision, but truthfully, it does not surprise me in the least. It angers me, yes; but surprises, no.
Americans can rightly demand an explanation for the vast gulf between the ideas espoused by free-market advocates and the failure of the market to provide essential social goods, most pressingly right now, healthcare. But instead, shortages of masks, ventilators and hospital beds are presented ahistorically, as though there is no cause; problems to be solved, but problems somehow without origins. A good bit of coverage addresses some of the political failures responsible for the shortages (that coverage has its own problems, though it is beyond the scope of my mental health to be able to address them here), but economic failures go completely without analysis, even when they are, on rare occasions, explicitly mentioned.
A Washington Post piece (3/28/20) noted that personal protective equipment (PPE) for health care workers cannot be bought from private vendors “because companies manufacturing masks and other emergency gear are demanding cash payments on delivery.” The same piece quotes Virginia Gov. Ralph Northam: “Allowing the free market to determine availability and pricing is not the way we should be dealing with this national crisis at this time.” But if you’re looking for criticism of the market-driven inability to provide life-saving equipment to front-line workers, you won’t find any in this article. Nor is there any analysis; Northam’s quote is close as it gets.
Similarly, the New York Times (3/29/20) ran a piece titled “The US Tried to Build a New Fleet of Ventilators. The Mission Failed”:
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…. 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.
This is a blow-by-blow account of the failed ventilator project, but it is as shallow in analysis as it is rich in detail. The subhead reads, “The collapse of the project helps explain America’s acute shortage,” but, really, all it does is describe it. The lines above are the only ones that even come close to analysis in the 1,800-word story. Also, “maximizing profits is not always consistent with the government’s goal of preparing for a future crisis” is a hell of a way to say capitalism is incompatible with public health.
As superficial and cursory as these two mentions of market failures are, they are the exception; hundreds of articles about the pandemic run every day without even this much. Even coverage of Trump’s use of the Defense Production Act—a Korean War–era law that gives the federal government significant additional power to compel private production and services—managed to sidestep mention of the fundamental truth underscored by the DPA’s very existence: that sometimes a visible hand is needed to “advance the interest of society.”‘Moral trade-off’ of lives vs. profits
Given the blasé response to the market’s inability to deliver life-saving equipment to those who need it, because it’s not “sufficiently profitable,” it is perhaps not surprising that the view that profits are more important than lives has been treated as a reasonable opinion by corporate media.
As if on cue, in mid-March political and economic elites started talking about the need to “get the economy going again,” making sure “the cure isn’t worse than the problem,” and public-health restrictions having “gone too far.” Texas Lt. Gov. Dan Patrick suggested senior citizens should be willing to get ill and die so we “don’t sacrifice the country.” Twitter responded with scathing dark humor and a trending hashtag, #NotDying4WallStreet.
Jesus died for our sins, grandma died for the Dow.
— Marie Connor (@thistallawkgirl) March 24, 2020
We should call dying “being taxed at 100%” so republicans will care about it
— Megan Amram (@meganamram) March 24, 2020
We’ve been saying that the Republican Party is a death cult, or that capitalism itself is a death cult, for so many years, but I never thought we’d get this close to them actually getting on TV and telling us it’s our patriotic duty to die for their money.
— Dan Fishback (@dangerfishback) March 24, 2020
But corporate media treated the idea as legitimate. The Washington Post’s story (3/24/20) on Patrick’s comment went so far as to frame it as a “he said, she said,” Republicans vs. Democrats issue:
Patrick (R) faced a sharp backlash Tuesday for suggesting that older Americans should sacrifice their lives for the sake of the economy during the coronavirus pandemic, with Democrats arguing that public health should remain the country’s top priority.
The Post (3/24/20) covered Trump’s “raring to go by Easter” pronouncement in a similar manner: “Trump’s optimism contradicted the warnings of some public health officials who called for stricter — not looser — restrictions on public interactions.” “Some” public health officials here means all public health officials, and what the Washington Post calls Trump’s “optimism” would more accurately be described as his utter disinterest in anything or anyone that does not profit him personally. Further down the article acknowledged:
Health experts have made clear that unless Americans continue to dramatically limit social interaction—staying home from work and isolating themselves—the number of infections will overwhelm the healthcare system, as it has in parts of Italy, leading to many more deaths.
