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--:-- Sean Rameswaram: It's Thursday, March 26th, 2020, and the Senate unanimously agreed on something. I'm Sean Rameswaram, and this is your coronavirus update from Today Explained.
--:-- Sean Rameswaram: 96 United States senators voted in favor of an 880-page, $2 trillion stimulus package late on Wednesday. We made an entire episode about what's included yesterday, but the big news for people earning up to $75k a year is checks for $1,200. The big news for wealthy corporations is a $500 billion slush fund. The House is expected to pass its own version of the bill tomorrow. After that, it's over to President Trump's desk for Sharpie time.
--:-- Sean Rameswaram: Unemployment numbers came in from the Labor Department today, and they were staggering in a history-making kind of way. 3.3 million Americans filed for unemployment benefits last week. For context, in well over a half century of collecting unemployment data, the highest number of claims ever recorded was something like 700,000 in October of 1982.
--:-- Sean Rameswaram: From grim to grim, more than 1,000 people have now died as a result of COVID-19 in the United States. New York is now reporting close to 40,000 confirmed cases, but keep in mind, the true number of cases is expected to be much, much higher. Louisiana has far fewer cases confirmed at the moment, something like 2,000, but the governor there says his state is experiencing the fastest growth of new cases in the world right now, potentially due to Mardi Gras festivities from a few weeks ago.
--:-- Sean Rameswaram: Meanwhile, the president continues his campaign to get the country back to business as usual. He tweeted on Wednesday, "The lamestream media is the dominant force trying to get me to keep our country closed as long as possible in the hope that it will be detrimental to my election success. So lame. Get in touch with Today Explained. Call 202-688-5944 with any questions about the coronavirus or email todayexplained at vox.com. Also, we are on Twitter at today underscore explained. I'm at Ramis Verum."
--:-- Sean Rameswaram: Support for this show comes from ServiceNow. AI is only as powerful as the platform it's built into, don't you know? That's why it's no surprise that more than 85% of the Fortune 500 use the ServiceNow AI platform. Didn't know that. While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI, connecting every corner of your business. And with AI agents working together autonomously, anyone in any department can focus on the work that matters most.
--:-- Sean Rameswaram: I've never met an AI agent. Learn how ServiceNow puts AI to work for people at servicenow.com. Support for this show comes from Strawberry.me. Be honest. Are you happy with your job? Or are you stuck in one you've outgrown? or never wanted in the first place? Sure, you can probably list the reasons for staying, but are they actually just excuses for not leaving? Let a career coach from strawberry.me help you get unstuck. Discover the benefits of having a dedicated career coach in your corner. Go to strawberry.me slash unstuck to claim a special offer.
--:-- Sean Rameswaram: New York City has become the center of the coronavirus crisis in the United States, and the hospitals there are nearing capacity. One general medicine resident at Elmhurst Medical Center in Queens told the New York Times the situation there was apocalyptic.
--:-- Sean Rameswaram: Dr. Calvin's son is an ER doctor in New York City who's been picking up shifts in emergency rooms across the city, kind of like a freelancer for matters of life or death. I asked him what life's been like during this crisis.
--:-- Calvin Sun: Usually I come in and there's stretchers lining down the block by EMS. or I walk through the waiting room and it's jam-packed. Probably all with presumed COVID-19 positive patients, all spreading it to each other, not really social distancing.
--:-- Calvin Sun: When I entered the emergency room, I already have an emergency room filled with stretchers in the hallways, outside the rooms. Most of the emergency rooms in New York City don't even have dedicated rooms with doors. It's essentially one giant room with curtains and patients only separated by curtains.
--:-- Calvin Sun: emergency medicine physicians and nurses and staff and PAs, mid-level providers, advanced care practitioners, nurses are all in the center. And we're all crammed in together in a small space. And we try to see as many patients as possible and doing our best to get people who don't need to be there out of the hospital as soon as possible.
--:-- Calvin Sun: So they don't infect themselves, right? The longer you're exposed to COVID-19, the more likely you're going to get it. So it's essentially think of like a burning building. And we're trying to get as many people out of this burning building before it collapses.
--:-- Calvin Sun: COVID-19 can be airborne. It's aerosolizable. You sneeze, you cough, or you intubate somebody. It then goes in the air and can survive in the air for three hours. And we are breathing in this air, especially under the context of not being provided enough protective personal equipment, like N95 masks, to be able to prevent ourselves from getting sick.
