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The White House faces alarm as the U.S. president's valet and vice president Mike Pence's press secretary tests positive for the coronavirus. The cramped quarters at the White House and lack of the recommended social distancing at meetings of the U.S. president, most of the meetings being conducted maskless, are also cause for concern. 

Admiral Gilday of the Joint Chiefs will quarantine for one week. Self-isolating for 2 weeks are Dr. Fauci, Dr Redfield head of the CDC, and Dr. Hahn head of the FDA.

A senior economic adviser to president Trump, Kevin Hassett, says on CBS television program "Face the Nation" that it is scary to go to work now.

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President Trump accepts the Republican nomination at a White House event resembling a rally.  His focus remained on the economy and putting America first.

Many of the 1500 people at the White House gardens did not wear masks. The WSJ report says not every attendee was tested for coronavirus.  The WSJ also says this was an unprecedented use of the White House as the lectern for the president was set right on the South lawn facing the White House. The speech was followed by a performance from an opera singer and a fireworks display over the Washington Monument. 

 

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The White House event related to the nomination of Amy Barrett to the U.S. Supreme Court that reports suggest may have led to President Trump's infection with the coronavirus. The Rose garden party was attended by guests being at close quarters and many maskless with guests later entering the spaces inside the White House. As a result many of the people in the upper echelons of the Trump administration are now infected with the coronavirus as reported here in The Times. Many testing positive include a University president (Notre Dame), Senator Mike Lee, and others.

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The head of the U.S. Department of Health and Human Services, Mr. Alex Azar, repeatedly assured the president as early as January 29, that there never had been a better interagency response to coronavirus, says the WSJ. This WSJ report says based on interviews with administration officials and others that Mr. Azar waited for weeks to brief the president on the threat from coronavirus, did not coordinate effectively across the health divisions,  failed to ramp up testing development, and oversold what had been done. Testing is one of the key issues raised at this time about the coronavirus effort. Mr. Trump tweeted on April 12 that Mr. Azar "told me nothing until later." The president was dissatisfied with Mr. Azar's handling of the flavored e-cigarettes ban. This report says Mr. Azar was slow in working with other agencies such as FEMA, and in involving directly the FDA, CDC, and other agencies, to create a strong and effective response to a fast developing public health crisis of enormous proportions. In February White House advisors were critical of Mr. Azar for delays in the testing program. As the delays progressed this report says Mr. Pence and the White House gave more responsibility to FEMA, and Dr. Hahn and CMS's Ms. Verma were made active members of the White House Task Force. FEMA also played a bigger role with greater funding.    ...

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Coronavirus testing is being ramped up in the U.S. as the Food and Drug Administration new regulations allow commercial labs to manufacture and distribute  coronavirus tests. Now many players can now acquire and conduct tests including state and local governments, hospitals, universities, and private companies. so that tracking nationwide distribution is still difficult. Deborah Brx the response coordinator of the White House task force on coronavirus says U.S. has completed 220,000 tests in last 8 days.  In New York the scaled up efforts in a region with over half the coronavirus cases in the U.S., 13,000 were tested on Monday, March 23. Some hospitals in New York such as Mount Sinai expect to do double or triple the tests a day in a scaling up effort by March 30. In Los Angeles a city councilman negotiated with a South Korean company for delivery of 100,000 tests a week, having already secured 20,000 new tests. Additionally swabs and protective equipment are also needed to conduct tests and labs need to process results with speed. ...

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President Trump has listened intently to Dr. Fauci and Dr. Brx of the White House team led by Vice President Pence, as he shapes policy decisions on tackling the epidemic. The White House team met again March 30 to see the data  about the coronavirus impact without lockdown and strict social distancing measures extended to April 30. Following this Mr. Trump extended the lockdown till April 30, 2020. This WSJ report shows how Mr. Fauci has forged a relationship with the president at a time of public health crisis. Dr. Fauci wins the respect of Democrats and Republicans, and the American people for the work he has done against epidemics, the valuable experience gained and how he is bringing this experience to the current crisis. It is also true that this is a team bringing different strengths and with mutual respect for each other- the calm demeanor and grip on data of Dr Brx, the experience of Dr. Fauci fighting epidemics for 30 years, the patience and hard work of Vice President Pence, and the president's fighting spirit and listening skills. ...

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Mr. Trump sees jobless aid and stopping evictions a top priority but negotiations with Democrats are not moving forward.