The Times (3/23/20) did no better:
President Trump, Wall Street executives and many conservative economists began questioning whether the government had gone too far and should instead lift restrictions that are already inflicting deep pain on workers and businesses.
So on the one hand we have those concerned that “many more deaths” will occur if we loosen social distancing practices, and on the other hand we have the investor class that thinks public health has “gone too far.” That these two perspectives are both presented as reasonable opinions is yet another example of the false equivalencies that so often plague the Times and the Post. But the equanimity with which these corporate outlets discuss the trade-offs of lives and profits is truly appalling.Stock market über Alles
The false equivalence between profits and lives is aided in part by an additional layer of obfuscation: Corporate media are presenting 1% concerns about the stock market as a general interest in “the economy.”
As always in a capitalist economy, gains are privatized while losses are socialized. What this means is that when a company does well, shareholders and executives divide the spoils; workers rarely benefit (and almost never without a union that collectivizes their fight and strength). When, on the other hand, business is bad, it is workers whose hours, benefits or wages are cut, or who lose their jobs entirely. When stocks rise, the investor class benefits; when they fall, everyone suffers.
The economic impacts of the coronavirus are massive and devastating: Brick-and-mortar businesses cannot sell goods and services, and millions of workers have been thrown out of work. Income loss means people go hungry, aren’t able to afford medical care, lose their homes. It also further depresses sales across the entire economy, not just in brick-and-mortar points of sale.
The obvious solution is to keep workers on payroll, and for the government to subsidize businesses that have lost revenue as a result of public-health restrictions in order to meet their payrolls. But this solution has never even been on the table in Washington. Instead, the policy discussion has been dominated by calls to “re-open the economy,” i.e., ease social-distancing restrictions in order to increase commerce, and calls for corporate bailouts. But neither the kill-grandma approach nor the slush-fund approach does anything for the 99%.
Against this background, a piece like the New York Times’s “Restarting the Economy Is About Lives Versus Livelihoods” (3/24/20) highlights corporate media complicity in promoting Wall Street’s agenda. “It’s a moral trade-off between saving lives and sustaining economic livelihoods,” it says, without even mentioning aid to those who have lost their jobs. The actual trade-off is between saving lives and boosting corporate profits and stock prices, and it’s anything but moral.
Coverage of the $2.2 trillion stimulus bill likewise conflated the stock market and the economy, describing the bill as “a lifeline to Americans and their employers” (Washington Post, 3/24/20). The final bill, signed by Trump on Friday, March 27, provides for a $600 increase in monthly unemployment benefits for four months; a one-time means-tested payment of $1,200 per adult (and $500 per child); some state aid that very partially addresses the massive cost increases states are facing; and $500 billion in corporate aid that has no meaningful strings attached to it.
The stock market reacted positively to the bailout bill. As for the rest of us, it’s talk to the invisible hand.
Italy’s disastrous coronavirus epidemic was kicked off by a soccer match in Bergamo that authorities decided not to cancel. In South Korea it was meetings of the Shincheonji Church of Jesus. In Spain it was—again—soccer matches, which weren’t shut down until mid-March. In Louisiana it was Mardi Gras. In Florida it was spring break. In France it was a five-day gathering of the Christian Open Door church. So count me as disgusted by this:
At any other time, in a predominantly Christian nation that enshrines freedom of worship in the Constitution, the news would sound absurd or terrifying: “Pastor arrested after holding church services.” But that’s what happened this week when sheriff’s deputies handcuffed a Tampa, Fla., minister for violating municipal stay-at-home orders by gathering hundreds to worship….Brown, now out on bail, has complained of “religious bigotry.”
….In Louisiana, police issued a summons Tuesday to the pastor of Life Tabernacle Church in Central, La., near Baton Rouge, after he held services for 1,200 people in violation of state limits. “Never been more proud to be persecuted for the faith like my savior,” the Rev. Tony Spell shot back.
