VS heeft een probleem

Verkorte transcript

So in 2018, it was the hundredth anniversary of the terrible 1918 flu pandemic. This was called the Spanish flu. And it just killed millions and millions of people around the world. So on that hundredth-year anniversary, many gatherings were held to discuss the lessons of that flu pandemic for today. And there was this one gathering of high-level people in Atlanta, Georgia, where the Centers for Disease Control and Prevention is based. And among the officials there was a group from the National Security Council. It had actually been created, a special unit on global health security that was created after that terrible Ebola outbreak in West Africa. So one of the officials with that group, with that unit steps up to the podium and she says —

Luciano Borio: "The threat of pandemic flu is our number one health security concern. We know that it cannot be stopped at the border."

So this is a pretty senior health official on the National Security Council warning her colleagues that there is a very predictable threat here — a pandemic flu and —

"Are we ready to respond to a pandemic? I fear the answer is no."

And as it happens, the very next day, that global health security unit where she worked was shut down by a senior member of the Trump administration. So fast forward two years. And it’s early January, January 3. It’s a Friday. And the secretary of health and human services, Alex Azar, is at home in Washington. And he gets this phone call from Robert Redfield, this doctor who’s the head of the C.D.C. And Dr. Redfield tells Dr. Azar about these reports coming out of China, that there are these clusters of pneumonia cases, and that the likely culprit is a new coronavirus. And Alex Azar, the health and human services secretary, says, this is a very big deal.

Even though it was a new virus, the Chinese quickly made the sequence of it available. And labs were really quickly able to create a test for that, including the World Health Organization had already approved a test that was developed by some German scientists. But the U.S., which considers the C.D.C the world’s premier public health agency, they decided to make their own test. But it didn’t actually get F.D.A. approved until the first week of February. And at that point, it could be distributed to public health laboratories across the country. But, you know, now we’re already over a month into this scary new outbreak by that point.

And they’re finally able to mail out the kits to public health laboratories around the country — state health laboratories, some big city health laboratories, this network of labs that our public health system has. And the next day — the first step that the labs have to do is they have to check that test. They have to what’s called “validate it,” make sure it’s working. And right that next day, the C.D.C starts getting reports from some of these public health labs, saying, we’re not able to validate this test. We’re having problems. We’re getting some inconclusive results. And that’s the first sign that something may have gone wrong.

The C.D.C says it was definitely working in their lab. So they’ve told all the labs across the country, if it’s not working for you, of course, don’t use it. Just send samples to us. Of course, that adds time. You have to collect a sample in your local area and then send it to Atlanta, and then wait for that result to come back.

There were travelers coming from parts of the world where we didn’t have a travel ban that now had a large number of cases. And they weren’t being screened at the airports. They were going out into the communities. And there was just this urgency of being able to test more. And that’s when this one group of doctors and researchers took matters into their own hands.

So her name is Helen Chu. She’s a physician and a researcher in Washington state, which is where the first case of coronavirus was detected in the U.S. back in January. And she and her colleagues see a potential solution to this testing problem in their own work.

Helen Chu: "We had a study in place that was set up for detection of respiratory viral illnesses in the community from people who are sick, and then testing them in the lab for flu and other respiratory viruses. So we had this infrastructure in place already, essentially, in the Seattle area to be able to detect early entry of a virus into the city and then to understand how it spread."

The state health officials knew about their project. And they immediately thought about the potential of this project to help with this issue of testing. They make their own coronavirus test really fast. And they’re ready to go to help the state by the first week of February. But there’s one hitch.

"We had to go through regulatory clearance, essentially. We had to talk to C.D.C. We had to talk to F.D.A."

They don’t have the approval to test and then give those results out for two reasons. One is they’re not a clinical lab, so they don’t have the regulatory approval for that. And number two is they’ve just created this new coronavirus test, which isn’t yet F.D.A. approved.

"And so we were at a point where we could test thousands and thousands of samples at very high throughput. But we didn’t know what to do when we found a positive.."

So there’s good reason to have some of those regulations in place. But they figure, this is a public health emergency. And they feel like there’s got to be some way around this bureaucratic red tape, where they could at least screen these samples and get that information out to the public health authorities to confirm that test, whatever it is.

"We had the information. We had the data there sitting in our lab where we could actually answer the question. And that was frustrating, that we could answer it. We had the capacity to answer it, but we couldn’t move forward, because we didn’t know what to do. Everybody felt very hesitant about us being able to provide results or to do the testing at all."