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How is it that Britain's regulatory agency approved the Pfizer vaccine before the U.S. FDA agency? This report in the NYT says FDA looks at the raw data. Britain's Medicine and Healthcare Products Regulatory Agency looks at the information provided by the company. It still does the testing batch by batch and has access to the data and looks at thousands of pages of data. What about the European Union? The European Union Medicines Agency meets on December 29. It takes days after it meets to get input of 27 countries so that vaccination cannot start till January. The U.S. president summoned the FDA to the White House to find out how soon the FDA could act. Both Britain and the U.S. are feeling the impact of the second wave of coronavirus.

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Dr. Antnony Faucci has been at the forefront of every major medical crisis from SARS, swine flu to ebola virus. He is credited with convincing president Reagan of the dangers of HIV. He is now at the forefront for coronavirus. 

In daily briefings he is present answering questions in the White House Brady Room with president Trump, vice president Pence and Deborah Brx the response coordinator.

For 32 years he has taken on each challenge of increasing public awareness of dangers in public health crises, meeting controversy along the way. 

He is son of Italian immigrants and helped his father in a Brooklyn, New York,  pharmacy. 

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Every day lost in the struggle with coronavirus is a big thing, which is why Itay's most affluent northern region has gone from being well equipped with resources of healthcare to seeing the health system overburdened to the point of disaster. This WSJ report shows why this has a lesson and an early warning for how the U.S. and other countries should design their response. It is also why the White House team that includes President Trump in the U.S. emphasized the plan for just the first 15 Days in the news conference at the Brady Room in the White House on March 16. It is saying the first 15 days are critical, not a day to lose.  It does not matter if you are an advanced economy with state of the art hospitals. Social behaviours must change, old rules rewritten and implemented throughout nations, quickly in days. Here WSJ shows lessons learned by Dr. Cereda at the Hospital of the University of Pennsylvania who trained in Milan and was in constant contact with colleagues in Milan and elsewhere. Many of the lessons relate to not overburdening hospitals and health systems and protecting health systems. This means mild to moderate cases are managed from home and not in the hospital, through massive deployment of outreach services and telemedicine. It means therapies can be delivered at home or through mobile clinics. The second major lesson from Italy is to protect healthcare workers and doctors. The entire White House team with Dr Faucci of CDC and Dr Brx, head of Infectious Diseases in the U.S. news conference of president Trump March 16, focused on the goal of protecting healthcare workers, doctors and hospitals, so they remained strong to take on the crisis. The second goal of the White House team is to protect the elderly with medical conditions. To do this only the most serious patients are treated in hospitals the rest for mild to moderate at home.  Studying the conditions in Bergamo and other parts of Lombardy and northern Italy, is helping U.S. medical leaders to prepare for the current nationwide effort, the 15 days plan announced by the White House. The lessons from the Papa Giovanni Hospital in Bergamo are important say U.S. medical leaders, including Dr. Brendan Carr, head of emergency medicine at Mount Sinai Health System in New York.  He says build capacity in hospital beds before we need it. Clear out hospital space and add new hospital beds.  ...

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 Frustration has grown with the poor early management response from U.S. Health and Human Services Secretary Alex Azar, says WSJ.  The president responded at one point with a tweet that "he told me nothing until later." The WSJ looked into Mr. Azar's missteps in a report recently. The president is considering replacing Mr. Azar says WSJ. Ms. Verma the head of Medicaid and Medicare Services is being considered. She has worked closely with vice president Mike Pence throughout this crisis. Mr. Azar served as HHS general counsel and later deputy secretary under president George W. Bush. He then worked as lobbyist for Eli Lilly.  This WSJ report says Mr. Trump called Mr. Azar on his flight from India to Washington, and the next day replaced Mr. Azar as head of the White House coronavirus task force with Mr. Pence. The president says repeatedly that vice president Mike Pence, as head of the White House task force has worked night and day round the clock to guide the effort- including talking to 51 state governors, coordinating the entire effort, and providing the president with reliable advice. In the depths of this crisis never has so much depended on so few- on vice president Pence, a former governor of Indiana, Admiral Polowczyk, Dr. Birx, Dr. Fauci, and the governors of states worst affected by the coronavirus. ...

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Deborah Brx, head of the White House coronavirus task force, says 60% of all new virus cases in the U.S. were coming from New York. 

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The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...

