“The epidemic goes faster than our bureaucracy“
– Angelo Borrelli
Chief of the Italian Protezione Civile
(Italy’s version of FEMA) March 23, 2020.
The world that you knew 4 weeks ago has been upended. There is a scramble for insights, options, and possible solutions. While emotions – like fear and panic – are often high, that’s precisely the time when cooler minds ought to examine reality and then act based upon evidence. Because even as some are in panic mode, others have or are moving to cash in on the unfolding tragedy.
In our profession and all others, there already are and will be short term winners and losers. Then, there will be middle term achievements that are possible that can lead to more ‘victories.’ It is with the future in mind that MHProNews looks to the evidence and will provide insights that could prove useful for thoughtful professionals, advocates and investors.
In June 2019 research published by the American Association for Retired Persons (AARP), is the following. “Among them, 3.3 million heads of households are ages 55+ and make up nearly half (48.9 percent) of all households living in manufactured housing, a slightly larger share than among households overall in the United States (45.6 percent; see table 1).”
A significant share of the manufactured housing market is connected with the most at-risk group in this COVID19/coronavirus contagion. That is but one of several possible specific points of importance for this report and analysis.
“However, two aspects of this crisis appear to be clear from the Italian experience. First, there is no time to waste, given the exponential progression of the virus. As the head of the Italian Protezione Civile (the Italian equivalent of FEMA) put it, “The virus is faster than our bureaucracy.” Second, an effective approach towards Covid-19 will require a war-like mobilization — both in terms of the entity of human and economic resources that will need to be deployed as well as the extreme coordination that will be required across different parts of the health care system (testing facilities, hospitals, primary care physicians, etc.), between different entities in both the public and the private sector, and society at large.” – Harvard Business Review, on March 27, 2020.
- Collecting and disseminating data is important. Italy seems to have suffered from two data-related problems. In the early onset of the pandemic, the problem was data paucity.
- More recently, the problem appears to be one of data precision. – “Lessons from Italy’s Response to Coronavirus,” ibid.
Angelo Borrelli’s and the Harvard Business Review (HBR) point are inexorably focused toward the following thought from the later source.
- “How bad will it get, and what could recovery look like?” In the article entitled “Understanding the Economic Shock of Coronavirus,” is the following.
“On the medical side: It’s clear that a vaccine would reduce the need for social distancing and thus relax the policy’s chokehold on the global economy. But timelines are likely long, and so the focus may well have to be on incremental innovation within the confines of existing solutions.
On the economic side: In the U.S., politicians have passed a $2 trillion stimulus package to soften the blow of the coronavirus crisis. But policy innovation also will have to occur. For example, central banks operate so-called “discount windows” that provide unlimited short-term finance to ensure liquidity problems don’t break the banking system. What is needed now, today, is a “real economy discount window” that can also deliver unlimited liquidity to sound households and firms.
The emerging policy landscape includes many worthwhile ideas. Among those are “bridge loans” that offer zero-interest loans to households and firms for the duration of the crisis and a generous repayment period; a moratorium on mortgage payments for residential and commercial borrowers; or using bank regulators to lean on banks to provide finance and to rework terms on existing loans. Such policy innovation could have meaningful impact in softening the virus’ impact on economies’ supply side. Yet it also needs agile and efficient execution.” – ibid.
It remains to be seen how “agile and efficient [in] execution” the public policy side will be. But among the problematic issues is the following point from HBR.
“The difficulty in diffusing newly acquired knowledge is a well-known phenomenon in both private- and the public-sector organizations. But, in our view, accelerating the diffusion of knowledge that is emerging from different policy choices (in Italy and elsewhere) should be considered a top priority at a time when “every country is reinventing the wheel,” as several scientists told us. For that to happen, especially at this time of heightened uncertainty, it is essential to consider different policies as if they were “experiments,” rather than personal or political battles, and to adopt a mindset (as well as systems and processes) that facilitates learning from past and current experiences in dealing with Covid-19 as effectively and rapidly as possible.”
MHProNews has since early on in what is now been branded a pandemic has been in touch with medical doctors (MDs) in an effort to sort out what were often clearly conflicting claims. Sometimes, misinformation is accidental. But it would be foolish to overlook the possibility that some misinformation, hype and hysteria may have been motivated by a possible financial, business and/or political agenda. The later has been pondered previously in the link above, here and will also be considered in more detail another time.