But the C.D.C doesn’t seem to find a way around it. Weeks go by. And they’re getting more and more frustrated. And they’re seeing the outbreak is growing in China, and it’s spreading to other countries. So we know there’s a potential for it to be an outbreak not just in China.

"Everyone wanted to be able to do this the proper way — to go through C.D.C and state labs and have them have the high capacity to do the testing of all of these patients who really needed a diagnosis. But it just couldn’t be done."

And then it gets to February 25. It’s more than a month since that first case. And they finally just said —

"What we would do is move forward with research testing only."

Well, they’re just going for it. And technically, they can test, right? But the issue is, they can’t report the results.

"So what we would do would just be to go ahead and test the samples for coronavirus, but not to associate that with the information from the sample. So the clinical information."

They’re sitting on information that they’re not supposed to communicate because of these regulatory issues. It’s all going to be fine as long as they don’t find a case. What happened was, one of the very first days that they started testing:

"February 27, we got the first positive. What I thought was, oh, no. If it came up that early in our testing, that meant that it had probably been here for a while and that we just didn’t know that it was there. And so the questions racing through my head at that point where, what is the right thing to do right now? And so what happened at that point was that we rapidly convened a meeting of the investigators. We talked through the ethics of the different options — keep it to ourselves, tell public health, or tell the participants. And what we are allowed to do was to keep it to ourselves. But what we felt like we needed to do was to tell public health. And so that’s what we did."

They decide that the most ethical thing is to report the result to the local health authority. They confirmed the result. And it’s this local teenager in the very same county as that first positive case, but no known link to that person and no travel history. And that next morning, the public health lab went out and they found this teenager, who was feeling better by that point. Because he had had a mild form of this illness, which is most common, especially in young people. And they get to him just after he walks into his school and they end up shutting the school down to make sure that nobody else will catch the virus.

It is a pattern that these programs, when there’s a crisis, they get really well funded. And as soon as Ebola recedes into history, we start cutting those parts of government. You can look back after the anthrax attacks and 9/11. And there was all this money that went into bio-terrorism preparedness and hospital preparedness. And then you look at the numbers, and they go down over time. This is a reaction of humanity and society and government, is to sort of like — when it’s in the news and it’s fresh in our minds, we invest in it, and then we turn away. So I feel like this is a pattern. And when this happens, and we have these gaps in our preparedness that the government always seems to have, what I have found over and over again as a reporter is regular people step in and fill some of those holes. And I’m thinking — right now I have this image of Hurricane Katrina and government officials not being able to rescue everybody who needed help all at once. People waving towels off of rooftops and people stuck in hospitals. And then it was these regular people who had airboats, who were fishermen from western Louisiana. And they show up, and they just take people to dry ground. I’ve seen examples like that over and over. In this case, we saw Dr. Chu and her colleagues doing something like that. But, what I found out today on the phone with Dr. Chu was that —

"Yesterday, the Washington state regulators called their lab and asked us to shut down."

Why the U.S. Wasn’t Ready for the Coronavirus
Hosted by Michael Barbaro; produced by Annie Brown, Luke Vander Ploeg, and Adizah Eghan; with help from Daniel Guillemette and Robert Jimison; and edited by Lisa Tobin
“Are we ready to respond to a pandemic? I fear the answer is no,” one senior U.S. health official said in 2018.
Wednesday, March 11th, 2020
Michael Barbaro
From The New York Times, I’m Michael Barbaro. This is “The Daily.”

Today: It was supposed to be a relatively simple part of preparing for the coronavirus in the United States — testing for it. My colleague Sheri Fink on what went wrong.

It’s Wednesday, March 11.

Sheri Fink
So in 2018, it was the hundredth anniversary of the terrible 1918 flu pandemic. This was called the Spanish flu. And it just killed millions and millions of people around the world. So on that hundredth-year anniversary, many gatherings were held to discuss the lessons of that flu pandemic for today. And there was this one gathering of high-level people in Atlanta, Georgia, where the Centers for Disease Control and Prevention is based. And among the officials there was a group from the National Security Council. It had actually been created, a special unit on global health security that was created after that terrible Ebola outbreak in West Africa.

Archived Recording
So let’s begin with you, Dr. [INAUDIBLE].

Sheri Fink
So one of the officials with that group, with that unit —

Archived Recording (Luciano Borio)
Well, it’s a pleasure to be here with so many of my colleagues. And we’ve been working together for more than a decade on these issues.