…R.R. Reno, editor of First Things, a prominent conservative Christian magazine, recently said in an article that politicians have been correct to put forth “stern measures to slow the spread of the virus.” But he added that churches should stay open. “When we worship, we join the Christian rebellion against the false lordship of the principalities and powers that claim to rule our lives, including sickness and death,” Reno wrote this month.
Idiots. I won’t pretend to offer Biblical advice to these guys, but at the very least they should care about hurting others even if God does protect them. And this kind of obduracy most definitely has the potential to hurt a lot of people. Shut ’em down. All of them.
In less than a single month, the coronavirus pandemic has completely altered the day-to-day lives of millions of Americans. With many stores running out of essential items such as milk, eggs, and canned food almost as soon as they’re stocked, it can be difficult to find the groceries needed to stay safely inside for weeks at a time.
That’s especially true for many of the 42 million people who rely on the Supplemental Nutrition Assistance Program—commonly known as SNAP, or food stamps. SNAP recipients each receive an electronic benefits transfer card, which works like a debit card, that’s recharged with a set amount of credits each month to use on groceries. So if they run low, they may have to postpone a trip to the grocery store until their SNAP accounts are refilled.
As a new month begins, there’s been messaging circulating online urging people who don’t rely on SNAP to refrain from grocery shopping during the first few days of April, so that people using food stamps have a better chance of stocking up on popular supplies. “If you’re not having a food emergency, please don’t go to the grocery store on April 1st and 2nd. Wait until the 3rd,” read one particularly viral tweet this week. “People who are on food stamps get their accounts recharged on the first of the month, and have likely been running on fumes.”
“Many of them haven’t been able to shop since March 1,” Hugh C. Minor IV, a spokesperson for the Rhode Island Community Food Bank, told the Providence Journal. On Monday, the food bank asked Rhode Island residents to “pause” their grocery shopping on April 1 and 2 for SNAP shoppers.
It’s a nice sentiment. But as I found out after calling around, this advice only applies to a handful of states that issue SNAP benefits at the beginning of the month. Rhode Island, Nevada, North Dakota, Vermont, Guam, and the US Virgin Islands all disperse SNAP benefits on the first day of each month, as established by the US Department of Agriculture. Most other states—including Florida, California, and Texas—and the District of Columbia have a more staggered schedule so that recipients don’t overwhelm grocery stores on the same day.
But there are bigger challenges for people using SNAP during the coronavirus pandemic, according to Ellen Vollinger, the legal director for the Food Research and Action Center. “Part of the tough times that low-income people have is how meager their normal-sized allotment is,” she says. The average SNAP recipient gets $127 a month; while the average cost of groceries per month for one person typically ranges from $165 to $345, based on data published by the USDA. “They were not as well situated to stockpile,” Vollinger notes. And while grocery delivery is an option for people who don’t want to risk a trip to the store, that option is not available for SNAP recipients in most of states.
The $2 trillion coronavirus relief bill that Congress passed last week includes a nearly $16 billion boost to the SNAP program for 2020, with the expectation that many more people will sign up for benefits as the economic fallout from the pandemic grows. That extra money will be sorely needed, but Vollinger is skeptical that it will be enough for people, especially during emergency situations like the one we’re currently experiencing. The increased funding will only cover the anticipated rise in SNAP enrollment; it won’t increase the benefits of current recipients.
“At the outset of this, there were recommendations that households all stockpile for 14 days worth of food,” Vollinger says. “When you’ve got a very meager SNAP allotment, that’s not easy to do. If people are concerned about the SNAP shopper, the best thing they could do is advocate to Congress and the White House to give them more benefits.”
Declaring that “Nicolas Maduro will never again govern Venezuela,” Mike Pompeo unveils a so-called “transition” plan that tells Venezuelans to…
The post Pompeo’s ‘transition’ plan tells Venezuela to suffer into submission appeared first on The Grayzone.
