Kyrosity
2020-03-10T07:31:05+00:00
如果这些条能落实的话，我觉得美国还真有可能能控制的住
但是已经养了这么长时间的蛊了，加上这些能不能落到实处还要打个问号，可能只是这些医生的美好愿望罢了。
不管美国政府怎么样，这些医务工作者还是可敬的，甚至还有一点要上战场的悲壮感。
官僚主义害死人啊，全世界都一样。
下面附上机翻全文：
致：副总统迈克·彭斯
回复：美国发生COVID-19疫情-医学界建议立即采取行动
彭斯副总统，
我们已经失去了遏制这种大流行的机会，现在正面临着无法缓解的医疗灾难。该主管部门的回应通过使错误信息永久存在并轻描淡写这种感染给公众带来的潜在威胁，从而极大地削弱了我们照顾患者的能力。确保健康安全是各级政府的基本职责和责任，我们恳请您将保护人民的工作置于政治和经济考虑之上。
我们看到自己在接下来的几周和几个月内就谁将活着以及谁会死做出决定，因为我们没有足够的资源来照顾他们。我们听说过来自中国和意大利的二手货和二手货，也没有理由认为美国不会遭受同样的命运。为了挽救生命，我们必须拉平大流行的曲线。
以下是我们的建议：
1.建立并赋予真正的自主权以根据医疗决定采取行动，由全职，多学科的公共卫生和医学专家团队(传染病，急诊医学，消防/护理人员，重症监护)组成，并在全国范围内为员工提供服务指挥中心指挥协调的国家反应。必须包括：
全国性呼叫中心，每天从当前或新建立的州级转接呼叫中心接收两次或更多次更新。这些呼叫中心的目的是要有一个集中的地方，每个州的一线医疗服务提供者都可以致电该地方，以协调患者到更高级别或更大能力的地区的转移。
应该有一个道德团队编写有关如何在资源有限时分配资源的建议指南，这些指南已公开。先到先得不能成为答案。它本质上必须是功利主义者。
面向一线医疗服务提供者的医疗保健信息热线，其书面，录制和视频更新均保持最新。
扩展CDC信息以供所有人查找最新更新-带有翻译服务的最新国家建议，可在进行更改时立即更新所有信息。这是人们需要知道的信息，以便在情况恶化时保持安全并前往何处。
2.现在通过一项全国性的刺激计划，以支持那些失业和上学的家庭。我们将需要我们的社区在不一定获得许可的学校中集中资源和为儿童保育中心工作。在没有老年人/高危人群的家庭中，人们应该有办法在共享育儿方面进行合作。这是对社区采取行动的重要呼吁，它将有助于保持低收入家庭的支持。这将不是完美的，并且比我们什么都不做会更好。在校内护理中心中，必须优先照顾基本工作者的子女，包括医疗保健工作者，环境服务工作者，基本服务提供者和急救人员。
3.主动关闭学校，以减缓传播(即“ 平缓曲线 ”)，以免压倒医疗体系。何时以及如何执行此操作应在地方和州一级确定。一个优先事项是为依赖它们的学生提供适当的食物，育儿和住所选择。我们必须暂时取消当前的限制，限制学校食品计划可以在哪里分发食物。建议2必须同时存在，以允许工人找到保育的选择。
4.立即需要进行广泛，安全地执行，可靠的测试。对于这些测试，我们需要为供应链的每个环节确定紧急替代品，以确认其准确性，并迅速，公平地分配它们。同时，我们需要明确的分配计划，以便我们可以确定感染者以照顾他们，并采取措施降低对他人的风险。必须进行移动驾驶测试，最好是在家进行自测工具包(类似于盖茨基金会在西雅图支持的工具包)。测试需要尽可能在急诊室和医院之外进行。
5.消除所有驱逐和抵押丧失抵押品赎回权的行为，直到COVID-19被遏制为止。
6.为所有弱势家庭建立带薪休假支持。
7.最大限度地生产口罩，机械呼吸机，洗手液，病毒测试棉签，测试试剂等，以保持供应链的空前需求。其他医疗用品(静脉输液，氧气面罩/管道，包括抗生素在内的支持药物和复苏药物)将需要增加产量，以维持用于治疗这种感染的用品。我们需要战术上和大量增加所有这些资源的生产。
8.免除因COVID-19爆发而给患者的护理费用。
9.允许在所有场所使用虚拟药品，从而减少护理交付中的面对面传播。这将需要取消对非农村虚拟药品就诊的医疗保险限制[附录：这已经在进行中]。
10.在尽可能多的大都市地区为无家可归者建立COVID-19正面和负面庇护所。必要时通过酒店和移动房屋扩大住房选择。
11.建立明确且以数据为依据的社会隔离建议。除了医疗，基本用品，基本工作服务和其他明确规定的令人信服的理由外，任何人都不得离开家园。应尽可能鼓励所有企业使用虚拟工作方式。
12.医院必须能够对门诊患者，住院患者和急诊室患者进行商业化测试，而不是进行测试并集中进行测试。如果将私人实验室用于COVID-19测试，则必须要求它们向地方卫生当局和CDC报告所有测试的结果。
