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One step forward, 2 steps back: Harvard's Dr. Thomas Tsai assesses Trump's response to COVID-19, and tells us his fears and hopes about the months ahead

<ul class="summary-list"><li>California is rolling back the reopening of its economy, closing bars statewide following an increase in <keyword id="8763838" type="UNKNOWN" weightage="60" keywordseo="covid-19">COVID-19</keyword> cases.</li><li>The state's rate of positive <keyword id="1754604" type="PERSON" weightage="60" keywordseo="coronavirus">coronavirus</keyword> tests has hit a two-week average of 7.4%.</li><li>The move comes weeks after Florida introduced restrictions for its bars. But the states are not doing equally as bad.</li><li>Florida's positive test rate has been in the double digits for weeks, while California hasn't cleared 10% since April.</li><li>"Miami is now the epicenter of the pandemic," Dr. Lilian Abbo, the chief of infection prevention at Jackson Health System, told the Associated Press. "What we were seeing in Wuhan six months ago. Now, we are there."</li><li>"I think what has happened is that some states have been content to flatten the curve as opposed to really bend the curve, as opposed to really bend the curve and drive it down to zero," Dr. Thomas Tsai, of Harvard University, <a href="https://www.businessinsider.com/covid-19-harvards-dr-thomas-tsai-asseses-trumps-pandemic-response-2020-7">told Business Insider</a>.</li></ul>Two early COVID-19 success stories in the US deployed wildly different approaches. California shut everything down early, while Florida opened back up — bars, gyms, and indoor dining — weeks before most other states.Neither state is in a particularly good place today. California reported more than 8,300 new coronavirus cases on Monday, up from just over 3,200 a month before. That's not just because it's conducting more tests, either; the rate of positives is climbing too, on Sunday hitting a 14-day average of 7.4%, up from 5.6% two weeks before.On Monday, Gov. <keyword id="173696" type="PERSON" weightage="60" keywordseo="Gavin-Newsom">Gavin Newsom</keyword>, a Democrat, reversed course: Instead of a phased reopening, he announced that he was closing bars, indoor restaurants, and movie theaters back down."This virus is not going away anytime soon," he said.For John Swartzberg, an infectious-disease expert at the University of California at Berkeley, it's about time. "I'm all for what he's suggested," Swartzberg <a href="https://www.sfchronicle.com/politics/article/Newsom-orders-all-California-counties-to-close-15405030.php">told the San Francisco Chronicle</a>. "And I'm sorry it wasn't done two weeks ago."California, in fact, is acting weeks after Florida. Bars in both states reopened in early June, but Gov. <keyword id="2947172" type="PERSON" weightage="60" keywordseo="Ron-DeSantis">Ron DeSantis</keyword>, a Republican, prohibited the consumption of alcohol at bars in his state on June 26.But while neither is in a great place, one is doing far worse. "Miami is now the epicenter of the pandemic," Dr. Lilian Abbo, the chief of infection prevention at Jackson Health System in Miami, <a href="https://www.usnews.com/news/best-states/florida/articles/2020-07-13/florida-records-another-12-000-virus-cases-eyes-icu-beds">told the Associated Press</a>. Referring to Wuhan, China, the city where the novel coronavirus was first identified, she said: "What we were seeing in Wuhan six months ago. Now, we are there."One of Abbo's colleagues told Business Insider it was DeSantis' early decision to return to business as usual — opening indoor dining in May, for example — that precipitated the current surge, which saw more than 15,300 Floridians diagnosed with COVID-19 on Sunday, a record for any state."When everything started to open up and ease up, then our volume picked up," Dr. Mark Supino, an emergency-medicine physician at Jackson Health System, <a href="https://www.businessinsider.com/florida-er-doctor-links-covid-surge-to-desantis-opening-economy-2020-6">said in an interview</a>.Dr. Thomas Tsai, a public-health expert at Harvard University, says Florida — unlike California — began reopening without really seeing a decline in infections. Both are struggling, <a href="https://www.businessinsider.com/covid-19-harvards-dr-thomas-tsai-asseses-trumps-pandemic-response-2020-7">he told Business Insider</a>, but Florida is reporting far more cases than California with just over half the population — not because it's conducting so many more tests, but because so many more people are testing positive.Over the past two weeks, Florida's positive rate has never fallen below 11.25%, and last Wednesday it surged past 18%. California, by contrast, hasn't hit double digits since April."California has been able to keep the lid on the pot and keep things from boiling over," Tsai said.But, he added, "It really hasn't had the opportunity to turn the temperature down.""In Florida, it's the opposite," Tsai commented. "I think what has happened is that some states have been content to flatten the curve as opposed to really bend the curve, as opposed to really bend the curve and drive it down to zero."The state has also failed to ramp up <keyword id="7313056" type="UNKNOWN" weightage="60" keywordseo="Contact-tracing">contact tracing</keyword>. The epicenter of Miami-Dade County never fulfilled the mayor's promise, back in May, to hire hundreds of tracers, <a href="https://www.businessinsider.com/miami-dade-county-never-got-the-contact-tracers-it-needs-2020-7">as Business Insider has reported</a>.The focus, too often, has been on reopening the economy — no matter the long-term economic and personal cost, Tsai said. And some jurisdictions need to do a lot more than just scale back."Clearly, in the states where the pandemic has gotten out of control, a limited shutdown is needed to prevent hospitals from being overrun," he said.Have a <keyword id="6355005" type="UNKNOWN" weightage="100" keywordseo="news">news</keyword> tip? Email this reporter: <a href="mailto:cdavis@insider.com">cdavis@insider.com</a>