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This report shows the level of coronavirus testing as of March 27, 2020 in different states in the U.S. The U.S. testing program and supplies of tests are being ramped up quickly. About 65,000 tests are being done on Americans each day. The need is for 150,000 tests a day say public health officials. Testing is slow in California compared to aggressive testing in New York which has 60% of all coronavirus cases. California with twice the population of New York has done 77,000 tests compared to 122,000 in New York. Texas has done only 21,000 states by comparison. Every week new testing technology is being developed in different labs, medical companies, and universities. Including tests that can be conducted quickly and not requiring health workers or health workers with protective gear. Speed of processing test, least point of testing contact, and the protocol for quarantine, are all part of the testing and isolating of clusters mechanism to tackle the virus. This is critical in the coronavirus action plan being developed by Dr Brx of the U.S. White House team. ...

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This editorial in the WSJ commends Congress for the $2 trillion U.S. aid package for households, small business and large corporations to keep workers on payroll, and aid to hospitals. It also commends the Federal Reserve for swift action to maintain liquidity in all corners of money markets. It was important to prevent a run on money market funds and municipal bond funds. The U.S. Senate bill adds $454 billion for Treasury that can support further Fed action if needed. This has also resulted in a recovery in the stock markets. The editors of WSJ caution Treasury from intervening too far up the risk curve to help companies that had overleveraged themselves with risk before coronavirus hit. It makes clear that the U.S. central bank the Fed should only offer liquidity against good collateral to companies that were healthy before the shock. As president  Trump never tires of telling listeners to his daily briefings from the Brady room in the White House- Boeing and the airlines were healthy before coronavirus hit. It was not their fault that coronavirus hit so suddenly. These companies deserve government help, says the president. By making the distinction between otherwise healthy companies and companies that overleveraged themselves on their own, the Fed, Treasury, and the U.S. government can get more bang for the buck. The WSJ editorial also says there is a bit of good news in the behaviour of politicians, media and the public in the way they are ignoring the trivial politics and self-centred behaviours, including indiscriminately being critical of the president, and focusing on the important matters that affect all our lives.  ...

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With U.S. crossing the 300,000 mark in infections on April 5 the country enters a new and critical phase in the fight against the global pandemic. Globally cases of infections jumped by 100,000 for the first time to 1.2 million. Health experts say the next 2 weeks are critical for winning the war against the global pandemic. White House coronavirus response coordinator Deborah Birx urges people to isolate themselves, avoiding even the trips to the grocery store or the pharmacy. Models show the infections peaking in New York, Detroit, and New Orleans in the next 6-7 days Birx says. In Europe the pandemic may be reaching a peak in Paris area and eastern France. High speed trains transferred patients from eastern France to western France as the fight continues. In Italy and Spain strict containment measures are now bringing in results with rate of infections increasing by less than 5% from the previous day. Daily deaths are less and pressure on hospitals is beginning to ease, with number of patients in intensive care decreasing. Queen Elizabeth II will address the British nation in a prerecorded address, the fourth one in seven decades of her reign, to thank health care workers. ...

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What is behind the anti-vaccine movement in the US? This NYT report looks at some of its unlikely origins- the anti-vaccine efforts of Robert Kennedy's son, Robert Kennedy Jr.. Mr. Kennedy is planning to run against Mr. Biden for the White House. Kennedy's opposition to vaccine's is traced back to his getting involved in cases as an environmental lawyer. Parents who had intellectually disabled children from other chemicals asked Kennedy to look into vaccines. Around 2010 Thimerosal, a mercury based preservative which been used for many years to prevent bacteria from growing in multiple dose vials of vaccine, was suspected to cause autism.  Already by 1999 the American Academy of Pediatrics, federal health agencies and pharmaceutical manufacturers agreed that thimerosal should be removed from childhood vaccines.  Yet it is still used, says this report.  This led to Mr. Kennedy's getting into vaccines in general by the time of the pandemic. He had a book out that was critical of Dr. Faucci, during the pandemic. Mr. Kennedy cautioned about the unintended effects of vaccines. He has another book out called the Wuhan Coverup that looks into the origins of the coronavirus. It refers to research conducted at the Wuhan Institute of Virology that was funded by the US. Mr. Kennedy believes that more transparency is needed on decisions made in the health care sector, and that critical views need to be aired for the public to be able to decide the right course of action. Vaccination is generally supported by people in America though there is a subsection of people who have concerns about side effects. On issues outside of vaccination there is a sense that America's health sector needs more transparency.     ...