Sheri Fink
— she steps up to the podium and she says —

Archived Recording (Luciano Borio)
The threat of pandemic flu is our number one health security concern.

We know that it cannot be stopped at the border.

Michael Barbaro
So this is a pretty senior health official on the National Security Council warning her colleagues that there is a very predictable threat here — a pandemic flu and —

Archived Recording (Luciano Borio)
Are we ready to respond to a pandemic? I fear the answer is no.

Michael Barbaro
— in her words, the country is just not really ready for it. So we should do something about it.

Sheri Fink
Exactly. And as it happens, the very next day, that global health security unit where she worked was shut down by a senior member of the Trump administration. So fast forward two years. And it’s early January, January 3. It’s a Friday. And the secretary of health and human services, Alex Azar, is at home in Washington. And he gets this phone call from Robert Redfield, this doctor who’s the head of the C.D.C. And Dr. Redfield tells Dr. Azar about these reports coming out of China, that there are these clusters of pneumonia cases, and that the likely culprit is a new coronavirus. And Alex Azar, the health and human services secretary, says, this is a very big deal.

Michael Barbaro
And what does Azar do with this information and this understanding that whatever this is, it’s going to be a big deal?

Sheri Fink
The Trump administration officials start meeting every day in the basement of the West Wing. And so at first, they say, OK, let’s screen the flights that are coming from China. But there’s an even more serious question that comes up, which is, should we ban flights altogether? And should we deny entry to anybody who has come from China in the last 14 days, to anybody who isn’t a citizen or a permanent resident here? So then that debate got shifted right to the Oval Office. And the top health officials of the nation, at that point, were agreed. A ban from traveling from the center of this epidemic could buy us some time, could help us to prepare ourselves before this came. It could slow that down. The president asked, what could the consequences be on the economy? All logical things that you would probably ask. In the end, he sided with the aides who supported the idea that this could actually help protect our nation’s health.

The problem was we weren’t completely prepared. Our government wasn’t completely prepared to use that time.

Michael Barbaro
What do you mean?

Sheri Fink
The biggest issue that the government had to face was testing — being able to diagnose somebody who has this illness.

Michael Barbaro
And what is the problem with testing at this point?

Sheri Fink
Well, it didn’t seem like there would be a problem. Even though it was a new virus, the Chinese quickly made the sequence of it available. And labs were really quickly able to create a test for that, including the World Health Organization had already approved a test that was developed by some German scientists. But the U.S., which considers the C.D.C the world’s premier public health agency, they decided to make their own test. But it didn’t actually get F.D.A. approved until the first week of February. And at that point, it could be distributed to public health laboratories across the country. But, you know, now we’re already over a month into this scary new outbreak by that point.

Michael Barbaro
So this is already off to a pretty slow start at a moment where every single day counts.

Sheri Fink
That’s right. So now, we’re like a month into this thing. And they’re finally able to mail out the kits to public health laboratories around the country — state health laboratories, some big city health laboratories, this network of labs that our public health system has. And the next day — the first step that the labs have to do is they have to check that test. They have to what’s called “validate it,” make sure it’s working. And right that next day, the C.D.C starts getting reports from some of these public health labs, saying, we’re not able to validate this test. We’re having problems. We’re getting some inconclusive results. And that’s the first sign that something may have gone wrong.

Michael Barbaro
This test is not working?

Sheri Fink
Well, the C.D.C says it was definitely working in their lab. So they’ve told all the labs across the country, if it’s not working for you, of course, don’t use it. Just send samples to us. Of course, that adds time. You have to collect a sample in your local area and then send it to Atlanta, and then wait for that result to come back.

Michael Barbaro
So what impact does this testing snafu have at this point on our understanding of the epidemic?

Sheri Fink
It just means that we don’t know. We actually don’t know. We say we have a low number of cases in this country at that point. But if you don’t test, how can you know?

Michael Barbaro
OK. And for these weeks where it seemed like we had cases in the low double digits in the United States, and there was a sense that things were quite stable and the danger was pretty low, the virus very well could have been spreading and spreading widely, and we wouldn’t have known. Because we weren’t doing the testing that would have told us that.

Sheri Fink
Exactly. And here’s why. Because only a small proportion of people who get the virus get really, really sick, fortunately. But by the time that they get into a critical care bed at a hospital — and the doctors there are scratching their heads, and they’ve tested for all the known things that cause like pneumonia and severe, severe respiratory distress — weeks have gone by since that person was infected. So you’re actually looking at history. If you finally get a positive test at that point, then, yes, it has been spreading in the community. And that’s all that time that you lose.