13.必须建立在州一级针对自我隔离人群的跟踪方法，以进行公共卫生监督和跟进。
14.我们需要有关护理，退休和团体之家的指南，包括优化的社会隔离和卫生程序，将COVID-19阳性患者分为单位甚至什至将疗养院分开以最大程度地减少传播。
15.根据中国的经验，包括急救人员在内的医护人员极易感染和死亡。我们立即需要所有危险医疗人员的足够和适当的个人防护服装/设备以及全面的测试可用性。
16.通过尽快储存/制造氧气来最大化氧气供应。受灾地区的医院已经用完了，这将是维持生命的核心支持。[附录：我们了解也必须放开通过分销商获得家用氧气的批准，因为这在某些领域受到计费问题的限制]
17.每个州都应记录并保持所有可用通风机的记录，并能够将其运输到最需要的区域。如果不使用OR，则可以在ICU中使用麻醉呼吸机。也可以使用消防员换气口。
18.我们应努力在所有营业场所的入口处提供洗手液和口罩。这些资源的优先级必须用于医疗服务。
19.在不久的将来，将需要可能需要紧急制造的新设计的临时通风机，如果可能的话最好配备内置的氧气浓度-我们应该与创新者签订合同，现在就制造这些通风机。
20.需要制定和执行医务人员扩充计划。
21.州医疗委员会必须共同努力，为医务人员提供紧急和免费许可，以便医疗提供者可以越过州界进行患者护理。
22.仇外心理正在煽动针对患者和提供者的种族主义语言和行为。所有各级领导人都应大声疾呼，以免导致暴力和妥协。
[在1017个签名者已经签名之后添加的内容]
23.我们需要在所有拘留设施中保护被监禁的人口，最好将COVID-19阳性个体与阴性个体区分开。强制性感染控制几乎是不可能的，应考虑允许适当的囚犯离开设施。
24.如果不立即处理，我们的ICE设施将具有灾难性的感染率。个人必须像任何美国公民一样受到强有力的保护。分离COVID阳性和COVID阴性的家庭成员是不可接受的。家庭单位应隔离在一起。
25.立即对所有必要的商品和服务，尤其是提供医疗保健的商品和服务，采取消费者保护措施。药品，物资和保险费用的所有价格应冻结在2020年3月13日或更早的价格上。
您和本主管部门必须立即采取行动。我国以前已经克服了逆境。我们需要再次使用该工具的工具。我们需要工具来挽救生命。
如果您是医学专业人员，并且想登录，请填写此表格。
* 免责声明：以下列出的所有人员均为个人签字，所陈述的意见是他们自己的观点，并不代表其组织或雇主的立场。*
由于需要手动更新名称，因此，每天将在太平洋标准时间上午9点，下午3点和晚上8点至少对名称进行3次更新。感谢您的耐心配合和支持
真诚的
(名单略)
[quote]
应水友要求附上原文：
March 13, 2020
*FOR URGENT CONSIDERATION*
To: Vice President Mike Pence
原文链接：
[url]https://medium.com/@maxinedexter/open-letter-to-vice-president-mike-pence-re-us-covid-19-response-5ee9eaece61e[/url]
Re: The COVID-19 Outbreak in the United States — Medical Community Recommendations for Immediate Action
Vice President Pence,
We have lost our chance to contain this pandemic and are now facing an unmitigated medical disaster. This administration’s response has actively undermined our ability to care for patients by perpetuating misinformation and downplaying the looming threat this infection poses to the public. Ensuring health security is the fundamental duty and responsibility of government at all levels and we implore you to prioritize protecting our people over political and economic considerations.
