Tuesday, March 31, 2020

Terminology - Price gouging (N95 face masks, ventilators, hazmat suits, US DPA)

Copyright@ Françoise Herrmann

Price gouging (i.e., extortion or making someone pay too much for something), in particular within the context of the current COVID19 pandemic, appears only slightly less gruesome than the original meaning of the term gouging. Indeed, the original meaning of the term gouging refers to a horrifying form of ocular torture, consisting in forcing an eyeball out of its socket using thumb pressure.[Merriam-Webster, gouging]

Perhaps then, that the current surge in the use of the term price gouging comes as no real surprise.  Use of the term price gouging has spiked recently in connection with logistics and procurement of medical equipment and safety supplies for the COVID19 Pandemic. Medical safety supplies such as N95 face masks and protective hazmat suits, and most recently medical equipment for COVID19 treatment, such as ventilators. N95 means that the masks are NIOSH (US National Institute of Occupational Safety and Health)-approved to reduce exposure to at least 95% of airborne particulate hazards.

In the highly contagious context of the COVID19 pandemic, where the survival of healthcare personnel depends on the use of protective wear such as N95 masks and hazmat suits, and admitted patients in critical condition depend on ventilators, nations worldwide are scrambling to stay ahead of the staggering number of cases and hospitalizations, replenishing stockpiles and creating them where there were none. However, such a scramble for procurement arises  in a bidding process, where states in the US, and beyond, are all competing against each other for critical medical supplies and equipment. As a result, prices are gouged. In other words, prices are driven up to unprecedented highs. 

In the matter of procurement price gouging, connected to the COVID19 pandemic, figures do the talking. For example, according to New York State Governor Andrew Cuomo, N95 masks that used to cost 85 cents/piece are now selling for 7$ a piece (Cuomo Press Conference, March 22, 2020). Likewise, according to Cuomo, ventilators that used to cost $20,000 now cost $50,000 (Cuomo Press Conference March 30, 2020). Thus, price gouging is occurring in a catastrophic situation that is recording exponential increases in the number of confirmed cases and death toll. For example, in New York City alone, between March 22 and March 31 (today), confirmed cases increased from approx. 10,764 and 76 deaths, to approx. 40,900 confirmed cases (at 9:30 EST) and 932 deaths (NYCity DOH, March 31, 2020). Likewise, confirmed cases for the State of New York have climbed to close to 80,000 cases to date, with no predicted leveling in sight (NY DOH, March 31, 2020)

To prevent further price gouging of medical equipment and safety supplies, ahead of the epidemiological catastrophe now unfolding, New York Governor Andrew Cuomo was even driven, on March 22, to call for the nationalization of medical supply procurement in the US, and use of the Defense Production Act (DPA). In other words, a plea for the Federal Government to take over the procurement of medical supplies, in an attempt to prevent uncontrolled bidding, and the inevitable spike in prices of critical medical equipment and supplies. In Cuomo’s own words:
“I’m calling on the Federal Government to nationalize the medical supply chain.The Federal Government should immediately use the Defense Production Act to order companies to make gowns, masks and gloves. Currently, states are competing against other states for supplies.” [Coleman,J., March 22, 2020]

Short of nationalizing the production of medical supplies and equipment in the US, which would mean that the Federal Government would take over and own the production facilities of US companies, the Defense Production Act (DPA) offers a close alternative form of executive intervention in private business and industry. Voted in 1950, during the Korean War, the DPA allows the Federal Government variously to regulate prices (prevent price gouging), to requisition property, to allocate resources, and/or to commission production (or request prioritization of production) for the procurement of vital defense equipment, whether the equipment consists of medical supplies, materials such as titanium and aluminum, the development of new technologies or the disclosure of information. Since voted in 1950, the DPA has been used on several low-key occasions (Kanno-Youngs, Z and A. Sawnson, March 31,2020). In fact, most recently, the DPA has been used, precisely in connection with the procurement of ventilators for the COVID 19 pandemic.  