Michael Barbaro
Right. So this time that the Trump administration had bought the American people with that dramatic step — with shutting its border to Chinese travelers — is kind of being squandered.

Sheri Fink
Yeah, there were so many people who were starting to feel, at this point, like this time is being squandered. And we needed to get eyes on this. There were travelers coming from parts of the world where we didn’t have a travel ban that now had a large number of cases. And they weren’t being screened at the airports. They were going out into the communities. And there was just this urgency of being able to test more. And that’s when this one group of doctors and researchers took matters into their own hands.

Michael Barbaro
We’ll be right back.

[Music]
Michael Barbaro
Sheri, who is this doctor?

Sheri Fink
So her name is Helen Chu.

[Phone Dialing]
Helen Chu
Hello? This is Helen.

Sheri Fink
Hi, Helen. How are you doing?

Helen Chu
I’m doing well. How are you?

Sheri Fink
I’m well. Thanks.

Sheri Fink
She’s a physician and a researcher in Washington state, which is where the first case of coronavirus was detected in the U.S. back in January. And she and her colleagues see a potential solution to this testing problem in their own work.

Helen Chu
We had a study in place that was set up for detection of respiratory viral illnesses in the community —

Sheri Fink
She specializes in studying how viruses pass from person-to-person within that same community. And she and her colleagues have this big study where they’re collecting all these samples.

Helen Chu
— from people who are sick, and then testing them in the lab for flu and other respiratory viruses.

Sheri Fink
And through collecting hundreds and hundreds of samples every week, they’re trying to track the spread of viruses.

Michael Barbaro
And she was in the middle of collecting samples when the coronavirus arrives in Washington?

Sheri Fink
That is right.

Helen Chu
So we had this infrastructure in place already, essentially, in the Seattle area to be able to detect early entry of a virus into the city and then to understand how it spread.

Michael Barbaro
And that sounds like it would make her very well positioned to do the same thing for the coronavirus.

Sheri Fink
Exactly. She thought of that. The state health officials knew about their project. And they immediately thought about the potential of this project to help with this issue of testing.

Michael Barbaro
And so what happens?

Sheri Fink
They make their own coronavirus test really fast. And they’re ready to go to help the state by the first week of February. But there’s one hitch.

Helen Chu
We had to go through regulatory clearance, essentially. We had to talk to C.D.C. We had to talk to F.D.A..

Sheri Fink
They don’t have the approval to test and then give those results out for two reasons. One is they’re not a clinical lab, so they don’t have the regulatory approval for that. And number two is they’ve just created this new coronavirus test, which isn’t yet F.D.A. approved.

Helen Chu
And so we were at a point where we could test thousands and thousands of samples at very high throughput. But we didn’t know what to do when we found a positive.

Sheri Fink
So there’s good reason to have some of those regulations in place. But they figure, this is a public health emergency. And they feel like there’s got to be some way around this bureaucratic red tape, where they could at least screen these samples and get that information out to the public health authorities to confirm that test, whatever it is. But —

Helen Chu
Everybody felt very hesitant about us being able to provide results or to do the testing at all.

Sheri Fink
— the C.D.C doesn’t seem to find a way around it. Weeks go by. And they’re getting more and more frustrated. And they’re seeing the outbreak is growing in China, and it’s spreading to other countries. So we know there’s a potential for it to be an outbreak not just in China.

Helen Chu
We had the information. We had the data there sitting in our lab where we could actually answer the question. And that was frustrating, that we could answer it. We had the capacity to answer it, but we couldn’t move forward, because we didn’t know what to do.

Sheri Fink
They feel like they’re sitting on a gold mine. And they feel like the virus very well could be out there. After all, there had been this case in Washington state more than a month earlier, and nobody’s had eyes on it. Nobody’s been doing surveillance in the community, testing samples. So they’re getting more and more nervous. Is there something we’re not seeing? Because we’re not really testing very widely.

Michael Barbaro
So what did they end up doing? Just kind of keeping those samples on ice and doing nothing?

Sheri Fink
Well, at first, that’s what they did. Because they thought they could speak with these officials and find out some official workaround, so that they wouldn’t be violating regulations and get in trouble.

