Coronavirus Response: Live Story- March

Community Healthcare Network staffers unpack medical supplies in NYC on March 18.(Photo Courtesy of Community Healthcare Network)
By Noah Smith
https://www.directrelief.org/podcast-player/47666/coronavirus-response-a-live-story.mp3?_=1

This live story is no longer being updated. For the latest news, see this month’s live story at Direct Relief News.

For the latest case totals and donation data at a glance, be sure to check Direct Relief’s live updating map:

March 31 –

Chris Alleway, of Direct Relief’s Emergency Response Team, delivers N95 masks to Sansum Clinic in Santa Barbara, Calif. on March 31, 2020. (Direct Relief)

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Today’s shipments for Covid-19 support went out to clinics in California, Texas, and New York. Direct Relief also sent triage tent deliveries to Virginia, with more tents scheduled to be sent to Los Angeles County and locations in Texas.

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Latest totals:

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March 30 –  As of today, 829 of the 1,100 shipments to help support community health centers have been delivered or are in transit. Shipments have now been sent to 48 states and Puerto Rico. Centers in the two remaining states, Delaware and Alaska, have shipments pending.

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March 29 –  Direct Releif CEO Thomas Tighe on why Direct Relief has extended its network during this pandemic from community health centers to hospitals and other health care centers:

Because of the heavy demand for treating Covid-19 patients and the disruption of medical supply chains, hospitals have been unable to secure the medical supplies they need through their normal distribution channels,” said Thomas Tighe, Direct Relief President and CEO. “We are responding to the greatest unmet needs, which right now are in our hospitals as well as in front-line safety-net clinics.

In addition to hospitals, Direct Relief supplied PPE for some of the first drive-through Covid-19 testing sites to begin operation in California last weekend.

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Latest shipment totals in response to Covid-19:

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March 28 –  

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Shipments that left on Friday included those for health care centers in Maryland, California, Washington, New York, and New Jersey.

A shipment of roughly 3,000 pounds of PPE is also headed to the Ministry of Health of Bolivia in La Paz. 40% of Bolivians live under the poverty line. The government is tracking the pandemic here:

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March 27 –  From Direct Relief CEO Thomas Tighe, some insights regarding the commitment to support 1,000 community health centers:

If it’s a war, the safety-net facilities and staff are the frontline soldiers and key line of defense. Thankfully, they are extremely good at two critical things that are critical at this moment : (1) communicating public health messages in a culturally appropriate and effective way so they register to their 30+ million patients who trust and rely on them, and (2) keeping people, particularly those managing chronic health conditions, healthy and out of the hospitals to which they will otherwise go if their managed chronic conditions become unmanaged acute crises.

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March 26 –   Moovit, a transportation app, analyzed how Covid-19 has affected public transportation use.

As of today, Los Angeles has seen a 56% decrease in ridership and San Francisco is down 73% compared to pre-pandemic levels.

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March 25 –  The latest Covid-19 shipment totals from inside Direct Relief:

Four shipments left the warehouse today, bound for Santa Barbara Neighborhood Clinics, Rochester General Hospital (NY), and RKM Primary Care (LA). On deck for tomorrow are shipments for St. Joseph’s (CA), Ventura County Medical Center (CA), and Alameda Hospital (CA).

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March 24 – U.S. community health centers, which treat over 29 million residents annually, without regard to their ability to pay, are responding to the pandemic in different ways.  Like other Federally Qualified Health Centers, the Saban Community Clinic in Los Angeles has implemented a series of changes to help mitigate risks to patients and health care providers, while maintaining continuity of care– even as patient visits have increased.

To manage the increase in a pandemic context, Saban has moved 80% of routine visits to telephone or video calls. The remaining in-person visits are for all urgent care needs. Patients are also able to visit sites for the free shower program.

Other changes for the clinic system, which sees more than 100,000 patient visits per year, include more frequent cleaning, free delivery for pharmaceuticals, and waiting all co-payments for their self-pay and uninsured patients.

Dr. Armen Arshakyan, chief medical officer at Saban Community Clinic, pictured here on June 28, 2019, has seen an uptick of anxious patients with flu symptoms since the coronavirus outbreak began. (Noah Smith/ Direct Relief)

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March 23 –

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From the LA Times:

Amid pandemic, hospitals need medical safety gear. Here’s how you can help

https://www.latimes.com/california/story/2020-03-23/coronavirus-medical-safety-gear-shortage-how-can-people-help

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Latest update from inside Direct Relief:
12 shipments were processed today, bound for community health care centers in California, New York, Tennessee, and Massachusetts. Included in this shipment were hygiene products earmarked for people experiencing homelessness in Santa Barbara County.