Indeed, on March 27, 2020, President Trump signed a Memorandum on Order Under the Defense Production Act Regarding General Motors Company, according to which General Motors, in collaboration with Ventec Life Systems, a small ventilator manufacturer, have risen to the occasion, stepping-in to volunteer, and subsequently agreeing  to set up crash production of ventilators at a General Motors factory in Kokomo, Indiana (Boudette & Jacobs, 2020). Ventilators that might be delivered, before the end of the month of April 2020, to places like New York City, dubbed the canary in the coal mine (1). In other words, the hardest-hit US city, where it is anticipated that there will be a desperate need for ventilators in the coming weeks, as well as many additional critical shortages, in the stressed-out healthcare system.


Note
(!) The canary in the coal mine: Expression used by Cuomo during the March 30, 2020 Press Conference. The term refers to the caged canaries that coal miners would carry into the coal mines to alert them to the presence of hazardous gases such as carbon monoxide.

References
Boudette, N. E. and A. Jacobs (March 30, 2020) Inside G.M.’s Race to Build Ventilators, Before Trump’s Attack. NYTimes
https://www.nytimes.com/2020/03/30/business/gm-ventilators-coronavirus-trump.html
CDC - COVID19 – Cases in the USA
h
ttps://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
CDC- NIOSH-approved N95 Particulate filtering facepiece respirators
Coleman, J. (March 22, 2020) Cuomo calls on the federal government to order companies to manufacture medical supplies.The Hill.com
https://thehill.com/policy/healthcare/public-global-health/488882-cuomo-requests-federal-
government-order-companies-to
DOH- D
epartment of Health – New York City - Daily Data Summary – COVID19 NYC – March 31, 2020
DOH- Department of Health – NY State - NY county by county breakdown of positive Novel CV cases – NY State
John Hopkins University Coronavirus Resource Center – World data on Coronavirus pandemic
h
ttps://coronavirus.jhu.edu/map.html
Kanno-Youngs, Z and A. Sawnson (March 31,2020) Wartime Production Law Has Been Used Routinely, but Not With Coronavirus,  NYTimes
NY Governor A. Cuomo Press Conference – March 22, 2020
NY Governor Cuomo Press Conference requesting Fed. Government to nationalize medical supply chain – Albany briefing – March 22, 2020
NY Governor A. Cuomo Press conference – March 30, 2020
Rascoe, A. (March 25,2020) Trump Resists Using Wartime Law To Get, Distribute Coronavirus Supplies--  NPR (National Public Radio)
Trump, D.J. (March 27, 2020) Memorandum on Order Under the Defense Production Act Regarding General Motors Company

Thursday, March 26, 2020

Terminology - Shelter-in-place (3) on lockdown

Copyright © Françoise Herrmann

Within the context of the COVID19 (Corona Virus Disease 2019) pandemic, the term (going) on lockdown has surged in reference to the State of Emergency, shelter-in-place orders or directives, issued by Governors and Mayors in the US, and Heads of State internationally.  (Goingon lockdown is being used in the American sense of the term lockdown, originating in the penal system, where according to Merriam-Webster’s dictionary lockdown refers to "the confinement of prisoners to their cells for all or most of the day as a temporary security measure."

In the rapidly evolving COVID19 situation, as of March 23, 2020,  fifteen US States were already on lockdown, meaning that the population of those states, an estimated 187 million people,  had been ordered to “stay home” for at least 21 days. The States on ordered lockdown, included: California, Oregon, Nevada, Michigan, Indiana, Illinois, Colorado, New York, Pennsylvania, Louisianna, Massachusetts, Connecticut, Delaware, New Jersey and West Virginia (Smith, March 23, 2020).  As a measure of how fast the situation is evolving, 10 more states had issued lockdown orders, between end of day on March 23, and 8 pm EST on March 24, the day after information rolled in for this post. Thus, on March 24 (at 8 pm EST), the total number of states under lookdown, according to the WSJ, was close to half of US states (Gershman, March 24, 2020).

Short of a national lockdown in the US, when individual States go on lockdown it is usually the culmination of a process of less draconian recommendations aimed at promoting social distance for protection against COVID19. Once on lockdown, however, the States transform previous social distancing recommendations into shelter-at-home (stay-at-home) orders, enforceable by fine and/or imprisonment, that fully detail restrictions on individual movement and social gatherings while mandating protective hygiene, telecommuting, and distance learning.