Here’s the coronavirus growth rate through March 31. Italy continues to slowly flatten and still has a chance of peaking within a week. Everybody else is tracking about the same as usual too.
I’ve gotten a lot of comments lately about the particular way I construct my charts. The most frequent questions have to do with my choice of Day 0 and whether or not I should simply show absolute death tolls rather than growth rates.
Day 0 is an interesting question. I am a per-capita guy: I think you need to account for a country’s population to get an accurate picture of how they’re doing. That’s why I chose to count Day 0 as the first day that deaths surpassed one in ten million. I figure that 33 deaths in the United States is about equivalent to 6 deaths in Italy.
But there’s an argument for simply assigning Day 0 to the day with the very first death. After all, in the early stages of an epidemic the numbers are so small that the size of the country doesn’t really matter: it’s going to grow at an exponential rate for at least several weeks until it starts to hit resistance as a significant percentage of the population becomes infected. So let’s take a look at mortality rates counting from the day of the first COVID-19 death in each country:
Note that I’m still using deaths per million. Especially now that we have more than a month of the pandemic under our belts, I can’t persuade myself that this is wrong. Using absolute deaths seems like nothing but a way to make big countries look gratuitously bad. It’s like calling California the drunk driving capital of the country without mentioning that this is only because it has more people than any other state.
As it turns out, this chart doesn’t look all that different from my usual batch. Using a different definition of Day 0 just doesn’t change much. For now, then, I’m going to keep them the way they are so that they’re comparable from day to day. I may change them later if I need to.
How to read the charts: Let’s use France as an example. For them, Day 0 was March 5, when they surpassed one death per 10 million by recording their sixth death. They are currently at Day 26; total deaths are at 588x their initial level; and they have recorded a total of 52.7 deaths per million so far. As the chart shows, this is slightly below where Italy was on their Day 26.
The raw data from Johns Hopkins is here.
Today is April 1, and millions across the country don’t have the money to pay rent. But despite eviction moratoriums and relief on mortgage payments in hard-hit states like California, Washington and New York, no rent freeze has been ordered. In response, tenants around the country are calling for immediate rent cancellation. Some are planning to “rent strike.” Meanwhile, many workers who lost their income due to the pandemic haven’t even been able to file for unemployment in New York state, with the unemployment website continually crashing and phone lines jammed. Seven-point-eight million people called the New York state Labor Department hotline last week, compared to the average 50,000. We get an update from Cea Weaver, campaign coordinator for Housing Justice for All, which is organizing to cancel rent during the coronavirus.
New York hospitals cannot force pregnant people to give birth without a chosen support person. That’s what an executive order released by New York Governor Andrew Cuomo Sunday revealed. The order comes in response to a move by the NewYork-Presbyterian and the Mount Sinai hospital systems to bar partners from labor and delivery rooms, causing widespread outrage. But how are pregnant people coping with new hospital guidelines and uncertain conditions during the COVID-19 pandemic? We speak with freelance journalist Amy Littlefield, who focuses on the intersection of religion and healthcare, about what she is confronting now at the end of her pregnancy. Her piece for Insider is “I’m nine months pregnant, and I’m bringing my baby into a world I no longer understand. I have to remain hopeful anyway.”
The White House is now estimating 100,000 to a quarter of a million people could die from the coronavirus pandemic. Some of those most concerned about exposure to the highly infectious virus are workers on the frontlines of grocery stores and delivery services. On Monday, Amazon warehouse workers in Staten Island walked off the job, and the company fired one of them in response. At least three employees at a large UPS facility near Boston have tested positive, and two dozen more have been quarantined. Details about the infections were shared by the workers’ union because they said the company refused to provide the critical information to its employees. We speak with Richard Hooker, secretary-treasurer of the Philadelphia Teamsters Local 623, and David Levin, lead organizer with Teamsters for a Democratic Union and the coordinator of the UPS Teamsters United campaign.