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118 charitable video game streams are helping to support Direct Relief’s Covid-19 response. Among these are top tier esports organizations Team Liquid and Evil Geniuses as well as individuals. Check out all the streams here, hosted by Tiltify:

https://tiltify.com/direct-relief/covid-19-response/campaigns

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March 22 – From Andrew Schroeder, Direct Relief’s Vice President of Research and Analytics:

This graph is highly suggestive of the idea that cost of testing is driving the low confirmed case counts in many different parts of the world – essentially a near-perfect correlation between confirmed cases per million and GDP per capita – in other words, the richer your country is on average the more likely you are to have high totals of confirmed cases relative to size of population.

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March 21 – From Andrew Schroeder, Direct Relief’s Vice President of Research and Analytics:
This particular chart from Imperial College paper shows the uneven impact of Covid-19 by age groups, based on analysis of the case data from China.

(Neil M. Ferguson et. al./ Imperial College)

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March 20 – Airing on 60 channels across the US, a look into Direct Relief’s warehouse, and response to the acute needs of health care centers in the U.S., and around the world, in the midst of this pandemic:

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NBA x Direct Relief
Direct Relief is proud to be included in NBA Cares’s #NBATogether initiative.
Get more info by clicking on the logo:

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Yesterday, Direct Relief sent out 2 shipments to San Mateo County and Ventura County, with an additional 4 shipments scheduled to leave today for Santa Barbara Public Health, Stanford Hospital, Cottage Hospital, and the California Department of Public Health drive-thru testing sites in Northern California.

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A list of some of the items Direct Relief has been purchasing, in response to partner requests:

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March 19 –  Many experts put the United States 10 days behind Italy in the severity of the Covid-19 pandemic. The country has been one of the hardest hit regions in the world, with more than 3,400 deaths and counting. Hospitals have been inundated with patients requiring ICU care, challenging the capacity of the nation’s healthcare system.

Earlier this week, a group of Italian doctors briefed healthcare providers from across the world on the situation in their country. On this episode of the podcast, Dr. Hayato Kurihara speaks about how his Milan-based hospital, Humanitas Research Hospital, adapted to admit, and treat, a mounting number of critically ill patients.

https://feeds.soundcloud.com/stream/779245486-directrelief-italys-covid-19-crisis-a-glimpse-into-the-future.mp3?_=2

Listen and subscribe to Direct Relief’s podcast from your mobile device:
Apple Podcasts | Google Podcasts | Spotify

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Yesterday, Direct Relief sent 14 shipments to community health clinics in California and Massachusetts. An additional 15 shipments are currently in process, including one for California’s San Mateo County, which is currently under a ‘shelter-in-place” order. Key items in these shipments include N95 masks, gloves, and disinfecting wipes.

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Twitch and PayPal are helping respond to the coronavirus pandemic, with Direct Relief as a featured charity.

Click the logos for more info:

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March 18 – Direct Relief this week is shipping 250,000 N95 masks and other personal protective equipment (PPE) to as many as 1,000 community health centers and free clinics in all 50 U.S. states that are playing a critical frontline role as Covid-19 spreads.

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Full story here.

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The latest coronavirus shipment totals:
Yesterday, Direct Relief sent 20 shipments to partner clinics in California, Washington, Massachusetts, Puerto Rico, and New York.

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Highlights from yesterday’s podcast episode featuring Leighton Jones, Director of Emergency Response & New Initiatives, US. Jones discussed how this outbreak differs form other disasters he has worked on, how Direct Relief prioritizes requests, and heroism in the midst of a pandemic.

I think for this one, as we’re all seeing, the disaster keeps increasing every day as we are responding to it.

A priority at Direct Relief is health care worker safety. We want to make sure that healthcare workers are protected themselves as they are treating and testing and triaging patients with symptoms, signs, confirmed cases… the challenge is there are many health care workers in America and around the world need personal protective equipment. They currently either don’t have or their supplies are dwindling hourly, daily through this response…they’re really concerned that they’re not going to be able to continue treating patients and serving their community.

Just today, we’ve seen a number of health centers who are actually worried they’re going to have to reduce services and even maybe close their doors because they can’t continue to protect the health care workers.

We are going to see it in the next few days and weeks where healthcare workers are going to become our national heroes because they are standing up and really on the front lines of tackling this outright.