On lockdown, public places such as parks, playgrounds and beaches are ordered closed. Likewise, nonessential businesses such as shops, bars, restaurants, cinemas, and theatres are ordered closed, while schools and universities are ordered to migrate online.  Gatherings of more than 2 people (except within a household) are prohibited, which means that weddings, christenings, bar and bat mitzvahs, parties and other sorts of social events and celebrations are banned. Most importantly, individuals are  finally ordered to stay (at) home, shelter-in-place or stay SaferAtHome, except for medical appointments, infrequent shopping for food, short physical exercising, caring for the elderly or vulnerable populations, and work in essential businesses and services.

Beyond the United States, in Europe, Africa and Asia, the following are a few of the nations on full  or sometimes partial lockdown:
  • Italy (since March 9) and Spain (since March 14), the European epicenters of the COVID19 pandemic,
  • France (since March 17)
  • Germany (since March 20)
  • The UK (since March 23)
  • India (since March 24, the largest lockdown in the world affecting a population of 1.3 billion)
  • Australia (since March 25)
  • New Zealand (since March 25, on full lockdown for one month)
  • South Africa (on full lockdown effective March 26 to April 16)
  • City of Wuhan Hubei Province of the People’s The Republic of China (since January 23, the model lockdown, now slowly easing certain orders, expected to lift on April 8)
In fact, one third (and still counting) of the world population, according to Business Insider (16 minutes ago at approx. 5:30 pm PST, on March 25) is now on lockdown orders.

Portrait of a place: Wuhan,  © 2020 Nowness.com

Under different non-emergency circumstances, and at other junctures in time, such lockdown measures would normally be considered an inconceivable breach of individual freedoms.  However, the COVID19 pandemic has created extraordinary conditions in the world, where the US is no exception. On March 25, 2020, the WHO dashboard on COVID19 statistics updated daily at 9 am indicated: more than 370,000 infections in the world, with a death toll of more than 16,000. According to the CDCs (Center for Disease Control), in the US, the total number of infections reported was in excess of 60,000, with New York State at the epicenter of the US outbreak, comprising close to 50% of all US cases (CDC, COVID 19).  

Update (March 31, 2020)
The WHO dashboard on COVID19  statistics indicated more than 750,000 infections in the world with a death toll of more than 34,000. 

References
CDC (Centers for Disease Control) - COVID19 cases in the US - Situation summary
https://www.cdc.gov/coronavirus/2019-ncov/index.html

Desai, S. (March 21, 2020)  You should already be on lockdown: 6 feet away just doesn’t cut it. The Atlantic.
Ferguson, R (March 25, 2020) Australia: How the new lockdown affects you. The Australian.
Gershman, J.  (March 24, 2020) A Guide to State Coronavirus LockdownsWall Street Journal
Merriam Webster dictionary definition for the term lockdown
Kaplan, J., Frias, L & M. McFall-Johnsen (March 25, 2020) A third of the global population is on coronavirus lockdown — here's our constantly updated list of countries and restrictions. Business Insider
Nowness
Smith, J. (March 23, 2020) More than 100 people die of coronavirus in one day in America for the first time. DailyMail.com
Tapsfield, J. & J. Maidment (March 23, 2020) Boris Johnson announces the most draconian lock-down in British peace or wartime history. DailyMail.com
The Guardian – Coronavirus:  Live updates
WHO - Coronavirus disease (COVID19) outbreak situation

Monday, March 23, 2020

COVID19 - The Italian Response

Copyright © Françoise Herrmann

Still spiking, with more than 53,000 cases and more than 4500 deaths (WHO COVID19 Pandemic), a nation on lockdown has spontaneously launched balcony concerts and virtual orchestras.

Below, a virtual choir, a compilation of voices on lockdown, singing Va pensiero from Giuseppe Verdi’s 1842 Opera Nabuco.