Helen Chu
Everyone wanted to be able to do this the proper way — to go through C.D.C and state labs and have them have the high capacity to do the testing of all of these patients who really needed a diagnosis. But it just couldn’t be done.

Sheri Fink
And then it gets to February 25. I mean, the month is almost gone. It’s more than a month since that first case. And they finally just said —

Helen Chu
What we would do is move forward with research testing only.

Sheri Fink
— we’re going to start using this unapproved coronavirus test that we have, and that we believe is very reliable, and start testing these samples.

Michael Barbaro
Wow. So they’re just going for it?

Sheri Fink
Well, they’re just going for it. And technically, they can test, right? But the issue is, they can’t report the results.

Helen Chu
So what we would do would just be to go ahead and test the samples for coronavirus, but not to associate that with the information from the sample. So the clinical information.

Michael Barbaro
So they have a plan to test for the coronavirus. And if they find it, that would mean that they’re sitting on information that they’re not supposed to have.

Sheri Fink
They’re sitting on information that they’re not supposed to communicate because of these regulatory issues. It’s all going to be fine as long as they don’t find a case.

Michael Barbaro
OK, so once they decided to do that, what happened?

Sheri Fink
What happened was, one of the very first days that they started testing —

Helen Chu
February 27, we got the first positive.

Sheri Fink
— they found a case.

Helen Chu
What I thought was, oh, no. If it came up that early in our testing, that meant that it had probably been here for a while and that we just didn’t know that it was there. And so the questions racing through my head at that point where, what is the right thing to do right now? And so what happened at that point was that we rapidly convened a meeting of the investigators.

Sheri Fink
The group just convenes. They all get on the phone. And they talk about ethics at this point.

Helen Chu
We talked through the ethics of the different options — keep it to ourselves, tell public health, or tell the participants. And what we are allowed to do was to keep it to ourselves. But what we felt like we needed to do was to tell public health. And so that’s what we did.

Sheri Fink
They decide that the most ethical thing is to report the result to the local health authority. They confirmed the result. And it’s this local teenager in the very same county as that first positive case, but no known link to that person and no travel history. And that next morning, the public health lab went out and they found this teenager, who was feeling better by that point. Because he had had a mild form of this illness, which is most common, especially in young people. And they get to him just after he walks into his school, because he’s —

Michael Barbaro
Oh, wow.

Sheri Fink
Yeah. And they end up shutting the school down to make sure that nobody else will catch the virus.

Helen Chu
I mean, that was a good moment for our team, I thought. You know, we did something that didn’t follow the rules, but we were able to prevent spread in a high school. And that seemed really important.

Michael Barbaro
So because of the doctor’s actions, they catch him, basically, in the nick of time.

Sheri Fink
They do. And they also realize that they may have a big problem on their hands. Because if this case descended from that first case, if that person potentially had infected somebody without knowing it, and then there was mild illness going on, and nobody caught it, there could be hundreds of cases in the area. And so that gave them the information that they needed to start acting, to start looking more seriously for the virus in the community.

Michael Barbaro
I wonder. Had Dr. Chu not broken the rules in this case, how that would have changed how we understand the coronavirus in the Seattle region?

Sheri Fink
Well, we wouldn’t have known, until the people started dying, that there was a problem. And unfortunately, the really sad thing is that that happened really soon after that. And so if Dr. Chu and her colleagues had been able to test sooner, they would have been able to alert the authorities earlier. And that’s the real tragedy here.

Michael Barbaro
Sheri, on the one hand, the story that you have just told — it’s a pretty heroic story of a doctor willing to go against the rules, the instructions, because she felt that it was needed in the moment, in the midst of a public health crisis. On the other hand, it feels risky for the lesson here to be that medical professionals should go rogue in the middle of a crisis. I mean, what in your mind is the lesson here?

Sheri Fink
I mean, I’m somebody who’s reported on disasters for many years and used to do some disaster response myself. And I’ve always seen in crises that thinking outside the box can really solve problems and it can save lives. And I think we generally accept that already, that the rules do have to bend, that people need to think creatively. And one of the reasons they have to do it — and it was so evident here — was that the larger system, the official responders, the official system in place couldn’t do everything and was faltering.

Michael Barbaro
But I wonder, how much would things potentially have been different, Sheri, if, thinking back to the start of our conversation, those government programs — the National Security Council’s health program, for example — hadn’t been cut? I mean, how much does that reflect an overall approach to this epidemic from the people currently in charge from the Trump administration?