Listen to the full episode here:
https://feeds.soundcloud.com/stream/777857533-directrelief-responding-to-a-pandemic-heres-what-it-looks-like.mp3

Listen and subscribe to Direct Relief’s podcast from your mobile device:
Apple Podcasts | Google Podcasts | Spotify

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March 17 – Since January, Direct Relief has been equipping healthcare workers with personal protective equipment to keep them safe while treating COVID-19 patients. In total, Direct Relief has shipped 30,000 pounds of personal protective equipment and nearly one million N-95 masks to health centers, clinics and hospitals impacted by the coronavirus outbreak. But as infections soar and stockpiles dwindle, allocating these scarce resources becomes a challenge.

On this episode of the podcast, we speak with Director of Emergency Response, Leighton Jones, who is responsible for managing Direct Relief’s stockpile of emergency medical supplies and equipment. We discuss how his team decides where to send supplies, and why, as health facilities across the world confront an ever-expanding public health crisis.

Listen to the full episode here:
https://feeds.soundcloud.com/stream/777857533-directrelief-responding-to-a-pandemic-heres-what-it-looks-like.mp3

Listen and subscribe to Direct Relief’s podcast from your mobile device:
Apple Podcasts | Google Podcasts | Spotify

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Direct Relief was featured on CBS This Morning today:
https://www.cbsnews.com/news/coronavirus-pandemic-threatens-hospitals-stretched-thin-medical-supplies-n95-masks

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Some updates on the latest news inside Direct Relief:

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Highlights from yesterday’s podcast episode featuring Andrew Schroeder, Direct Relief’s Vice President of Research and Analytics:

…a lot of what we’re going to see in terms of detected transmission in the next week is basically the result of infections that have already happened. So we need to be prepared to move those resources forward as quickly as possible. And that includes potentially setting up new areas where COVID patients can be isolated, where they can be treated, and where we can try to keep health workers safe from infection.

We’re having to rethink on the fly how our health systems are set up to be able to respond to these new cases.

I wouldn’t say that we’re definitely going to be overwhelmed. This is why the next five days are absolutely of critical importance and everybody that can focus on this needs to go into laser focus on making sure that we don’t get overwhelmed.

…about 13% of total cases are represented in the data that has been reported out thus far. So you can multiply that out to kind of get a sense of what probable, although not definitively known, total cases in the population might be.

Listen to the full episode here:
https://feeds.soundcloud.com/stream/777184486-directrelief-social-distancing-do-it.mp3

Listen and subscribe to Direct Relief’s podcast from your mobile device:
Apple Podcasts | Google Podcasts | Spotify

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March 16 – As the COVID-19 outbreak graduates to pandemic status, United States public health officials are urging individuals to practice social distancing. Schools have closed, social gatherings have been canceled, and employees are being asked to work from home. While Americans grapple with the implications of a pandemic, health officials are advocating for drastic measures to prevent the American health care system from becoming overwhelmed.

On this episode of the podcast, we speak with Direct Relief’s Vice President of Research and Analytics Andrew Schroeder who has been tracking social distancing using population data. According to Schroeder, the U.S. is at a tipping point:

“A lot of what happens for the rest of the year will actually be decided in the next five days.”

In this episode, we discuss the projected impacts of the COVID-19 pandemic and what can be done to mitigate the most severe effects.

Listen to the full episode here:
https://feeds.soundcloud.com/stream/777184486-directrelief-social-distancing-do-it.mp3

Listen and subscribe to Direct Relief’s podcast from your mobile device:
Apple Podcasts | Google Podcasts | Spotify

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A dispatch from Dr. Bert Green, a retired cardiologist based in Seattle. Washington has seen the highest death toll in the U.S. so far from COVID-19, with at least 48 deaths. Dr. Green is currently in self-quarantine after being in contact with a friend who was exposed to the virus.

In conversations with Direct Relief both today and last week, Dr. Green called for a paradigm shift in how both government and individuals are approaching the pandemic, due to the severity of both what he has already seen and what he believes is likely to occur.

He also noted that Seattle is among the wealthiest cities in the U.S. It has excellent and extensive medical facilities and has a high concentration of public health researchers, universities, and infrastructure. With that array of resources, it may be among the best equipped and well-resourced places for an outbreak to have occurred. Nevertheless, the effects of the outbreak have been fast and far-reaching, leaving uncertainty, and concern, in its wake.