References
WHO – Corona Virus Disease (COVID19) Pandemic (Updated daily)

Sunday, March 22, 2020

Terminology – Flattening the curve (aplatissement de la courbe)

Copyright © Françoise Herrmann 

At any other time in history, you might have honestly wondered which curve? On March 22, 2020, however, the only curve that really matters has become a question of shared planetary destiny. Indeed, almost everyone in the world has been enlisted to participate in containment and mitigation efforts to flatten the curve, the curve that statistically models the spread of COVID-19 (Corona Virus Disease 2019). In other words, according to Spektor (2020), a steep curve that might model an exponential rise and fall in the number of cases recorded, when the number of cases doubles, and subsequently decreases, rapidly each day. Or, a more gentle curve, when it is “flattened” across time with interventions designed to prevent the spread of the virus. Interventions (when successful) that result in decreasing the speed of contagion and predicted spike in cases, which might otherwise overload existing health services. The following illustration shows the two sorts of curves, modeling COVID19 spread scenarios, the steep and rounded (or flattened) curves, with and without interventions (indexed as protective measures).



Originating in the domain of epidemiology, the term flattening the curve, in fact, tells the story of all virus outbreaks, and of the action that must be quickly deployed to avoid the corollary risks of exceeding the capacity of healthcare systems. In the US, the  leading epidemiologist, Head of the NIH - NIAID (National Institute of Allergy and Infectious Diseases), Dr. Anthony Fauci, explained the containment and mitigation strategies designed to flatten the curve, during the Presidential Press Conference, on March 13, 2020, announcing the US State of Emergency.  Containment measures such as restrictions on travel, and in the absence of containmentmitigation efforts such as shelter-in-place orders, social distancing, hand washing hygiene, and telecommuting [CDC-US Gov. COVID19]. Measures and efforts that appear none too radical when facing a virus, without a vaccine,  that is in fact 10 times more potent than seasonal flu viruses. Indeed, a virus that has now infected more than 250,000 people worldwide, killing to date a total of more than 11,000 people, since the first case was reported in November 2019, in Wuhan, Hubei Province of The People's  Republic of China [WHO, COVID19 Outbreak situation]. 

Below, a recorded segment of the March 13, 2020, Presidential Press Conference, at the White House Rose Garden. A Press Conference, where the US State of Emergency was announced, and key members of the COVID19 Taskforce were presented. This particular segment, occurring during the Q&A part of the Press Conference, captures Dr. Fauci’s re-iterated explanation of the US government response, designed to flatten the curve.


References
CDC – Corona Virus Disease (COVID-19)
The White House, DHHS & CDC  - Corona Virus Disease (COVID-19)
Trump, D. ( March 13, 2020) Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak
Spektor, B. (March 16, 2020) Coronavirus: What is 'flattening the curve,' and will it work? Live Science
WHO - COVID19 outbreak situation
Youtube (March 13, 2020) The White House Rose Garden Press Conference – Introducing the COVID-19 Task Force
https://www.youtube.com/watch?v=mB6mzESzUf0 (Full conference)

Friday, March 20, 2020

Terminology – Shelter-in-place (2) viz. hunkering down

Copyright © Françoise Herrmann

It is no coincidence that you have been hearing the terms “to hunker down” lately, in connection to the COVID19-related Shelter-in-place or Stay-at-home Orders. Both terms are actually synonymous, even if the registers are different.

The term "to hunker" is a term that originally means “to squat”. According to the Oxford English Dictionary (OED), the term to hunker is originally Scottish, recorded as far back as 1750, with the following definition: 
To squat, with the haunches, knees, and ankles acutely bent, so as to bring the hams near the heels, and throw the whole weight upon the fore part of the feet.
A definition that by the same token explains the Scottish expression on one's hunkers, also meaning to squat.

Figuratively, chiefly in the United States, especially in the military, and in association with the preposition ‘down', to hunker down means to shelter or take cover and lie low. Thus, it is the meaning by extension of the term to hunker, associated with the preposition down, that is surfacing so much of late, within the context of the call to action against COVID19.

Here are a few illustrations reflecting the synonymy.

On one's hunkers...



Incidentally, on March 15, 2020, Merriam-Webster's online dictionary registered an 8,500% increase in lookups for the term "hunker down".

References
Merriam-Webster - Trending: 'hunker down'
https://www.merriam-webster.com/news-trend-watch/fauci-americans-must-hunker-down-20200315
Oxford English Dictionary - Hunker (verb) - Full entry
https://www-oed-com.libaccess.sjlibrary.org/view/Entry/89505?