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Mr. Trump says he will wear a mask on a visit to soldiers at Army's Walter Reed Hospital. Trump says its "a very appropriate thing. I have no problem with a mask." As cases hit 3 million in the U.S., close to 1 million in India and Russia, Mr. Trump joins the movement for masks worldwide. Early on Mr. Trump  took up the issue of transmission from Wuhan by banning flights from China, failed to get WHO and China to respond quickly to the pandemic requests from U.S. by providing information and allowing a team to visit Wuhan quickly in January. A stumbling block appeared within the health ministry in the U.S. with poor leadership which Trump had to overcome by relying on Vice President Pence to lead the stop coronavirus team at the White House.   Trump's reopening decision came under criticism and he says he had to balance the damage to jobs and economic well being that also affected health. Some of the states and young people responded in ways that led to public gatherings that have led to surges in the south and the western states such as Calfornia. The WSJ reported that in Los Angeles County on June 20 half a million people went to bars after they reopened, showing that culturally even counties in states like California lacked what is accepted good sense. For instance Tokyo bars were paid by the Japanese government not to reopen, according to one report. By wearing a mask Trump is simply acknowledging facts about transmission - a German study shows 40% reduction in cases with face coverings. ...

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The contrast between lack of effective measures taken in the Lombardy region with the aggressive action in Veneto that has proved effective. Veneto followed the method of quarantining, mass testing for clusters and isolating the affected people.  The Italian government took the first steps to close off northern Italy Feb 22, and it was not till March 10 that a nationwide lockdown was done. The action taken in the Veneto region is shown here in this WSJ report with the town of Vo as an example of steps taken that worked. A microbiology professor and infectious diseases expert at the University of Padua, Dr Crisanti, developed a test for the coronavirus as early as mid-January using the information made public by Chinese doctors. Dr. Crisanti oversaw the testing of 95% of residents of Vo, a town of 3400 people in Veneto region. He found 3% of the population was infected, with half testing positive asymptomatic. Following the aggressive lockdown the tests were done two weeks later and the rate of infection had fallen to 0.1% with only 8 new infections. "The main lesson from VO is that when you have a cluster of infected people, you should do a very aggressive lockdown and then test as many people as possible," Dr Crisanti says. The results from Vo led to Veneto increasing testing in the rest of the region carrying out 80,000 tests, compared to 88,000 in Lombardy, with double the population and 5 times more infections. Lombardy followed government directives to test only those with symptoms. When it spreads it is harder to do the test isolate clusters, test isolate clusters, in a continual loop, yet this remains the method cited by Dr. Brx in the U.S. today as the right way to target clusters in a laser approach. In yesterday's briefing at the White House Dr Brx said this is a method the U.S. is familiar with and has used in Africa to tackle HIV, Ebola Virus. It is possible using GPS to target down to a specific clinic in a specific place, which is how it was successfully done in Africa. ...

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The Biden vaccination target of 70% of American adults at least partially vaccinated with one dose by July 4, 2021 remains elusive as vaccination rates have dropped. From a high of 2 million a day vaccinations have dropped to 400,000 a day during the first week of June 2021. Vaccination skepticism particularly in the south and western part of the US is making it harder to vaccinate the rest of the US population. This poses increasing risks as the new variants of the virus such as the Delta variant found in India, and now the most widely prevalent strain of virus in the UK, remain a serious problem. The unvaccinated population in the US is too large for any degree of safety in numbers vaccinated. Consider that at the press briefing given by the White House on June 3, 2021, only 28 states out of 51 states have fully vaccinated 50% or more of their population. There is a large variation between different states with states in the south such as Mississippi as low as 34% at least one dose and a similar situation in Alabama. In Arkansas, Georgia, Carolinas, and Louisiana  it is higher at about 50% with at least one dose. Even these figures are deceiving as in some parishes in Louisiana only 20% have even one dose. Studies show that only after the second dose are enough antibodies released to protect well against coronavirus. This is why vaccine experts at Baylor College of Medicine cited in NYT foresee a second wave in the southern US because of the South so underachieving in the case of vaccination.  ...