--:-- Sean Rameswaram: Let's talk more about protective personal equipment or PPE like those N95 masks you said you don't have enough of because there's been a lot of talk about shortages right? I mean, and these aren't fancy masks I bought a bunch at Home Depot last year do you have enough?
--:-- Calvin Sun: We're supposed to be switching out N95 masks per patient however there are so few N95 masks or just masks in general, that we have to use one single mask over the course of many days. Over many days?
--:-- Calvin Sun: Many days, yes. I've worn the same N95 mask for about five days before I was able to get a donation from my friends just recently. I was wearing my personal protective goggles that I had to steal from a bundle kit from another ER that I worked in. That was supposed to be a disposable goggles. I've kept that one for about eight to nine days until my brother gave me his goggles yesterday
--:-- Calvin Sun: And a face shield that was meant to be disposed with this plastic flimsy face shield that I got a week and a half ago I still have the paint wearing off on the front.
--:-- Sean Rameswaram: Wait, you're taking your N95 mask home with you? Like the mask that you use to protect yourself from all these patients who might have COVID-19?
--:-- Calvin Sun: Yeah, my stuff is right now is in the oven. Because just today, somebody said, well, if you don't have a UV light, which is one theory to disinfect old N95 masks, try putting it in a hot environment that's over 70 degrees Celsius or like 120 degrees Fahrenheit.
--:-- Sean Rameswaram: I'm guessing that this isn't conventional practice?
--:-- Calvin Sun: Yeah. Today was finally a fresh batch. But I'm still reusing stuff because I never know when it's going to run out again.
--:-- Sean Rameswaram: Is this just a you problem because you're kind of like an ER freelancer or are like the full-timers who work at these hospitals you go to every day going through this too?
--:-- Calvin Sun: No emergency room I know of in New York City has enough personal protective equipment for their entire staff on an unlimited or at least adequate amount for this pandemic.
--:-- Sean Rameswaram: This sounds bush league. I mean, are you telling me that you wear the same mask, same goggles, same plastic face shield all day in these hospitals dealing with COVID-19 patients and then take it home and go back to work and put that same stuff on again the next day?
--:-- Calvin Sun: Yes. For the last two weeks, I went in, was able to get a mask on the early stage of the pandemic. But seeing the writing on the wall, I decided to play it safe and then keep that mask after my shift instead of throwing it out. And, you know, rinse and repeat for the face shield and the goggles, anything I got was worth its weight in gold. And I kept it until just yesterday, I got a huge batch of personal donations from friends and family who came back to my apartment. They literally handed it to me and ran away, given what I'm exposed to.
--:-- Sean Rameswaram: And now I have a batch where I can give it to my staff members who've been starting to survive on the same mask in my situation. But only after I went on my social media for two weeks calling for help. It took two weeks. What could have happened those two weeks?
--:-- Calvin Sun: I could have been exposed. Other people couldn't be exposed. Thank God they came together. But it shouldn't be coming from them. And the doctors and nurses you're working with Are we using masks too? I mean, I used to bring donuts and coffee and pizza for my residents and PAs and nurses and nurse practitioners. Now I bring in masks.
--:-- Sean Rameswaram: Today or this morning, I brought in my donations from my friends. And oh my God, people were just taking two or three at a time, putting in their pockets.
--:-- Calvin Sun: Yeah. It's like a lottery that we don't want to play, but we're forced to play.
--:-- Sean Rameswaram: How long can you and your fellow doctors in New York keep this up?
--:-- Calvin Sun: I think if things don't change I think in about one or two weeks it may collapse. Collapse how we don't have enough beds we don't have enough ventilators we don't have any room patients will have to go outside and and then and then you're going to have to enact New York state's ventilator guidelines that they published on their website in November 2015. Health.ny.gov, I think, is public on the ethical decision-making that goes into deciding who gets to get a ventilator or breathing machine to live and who to get palliative, compassionate care without a ventilator.
--:-- Sean Rameswaram: Do you know how it works? Who gets to live and who dies?
--:-- Calvin Sun: It is impossible to expect every single clinician to unilaterally decide who gets to live and who gets to die. That's unfair because not all of us have that experience or training in rationing care. It goes to a committee and a committee of ethicists, you know, administrators and doctors takes in the clinical assessment that is provided by the people on the ground and then decides whether to get a ventilator or not.
--:-- Sean Rameswaram: We haven't crossed that bridge there. I think it is hospital dependent. And once we get to that point, I'll get a better idea of what the parameters are.