We see ourselves making decisions in the next weeks and months on who will live, and who will die because we don’t have resources sufficient to care for them. We have heard the stories second- and farther-hand from China and Italy and have no reason to think the United States won’t suffer the same fate. We must flatten the curve of this pandemic to save lives.
Here are our recommendations:
1. Establish and empower, with true autonomy to act on medical decisions, a full-time, multidisciplinary team of public health and medical experts (Infectious Disease, Emergency Medicine, Fire/paramedic, Critical Care needed) who staff a central nation-wide command center to direct a coordinated national response. This must include:
A national call center that receives twice-daily or more updates from current or newly-established state-wide transfer call centers. The purpose of these call centers is to have a centralized place where front-line care providers in each state can call to coordinate transfers of patients to areas with higher levels or greater capacity for delivering care.
There should be an ethics team writing recommended guidelines for how to allocate resources when they become limited that is made public. First-come, first-serve cannot be the answer. It will need to be utilitarian in nature.
A healthcare information line for front-line care providers with written, recorded and video updates that are meticulously kept up to date.
Expansion of the CDC information for all to find the latest updates — with up to date national recommendations with translational services keeping all information immediately updated when changes are made. This is the information people need to know how to stay safe and where to go as things get worse.
2. Pass a nationwide stimulus package now to support families who will miss work and school. We will need our communities to pool resources and staff childcare centers in schools that aren’t necessarily licensed. People should have ways to collaborate on childcare sharing in their homes where there are no elderly/at risk individuals. This is an important call to action for the community that will help keep low-income families supported. This will NOT be perfect and it will be better than if we don’t do anything. Priority needs to be given in school-based care centers to children of essential workers including healthcare workers, environmental service workers, essential service providers, and first-responders.
3. Close schools proactively, with the intent to slow the spread (ie. “flatten the curve”) so as not to overwhelm the healthcare system. When and how to do this should be determined at the local and state levels. A priority is to keep food, childcare and shelter options in place for students who depend on them. We must temporarily lift the current restrictions limiting where school-based food programs may distribute food. Recommendation #2 will need to be in place concurrently to allow workers to find options for childcare.
4. Expansive, safely executed, reliable testing is needed immediately. We need to identify emergency replacements for every step of the supply chain for these tests, corroborate their accuracy, and distribute them rapidly and equitably. In the meantime, we need clear allocation plans so we can identify infected individuals to care for them and take steps to decrease risk to others. Mobile, drive through testing must be instituted and preferably self-testing at-home kits (similar to kits in Seattle supported by The Gates Foundation). Testing needs to happen outside of the ER and hospitals as much as possible.
5. Eliminate all evictions and mortgage foreclosures until COVID-19 has been contained.
6. Establish paid leave support for all vulnerable families.
7. Maximize production of masks, mechanical ventilators, hand sanitizer, viral testing swabs, test reagents, etc. to maintain the supply chain in what will be an unprecedented need. Other medical supplies (intravenous fluids, oxygen masks/tubing, supportive medications including antibiotics and resuscitation medications) will need to have increased production to maintain supplies to treat this infection. We need tactical and massive increased production of all these resources.
8. Waive patient costs for care given in response to the COVID-19 outbreak.
9. Enable virtual medicine to be used in all venues, decreasing face-to-face transmission within care delivery. This would require lifting Medicare restrictions on non-rural virtual medicine visits [addendum: this is already in process].
10. Establish COVID-19 positive and negative shelters for our houseless populations in as many metropolitan regions as possible. Expand housing options through hotels and mobile homes as necessary.
11. Establish clear and data-driven social isolation recommendations. No one should leave their homes in impacted regions except for medical care, essential supplies, essential work services and compelling other reasons that are clearly defined. Virtual work options should be encouraged for all businesses, whenever possible.
12. Hospitals must be able to test outpatients, inpatients, and emergency room patients commercially, rather than transporting tests and running them centrally. If private labs are being used for COVID-19 testing, they must be required to report the outcomes of all tests to local health authorities and the CDC.
13. A tracking method at the state level for people self quarantined must be instituted for public health surveillance and follow up.
14. We need guidelines for nursing, retirement and group homes, including optimized social isolation and sanitation processes, separation of COVID-19 positive patients into units or even separate nursing homes to minimize transmission.
15. Healthcare workers, including first-responders, are at high risk for infection and death according to China’s experience. We immediately need sufficient and appropriate personal protective attire/equipment and comprehensive testing availability for all at-risk healthcare workers.