Hospitals are pretty maxed out already. There are no elective surgeries, like knee replacements, hip replacements, and they’re not doing things like colonoscopies, screenings, it’s all shut down. Nurses and doctors, they’re in the trenches, on the front lines.

There are sick patients in intensive care units that need stuff done and coronavirus is just making it really, really difficult.

We haven’t mobilized the strength of this country, and industry, like we did in World War II, and that’s what we’re going to have to do. In my lifetime, there is nothing that comes close to this, and we’re not even close to seeing its full impact. This is the lull before the storm. I think there will be a tidal wave.

Most hospitals run at 70% capacity, otherwise, they can’t financially stay open. There are about 65,000 ICU beds and 985,000 hospital beds [in the United States]. So if 30% of beds, at most, are available, there would be about 295,000 hospital beds and about 20,000 ICU beds available.

On life in Seattle:

What you’re seeing, this surge of people going to the store and the shelves being empty and stuff like that, we went through that, there’s significantly less of that now because people have stocked up a lot of stuff. The same thing with pharmacies, we saw an initial rush of people trying to get their prescriptions filled.

The streets are empty, there is no traffic, you don’t see people out every much and I think we’re just sort of, right now, in a lull. There are neighborhood digital bulletin boards with people saying “I have a car, I’m glad to run errands for people who don’t, or for those who are elderly.” Some teachers are volunteering to teach kids who are at home.

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Direct Relief’s latest shipment of requested medical aid to community health facilities in the United States rolled out of the warehouse today, in support of health care providers working to provide care in the midst of the coronavirus pandemic.

Personal protective gear, including gowns, gloves, masks and hand sanitizer were included in one of several shipments that departed Monday. Health care facilities included MultiCare Health System in Tacoma, Washington, and Neighborcare Health in Seattle, Washington.

Washington has been the hardest-hit U.S. state, with at least 48 deaths from COVID-19. Direct Relief has sent shipments to 33 U.S. partners as part of the response to coronavirus.

Shipments of requested medical aid depart Direct Relief’s warehouse on March 16, 2020, bound for health care providers in the United States. (Tony Morain/Direct Relief)

Supplies included personal protective gear, such as gowns, gloves, masks and hand sanitizer. (Tony Morain/Direct Relief)

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March 15 – A exclusive dispatch from Direct Relief partner Drew Kabbe on how the coronavirus outbreak has impacted refugees and internally displaced people in Iraq and Syria:

I have spent the last few weeks in Iraq and Syria delivering critical medical supplies on behalf of Direct Relief as the coronavirus epidemic has spread.

In the Kurdistan Region of Iraq, where 1 in 5 people are a refugee or internally displaced person, the impact of this coronavirus outbreak crisis is far more severe.

Iraq neighbors Iran, which is one of the worst-affected nations. As a result, Turkey, the only country that supplies the Kurdistan Regional Government (KRG), has closed the border. Even though the border closure does not include goods, there are still a lot of downhill effects of these measures, and goods are not all passing normally– especially pharmaceuticals, which are more complex and regulated.

Now that the virus has captured the zeitgeist of the world, the KRG is reacting in many of the same ways as other democracies. The public outcry has government reacting, shutting schools, all government offices, and even roads.

The KRG was already struggling to deal with basic life support needs. Preventing the spread of the virus is a top priority, but not the only one. The coverage in the West dominates the conversation, and the rest follow. The differences here between the haves and have-nots becomes clear.

If you are dying from a preventable illness, any disruption in the supply line is fatal and many of the measures governments are taking are disrupting supply lines in a major way.

This can lead to many preventable deaths.

As health care providers worldwide deal with this crisis, a serious effort must be made to keep these vital supply chains functioning. The work that Direct Relief does in these regions saves lives. This work must continue.

Brothers Drew and Dave Kabbe are the co-founders of Culture Shock Productions, a media production company, and regularly travel to areas of humanitarian crisis to assist with aid distribution.

Dr. Lazgeen Jamil unpacking supplies at a Department of Health warehouse in Duhok, in the Kurdistan region of Iraq. ( Photo Courtesy of Culture Shock Productions)

(L to R) Dr. Lazgeen Jamil, Pharmacist Mr. Ishmael, Dr. Hozan, who works for the Kurdistan Medical Control Agency, and Drew Kabbe at the airport in Erbil. This team received the medical supplies and handled customs. (Photo Courtesy of Culture Shock Productions)

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Direct Relief’s VP of Communications, Tony Morain, on personal responsibility in this outbreak:

Everyone is a responder in this crisis, in one way or another, whether it’s protecting their family or themselves,” Morain said. “In the worst of times, we see the best of people.”