- No Longer Downplaying Virus, Trump Says Up to 240,000 Will Die in U.S. from COVID-19
- FEMA Sends 85 Refrigerated Trucks to NYC as Makeshift Morgues as COVID-19 Deaths Grow
- As Confirmed U.S. Cases Top 188,000, Unhoused People Forced to Sleep in Las Vegas Parking Lot
- Chicago COVID-19 Nurse Quits over Critical Lack of Personal Protective Equipment
- Fed Economists: U.S. Unemployment Could Reach Record 32% in June
- Congressional Hispanic Caucus Demands Release of All Jailed Immigrants Amid Pandemic
- Captain Calls for Evacuation of Infected U.S. Aircraft Carrier: "Sailors Do Not Need to Die"
- Governor Won't Allow Sickened Cruise Ship Passengers to Be "Dumped" in Florida
- Italy Holds Moment of Silence as COVID-19 Deaths Reach 12,000
- Spain Records Highest COVID-19 Death Toll Yet, as Medical Workers Warn of "Inferno"
- Asylum Seeker Gets COVID-19 in Greece; Brazilians Continue to Protest from Home
- Nigerians Fear Starvation as Africa's Largest City Enters Lockdown
- Ugandan Police Arrest Homeless LGBTQ Youth for Alleged Quarantine Violation
- Indonesian Drones Spray Clouds of Disinfectant, Raising Fears of Poisonings
- CNN's Chris Cuomo Tests Positive for COVID-19 as Fox News Fears Lawsuits over Coverage
- Federal Appeals Court Will Allow Texas Abortion Ban to Remain in Effect for Now
- Trump Finalizes Rollback of Mileage Standards, Gutting Efforts to Stem Climate Crisis
- U.S. Shifts Policy on Venezuela, Suggesting "Power Sharing" Interim Government
Five years ago, the U.S. Department of Health and Human Services tried to plug a crucial hole in its preparations for a global pandemic, signing a $13.8 million contract with a Pennsylvania manufacturer to create a low-cost, portable, easy-to-use ventilator that could be stockpiled for emergencies.
This past September, with the design of the new Trilogy Evo Universal finally cleared by the Food and Drug Administration, HHS ordered 10,000 of the ventilators for the Strategic National Stockpile at a cost of $3,280 each.
But as the pandemic continues to spread across the globe, there is still not a single Trilogy Evo Universal in the stockpile.
Instead last summer, soon after the FDA’s approval, the Pennsylvania company that designed the device—a subsidiary of the Dutch appliance and technology giant Royal Philips N.V.—began selling two higher-priced commercial versions of the same ventilator around the world.
“We sell to whoever calls,” said a saleswoman at a small medical-supply company on Staten Island that bought 50 Trilogy Evo ventilators from Philips in early March and last week hiked its online price from $12,495 to $17,154. “We have hundreds of orders to fill. I think America didn’t take this seriously at first, and now everyone’s frantic.”
Last Friday, President Donald Trump invoked the Defense Production Act to compel General Motors to begin mass-producing another company’s ventilator under a federal contract. But neither Trump nor other senior officials made any mention of the Trilogy Evo Universal. Nor did HHS officials explain why they did not force Philips to accelerate delivery of these ventilators earlier this year, when it became clear that the virus was overwhelming medical facilities around the world.
An HHS spokeswoman told ProPublica that Philips had agreed to make the Trilogy Evo Universal ventilator “as soon as possible.” However, a Philips spokesman said the company has no plan to even begin production anytime this year.
Instead, Philips is negotiating with a White House team led by Trump’s son-in-law, Jared Kushner, to build 43,000 more complex and expensive hospital ventilators for Americans stricken by the virus.
Some experts said the nature of the current crisis—in which the federal government is scrambling to set up field hospitals in New York’s Central Park and the Jacob K. Javits Convention Center—underscores the urgent need for simpler, lower-cost ventilators. The story of the Trilogy Evo Universal, described here for the first time, also raises questions about the government’s reliance on public-private partnerships that public health officials have used to piece together important parts of their disaster safety net.
