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

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

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

…

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

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

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

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

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

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

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

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

TTG

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

Comments

[Terence Gore]

Sorry to read your post and hope everyone fares well. Many nursing homes may be in the same situation.

https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/uchicago-medicine-doctors-see-truly-remarkable-success-using-ventilator-alternatives-to-treat-covid19

“The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it’s been fascinating and wonderful to see,” Spiegel said."

Possibly positive news.

[Laura Wilson]

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

[Pj20]

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

[turcopolier]

All

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

[turcopolier]

All

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

[Fred]

"The federal government dropped the ball… for several administrations."

Pray tell how that is now Trump's fault? What were the experts of the federal government doing since January of 2016 when he was inaugurated. Were Sally Yates, James Comey, LTC Vindman, "The super secret only Schiff knows his name whistleblower" et. al. just anomalies and all the other federal employees on the ball; except for the ones who dropped the ball - like NOT ordering PPE or NOT budgeting for PPE "for several administrations."?

"Trump should have invoked and used the Defense Production Act robustly in January ..."
Based on what, the impeachment hearing, the Speaker of the House showing great courtesy and concern by ripping up the SOTU speech transcript or just Fauci, who said just what? Oh, no need for a travel ban and his counterparts were saying - in that very timeframe - there was nothing to worry about.

"Every household could have been sent a dozen disposable masks with a note from President Trump ..."
Well that would have induced either some fatal cases of laughter or a panic, but by all means tell us just how you would have managed all this without the information that is avialable on April 24th but with only the infromation available in January, when it would have been politically impossible to do what you propose.

[JoeC100]

TTG -

I read a while back that the key supply chain issue with N-95 masks is that their essential core material is a synthetic spun fiber that we are completely reliant on China for sourcing. In addition. the machines that make this fiber are complex, quite expensive and there is no capability to quickly and significantly ramp up their production. Further they are challenging to set up and operate.

And for perspective, of the 200 million masks China currently makes a day, only 600,000 are N95 standard masks, used by medical personnel,

So yet another "essential supply chain" item for a critical health system need that simply can't be ramped up out of this air.

Hopefully some one in the Federal system is looking for all similar needs and working on a plan to facilitate onshore manufacturing.

Full (scary/sobering) details are at: https://www.npr.org/sections/goatsandsoda/2020/03/16/814929294/covid-19-has-caused-a-shortage-of-face-masks-but-theyre-surprisingly-hard-to-mak

I see this as a long term "lack of US preparedness" problem vs. something that could have been easily addressed if the administration had moved a couple on months earlier..

[JohninMK]

We have the same problems here in the UK. With people, mainly it seems like in the MSM, blaming the Government's leadership for the supply issues.

Ignoring totally the management of our respective national health organizations who knew, at the latest in mid January, that there was probably a nasty contagious problem coming down the tracks, that would, based on already clear Chinese actions, need more PPE than was on their shelves.

Bear in mind that, in the UK at least, hundreds of these NHS bureaucrats earn twice what a Government minister earns and a few twice the PM's salary. In both nations they have failed their people dismally, seemingly like rabbits trapped in the headlights. None will be punished of course for failure, they are just pleased that the Government steps up and takes the blame.

Then we have the academics and think tank personnel. All accepted as impartial and offering honest opinions based on state of the art models. Again the Governments take what they are offered as gospel and acts on it. Only to discover that the models are more of the garbage in garbage out variety, not fit for purpose. Then we find how much funding the impartial academics are receiving from potentially very interested parties, as there are $Bs at stake. In the UK there was a Pandemic 2016 exercise to check things out. Result everything in NHS under control. In the real world under four years later, a shambles. Did you have a similar last autumn?

The real heroes and heroines in this saga are the doctors, nurses and their support and ancillary staff who are actually at the sharp end. Many working in appallingly unsafe conditions. Hats off to them.

[turcopolier]

JoeC100

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

[JoeC100]

Col Lang -

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

[turcopolier]

joeC100

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

[turcopolier]

All

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

[mcohen]

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

[Bobo]

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

[The Twisted Genius]

Fred,

"The federal government dropped the ball… for several administrations."
"Pray tell how that is now Trump's fault?"

That's easy. Who led the last two administrations? Obama and Trump. Given the 2009-2010 H1N1 pandemic, Obama should have definitely improved our readiness in remaining six years in office. Trump had three years to fix what I'm sure he would view as one of Obama's failures. He didn't. Hence, they both dropped the ball.

[Terence Gore]

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

[steve]

Obama did have longer to refill the stockpile, but the economy was much, much worse under Obama. Trump has lead us to the best economic performance in US history so we should have been able to afford to refill the stockpile during the last 3 years.

We decided early that there wasn't going to be much access to extra PPE for quite a while. The US can tramp us production very much. No company is going to open up a new factory to make PPE for just year or two. Foreign countries will want to keep the PPE they can make, at least for a while. So we invented our own mask sterilizer. We are sterilizing our masks plus those of the local nursing homes and some of our local first responders.

Steve

[Fred]

TTG,

What is "The Resistance" and how did that affect Obama's terms in office and how is it effecting Trump's?

[The Twisted Genius]

Fred,

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

[BillWade]

TTG and JoeC100, Just wondering, what was more egregious:

President Trump comes into office and does not know of an inventory deficiency of N95 masks and similar.

President Bush comes into office and does not know of a planned attack on the United States of America.

[optimax]

Much of the federal stockpile of PPE sent to the states had passed their expire dates, 2010 for some, and was either useless or had to be repaired. I blame the failure on the person, or persons, charged with monitoring the wharehoused stockpiles. The president only knows what he's told. He can't micromanage the nation. He needs Jack Webb directing him to stick with the facts.

We have two groups of psychopaths vying for political power.

https://time.com/5815652/national-stockpile-medical-supplies-unusable/

[elaine]

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

[Jose]

Trump should have invoked and used the Defense Production Act robustly in January rather than waiting until March and April to weakly wield that executive authority. TTG

And if Obamacare did not impose a medical device tax maybe all these things would still be made in America.

Also, why did Obama-Biden-Fauci send $3.7 million to Wuhan to study Corona viruses, Fort Detrick, John Hopkins, Harvard-MIT, Satnford-UCSG-Berkely were to busy or not good enough?

[Philip Warren]

The Chinese Communist Party in January bought up all the PPE they could find in the US, Europe and Australia. My friend’s wife is a manager at the Home Depot in the Bronx and she she witnessed this first hand. The PPE was manufactured in the PRC, and they knew exactly where it was going abroad. They took this action not only for their own needs, but also to make it harder for the West to protect its medical community. The goal of this is to try they get their economy open while the rest of the world is locked down. Many people may not be interested in Chinese communists, but they are interested in you and your N95 masks.

https://nationalfile.com/video-chinese-woman-brags-about-buying-truckloads-of-facemasks-from-us-supermarkets/

https://en.wikipedia.org/wiki/Unrestricted_Warfare

[JohninMK]

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

This is the wrong mindset at work.