--:-- Sean Rameswaram: The governor of your state seems to be taking this pretty seriously. He's been asking for military intervention and more help from the federal government for a while now. But the president seems to be, you know, urging the country towards moving past this to having everyone in the clear by Easter.
--:-- Sean Rameswaram: I mean, if you could talk to the president today, what would you say to him?
--:-- Calvin Sun: I would say this is not your lane. You don't know what it's like to be in the trenches taking care of all these patients who are young and healthy, who may die from this, who have spread to other people. You don't know what it's like to come into the emergency room and know that automatically you're exposed to this virus that you can bring home to your family members.
--:-- Sean Rameswaram: So this is not something that you should comment on.
--:-- Sean Rameswaram: What do you most need right now?
--:-- Calvin Sun: We need the military. We need federal support, FEMA. We need disaster infrastructure to be put in place and build a new hospital from scratch with COVID-19 only patients with negative pressure rooms. You activate the millions and millions and millions of dollars that you get when you declare national emergency and you put those millions and millions and millions of dollars into building a hospital.
--:-- Sean Rameswaram: Basically anyone with COVID-19 gets the best care, the best clinicians all gowned up in hazmat, Tyvek bunny suits, head to toe. So we're all protected, taking care of these patients to best our ability, get enough ventilators to take care of the patients that need them and make sure nobody dies.
--:-- Sean Rameswaram: Then we develop a vaccine by then and then everyone becomes immune once we vaccinate everyone like we did with smallpox. We have the money for it. We have the resources for it. But does someone want to pull the trigger and activate all those things?
--:-- Sean Rameswaram: I sense a lot of reluctance because we have developed a habit of trying to find a way to cut corners. And that's how we got in this problem in the first place.
--:-- Sean Rameswaram: All right, Calvin. Well, I really hope you get it. I really hope you all get what you need to stay safe and keep other people healthy as well.
--:-- Calvin Sun: Oh, absolutely too. Because if we don't, in one or two weeks, the system will collapse. And I want to say that is that we will all get sick, right? A couple of my colleagues are on life support. I'm filling in shifts for fallen sick colleagues knowing that I might be next. And if there's enough of me who gets sick and it might be my turn, who's going to be around to take care of you? Who's left?
--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards. These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars. But with your rent, frequently you just pay month after month. You never get anything from it other than that roof over your head. Not anymore, says Built Rewards.
--:-- Sean Rameswaram: Built Rewards says it lets you earn points on your rent. By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more.
--:-- Sean Rameswaram: Your home isn't just where you sleep. It's your community and Bilt wants you to go out and do things in the community. You can eat at your favorite local restaurants, then earn more points. You can get VIP treatment at certain fitness studios. You can enjoy exclusive experiences just for Bilt members every month.
--:-- Sean Rameswaram: When you're ready to travel, they say Bilt points can be converted to miles or hotel points all around the world. You can earn points on rent and around your neighborhood wherever you call home by joining Bilt.com slash Explained.
--:-- Sean Rameswaram: That's J-O-I-N-B-I-L-T dot com slash explained.
--:-- Sean Rameswaram: Dr. Jim Hamblin doesn't practice medicine anymore, but he writes about it for The Atlantic. And way back in January, he published an article bluntly titled, We Don't Have Enough Masks.
--:-- Sean Rameswaram: Yeah, this level of pandemic has been modeled and warned about as a very real possibility. And yet our country did not invest in the preparation that would be required for it.
--:-- Jim Hamblin: And why don't we have enough of these masks to begin with? Don't we have like a stockpile or a reserve or something?
--:-- Sean Rameswaram: We're bad at preparation. We have a tough time allocating funds to potential problems, except for the military. We like to pay for huge military. But the stockpile was started as a way of saying, you know, if there's a biological warfare attack on the country and we run out of masks or antibiotics or ventilators, anything we could need in that scenario, we should have those kind of hidden away around the country.
--:-- Jim Hamblin: And then H1N1 hit, which was not an attack, but it was just an outbreak. And we went through a vast majority of our masks at that time. There was some restocking, but the warning sign that should have been there that said, hey, we almost used this all up. What if something much worse hit us that didn't make it home?
--:-- Jim Hamblin: And why these N95 masks? These are like surgical masks. Plus, carpenters use them. I use them when I'm cleaning my house. Like, what is it about them that's so essential to health care workers?
--:-- Jim Hamblin: These are the kind of masks that allow you to get right up in someone's face while they're coughing and put a tube down their throat to ventilate them and keep them alive, which is obviously a super high-risk scenario.