“That’s the problem of leaving any kind of disaster preparedness up to the market and market forces—it will never work,” said Dr. John Hick, an emergency medicine specialist in Minnesota who has advised HHS on pandemic preparedness since 2002. “The market is not going to give priority to a relatively no-frills but dependable ventilator that’s not expensive.”
The lack of ventilators has quickly become the most critical challenge to keeping alive many of the people most seriously sickened by the virus. Ventilators not only help people breathe but also can provide pressure that holds the lungs open so the air sacs don’t collapse.
Neither HHS nor Philips would provide a copy of their contract, citing proprietary technical information that would have to be redacted under a Freedom of Information Act request. But from public documents and interviews with current and former government officials, it appears that HHS has at times been remarkably deferential to Philips—and never more so than in the current pandemic.
From the start of its long effort to produce a low-cost, portable ventilator, the small HHS office in charge of the project, the Biomedical Advanced Research and Development Authority, or BARDA, knew that it might need to move quickly to increase production in an emergency and insisted that potential partners be able to ramp up quickly in the event of a pandemic.
But the contract HHS signed in September 2019 gave Philips almost a year before it had to produce a single Trilogy Evo Universal, and two more years to fulfill the order of 10,000 ventilators.
On the same day in July that the FDA cleared the stockpile version of the ventilator, it granted the application of Philips’ U.S. subsidiary, Respironics, to sell commercial versions of the Trilogy Evo. Philips quickly began shipping the commercial models overseas from its Murrysville, Pennsylvania, factory.
Steve Klink, the company’s Amsterdam-based spokesman, said Philips was within its rights under the HHS contract to prioritize the commercial versions of the Trilogy Evo. An HHS spokeswoman—who insisted she could not be identified by name, despite speaking for the agency—did not disagree.
“Keep in mind that companies are always free to develop other products based on technology developed in collaboration with the government,” she said in a statement to ProPublica. “This approach often reduces development costs and ensures the product the government needs is available for many years.”
Just last month, HHS gave a very different impression to Congress, hailing the Trilogy Evo it funded as a breakthrough in its campaign for pandemic preparedness.
“This game-changing device, considered a pipedream just a few years ago, is now available at affordable prices to improve stockpiling and deployment” in an emergency, the agency told Congress in a budget document delivered on Feb 10.
But less than two weeks later, officials overseeing the Strategic National Stockpile approached Philips with an urgent appeal: Start making our ventilators. On March 10, Philips agreed to a modification of the HHS contract—one that called for the company to produce the Trilogy Evo Universal “as soon as possible,” a spokesperson said.
However, in a subsequent statement, the HHS spokeswoman said Philips is only required to deliver the ventilators “as they are completed.” Klink, the company spokesman, said Philips was only committed to meeting the original contract deadline of 10,000 ventilators by September 2022.
Had government officials insisted that Philips first produce the ventilators that taxpayers paid to design, the government could conceivably be distributing all 10,000 to hospitals now. Last year, Philips plants in Pennsylvania and California produced 500 ventilators of various models per week; they sped up to 1,000 per week earlier this year, Klink said. At that pace, the stockpile ventilators could have been completed even if Philips devoted only part of its lines to their production.
Klink said the reason the company is not producing the stockpile ventilator is because it has not yet been mass-produced and would require time-consuming trial runs. In the current crisis, it’s faster and more efficient to continue producing the versions it is already making, he said.
Asked if Philips could hand over its Trilogy Evo Universal design to another manufacturer, he argued that the fundamental constraint on production is not the company’s assembly lines but its dependence on more than 100 smaller companies around the world that make the 650 parts needed for a hospital ventilator.
“We cannot sell a ventilator with only 649 parts,” he said. “It needs to be the whole 650.”
It is difficult to assess how much profit motives might be driving Philips’ decisions about which ventilators to produce because the company does not disclose how much it charges different clients for commercial models.
The commercial version of the Trilogy Evo has had its own problems. Not long after it began selling the ventilators last summer, Philips sent out recall notices to customers in Europe and the U.S., alerting them to a software glitch that prompted the devices to shut down without sounding their alarm. The software has since been updated and the problem solved, the company said.