This publication previously published a post from an emergency room (ER) doctor in order to clarify why the emerging coronavirus outbreak was being viewed so seriously by certain front-line medical professionals. That report was made possible by a tip from a medical professional engaged on the coronavirus related issues and is linked below.
The reflections below, per an informed source, are from an MD that is part of a larger group of doctors that are sharing information on the COVID19 pandemic. Part of the post makes the same point. So, while this is one professional’s take on matters that are described, it is also informed from a far larger pool of MDs. Doctor’s consider their professional reputations before publishing something under their own name. Keep in mind that those with underlying medical conditions plus those who are over 60 are often considered to be those at greater risk.
COVID-19 Diary. Aspirus Cardiology Clinic, Wausau Wisconsin – D.K. Murdock, M.D.
This posting and other related postings are part of a COVID Dairy. I’m recording this for posterity sake.
Today I’m in clinic. Since the National Emergency and state lockdown due to the pandemic was declared, clinics throughout the Aspirus system have been very light. Only emergent patients, and “must see” patients, are seen. For me the patient load today was only about a third of normal volume.
This has lead to a lot of free time. We talk a lot with our colleagues and we all wonder if, and when, it will get crazy in our community. I spend a lot of my free time reading to try and understand how the virus effects the cardiovascular system. We all try to educate each other and provide input as to how we’ll manage the rapidly changing landscape. I recently joined a COVID group for medical personal on Facebook which has members from all over the world. It’s very educational to learn from others who have been on the frontlines for awhile now.
On this post today I want to cover two issues which one may wonder about and is commonly in the news; respirators and ECMO. This virus predominately effects the lungs. The inflammation essentially fills the lungs with fluid and impairs oxygen exchange. It also makes the lungs much stiffer dramatically increasing the work of breathing. If the patient can’t maintain this work and adequate oxygen levels, the oxygen levels could fall to critical levels and shock and death occurs. This is where ventilators come in. They pump the air into the lung so the patient doesn’t have to work hard to do it themselves. They can be set to assist, or completely take over, respiration. The oxygen can be adjusted from the same as the room air concentration or up to nearly 100 percent. Oxygen is toxic so we try to use the lowest amount needed to do the job by measuring the levels in the blood. Running ventilators takes a lot of skill. Simply having enough ventilators is not enough. One has to have the trained people to run them. Thus, while we may be able to rapidly manufacture new ones, we can not multiply the number of trained people to run them as fast.
Another less common machine you may hear about is Extracorporeal Membrane Oxygenation or ECMO. These are essentially artificial heart lung machines. A major artery and vein is cannulated and this venous blood can be oxygenated when the lungs don’t work well enough. The machine then pumps the oxygenated blood into the artery to circulate around when the heart can’t do the job. They may be used when the lungs fail dramatically and can’t provide adequate oxygen despite using a ventilator. These are obviously temporary devices used short term while we give the heart and lungs time to repair to themselves. These machines are very resource intensive. Currently we have virtually no data on survival rates when used for this disease. Most countries don’t have access to them. Thus far we have not use ECMO for COVID but have for influenza.
COVID-19 Diary. Aspirus Cardiology Clinic, Rhinelander Wisconsin
This posting and other related postings are part of a COVID Dairy. I’m recording this for posterity sake. Hopefully my grand children and great, great, great grandchildren will read it, even if nobody else does.
Today I drove to Rhinelander WI, one of our cardiology outreach sites about 70 miles from Wausau. Usually a busy clinic, I had only 5 patients scheduled. One cancelled and one didn’t show up. Thus a light clinic day again. The drive is though the country and always a pleasant and relaxing one. Usually I listen to audible books on the way or just think. Today it’s podcasts about COVID-19.
It’s a lot easier to get dressed in the morning since the outbreak. Instead of trying to properly match my pants, shirt and tie (something I’m not very good at) I put on my jeans, a tee shirt and boots and pulled over them a set of baggy scrubs. When in the hospital, these are exchanged for a new set and then again upon leaving.
News-wise the senate passed a huge rescue bill last night worth $2,000,000,000,000. Many already saying it isn’t nearly enough. Some, but not all, of the pork was removed. Today it was announced that 3.3 million people applied for unemployment. A near 40 year record. We’re still learning about the medical fall out. The economic fall has already been disastrous all over the USA.