Thursday, March 19, 2020

Terminology: Shelter-in-place (1) (mesures de confinement)

Copyright© Françoise Herrmann

Effective at midnight on March 17, 2020, through to April 7, 2020,  the City and County of San Francisco, Department of Public Health (DPH) Officer issued Order No. C19-07 to Shelter-in-place. This Shelter-in-place DPHOrder No. C19-07, together with the Shelter-in-place orders of 5 additional Bay Area counties, affecting more than 7 million people, are the first in the history of California, and the first-ever, issued at State level, in the United States.

Used within the context of the efforts to mitigate the spread of COVID 19 – the COrona VIrus Disease caused by the coronavirus 2019, the term Shelter-in-place actually originates in the domain of emergency preparedness (CDC; Homeland Security) Outside of the COVID19 context, it is an order to seek safety indoors for protection against an active shooter, a chemical or radiological hazard, or other outside threat, until a second, “all clear, order to evacuate”, is issued.

Within the context of COVID-19, the City & County of San Francisco DPH Shelter-in-place Order C19-07 is a 10-page document that directs all residents of the City & County of San Francisco to shelter at their place of residence “except that they may leave to provide or receive certain essential services or engage in certain essential activities, and work for essential businesses and government services.”  Non-compliance with this order is a misdemeanor, punishable by fine, imprisonment, or both [California Health and Safety Code § 120295, et seq.; California Penal Code §§ 69, 148(a)(1); San Francisco Administrative Code section 7.17(b). Individuals experiencing homelessness are exempt from the Order to Shelter-in-place, although they are urged to find shelter and government agencies to provide it.

The Shelter-in-place Order No. C19-07 document further outlines and defines exactly those activities, businesses and services considered essential, which explains why so many businesses and services have been sending out messages detailing their plans for closure, online support, and/or varying compliance measures. The order also incorporates measures previously publicized, such as maintaining a 6-feet distance between people outside homes, hand washing, using of hand sanitizer, refraining from handshakes, resorting to telecommuting or telelearning to the widest possible extent, and generally prohibiting gatherings outside of homes, or unrelated to essential activities, businesses and services. Measures, which under other far less threatening circumstances, have given rise to more than one uprising.

In French, shelter-in-place Orders are referred to as “confinement measures”. In fact, the French variation on shelter-in-place was decreed as “National Confinement”, also on March 16, 2020. However, France’s National confinement was decreed, at the executive level, by the President of France, Monsieur Macron, effective at midnight on the same day (Macron, 03-16-2020).

Update (March 19, 2020 - evening)
The Governor of California, Gavin Newsom, issued a California, statewide, "stay-at-home" Order, affecting approx. 40 million people.

Update (March 31, 2020 -  evening)
The City of San Francisco extended the city's Shelter-at--home orders through to May 3, 2020. 


References
CDC - Emergency preparedness and response 
https://emergency.cdc.gov/shelterinplace.asp
Department of Homeland Security - Sheltering in place
https://www.ready.gov/shelter
Department of Public Health,  City & County of San Francisco,  Order of the Health Officer C19-07 – March 16, 2020  (Shelter-in-Place
Macron, E. (March 16, 2020) Déclaration du 2020
France – COVID19 - Mesures de confinement

Thursday, March 12, 2020

Oh, patents! The InfaClip™

Copyright © Françoise Herrmann

Whether due to unsafe socio-cultural practices, inadequate access to healthcare or a combination of both, two-thirds of neonatal deaths occur in the developing world. To prevent neonatal death in the developing world, specifically due to umbilical cord infections, University of Tulane spinoff, at Novate Medical Technologies, has developed the InfaClip (formerly designated the SafeSnip).

The InfaClip is a patented invention, recited in the UN WIPO (World Intellectual Property Organization) patent, WO2012129317A1, titled Multi-component detachable jaw tools and methods of using and making same. Specifically, the InfaClip is a 3-inch, disposable, plastic obstetric device, intended to clamp, severe and disinfect the umbilical cord. The InfaClip actually consists of two identical clips, made from the same plastic injection mold, one of which breaks off, after the cord has been severed from the placenta. The clip left in place then seals the wound, protecting it from infection.