Klink said Philips hopes to be making 4,000 ventilators of all types each week in the U.S. by October, and that it would prioritize “those communities and countries that need it the most.”
But as the pandemic spreads, desperate global demand for the commercial models of the Trilogy Evo is driving up prices sharply, and evidence from the chaotic open market for the devices raises questions about Philips’ stated commitment to prioritize the neediest.
On Staten Island, a saleswoman at No Insurance Medical Supplies, who would give her name only as Jeanette, said the company was selling to “anyone who calls,” including doctors and individuals. The company’s first shipment of 50 devices sold out quickly, but an additional five ventilators arrived on Friday. The company requested 148 more, but Philips Respironics said it could only provide 11 ventilators by April 6, she said. The company’s prices are determined by what the manufacturer charges, she said.
The competition abroad is also intense. On March 12, the regional government of Madrid, one of the cities hardest hit by the virus, bought 10 Trilogy Evo ventilators from a Spanish medical supply company for about $11,000 each. In Budapest, Hungary, the Uzsoki Street Hospital announced that a local property development company had donated two “ultra-modern” Philips Trilogy Evo ventilators on March 18.
The struggle has grown so fierce that last week, a trade group representing ventilator manufacturers asked the head of the Federal Emergency Management Agency to decide for the manufacturers whom they should sell to first.
“We would appreciate the Administration’s leadership and the advice of clinical and other experts within the Administration in deciding how to allocate these products in the most effective way,” the Advanced Medical Technology Association wrote in a letter to FEMA Administrator Peter Gaynor.
Medical experts and public health officials have believed for nearly two decades that they needed a less-expensive and simpler-to-operate portable ventilator that could be made and distributed quickly in an emergency.
“This is not a new problem,” said W. Craig Vanderwagen, a former senior HHS official who oversaw studies that led to the government’s early efforts to design and build a low-cost portable ventilator for such eventualities. “We knew back in the 2000s that ventilators were going to be critical in pandemic preparedness. That was a clear gap that we identified.”
In the early 2000s, American public health experts and government officials were gripped by a sense of urgency they had not felt before. The 9/11 attacks and the anthrax scare that followed underscored the need for sweeping new actions to keep the country safe. Outbreaks of Avian influenza—first reported in Hong Kong in 1997—exposed the public health system’s vulnerability to new, highly fatal pathogens from overseas. The George W. Bush administration’s disastrously slow and inept response to Hurricane Katrina in 2005 prompted widespread calls for the government to strengthen its ability to deal with a growing array of emergencies, from new, highly contagious diseases to previously unthinkable terrorist attacks.
One obvious vulnerability was to a viral pandemic or a chemical or biological attack that would ravage the lungs of its victims, setting off a cascade of cases of what doctors call Acute Respiratory Distress Syndrome, or ARDS.
“None of us expected an event on the scale of what we’re going through now,” said Dr. Lewis Rubinson, a pulmonologist who participated in several of the early government-sponsored medical studies. “We had to guess: What would the patients look like? What we predicted correctly was that we could face massive cases of ARDS.”
By the early 2000s, officials at the Centers for Disease Control and Prevention had already begun working to stockpile a few thousand ventilators for such an eventuality, former officials said. But studies by medical experts and government scientists—including sophisticated models of what might occur in the event of various disasters, outbreaks or attacks—suggested a bigger problem. Hospitals could be crippled not only by shortages of complex and costly ventilators, but also by a lack of the trained respiratory technicians who are generally required to operate the machines.
The experts envisioned one important solution: a portable ventilator that was less complex than hospital machines and could be more quickly produced, safely stockpiled and widely distributed in emergencies. They envisioned a device that could be deployed in field hospitals like the ones that authorities are now rushing to create in Central Park and elsewhere.
The job of bringing such a device to life fell to BARDA, an innovative office of HHS that was established in 2006 to help the country prepare for pandemic influenza, new types of infectious diseases or an attack or accident involving chemical, biological or radiological weapons.