16. Maximize oxygen supplies by stockpiling/making oxygen as rapidly as possible. Hospitals in impacted areas have run out, and this will be a core life-sustaining support. [addendum: we understand getting approval for home oxygen through distributors must also be liberated as this has been limited by billing issues in some areas]
17. Each state should make and maintain a record of all available ventilators with the capability to transport them to the areas with the greatest need. Anesthesia ventilators can be used in the ICUs if the ORs aren’t being used. Firefighter transfer vents may also be used.
18. We should strive to have available hand sanitizer and masks available at the entrance to all open businesses. Priority for these resources must go to medical care delivery.
19. Temporary ventilators of new designs that may be urgently manufactured, preferably with built-in oxygen concentration if possible, will be needed in the near future — we should contract with innovators to create these now.
20. Medical workforce expansion plans need to be created and implemented.
21. State medical boards must work together for emergent and free licensing for medical personal so medical providers can cross states lines for patient care.
22. Xenophobia is fomenting racist language and behavior against patients and providers. All leaders, at every level, should speak out against it so that it does not lead to violence and compromise.
[additions after 1017 signers had already signed]
23. We need to protect our incarcerated populations in all retention facilities, ideally separating COVID-19 positive individuals from negative. Compulsive infection control will be nearly impossible and consideration should be given for allowing appropriate inmates to leave facilities.
24. Our ICE facilities will have catastrophic infection rates if not dealt with immediately. Individuals must be protected as robustly as any American citizen. Separating family members who are COVID-positive vs. COVID-negative is not acceptable. Family units should be isolated together.
25. Enact consumer protections for all necessary goods and services immediately, especially those to deliver healthcare. ALL prices for medications, supplies and insurance costs should be frozen at the prices as of March 13, 2020 or earlier.
You and this administration must take action now. Our country has overcome adversity before. We need the tools to do it again. We need the tools to save lives.
If you are a medical professional and would like to sign on, fill out this form.
*DISCLAIMER: All persons listed below are signing as individuals, their opinions as stated are their own and do not represent the position of their organization or employers.*
**Due to the need to update names manually, names will be updated at least three times daily at 9 am, 3 pm and 8 pm PST. Thank you for your patience and support**
[/quote]
但是已经养了这么长时间的蛊了，加上这些能不能落到实处还要打个问号，可能只是这些医生的美好愿望罢了。
不管美国政府怎么样，这些医务工作者还是可敬的，甚至还有一点要上战场的悲壮感。
官僚主义害死人啊，全世界都一样。
下面附上机翻全文：
致：副总统迈克·彭斯
回复：美国发生COVID-19疫情-医学界建议立即采取行动
彭斯副总统，
我们已经失去了遏制这种大流行的机会，现在正面临着无法缓解的医疗灾难。该主管部门的回应通过使错误信息永久存在并轻描淡写这种感染给公众带来的潜在威胁，从而极大地削弱了我们照顾患者的能力。确保健康安全是各级政府的基本职责和责任，我们恳请您将保护人民的工作置于政治和经济考虑之上。