Today I’m going to discuss testing for COVID. Something that is dominating the news.
The standard test is a PCR obtained from a nasal-pharyngeal swab or from tracheal suctioning if on a ventilator. PCR (polymerase chain reaction) is a method to analyze a short sequence of DNA (or RNA) even in samples containing only minute quantities. Since the RNA of the COVID -19 virus has been sequenced, we can pick out certain sequences which are unique to this virus and not in any of the other corona viruses. The technique uses enzymes to amplify the DNA compliment of the RNA millions of times. Thus if the RNA is there, the tests makes millions of copies which can be detected. No viral RNA, no complimentary DNA. Usually more than one unique sequence is tested to increase accuracy and specificity. A fluorescent probe is added and gets incorporated into the copies of DNA. This allows one to measure the intensity of the reaction optically which should increase exponentially if the viral RNA is present. Whether positive or negative, the PCR test is only indicative of whether the virus is present at the time and location the test was taken. It neither rules out whether the patient was infected in the past and therefore has developed immunity, nor that the patient is at an early stage and will show symptoms in the future but not yet detected on the swab. This test is used for many other virus as well. It is the standard way we screen for influenza A, B and RSV. If the lab has the necessary reagents and equipment the test is fairly fast and can be done in about an hour.
That’s where the problem with USA testing occurred. The CDC had the sequences but decided to make its own kits and do in-house testing. The first batch of kits were sent to more than fifty state and local public-health labs and arrived in early February 2020. Unfortunately most couldn’t pass the verification steps due to faulty agents or other technical issues. Thus all testing was done at the CDC lab in Atlanta which rapidly became overwhelmed. The public-health-laboratory network was never intended to provide widespread testing in the event of a pandemic. To offer tests to anyone who wanted them was always going to require commercial testing facilities to come on line. The three-week delay caused by the CDC’s failure to get working test kits into the hands of the public-health labs came at a crucial time. In the early stages of an outbreak, contact tracing, isolation, and individual quarantines are regularly deployed to contain the spread of a disease. We were thus going blind at a crucial time. Several commercial pharmaceutical companies are now getting fast tract status to get out working kits in order to do this onsite locally. Hopefully available soon.
It is important though to put into perspective how fast we did get testing in the scheme of things. For SARS, the development of tests took about five months. With COVID-19, it has been remarkable how short the time it took from the detection of the first case (Nov. 2019) to the sequencing of the viral genome by Chinese scientists (Jan 2020) to the development of the first molecular assay (13 Jan 2020). In many countries, testing is still minimal or rationed, as the testing capacity is overwhelmed by the extent of the outbreak.
You also hear about rapid tests that use blood for testing. This was mentioned in several of the COVID news updates. These tests are less reliable than RT-PCR tests but can be performed at the point-of-care, or in community settings without the need of expensive equipment. The concept of the test is a bit similar to how pregnancy tests work. It’s not looking for the virus itself. It’s looking for an immune response indicating that the virus was, or still is present. Cloned viral antigens are exposed to the patient’s serum. If the patient has antibodies to the virus they will attach to the viral particle. This forms a new antigen complex. Added indicator antibodies to this new complex will attach if the complex is present and the color of the testing cell will change indicating a positive test. The test is fast but may not pick up early cases prior to developing an immune response. It is usually positive in symptomatic cases. However, even after the patient recovers and has cleared the virus, the test will remain positive due to the presence of immunity antibodies.
o This stands for polyme xx
COVID diary. Wausau Wi.
Recorded for posterity sake
It’s Friday and I have off today. I’m on hospital duty for the week starting 6 am Monday morning. I don’t plan on doing daily posts but will do a brief one today.
I started the day by going to St Mary’s. The priest was saying his private mass and the door was opened so I attended it. There were about 7-8 others. If more came I would leave in order to keep the 10 people rule in place. As I walked in I instinctively dipped my hand into the holy water fount. It was dry and I quickly recalled I had encouraged this a few weeks back in the early stages of the outbreak. Old habits are hard to change. The mass was quite consoling and I thanked God for the opportunity to be here and prayed for the health of family and friends.
At home I checked the COVID update. Not looking good for the USA. We now have the most cases in the world with no signs of it slowing.