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In the meeting in the Oval Office Biden and Modi had this to say about India US relations. Modi called it a "transformative" decade. Mr. Biden called it a "new chapter" in ties, taking on tough challenges in coronavirus vaccines for the rest of Asia outside India and China, tackling climate change, and ensuring rule of law in the Indo-Pacific region.  Biden's view- "I think that the relationship between India and the US, two of the largest democracies in the world, is destined to be stronger, closer, tighter, and I think it can benefit the whole world." A look at the US under the Biden administration shows a US that is very different from that of the US in the period of presidents since Harry Truman when he met Jawaharlal Nehru at the White House in October 1949. Biden sees the US needing renewal of its infrastructure, reviving worker incomes and families, regaining its leadership of the free world, for its role and place in the world. Throughout the period 1949 to 2020 for 70 years India was never seen as a modernizing nation of 1.2 billion people. For most of this period it lacked the good governance and speedy implementation of modernization of economy that is essential for a truly good relationship. By releasing the potential of the younger generation in a country where people under 35 years form the major part of the population, with good governance and development agenda, the Indian prime minister has changed the entire dynamics of the India US relationship. This is happening in the way China had done in its relationship with the US after 2000 by modernizing the country. India is now the country with huge potential and the country the US sees as helping it build its own role and place in the world. The sheer size of India and its population with countries around it in the east such as Bangladesh, Indonesia, Malaysia and Vietnam with shared values in south and southeast Asia bring together a population of close to 2 billion people much larger than China, to determine the direction of Asia.  This is the new chapter that president Biden has in mind, and it is also the "transformative decade" in the eyes of prime minister Modi as India finally puts behind it years of bad governance, and speeds up modernizing its economy.   ...

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Schools, shops, restaurants, cafes and offices are reopening and people are getting back to work and outdoors. What are the ways to reduce chances of getting the coronavirus and what is the latest advice from public health experts.  More attention is now being given by CDC and other experts to the aerosols, the smaller particles that are airborne that can spread the virus to people unawares in breathing, talking and singing activities. larger droplets come down to the ground, smaller droplets can be airborne for hours. This makes masks wearing very important, call it essential protection. Air filtration and proper ventilation is also important. What about social distancing? Experts now say 6 feet is good, 10 feet is better. This is from Joseph Allen director of the Healthy Buildings program at Harvard School of Public Health. No magic number but 6-10 feet or more is good for safety. Can one start expanding one's social circle? The fewer contacts the better says Dr. Allen. You can he says expand the circle but this depends a lot on how serious the other family is in taking precautions. Are elevators risky? If one can one should take stairs but do not board a crowded elevator unless the lobby is more crowded. Do not touch buttons, if you do use elbow or use sanitizer from your shirt pocket after pressing. This is where mask is essential. Here a tip is useful. Talking does not help as talking emits 10 times the particles than when you are quiet and this is true for small spaces such as elevators. Continual talk is not a good idea such as a long time spent talking, here watch that habit of getting into long conversations face to face.  Is it good to take a summer vacation. Here the answer is yes, as no one really knows how the winter will be. And remember outdoors is good for renewal of health, and one can look for places that are not crowded where the 10-12 feet or more can be easily done. One tip here is to take your own food and supplies from home so there is no need to go to crowded restaurants. Swimming in a lake or ocean is fine. Camping outdoors is fine and actually a good idea if you are with your own family. Try to use an empty restroom and one that is clean and wear the mask. While camping keep the 6-10 foot rule with people outside your immediate family, do not share food and drinks and try not to touch each other's supplies, and sanitize your hands or wash if you do. When hiking keep the mask in your pocket so you can wear it when you see others passing on trails. In hotels skip the cleaning service, in a rented property ask the owner to keep the windows open before you arrive, and put a day or two between your coming and the last person who rented the place. Renting a car is tricky allow a couple of hours to elapse between you and the last rental, open windows. Public restrooms. Always wear a mask many are poorly ventilated. Open the door without use of hands if possible,or use a paper towel to open and discard. Do not use air dryers. Is it safe for your house cleaning person to return. Keep the windows open to let in fresh air. Make sure your cleaner wears gloves. And all should wear masks. How to visit grandparents? Experts advise keeping visits outside and wearing masks when not 6-10 feet apart. Anyone not feeling healthy should avoid the visit. And bathrooms should be sanitized after people leave even wait a day if there is another bathroom. Experts advise against sharing food and buffet type meals. Ten feet distance is better than six feet. Can one use a gym? Here the advice is to exercize outdoors or at home if one can. It says be cautious unless your gym is limiting the number of people or spacing the equipment adequately. Ask about open windows, air filtration systems, ventilation.  This is excellent advice from experts with the latest information. Over the last few months from March to May most of the information was during lockdown, and a lot can be forgotten or seen as not necessary as things return to normal, as shops schools and cafes, office reopen, and cases remain steady and under control. Being vigilant is good for safely navigating this period through the summer and into winter till a vaccine is found. It is also about being a good civic minded person aware of one's own responsibilities, as when all take safety seriously and practice it everyday, it builds another layer of protection for everybody- because it creates a safer environment for all.     ...