我们看到自己在接下来的几周和几个月内就谁将活着以及谁会死做出决定，因为我们没有足够的资源来照顾他们。我们听说过来自中国和意大利的二手货和二手货，也没有理由认为美国不会遭受同样的命运。为了挽救生命，我们必须拉平大流行的曲线。
以下是我们的建议：
1.建立并赋予真正的自主权以根据医疗决定采取行动，由全职，多学科的公共卫生和医学专家团队(传染病，急诊医学，消防/护理人员，重症监护)组成，并在全国范围内为员工提供服务指挥中心指挥协调的国家反应。必须包括：
全国性呼叫中心，每天从当前或新建立的州级转接呼叫中心接收两次或更多次更新。这些呼叫中心的目的是要有一个集中的地方，每个州的一线医疗服务提供者都可以致电该地方，以协调患者到更高级别或更大能力的地区的转移。
应该有一个道德团队编写有关如何在资源有限时分配资源的建议指南，这些指南已公开。先到先得不能成为答案。它本质上必须是功利主义者。
面向一线医疗服务提供者的医疗保健信息热线，其书面，录制和视频更新均保持最新。
扩展CDC信息以供所有人查找最新更新-带有翻译服务的最新国家建议，可在进行更改时立即更新所有信息。这是人们需要知道的信息，以便在情况恶化时保持安全并前往何处。
2.现在通过一项全国性的刺激计划，以支持那些失业和上学的家庭。我们将需要我们的社区在不一定获得许可的学校中集中资源和为儿童保育中心工作。在没有老年人/高危人群的家庭中，人们应该有办法在共享育儿方面进行合作。这是对社区采取行动的重要呼吁，它将有助于保持低收入家庭的支持。这将不是完美的，并且比我们什么都不做会更好。在校内护理中心中，必须优先照顾基本工作者的子女，包括医疗保健工作者，环境服务工作者，基本服务提供者和急救人员。
3.主动关闭学校，以减缓传播(即“ 平缓曲线 ”)，以免压倒医疗体系。何时以及如何执行此操作应在地方和州一级确定。一个优先事项是为依赖它们的学生提供适当的食物，育儿和住所选择。我们必须暂时取消当前的限制，限制学校食品计划可以在哪里分发食物。建议2必须同时存在，以允许工人找到保育的选择。
4.立即需要进行广泛，安全地执行，可靠的测试。对于这些测试，我们需要为供应链的每个环节确定紧急替代品，以确认其准确性，并迅速，公平地分配它们。同时，我们需要明确的分配计划，以便我们可以确定感染者以照顾他们，并采取措施降低对他人的风险。必须进行移动驾驶测试，最好是在家进行自测工具包(类似于盖茨基金会在西雅图支持的工具包)。测试需要尽可能在急诊室和医院之外进行。
5.消除所有驱逐和抵押丧失抵押品赎回权的行为，直到COVID-19被遏制为止。
6.为所有弱势家庭建立带薪休假支持。
7.最大限度地生产口罩，机械呼吸机，洗手液，病毒测试棉签，测试试剂等，以保持供应链的空前需求。其他医疗用品(静脉输液，氧气面罩/管道，包括抗生素在内的支持药物和复苏药物)将需要增加产量，以维持用于治疗这种感染的用品。我们需要战术上和大量增加所有这些资源的生产。
8.免除因COVID-19爆发而给患者的护理费用。
9.允许在所有场所使用虚拟药品，从而减少护理交付中的面对面传播。这将需要取消对非农村虚拟药品就诊的医疗保险限制[附录：这已经在进行中]。
10.在尽可能多的大都市地区为无家可归者建立COVID-19正面和负面庇护所。必要时通过酒店和移动房屋扩大住房选择。
11.建立明确且以数据为依据的社会隔离建议。除了医疗，基本用品，基本工作服务和其他明确规定的令人信服的理由外，任何人都不得离开家园。应尽可能鼓励所有企业使用虚拟工作方式。
12.医院必须能够对门诊患者，住院患者和急诊室患者进行商业化测试，而不是进行测试并集中进行测试。如果将私人实验室用于COVID-19测试，则必须要求它们向地方卫生当局和CDC报告所有测试的结果。
13.必须建立在州一级针对自我隔离人群的跟踪方法，以进行公共卫生监督和跟进。
14.我们需要有关护理，退休和团体之家的指南，包括优化的社会隔离和卫生程序，将COVID-19阳性患者分为单位甚至什至将疗养院分开以最大程度地减少传播。
15.根据中国的经验，包括急救人员在内的医护人员极易感染和死亡。我们立即需要所有危险医疗人员的足够和适当的个人防护服装/设备以及全面的测试可用性。
16.通过尽快储存/制造氧气来最大化氧气供应。受灾地区的医院已经用完了，这将是维持生命的核心支持。[附录：我们了解也必须放开通过分销商获得家用氧气的批准，因为这在某些领域受到计费问题的限制]
17.每个州都应记录并保持所有可用通风机的记录，并能够将其运输到最需要的区域。如果不使用OR，则可以在ICU中使用麻醉呼吸机。也可以使用消防员换气口。
18.我们应努力在所有营业场所的入口处提供洗手液和口罩。这些资源的优先级必须用于医疗服务。
19.在不久的将来，将需要可能需要紧急制造的新设计的临时通风机，如果可能的话最好配备内置的氧气浓度-我们应该与创新者签订合同，现在就制造这些通风机。
20.需要制定和执行医务人员扩充计划。
21.州医疗委员会必须共同努力，为医务人员提供紧急和免费许可，以便医疗提供者可以越过州界进行患者护理。
22.仇外心理正在煽动针对患者和提供者的种族主义语言和行为。所有各级领导人都应大声疾呼，以免导致暴力和妥协。
[在1017个签名者已经签名之后添加的内容]
23.我们需要在所有拘留设施中保护被监禁的人口，最好将COVID-19阳性个体与阴性个体区分开。强制性感染控制几乎是不可能的，应考虑允许适当的囚犯离开设施。
24.如果不立即处理，我们的ICE设施将具有灾难性的感染率。个人必须像任何美国公民一样受到强有力的保护。分离COVID阳性和COVID阴性的家庭成员是不可接受的。家庭单位应隔离在一起。
25.立即对所有必要的商品和服务，尤其是提供医疗保健的商品和服务，采取消费者保护措施。药品，物资和保险费用的所有价格应冻结在2020年3月13日或更早的价格上。
您和本主管部门必须立即采取行动。我国以前已经克服了逆境。我们需要再次使用该工具的工具。我们需要工具来挽救生命。
如果您是医学专业人员，并且想登录，请填写此表格。
* 免责声明：以下列出的所有人员均为个人签字，所陈述的意见是他们自己的观点，并不代表其组织或雇主的立场。*
由于需要手动更新名称，因此，每天将在太平洋标准时间上午9点，下午3点和晚上8点至少对名称进行3次更新。感谢您的耐心配合和支持
真诚的
(名单略)
[quote]
应水友要求附上原文：
March 13, 2020
*FOR URGENT CONSIDERATION*
To: Vice President Mike Pence
原文链接：
[url]https://medium.com/@maxinedexter/open-letter-to-vice-president-mike-pence-re-us-covid-19-response-5ee9eaece61e[/url]
Re: The COVID-19 Outbreak in the United States — Medical Community Recommendations for Immediate Action
Vice President Pence,
We have lost our chance to contain this pandemic and are now facing an unmitigated medical disaster. This administration’s response has actively undermined our ability to care for patients by perpetuating misinformation and downplaying the looming threat this infection poses to the public. Ensuring health security is the fundamental duty and responsibility of government at all levels and we implore you to prioritize protecting our people over political and economic considerations.