Much of BARDA’s work has been focused on developing potentially critical vaccines and other medicines that are not necessarily profitable for big pharmaceutical companies. The agency often works with medical researchers at the National Institutes of Health and elsewhere, identifying promising therapies and other innovations, and then forms partnerships with private biotechnology or other companies to create the drugs and move them through various stages of regulation.
In 2008, BARDA began trying to find a company that could make a ventilator that would be inexpensive—ideally, less than $2,000 each—and could be simple enough to use that “inexperienced health care providers with limited or no respiratory support training” could operate the devices during a pandemic, according to the agency’s solicitation for bids.
BARDA also anticipated the shortage of parts and competing priorities that the ventilator industry now faces. Companies bidding for the contract had to show they could secure the parts needed to “ramp up production to supply at least” 1,700 ventilators per month and 10,000 in six months’ time. The companies also had to pledge that government “contracts will be honored during a pandemic,” the initial solicitation said.
With only a couple of bids, BARDA settled on a small, privately held ventilator company in Costa Mesa, California, Newport Medical Instruments Inc. BARDA and Newport signed a $6.4 million contract in September 2010, specifying that the money would be doled out incrementally as the company met various milestones.
But in May 2012, Newport was purchased by a larger Irish medical device company, Covidien, for $108 million. Covidien quickly downsized and asked Rick Crawford, Newport’s former head of research and development and the lead designer of the BARDA ventilator, to finish up the project without any staff assigned to him. Crawford said he took a job with another company.
“I don’t know how you finish a project when nobody reports to you,” he recalled thinking.
A former BARDA official who worked on the project said that Covidien began raising issue after issue and demanded more money. BARDA agreed, eventually tacking on almost $2 million more to the price tag, records show. Even so, Covidien abandoned the project.
A spokesman for the still-larger firm that acquired Covidien in 2015, Medtronic, said that the prototype ventilator created by Newport Medical “would not have been able to meet the specifications required by the government, nor at the price required.” In a statement responding to a story in The New York Times, Medtronic said it left the federal government with all the designs and equipment created in the project.
Several former BARDA officials said such outcomes come with their territory. Like big pharmaceutical companies, they had to take chances, especially in the development of vaccines.
“There are going to be risks like that when you partner with businesses,” said one former senior BARDA official, who, like others, asked for anonymity because she was not authorized to speak for the agency. “It’s a problem that we at BARDA had encountered before, where a company changed hands and changed priorities.”
In March 2016, less than two years after signing its ventilator contract with BARDA, Philips Respironics agreed to pay $34.8 million to settle a Justice Department lawsuit under the False Claims Act and the Anti-Kickback Statute. Justice lawyers accused the manufacturer of effectively paying kickbacks to medical suppliers to buy its masks for sleep apnea. The company also agreed to abide by a five-year Corporate Integrity Agreement with HHS inspector general that imposed a series of oversight measures on the company’s operations.
With BARDA’s continuing support, Philips finally won FDA approval for the Trilogy Evo Universal ventilator in July 2019. Klink, the Philips spokesman, said the $13.8 million from HHS covered only a portion of the design and development costs for the ventilator and that the company invested more.
Rubinson, now the chief medical officer of Morristown Medical Center in Morristown, New Jersey, praised the BARDA effort as essential, adding that if 10,000 ventilators seems like a small number in the COVID-19 crisis, it had to be understood in the context of government officials’ typical unwillingness to buy equipment it might only need in an emergency.
“They could have bought a million ventilators,” he said. “And then you would be writing about the boondoggle of all these devices that never got used.”
Today, the government’s failure to obtain the Trilogy Evo Universal is seen by some experts as the real game changer.
“Even if a few months ago we had taken dramatic action to develop these kinds of ventilators, it would have been better,” said Hick, the emergency medicine specialist in Minnesota. “If I had a ventilator that cost $4,000 rather than $16,000, I’d be in better shape. We can buy a lot more of them.”
Claire Perlman contributed reporting.
Shuja HaiderThe disparity in who has access to coronavirus tests is just the beginning.
The post Covid-19 Shows America’s Class Divide Is Untenable appeared first on The Nation.