California and Florida are rolling back the opening of their economies as they struggle with COVID-19. But public-health experts say the 2 states are not the same.

<ul class="summary-list"><li>Seven states — <keyword id="105921" type="ORGANIZATION" weightage="60" keywordseo="Maryland">Maryland</keyword>, <keyword id="60111" type="CITY" weightage="60" keywordseo="Louisiana">Louisiana</keyword>, <keyword id="21044" type="ENTERTAINMENT" weightage="60" keywordseo="Massachusetts">Massachusetts</keyword>, <keyword id="18877" type="PERSON" weightage="60" keywordseo="Michigan">Michigan</keyword>, <keyword id="15091" type="CITY" weightage="60" keywordseo="Ohio">Ohio</keyword>, North, Carolina, and Virginia — have entered into an agreement to purchase 3.5 million <keyword id="8763838" type="UNKNOWN" weightage="60" keywordseo="covid-19">COVID-19</keyword> tests.</li><li>"With severe shortages and delays in testing and the federal [Trump] administration attempting to cut funding for testing, the states are banding together to acquire millions of faster tests to help save lives and slow the spread of COVID-19," Maryland Gov. Larry Hogan, a Republican, said in a statement.</li><li>The states are purchasing antigen tests, which can produce results in less than 20 minutes.</li><li>However, according to the US Food and Drug Administration, "antigen tests have a higher chance of missing an active infection."</li></ul>Seven governors from across the United States have joined together to bulk purchase <keyword id="1754604" type="PERSON" weightage="60" keywordseo="coronavirus">coronavirus</keyword> tests, it was announced Tuesday."With severe shortages and delays in testing and the federal [Trump] administration attempting to cut funding for testing, the states are banding together to acquire millions of faster tests to help save lives and slow the spread of COVID-19," Maryland Gov. Larry Hogan, a Republican, said in a statement.The agreement, made with the Rockefeller Foundation, will result in each signatory receiving 500,000 antigen tests from private manufacturers. Those signatories include Maryland, Louisiana, Massachusetts, Michigan, Ohio, North Carolina, and Virginia.Antigen tests, which entail collecting fluids from a nasal or throat swab, can deliver results in less than 20 minutes, allowing states to rapidly detect and control outbreaks of COVID-19. However, accuracy can be an issue: according to the US Food and Drug Administration, "antigen tests have a higher chance of missing an active infection."Nevertheless, the ability to rapidly test large amounts of people is appealing not just to governors but public health experts: as Harvard University's Dr. Thomas Tsai <a href="https://www.businessinsider.com/covid-19-harvards-dr-thomas-tsai-asseses-trumps-pandemic-response-2020-7">told Business Insider</a>, such testing is essential if there is to be any hope of safely opening the economy."So clearly, a coordinated strategy needs to happen," Tsai said last month. "If it can't happen at the federal level for political reasons, then it needs to happen at the state level. So governors need to work together and form interstate compacts and collaboratives to coordinate testing and social distancing policy on the regional level and that also translates down to within a state to coordinate that effort county to county."Under the agreement, the Rockefeller Foundation will work to facilitate the financing of the interstate testing arrangement, which is open to new members."Widespread testing is one of the most crucial tools we have to stop the spread of this virus and save lives," Michigan Gov. Gretchen Whitmer, a Democrat, said in <a href="https://www.michigan.gov/whitmer/0,9309,7-387-90499_90640-535674--,00.html">a press release</a>. "I'm hopeful that the president and Congress will follow our lead and work together on a recovery package that includes support for states like ours so we can continue to protect our families."Have a <keyword id="6355005" type="UNKNOWN" weightage="100" keywordseo="news">news</keyword> tip? Email this reporter: cdavis@insider.com

