Replies

> I think you heard correctly. Dr. Birx implied that the virus would roll over the entire country in a wave, beginning in New York (me: the NYC metro area ?) and then moving west. For several reasons, I do not think that any area will be hit as hard as NYC. I also hope that NYC is not hit as hard as the dire predictions seem to say right now.

I suppose that could still happen. The confidence interval seemed fairly wide, perhaps accommodating differing scenarios. One scenario could be that NYC is an anomaly because it is so densely populated. Another, different scenario is that the NYC situation could be replicated in other densely populated cities. (Personally I’m not certain at this time although it could have been in the briefing somewhere. I am just going from my memory right at the moment and I missed seeing a few minutes of the briefing here and there due to other things going on where I am at right now.) The sense I am left with at this moment is that NYC numerically will be the hardest hit area, due to a combination of prior exposure, population density, and size. What might be getting the most focus are numerical expectations: specifically, where will the most hospitalizations be expected to occur in the immediate future. At the detail level, this will change somewhat every day (NYC will likely dominate the national numbers for the near term future). Then, provide the numerically proportional combined resources to those areas where the most hospitalizations are expected to occur in the immediate future. Then, the next day, recalibrate the model based on updated inputs, and repeat the drill every subsequent day, until the worst is verified to be passed. Over time, the largest influxes of hospitalizations, including those in NYC, will diminish, possibly leaving smaller influxes which will then of course still need to be mopped up. One would also want to make certain (IMHO) that so-called flyover country is not left entirely bereft of support to deal with their own local emergency situations (eg hospitalizations).

Trump was talking about a different emergency scheme of distribution than what might be a typical emergency distribution scheme. For example, Trump wants ventilators to go direct from the point of origin (manufacturers) DIRECTLY to the hospitals (points of critical need, destination). The reason is that this is the most efficient way to perform the task at hand. Trump is claiming that it can be done with the delivery systems now in place. Trump is claiming that if the situation requires it, the military and/or other federal resources will be used for delivery. The reporters seemed to have some difficulty wrapping their heads around the concept. Also if Trump is correct some governors seemed to have difficulty wrapping their heads around the concept. Some governors (and some reporters) seem to presume that state level warehousing and state level stockpiling is the obvious best distribution scheme. Trump said that people were not always seeing eye to eye on everything but that most people were getting along and that some governors were happier (in so many words) than other governors. Trump was saying that the feds are keeping a very close watch at the local hospital level to see what supplies were actually needed, and would make certain that each hospital would get what supplies were actually needed as dictated by the emergency at hand at that hospital.

This reminds me that the governor of Connecticut had just been on CNN prior to the start of the briefing (interviewed by Jake Tapper) complaining that he only had 50 ventilators, and that he felt Trump and the feds were actively and passively interfering with his state getting the ventilators it needed in its emergency stockpile. His concerns seemed IMHO to be answered by the briefing, although he may belong to the category of people highlighted by Trump as never being satisfied and always wanting more than what they could get.

I think what Trump is not saying is that computers and routing/inventory software are very well positioned to help keep the supply chain working adequately during the emergency. This is a large scale, somewhat complex application of routing and just in time delivery systems, with multiple servers, multiple queues, and multiple client delivery destinations. This is an industrial engineering and operations research type of application. There is lots of theory and systems that can be used for this type of application. Most people are not familiar with industrial engineering and operations research (why should they be? it is a specialty), and so they react with fear and confusion (or worse, if someone is dishonestly refusing to come up to speed on this stuff and keeps harping about lack of stockpiles as if it is still 1944 or whatever). Trump knows about this stuff, and it does not frighten him. Also, and equally important, Trump’s team knows about this stuff, and it does not frighten them. One possible positive thing that the naysayer MSM reporters could do is (1) to get into the details of the distribution scheme and report on how it is supposed to work and (2) report on whether it is or is not working as intended. As we can see, sometimes the reporters just parrot the confusion and panic that some of the state leaders have about this.

There does seem to be a valid concern about testing. In addition to the above considerations as applied to testing, they are switching from an older, “antiquated” testing system to a newer, faster point-of-delivery style testing system. I believe that that might be (?) the Abbott system. It can reputedly yield results in 15-20 minutes. Perhaps it involves the toaster-sized devices such as what they had on the table next to the podium at yesterday’s briefing. Dr. Birx said that many (hundreds? thousands?) of the devices were already delivered but were sitting relatively idle, while old style (slower) testing was still piling up in central processing laboratories. Dr. Birx said that this was a result of inertia at the organizational level and that it typically took a few days or so for everyone involved in testing to switch over from an older and antiquated system to a newer and better system.

They also talked about the mask issue, which seems to be a bit of a medical technology hot potato at the moment... Trump suggested the use of objects such as scarves at the local level. There seems to be a continuing shortage of masks at the point of care locations, and an ongoing need for masks just about everywhere.