Read the article in Marketwatch:
https://www.marketwatch.com/story/everyone-is-a-responder-in-this-crisis-heres-where-you-can-donate-and-volunteer-2020-03-15

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From NBC News, a report on how U.S. community health centers are responding to the pandemic, and the challenges they are facing:
https://www.nbcnews.com/news/us-news/they-re-treating-uninsured-americans-coronavirus-ramps-money-running-out-n1157496

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Andrew Schroeder, Direct Relief’s VP of Research and Analysis:

This document is well worth your time to read. It’s very, very sobering in terms of what the expert epidemiology community is now predicting for Covid-19 in the US.

Hospitalizations are not expected to peak until May and there is exponential growth predicted between now and then. It’s likely that only 13% of cases have been detected:
https://works.bepress.com/mcandrew/1/

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March 14 – An illuminating report from Reuters outlining how one person’s actions can spread the virus to hundreds of people. From the article:

…South Korea managed to avoid a major outbreak with only 30 people contracting the virus, despite many interactions between those later confirmed as being sick and hundreds more people being identified as contacts of the sick patients.

This changed with the emergence of “Patient 31.”

In only a matter of days, those numbers had soared as hundreds of people at [Patient 31’s] Church and surrounding areas tested positive.

Read the story and check out the graphics here:
https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html

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March 13 – An analysis from Andrew Schroeder, Direct Relief’s VP of Research and Analysis, on the status of the pandemic in the United States:

Based on the successes in South Korea, Singapore, Hong Kong, and China (outside of Hubei), four key elements are necessary to combat the spread of the disease: mass testing, social distancing, public hygiene, and a surge of medical resources.

There is no time left to lose at this point.

Modeling the case count and trying to see how big of a problem this is going to be is an irrelevant question at this point, in terms of the most important actions to flatten out the case curve. The predicted scale is likely to be so large and so fast, that the focus is now on mitigation.

There needs to be a sudden shift in mindset and practices. The country is still all too much in the mode of following normal processes and habits, which seems like a problem when I’m being told by highly reputable folks that we are likely to have an overwhelmed U.S. hospital system in about 10 days. We’re painting too rosy of a picture.

Fatality rate is not the central problem. What we face, based on the research in Wuhan and driven home by the current situation in Italy, is that if you are not responding fast enough, and in the right ways, the ways that we have seen work in South Korea and Singapore, you are going to be too late.

There is a big difference in response to this disease between being just slightly too early and just slightly too late. Japan and South Korea were early with mass testing. South Korea was running 10,000 tests per day with 50 cases.

However, South Korea is what happens when you have mass tests, social distancing, public hygiene, and a surge of medical resources in a timely fashion. The fatality rate is 0.9% in South Korea and in China, outside of Hubei.

If you don’t get the tactics lined up right away, then you waited too long; and this becomes then just a problem of exponential math meeting somewhat fixed resource constraints: there are only so many ICU beds in the country and so many ventilators in the country. Italy and Wuhan are what it looks like when you are too late and you don’t come at it with those four combined factors that worked in South Korea. Basically, what happens is cases multiply at an exponential rate, health systems get overwhelmed, and extreme measures must be taken like what we see right now in Italy.

There is also a bifurcated case fatality problem, because countries that didn’t do those things are overwhelmed. You don’t have the ability to test fast enough and impose social distancing measures. Consider that 5% of cases require mechanical ventilation and being in ICU, the length of stay for patients that require intensive care is 2 weeks, and Lombardy, Italy has a 6.2% case fatality rate.

The U.S. is on the Italy path. Point blank. We are not testing enough – we are not doing any of the four things well. Social distancing is coming on now. We better double down on it. Even though it’s also coming online now it’s far too late– early mass testing has failed.

This is definitely not the flu– it’s far more contagious and far more virulent.

South Korea is the best case and it is 9 times as deadly as flu there. The worst case is several hundred times more deadly.

This is the biggest health crisis any of us will face in our lifetimes, potentially.

If this was an earthquake or hurricane, the humanitarian system would’ve kicked into gear already.

The good news is South Korea. This is not a mystery. We actually have a strong working example of a place that has beaten this. It’s a question of timing – move all at once, at scale, very fast – you don’t have a choice if you want to beat this.

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The latest shipment data from Direct Relief (as of March 12):

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Coronavirus Response: Live Stories by Month:

June

May

April

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