In contrast to existing obstetrical devices for clamping and severing umbilical cords, consisting within medical settings of several instruments (metal clamps and scissors, plus plastic clamp), or in non-medical settings of strings and a blade, the InfaClip offers a two-step process. The two-step process comprises 1. disengaging a hinge-locking mechanism for the purpose of unlocking the open jaws of the InfaClip to clamp/cut the cord, and  2. breaking off the InfaClip part connected to the severed cord and placenta, leaving the other half in place. The part that stays to protect the wound is also removable, without the use of any extra cutting tools,  just applying downward pressure on a disengageable lip and lever closure of the two jaws, at the opposite end of the hinge. Finally, the InfaClip grip is specifically designed to distribute the forces applied when closing the jaws, at the center of the clip, thereby facilitating severance, while protecting for against blood splatter, to prevent Hepatitis B &C and HIV contamination.

The patent recites various embodiments of this invention applied to the severance of an umbilical cord, but it is also disclosed that the scope of the invention is in fact much larger. Indeed, variations, known to persons skilled in the art, might be designed for other vascular, gastrointestinal, gynecological (e.g.; tubal ligations) or respiratory purposes, without departing from the spirit of the invention.  In this regards the detailed description of the invention also contains a detailed section on the definition of terms. For example, the patent recites the regulatory “open-ended” definitions of such terms as “comprising” and the indefinite articles “a/an”,  respectively used  within the patent to mean: “at least” and “one or more”, precisely for the purpose of construing the broadest possible claims, without limitations (unless nonsensical).

The abstract of this invention is included below together with the patent Figure 2, and a corresponding image of the separated InfaClip. The patent Figure 2 shows the two symmetrical components, Unit A and Unit B, of the InfaClip device 1, that separate after clamping/cutting of the cord. The hinge 50 brings both units together, while comprising hinge portions 52 and 54 on each unit. The Units A and B, working together as unitary jaw members, are designated 40 and 30. Figure 2 further depicts the sawtooth blades 91, 92, configured to receive one another when the jaws are closed, and the chamfered clamping surfaces, comprising working surfaces 34 and 44, on Unit B, and working surfaces 32 and 42 on Unit A, each abutting one another when the jaws are closed.
Provided is a jaw tool formed from two separable units and which includes a fastening device that attaches the two units together when the jaw tool is in use and which may automatically separate the units after the device performs its function such as clamping and/or cutting. Also provided is a jaw tool having a cutting blade wherein the contours of the device are shaped so that force is concentrated on the cutting bade when the device is closed. The jaw tool may be manufactured from a single injection molded-component that is used in duplicate to form the jaw tool. The jaw tool may be used in various applications in which it may be beneficial to simultaneously clamp and cut an object, such as various medical applications including vascular, gastrointestinal, respiratory, and placental. [Abstract WO2012129317A1]
References
Brannon, K. (2009) Student's invention aids safe childbirth. 
http://www2.tulane.edu/news/newwave/081809_safesnip.cfm
WHO - Innovation in umbilical cord severance
https://www.who.int/medical_devices/global_forum/3rd_gfmd/umbilicalcordseverance.pdf
Youtube - Infaclip™ - Novate Medical Technologies
https://www.youtube.com/watch?v=J1TSi6iMbR8

Sunday, March 8, 2020

International Women’s Day (IWD) 2020

Copyright © Françoise Herrmann

The first International Women’s Day (IWD) was celebrated more than one century ago, within the context of the women’s suffrage movement and the International Socialist Party platforms of Europe and the US. On March 19, 1911, more than 1 million women, in Europe and the US, responded to the call for peace and universal suffrage. In 1917, after granting women the right to vote, March 8 was declared International Women’s Day, in the Soviet Union, a day that began to be widely celebrated, in both Europe and the US. In the United States, it was just three years later, on August 18, 1920, that the Nineteenth Amendment to the US Constitution was ratified, prohibiting States and the Federal government from denying or abridging the right to vote, on the basis of sex. 

In 2020, the IWD theme “An equal world is an enabled world” reiterates the underlying tenets of a movement still in progress, striving to show that equality for women is progress for all. In the 60s, IWD also became part of the international Women’s Liberation Movement (WLM), integrating both the political and personal aspects of womanhood.

Suffragettes - 1911

The opposition.... 

IWD 2020

References
International Women’s Day
United Nations Observance of March 8