We see ourselves making decisions in the next weeks and months on who will live, and who will die because we don’t have resources sufficient to care for them. We have heard the stories second- and farther-hand from China and Italy and have no reason to think the United States won’t suffer the same fate. We must flatten the curve of this pandemic to save lives.
Here are our recommendations:
1. Establish and empower, with true autonomy to act on medical decisions, a full-time, multidisciplinary team of public health and medical experts (Infectious Disease, Emergency Medicine, Fire/paramedic, Critical Care needed) who staff a central nation-wide command center to direct a coordinated national response. This must include:
A national call center that receives twice-daily or more updates from current or newly-established state-wide transfer call centers. The purpose of these call centers is to have a centralized place where front-line care providers in each state can call to coordinate transfers of patients to areas with higher levels or greater capacity for delivering care.
There should be an ethics team writing recommended guidelines for how to allocate resources when they become limited that is made public. First-come, first-serve cannot be the answer. It will need to be utilitarian in nature.
A healthcare information line for front-line care providers with written, recorded and video updates that are meticulously kept up to date.
Expansion of the CDC information for all to find the latest updates — with up to date national recommendations with translational services keeping all information immediately updated when changes are made. This is the information people need to know how to stay safe and where to go as things get worse.
2. Pass a nationwide stimulus package now to support families who will miss work and school. We will need our communities to pool resources and staff childcare centers in schools that aren’t necessarily licensed. People should have ways to collaborate on childcare sharing in their homes where there are no elderly/at risk individuals. This is an important call to action for the community that will help keep low-income families supported. This will NOT be perfect and it will be better than if we don’t do anything. Priority needs to be given in school-based care centers to children of essential workers including healthcare workers, environmental service workers, essential service providers, and first-responders.
3. Close schools proactively, with the intent to slow the spread (ie. “flatten the curve”) so as not to overwhelm the healthcare system. When and how to do this should be determined at the local and state levels. A priority is to keep food, childcare and shelter options in place for students who depend on them. We must temporarily lift the current restrictions limiting where school-based food programs may distribute food. Recommendation #2 will need to be in place concurrently to allow workers to find options for childcare.