--:-- Sean Rameswaram: You know, I mean, we're being told to stand six feet away from somebody who's not even coughing, and you're asking a doctor or a nurse to get their face right up near someone who's definitely sick.
--:-- Jim Hamblin: They need to be changed regularly and ideally disposed of right after use. I mean, that's the standard protocol. Without it, they're almost certainly contracting the virus. And even if they don't personally get very sick, they would be spreading it to other people they see, to the rest of the staff.
--:-- Sean Rameswaram: And if the doctor decides to take a risk, they might have to go into isolation or quarantine later or get sick or be totally out of the workforce.
--:-- Jim Hamblin: So the whole health care system breaks down if we don't have this PPE during a pandemic. We just heard from a doctor who says that he's been using the same mask over and over for days and is putting it in his oven when he gets home at night to disinfect it. It's shocking, probably ill-advised.
--:-- Sean Rameswaram: A lot of people have been calling on President Trump to use this Defense Production Act to ramp up production of masks. What is that act exactly for people who are unfamiliar?
--:-- Jim Hamblin: This is a Korean War era thing that is not used except in the most extreme circumstances, but it's sort of marching rights for the government to go and say to a private company, hey, we need you to do something right now. You're going to turn this auto factory into making ventilators. And it actually works out kind of well because that auto factory probably wasn't going to sell a lot of cars right now anyway, and if they could stay in business by making ventilators, it's kind of win-win.
--:-- Sean Rameswaram: And the president can order places to stop making, for example, clothes and figure out how to make these masks.
--:-- Jim Hamblin: We'll be invoking the Defense Production Act just in case we need it. In other words, I think you all know what it is. And it can do a lot of good things if we need it.
--:-- Sean Rameswaram: It sounds like he doesn't know what it is. It's hard to believe anything that he says because he's lied so consistently. And he's indicated that hasn't been invoked, then sort of said that it doesn't need to be because places are doing this already voluntarily.
--:-- Jim Hamblin: Using it's actually a big deal. I mean, when this was announced, it sent tremors through our business community and through our country. Because basically, what are you doing? You're talking about you're going to nationalize an industry or you're going to nationalize, you're going to take away companies, you're going to tell companies what to do.
--:-- Sean Rameswaram: The truth is, most people, nobody would know where to start. But then the FEMA director said otherwise on Tuesday. He indicated that it was being invoked.
--:-- Jim Hamblin: So just a little while ago, my team came in, and we're actually going to use the DPA for the first time today. Really? There's some test kits we need to get our hands on. And the second thing we're going to do is we're going to insert some language into this mask contract that we have for the 500 million masks. DPA language will be in that today. So we're going to use it. We're going to use it when we need it, and we're going to use it today.
--:-- Sean Rameswaram: What should be happening is that it should be invoked to its fullest potential to get these masks to people because without them, there is no health care system.
--:-- Jim Hamblin: We can have all the ventilators we want. We can have all the doctors. But if you can't protect them, it's a played out analogy, but you're sending soldiers to war without guns.
--:-- Sean Rameswaram: And of course, once we get the masks, if we do, there is the issue you just referenced of ventilators and also just space. How is this situation looking not just in New York, but across the country right now with ventilators and hospital beds?
--:-- Jim Hamblin: Not good. So New York is adapting for field hospitals right now. They're called field hospitals but they kind of just modified public spaces like the Javits Convention Center where you could go and ideally receive some care.
--:-- Sean Rameswaram: And they calling into service or asking for volunteers from doctors who are retired NYU just said that medical students could graduate early and be recruited into the cause.
--:-- Jim Hamblin: Wow. Yeah. Because we're also running out of doctors and nurses?
--:-- Sean Rameswaram: That potential certainly exists, and it's hand in hand with the mask situation, right?
--:-- Jim Hamblin: Yeah. And that supply chain of the number of providers you have can quickly break down as soon as people don't feel safe coming to work or have sick family members at home, have kids they have to take care of, all these different reasons that they can't do their job as they normally would.
--:-- Sean Rameswaram: And as we heard from Dr. Sun, when we don't have enough masks, we lose doctors and nurses. When we lose doctors and nurses, we have to start making some difficult decisions, right?
--:-- Jim Hamblin: Yeah, and we're already starting to make those decisions. In New York, you're being urged not to seek care unless you are very sick. And doctors are being told not to test, except among people, you know, if they would require hospitalization, if they got a positive test.