Sheri Fink
I think you can trace it back further than that. It is a pattern that these programs, when there’s a crisis, they get really well funded. And as soon as Ebola recedes into history, we start cutting those parts of government. You can look back after the anthrax attacks and 9/11. And there was all this money that went into bioterrorism preparedness and hospital preparedness. And then you look at the numbers, and they go down over time. This is a reaction of humanity and society and government, is to sort of like — when it’s in the news and it’s fresh in our minds, we invest in it, and then we turn away. So I feel like this is a pattern. And when this happens, and we have these gaps in our preparedness that the government always seems to have, what I have found over and over again as a reporter is regular people step in and fill some of those holes. And I’m thinking — right now I have this image of Hurricane Katrina and government officials not being able to rescue everybody who needed help all at once. People waving towels off of rooftops and people stuck in hospitals. And then it was these regular people who had airboats, who were fishermen from western Louisiana. And they show up, and they just take people to dry ground. I’ve seen examples like that over and over. In this case, we saw Dr. Chu and her colleagues doing something like that. But, what I found out today on the phone with Dr. Chu was that —

Helen Chu
Yesterday, the Washington state regulators called their lab and asked us to shut down.

Sheri Fink
— the project got shut down again. So the state regulators told them they can’t keep doing this. So it looks like the government isn’t going to allow this to continue to fill that hole. And so that hole remains.

[Music]
Sheri Fink
The question is whether this will be one of those lessons that comes out of this particular outbreak. And of course, there will be a tomorrow. There will be a day where we’re not in the midst of something so frightening that we’re in right now. And the question is, will this fit that same cycle where we say, we’ve learned the lesson, we need to kind of innovate and come up with new systems that will ensure that we’re on a better footing, that we can have some backup system so that we can roll out testing as a country much more quickly? Or will this fit that same cycle, where once the immediate danger goes away, we stop investing, or we just forget?

Michael Barbaro
Sheri, thank you.

Sheri Fink
Thank you.

Michael Barbaro
A few days ago, my colleague Peter Baker asked President Trump whether he regrets eliminating the global health unit of the National Security Council in light of the coronavirus epidemic.

Donald Trump
I just think this is something, Peter, that you can never really think is going to happen. I’ve heard all about, this could be a big deal, from before it happened. Something like this could happen.

Michael Barbaro
The president claimed, despite past warnings from federal health officials, that such an epidemic was previously unimaginable.

Donald Trump
But who would have thought? Look, how long ago was it? Six, seven, eight weeks ago, who would have thought we’d even be having this subject? We were going to hit 30,000 on the Dow like it was clockwork, right?

Michael Barbaro
We’ll be right back.

[Music]
Michael Barbaro
Here’s what else you need to know today. On Tuesday, public and private institutions across the United States took their strongest measures yet to limit the spread of the coronavirus. Dozens of colleges and universities, from the University of California, Berkeley to Harvard, are closing their doors or asking students to attend classes remotely. Major airlines, including Delta and American Airlines, said they would drastically cut back on international flights. And the nursing home industry issued a recommendation to bar visits from family and friends after deadly outbreaks inside of five nursing homes around Seattle. In New York, officials have created a containment cell around the source of a major outbreak in the city of New Rochelle, north of New York City, ordering schools, community centers and houses of worship within the zone to close for the next two weeks and deploying the National Guard inside the containment area. And in California, a cruise ship with at least 21 infected passengers docked in Oakland, where it was met by workers in protective gear, who took those on board to a nearby military base in the largest quarantine operation so far on American soil.