4. Expansive, safely executed, reliable testing is needed immediately. We need to identify emergency replacements for every step of the supply chain for these tests, corroborate their accuracy, and distribute them rapidly and equitably. In the meantime, we need clear allocation plans so we can identify infected individuals to care for them and take steps to decrease risk to others. Mobile, drive through testing must be instituted and preferably self-testing at-home kits (similar to kits in Seattle supported by The Gates Foundation). Testing needs to happen outside of the ER and hospitals as much as possible.
5. Eliminate all evictions and mortgage foreclosures until COVID-19 has been contained.
6. Establish paid leave support for all vulnerable families.
7. Maximize production of masks, mechanical ventilators, hand sanitizer, viral testing swabs, test reagents, etc. to maintain the supply chain in what will be an unprecedented need. Other medical supplies (intravenous fluids, oxygen masks/tubing, supportive medications including antibiotics and resuscitation medications) will need to have increased production to maintain supplies to treat this infection. We need tactical and massive increased production of all these resources.
8. Waive patient costs for care given in response to the COVID-19 outbreak.
9. Enable virtual medicine to be used in all venues, decreasing face-to-face transmission within care delivery. This would require lifting Medicare restrictions on non-rural virtual medicine visits [addendum: this is already in process].
10. Establish COVID-19 positive and negative shelters for our houseless populations in as many metropolitan regions as possible. Expand housing options through hotels and mobile homes as necessary.
11. Establish clear and data-driven social isolation recommendations. No one should leave their homes in impacted regions except for medical care, essential supplies, essential work services and compelling other reasons that are clearly defined. Virtual work options should be encouraged for all businesses, whenever possible.
12. Hospitals must be able to test outpatients, inpatients, and emergency room patients commercially, rather than transporting tests and running them centrally. If private labs are being used for COVID-19 testing, they must be required to report the outcomes of all tests to local health authorities and the CDC.
13. A tracking method at the state level for people self quarantined must be instituted for public health surveillance and follow up.
14. We need guidelines for nursing, retirement and group homes, including optimized social isolation and sanitation processes, separation of COVID-19 positive patients into units or even separate nursing homes to minimize transmission.
15. Healthcare workers, including first-responders, are at high risk for infection and death according to China’s experience. We immediately need sufficient and appropriate personal protective attire/equipment and comprehensive testing availability for all at-risk healthcare workers.
16. Maximize oxygen supplies by stockpiling/making oxygen as rapidly as possible. Hospitals in impacted areas have run out, and this will be a core life-sustaining support. [addendum: we understand getting approval for home oxygen through distributors must also be liberated as this has been limited by billing issues in some areas]
17. Each state should make and maintain a record of all available ventilators with the capability to transport them to the areas with the greatest need. Anesthesia ventilators can be used in the ICUs if the ORs aren’t being used. Firefighter transfer vents may also be used.
18. We should strive to have available hand sanitizer and masks available at the entrance to all open businesses. Priority for these resources must go to medical care delivery.
19. Temporary ventilators of new designs that may be urgently manufactured, preferably with built-in oxygen concentration if possible, will be needed in the near future — we should contract with innovators to create these now.
20. Medical workforce expansion plans need to be created and implemented.
21. State medical boards must work together for emergent and free licensing for medical personal so medical providers can cross states lines for patient care.
22. Xenophobia is fomenting racist language and behavior against patients and providers. All leaders, at every level, should speak out against it so that it does not lead to violence and compromise.
[additions after 1017 signers had already signed]
23. We need to protect our incarcerated populations in all retention facilities, ideally separating COVID-19 positive individuals from negative. Compulsive infection control will be nearly impossible and consideration should be given for allowing appropriate inmates to leave facilities.
24. Our ICE facilities will have catastrophic infection rates if not dealt with immediately. Individuals must be protected as robustly as any American citizen. Separating family members who are COVID-positive vs. COVID-negative is not acceptable. Family units should be isolated together.
25. Enact consumer protections for all necessary goods and services immediately, especially those to deliver healthcare. ALL prices for medications, supplies and insurance costs should be frozen at the prices as of March 13, 2020 or earlier.
You and this administration must take action now. Our country has overcome adversity before. We need the tools to do it again. We need the tools to save lives.
If you are a medical professional and would like to sign on, fill out this form.
*DISCLAIMER: All persons listed below are signing as individuals, their opinions as stated are their own and do not represent the position of their organization or employers.*
**Due to the need to update names manually, names will be updated at least three times daily at 9 am, 3 pm and 8 pm PST. Thank you for your patience and support**
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