A bipartisan group of 7 US governors banded together to purchase COVID-19 testing equipment in the absence of a strong federal testing program

Mount SinaiHealthcare workers who helped create the ventilator prototype. From left to right: Drew Copeland, RPSGT; Dr. Thomas Tolbert, Dr. Brian Mayrsohn, and Dr. Hooman Poor.<ul class="summary-list"><li>New York is running short on ventilators, the breathing machines that could be the difference between life and death for some <a href="https://www.businessinsider.com/wuhan-coronavirus-us-cases-health-risk-2020-1">coronavirus patients</a>.</li><li>Mount Sinai Hospital in Manhattan has figured out a way to turn sleep apnea machines into ventilators after receiving a donation from Tesla CEO Elon Musk in late March</li><li>Dr. Hooman Poor, who helped convert the machines, told Business Insider that after a few tweaks, "there was really no reason why this couldn't work."</li><li><a href="https://inside.mountsinai.org/wp-content/uploads/sites/14/2020/04/NIV-to-Ventilator-Modification-Protocol-v1.02-for-posting.pdf">Instructions and protocols</a> developed by the hospital to modify and use these machines have now been shared with other hospitals around the state and country</li><li><a href="https://www.businessinsider.com/coronavirus-live-updates-latest-news">Read live updates about the coronavirus here</a></li></ul>New York is running out of ventilators. To address the shortage, doctors are getting creative.At Mount Sinai Hospital in Manhattan, a team of healthcare workers developed a way to turn sleep apnea machines, devices typically used to help people who have trouble breathing while they're asleep, into ventilators.The hospital received a donation of 200 sleep apnea machines <a href="https://www.businessinsider.com/elon-musk-criticized-possible-bipap-machines-ventilators-new-york-hospital-2020-4">from Tesla CEO Elon Musk</a> in late March. Since then, staff has worked to turn the devices into tools that could help patients with trouble breathing, a common symptom of COVID-19, the disease caused by the <a href="https://www.businessinsider.com/wuhan-coronavirus-us-cases-health-risk-2020-1">coronavirus</a>. The hospital plans to use them for patients whose breathing problems aren't as severe as some other COVID-19 patients.Currently, Mount Sinai has 300 of the machines on hand and has modified 30 of them. Conversion of the remaining 270 will be finished in the next few days, and the hospital expects an additional 1,000 to arrive in the near future. The idea is to use them to stave off a worst-case scenario: running short on ventilators as the number of coronavirus cases in New York City reaches a peak."The one horrific decision I never want to have to make is who gets a ventilator and who doesn't," Dr. Hooman Poor, a physician at Mount Sinai who worked on the project, told Business Insider. "That's a horrifying situation. It's an ethical dilemma that has been discussed widely in this pandemic and having these machines available would reduce the likelihood that we would ever have to make that decision." <h2>'There was really no reason why this couldn't work'</h2>When the hospital received the donation, healthcare workers discussed whether these machines - which also help people breathe, albeit in usually less critical conditions - could be used to help coronavirus patients."There was really no reason why this couldn't work," said Poor, who's an assistant professor of pulmonary, critical care and sleep medicine at the Icahn School of Medicine at Mount Sinai. There were some tweaks that the hospital had to make.One of the biggest concerns with using sleep apnea machines as ventilators for coronavirus patients is the risk of the machine aerosolizing the virus, spreading it more readily and putting healthcare workers at increased risk of catching it."We had to deal with the fact that we're dealing with a highly contagious virus," Poor said. <h2>The conversion process</h2>With standard ventilators, air that is breathed out by the patient is sent to an exhalation port that prevents the air - that is potentially contaminated with a virus - from directly entering the room. Mount SinaiPrototype of a sleep apnea machine-turned-ventilatorPoor said he and a team of around 15 healthcare workers modified the sleep apnea machines to perform a similar function by putting a viral filter on the exhalation port of the machine, which would make sure the air breathed out by the patient would go through the filter instead of directly into the air in the room.The conversion from sleep apnea machine to ventilator is simple, Poor said. With the <a href="https://inside.mountsinai.org/wp-content/uploads/sites/14/2020/04/NIV-to-Ventilator-Modification-Protocol-v1.02-for-posting.pdf">instructions</a> they've currently laid out, it would take around 10 minutes to modify each machine, though they are only able to convert bilevel machines, also known as BiPAP machines.CPAP machines, also used by people with sleep apnea, can't be converted in the same way.Read more: <a href="https://www.businessinsider.com/ventilators-for-coronavirus-patients-how-they-work-2020-3">The US is running short on ventilators amid the coronavirus pandemic. Here's how they work and why they're so important.