Politically (I want to keep this non-political as much as possible) there is a lot of finger pointing going on. Both sides putting blame elsewhere, trying to gain some political advantage. Most Americans I’ve talked to seem sick of this bantering. Overall, I feel the response has been fairly good despite the early setback with testing.
A big question remains, When do we relax the shutdown rules? Certainly not till we see substantial slowing of the pandemic. I’m glad I don’t have to make the decision. The two parties will definitely use any inevitable adverse outcome from that decision to their political advantage in this election year. The shutdown has caused severe economic damage. A weak economy makes it hard to fight back. Many making the decision to keep the shut down for longer periods aren’t dependent upon a job to survive. A lot of Americans now wondering where and how they are going to make it and how long before this mess is over.
MHProNews Analysis and Commentary
As both the medical and business snapshots above reflect, the depth and breadth of the issues can only be summarized by missing often important granular details. There have been, for example, efforts to politicize the matter. There are also obvious efforts toward finger-pointing and blame-shifting.
The recent report on Crimson Contagion is useful background in understanding some of the political and medical aspects of this unfolding tragedy.
Revisionist history and spin are also being deployed within manufactured housing but also in the broader social setting. Questions arose as to why, for example, MHProNews and/or other associations were doing more to inform their members than the larger and better funded national Manufactured Housing Institute (MHI) was?
A source with long ties to MHI said, “Typical MHI…never a leader, but routinely a follower seeking the credit that rightly belongs to others.” That will be examined another time, but a simple point previously documented will be emphasized. MHI often signs on with a group of other organizations, and then purportedly claims credit or postures for their members, when they did little more than ‘sign on’ to a “coalition” of other nonprofits. That’s not hard work, that’s the easy way to preen and grab credit, as the comment noted above also aptly summed it up.
Years of manufactured housing underperformance has left the industry more vulnerable than it might otherwise have been during such a pandemic. Whenever businesses that are now shuttered are allowed to return to work, there will be an even greater need for affordable housing now than there was just a few weeks ago. But that need was already immense, measured in at least a 7 million affordable housing unit shortage, according to the National Low Income Housing Coalition (NLIHC).
To return to the point at the top, seniors and those with underlying medical issues seem, at this time, to be the most at risk. That’s long been a key segment of the actual buyers of manufactured homes, as the AARP research above demonstrated.
The goal for manufactured housing independents, professionals, advocates and others should not be to return to ‘business as usual.’ The status quo ante should have been utterly unacceptable. But for a variety of reasons, it has been tolerated, even as resistance to the purported treachery that has subverted the industry from within has occurred.
There will be a special report based upon on a fresh news tip from a Berkshire Hathaway connected source that will be critical for manufactured home independent producers and others to grasp. Watch for that in the days ahead. For those who may have missed it, see another recent report based upon a news tip by a reader, in the hot-linked report below. NOTICE: the report below has resulted in record March readership, more on that in a planned update.
In addition to all else, one might wonder. Is the handling and spin related to what the Epoch Times has dubbed the CCP virus an early October Surprise in the 2020 election cycle? The politics are obviously well underway, but in a morphed fashion. To sum up, there is an array of harm that has been and is being done. The need for sound information from sources that aren’t feeding into the narratives of those who have led manufactured housing into historic underperformance has arguably never been greater.
To learn more about these issues and how they impact affordable manufactured housing, see the related reports for more. That’s a wrap on this installment of “News through the lens of manufactured homes and factory-built housing” © where “We Provide, You Decide.” © (Affordable housing, manufactured homes, reports, fact-checks, analysis, and commentary. Third-party images or content are provided under fair use guidelines for media.) (See Related Reports, further below. Text/image boxes often are hot-linked to other reports that can be access by clicking on them.)
By L.A. “Tony” Kovach – for MHLivingNews.com.
Tony earned a journalism scholarship and earned numerous awards in history and in manufactured housing. For example, he earned the prestigious Lottinville Award in history from the University of Oklahoma, where he studied history and business management. He’s a managing member and co-founder of LifeStyle Factory Homes, LLC, the parent company to MHProNews, and MHLivingNews.com. This article reflects the LLC’s and/or the writer’s position, and may or may not reflect the views of sponsors or supporters.
Connect on LinkedIn: http://www.linkedin.com/in/latonykovach
The text/image boxes below are linked to other reports, which can be accessed by clicking on them.