--:-- Sean Rameswaram: So we're already rationing who's getting tested, who can come to the ER, who can wait it out at home.
--:-- Jim Hamblin: And so those are rationing decisions that haven't posed extreme ethical challenges, but you could very quickly get into a situation, and we certainly will in places around the country, we'll get into decisions about who gets the ICU beds and who doesn't, who gets to come into the hospital and who doesn't, even when you're in a situation where, yeah, under ideal circumstances, I would give you a hospital bed, but you need to go over to the convention center and be treated by a glorified medical student.
--:-- Sean Rameswaram: And that's going to make some people very uncomfortable. I mean, are we going to get to the point where we have to let people die? I don't want to forecast here, but that's something we need to absolutely treat as a very real possibility.
--:-- Jim Hamblin: There are always decisions about, you know, how care should be pursued. When there's a 99-year-old person with advanced dementia and metastatic cancer who develops pneumonia, you know, it's not the correct course of action to take them to the ICU. It is the correct course of action to help them be comfortable.
--:-- Sean Rameswaram: Those are discussions that we don't like to talk about, but will have to be made factoring in other concerns right now.
--:-- Jim Hamblin: Like, could that bed be, you know, used by a 30-year-old school teacher versus that 99-year-old person. And if a doctor has the two of them sitting in front of them, a decision has to be made in some way.
--:-- Sean Rameswaram: So I think that's the level we should be thinking of right now.
--:-- Jim Hamblin: Yeah. I mean, just hearing you present that scenario, it just feels like so foreign to our culture. This is America.
--:-- Sean Rameswaram: Yeah. We tend to ration care based on who has jobs and money. And so it makes people very uncomfortable to think about rationing care.
--:-- Jim Hamblin: Even if you are able to pay and even if you have insurance, there's no hospital bed for you to purchase.
--:-- Sean Rameswaram: The scary thing for Americans is being a normal, working, employed person who's always been able to see a doctor, always been able to get into the hospital if they really needed to, who will have to go to a convention center or a gym or a hotel or be asked to stay at home.
--:-- Jim Hamblin: And that uncertainty, yeah, it can be terrifying to people.
--:-- Sean Rameswaram: You know, Jim, as someone who thinks about health care all the time when everyone else is, you know, quibbling about politics and everything else, do you think this might be the moment that America thinks about seriously rethinking the way our health care system works?
--:-- Jim Hamblin: I mean, we did this episode on Tuesday all about how Taiwan and Hong Kong and Singapore handled this really well, initially at least. And the big reason was because they had been through SARS in a way that we hadn't. And they had set up infrastructure and they had the familiarity to deal with a problem like this.
--:-- Sean Rameswaram: And it seems like we just weren't there.
--:-- Jim Hamblin: Yeah, you know, you would think this would be cause for us to invest in prevention and preparation. You know, we just passed a $2 trillion economic stabilization act, and all of that money could have just been way better spent in preparation.
--:-- Sean Rameswaram: Each dollar goes much farther when you spend it up front. A pandemic is always going to be bad, but depending how prepared you are, that completely determines how much shutdown has to happen.
--:-- Jim Hamblin: And, you know, South Korea barely had to shut down. They just got really out in front of the testing and tracking and they were real successful. And we are not at all.
--:-- Sean Rameswaram: Jim Hamblin is a staff writer at The Atlantic. He also hosts a brand new podcast called Social Distance. It's all about living through this pandemic. You can find it and subscribe wherever you're listening to this right now. Just search for social distance.
--:-- Sean Rameswaram: During his daily press conference earlier today, New York Governor Andrew Cuomo was asked about the personal protective equipment shortage, PPE. Equipment and PPE is an ongoing issue. Right now, we do have enough PPE for the immediate future.
--:-- Sean Rameswaram: Now, that was very confusing to us considering what Dr. Calvin's son and other New York City health care workers had told us. So we reached out to Governor Cuomo's office for comment and the New York State Department of Health responded, we remain confident that we have enough PPE in stock for the immediate need.
--:-- Sean Rameswaram: But for long-term requirements, we continue working with manufacturers and distributors to maintain and increase our supply. They did not respond to questions about whether there was enough PPE to change masks every day or between each patient or whether there was enough PPE at all New York City hospitals.
--:-- Sean Rameswaram: We reached out to Dr. Sun and he replied, I hope that's not a joke. I haven't seen anything yet.
--:-- Sean Rameswaram: It's Today Explained. A next guest.
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