</a>Other hospitals have gotten creative as well. Stanford has <a href="https://bioengineering.stanford.edu/modified-full-face-snorkeling-mask-reusable-ppe-health-care-worker">repurposed snorkeling masks</a> as reusable PPE for healthcare workers and The University of Nebraska Medical Center has said it is using <a href="https://www.unmc.edu/news.cfm?match=25283">UV light to disinfect and sterilize</a> N95 masks so they can be resued. Other medical centers and hospitals around the country, that are facing or expecting serious shortages, are using household materials to design makeshift masks as short-term PPE replacements.At Mount Sinai, the reconfigured machines can alert healthcare workers if there is a problem with the patient's air flow and can be accessed and controlled from outside the patient's room, allowing clinicians to make minor changes to the ventilator's settings without having to go into the patient's room. This helps to preserve personal protective equipment for healthcare workers.<h2>New York's need for ventilators</h2>New York, which has become the epicenter of the coronavirus pandemic in the US with over 130,000 confirmed cases as of Tuesday morning, is running short on ventilators. Governor Andrew Cuomo has publicly asked for help from the federal government and other states.Ventilators could be "the difference between life and death," Cuomo <a href="https://www.businessinsider.com/new-york-governor-cuomo-begs-us-government-for-more-ventilators-2020-3">said at a press conference</a> late March, where he stressed the state's need for the machines.Last week, the state received 1,000 from billionaires Jack Ma and Joseph Tsai, the founders of Alibaba, a Chinese e-commerce company. States like California, Washington, and Oregon have pledged to send more.Mount SinaiA sign tells visitors that masks are required.<h2>A safer option</h2>The reconfigured ventilators are safer than <a href="https://www.businessinsider.com/new-york-ventilator-shortage-may-force-sharing-but-its-risky-2020-3">splitting ventilators to serve multiple patients</a> at the same time, according to Poor. That's been suggested as a last resort option that some hospitals have been preparing for as ventilator supplies run low.If a hospital were to connect two patients to a single ventilator, they would, first of all, have to match patients closely in terms of condition and the amount of oxygen and pressure they'd require. If one of these patients were to get suddenly worse, however, they would suddenly need different settings on the ventilator than their partner-patient, causing problems.Though the sleep apnea machines-turned-ventilators are useful for patients who may be on their way to recovery, they are not powerful enough to stabilize patients with severe respiratory issues. Regular ventilators, which are more powerful, will still be needed to treat patients with more severe breathing problems.Do you have a personal experience with the coronavirus you'd like to share? Or a tip on how your town or community is handling the pandemic? Please email <a href="mailto:covidtips@businessinsider.com">covidtips@businessinsider.com</a> and tell us your story.And get the latest <a href="/coronavirus-business-impact">coronavirus analysis and research</a> from Business Insider Intelligence on how COVID-19 is impacting businesses. <h3>NOW WATCH: <a href="https://www.businessinsider.com/novel-coronavirus-covid-19-symptoms-day-by-day-2020-3">What coronavirus symptoms look like, day by day</a></h3>

A NYC hospital has figured out how to turn sleep apnea machines it got from Elon Musk into ventilators for coronavirus patients

You Searched For "dr thomas tsai" and got 4 results

One step forward, 2 steps back: Harvard's Dr. Thomas Tsai assesses Trump's response to COVID-19, and tells us his fears and hopes about the months ahead

Charles Davis

California and Florida are rolling back the opening of their economies as they struggle with COVID-19. But public-health experts say the 2 states are not the same.

Charles Davis

A bipartisan group of 7 US governors banded together to purchase COVID-19 testing equipment in the absence of a strong federal testing program

Charles Davis

A NYC hospital has figured out how to turn sleep apnea machines it got from Elon Musk into ventilators for coronavirus patients

Yeji Jesse Lee

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