Salina	maandag 2 maart 2020 @ 10:12
	Bespreek hier het probleem dat de Verenigde Staten te wachten staat zoals het er naar uit ziet. Paar punten ter overweging: - tot recent werd er amper getest; - medische kosten zijn voor veel Amerikanen amper of niet te betalen; - veel inwoners VS niet of slecht verzekerd tegen medische kosten; - slechte arbeidsvoorwaarden m.b.t. ziek melden, doorbetaald krijgen, vakantiedagen, etcetera. Ik lees nu al op Amerikaanse fora (Reddit, Yahoo) verhalen over dat men bang is zich ziek te melden, men maar beter door kan werken (want weinig doorbetaalde vakantiedagen), men de huur niet kan betalen als men niet gewoon naar het werk gaat, etcetera. Voeg daar aan toe de enorme polarisering in de VS (links-rechts, elkaar continue verwijten) en men heeft een potentiële grootschalige clusterfuck te pakken.
#ANONIEM	maandag 2 maart 2020 @ 10:24
	Grootste probleem is dat niemand zich laat checken aangezien dat ruim 3000 Dollar kost.
Salina	maandag 2 maart 2020 @ 11:00
	https://edition.cnn.com/2(...)ashington/index.html Trump's coronavirus strategy faces new scrutiny after second US death
vosss	maandag 2 maart 2020 @ 11:26
	quote: Op maandag 2 maart 2020 10:24 schreef Lenny_Leonard het volgende: Grootste probleem is dat niemand zich laat checken aangezien dat ruim 3000 Dollar kost. Ik heb het allemaal niet gevolgd in dat gaar kutland, maar is dit nou het resultaat van dat bejubelde Obamacare? Of was dat wat anders?
Fretwork	maandag 2 maart 2020 @ 11:58
	quote: Op maandag 2 maart 2020 11:26 schreef vosss het volgende: [..] Ik heb het allemaal niet gevolgd in dat gaar kutland, maar is dit nou het resultaat van dat bejubelde Obamacare? Of was dat wat anders? Dat heeft de huidige regering alweer teruggedraaid. Heerlijk zo'n (voornamelijk) tweepartijenstelsel
Salina	maandag 2 maart 2020 @ 12:32
	https://medical.mit.edu/m(...)thcare-united-states Healthcare in the United States: The top five things you need to know 1. There is no universal healthcare. The U.S. government does not provide health benefits to citizens or visitors. Any time you get medical care, someone has to pay for it. 2. Healthcare is very expensive. According to a U.S. government website, if you break your leg, you could end up with a bill for $7,500. If you need to stay in the hospital for three days, it would probably cost about $30,000. 3. Most people in the U.S. have health insurance. Health insurance protects you from owing a lot of money to doctors or hospitals if you get sick or hurt. To get health insurance, you need to make regular payments (called “premiums”) to a health insurance company. In exchange, the company agrees to pay some, or all, of your medical bills. Learn more about health insurance. -------------------------------------- https://www.footholdameri(...)oes-sick-leave-work/ How does sick leave work in the US? There is no national requirement in the US to offer paid sick leave, though many states have their own laws on this. In the US, there is no requirement that businesses offer paid sick leave to their employees. The only thing they must do (provided the business employees more than 50 employees) is to allow staff unpaid time off for medical leave, or to care for a family member. However, in reality, even without a legal obligation to provide paid leave, 74% of full-time US workers have an arrangement with their employer to provide paid time off in the event of sickness. Arrangements vary from state to state. Are US workers entitled to paid holiday? US workers are not legally entitled to paid holiday. There is no law that obliges US employers to offer it. However, in practice, the majority of US employers provide paid holiday to their workers. US workers are renowned for taking very little holiday compared to workers in the UK or Europe. While US workers are not legally entitled to paid holiday leave (as there is no law obliging US employers to offer paid vacation days), the majority of US employers do offer paid holiday to their employees. The amount of paid holiday US workers receive varies from employer to employer. However, as a general rule of thumb, you can expect to offer your US worker at least 10 days of paid vacation time each year. Are US workers entitled to paid sick leave? There is no federal law mandating sick leave. However, many states and cities require sick leave by law. In practice, US employers offer some form of paid sick leave to their employees. For instance, the state of Massachusetts mandates 5 days of sick leave. Klinkt al met al niet echt aanlokkelijk.
-Straw-	maandag 2 maart 2020 @ 13:01
	quote: Op maandag 2 maart 2020 10:24 schreef Lenny_Leonard het volgende: Grootste probleem is dat niemand zich laat checken aangezien dat ruim 3000 Dollar kost. Hierboven staat dat de meerderheid wel een zorgverzekering heeft, dus die kunnen zich gewoon laten testen. Het missen van werkdagen en daardoor geld lijkt me een groter probleem zonder fatsoenlijke sick leave.
heywoodu	maandag 2 maart 2020 @ 13:05
	quote: Health insurance protects you from owing a lot of money to doctors or hospitals if you get sick or hurt. To get health insurance, you need to make regular payments (called “premiums”) to a health insurance company. In exchange, the company agrees to pay some, or all, of your medical bills. Learn more about health insurance. Dit is vrij normaal toch? Je betaalt regelmatig en bent dan in meer of mindere mate verzekerd.
Eyjafjallajoekull	maandag 2 maart 2020 @ 13:06
	Probleem voor ons is dat als de VS in paniek raakt de beurzen wereldwijd onderuit gaan. En die Amerikanen zijn volgens mij veel paniekeriger dan west Europa. Iig zijn ze veel dramatisch. Van, dit is allemaal media onzin, tot; de media verbergen het echte verhaal. En tot slot gieten ze over alles ook nog een politiek sausje
Salina	maandag 2 maart 2020 @ 14:30
	quote: Op maandag 2 maart 2020 13:06 schreef Eyjafjallajoekull het volgende: Probleem voor ons is dat als de VS in paniek raakt de beurzen wereldwijd onderuit gaan. En die Amerikanen zijn volgens mij veel paniekeriger dan west Europa. Iig zijn ze veel dramatisch. Van, dit is allemaal media onzin, tot; de media verbergen het echte verhaal. En tot slot gieten ze over alles ook nog een politiek sausje Klopt. Ik denk wel dat het deels ervaring is die mensen in de VS paniekeriger maakt dan ons Europeanen. Ze hebben immers vaker te maken gehad met grote (natuur)rampen (denk aardbevingen, tornado's, bosbranden etc.) plus de nodige oorlogen en de daaruit ontstaande angsten. Plus natuurlijk de filmcultuur, politiek, etcetera. In NL heerst er dan weer iets te veel een "mwah, het zal allemaal toch wel loslopen"-mentaliteit die denk ik deels komt doordat NL amper te maken heeft gehad met rampen van dit kaliber (1953 de laatste).
marzman	maandag 2 maart 2020 @ 14:36
	De VS is veel minder druk bevolkt en heeft veel minder besmette en overleden mensen. Volgens mij hebben we hier een groter probleem.
hollandia02	maandag 2 maart 2020 @ 14:52
	quote: Op maandag 2 maart 2020 14:36 schreef marzman het volgende: De VS is veel minder druk bevolkt en heeft veel minder besmette en overleden mensen. Volgens mij hebben we hier een groter probleem. Veel minder druk bevolkt?! Het gebied tussen Washington D.C. en New York is een en al bevolkt gek.
Jaeger85	maandag 2 maart 2020 @ 14:52
	quote: Op maandag 2 maart 2020 14:36 schreef marzman het volgende: De VS is veel minder druk bevolkt en heeft veel minder besmette en overleden mensen. Volgens mij hebben we hier een groter probleem. Je weet dat ze in de VS niet tot nauwelijks testen? Het probleem is daar veel groter dan de officiële cijfers. De bevolking daar maakt zich grote zorgen.
Salina	maandag 2 maart 2020 @ 15:03
	En positief geteste mensen vrijlaten: https://www.businessinsid(...)ernational=true&r=US Man man man, als wij "blij" zijn met de RIVM, vraag ik me af hoe blij de Amerikanen zijn met hun CDC en consorten.
Eyjafjallajoekull	maandag 2 maart 2020 @ 15:13
	quote: Op maandag 2 maart 2020 14:36 schreef marzman het volgende: De VS is veel minder druk bevolkt en heeft veel minder besmette en overleden mensen. Volgens mij hebben we hier een groter probleem. New York heeft pas gister toestemming gekregen om te testen.
Salina	maandag 2 maart 2020 @ 15:13
	quote: Op maandag 2 maart 2020 14:52 schreef Jaeger85 het volgende: [..] Je weet dat ze in de VS niet tot nauwelijks testen? Het probleem is daar veel groter dan de officiële cijfers. De bevolking daar maakt zich grote zorgen. https://www.cnbc.com/vide(...)alth-squawk-box.html NYC ER doctor: I have to ‘plead to test people’ for coronavirus
tijnbrein	maandag 2 maart 2020 @ 15:17
	Veel Amerikanen leven van paycheck tot paycheck. Dus iets als een ziekmelding daar hebben ze het geld niet.
Eyjafjallajoekull	maandag 2 maart 2020 @ 15:20
	quote: Op maandag 2 maart 2020 15:17 schreef tijnbrein het volgende: Veel Amerikanen leven van paycheck tot paycheck. Dus iets als een ziekmelding daar hebben ze het geld niet. Ik ben vooral benieuwd wat het virus doet met al die vatsige amerikanen. Diabetes gaat slecht samen met dit virus geloof ik.
BasEnAad	maandag 2 maart 2020 @ 15:23
	quote: Op maandag 2 maart 2020 14:36 schreef marzman het volgende: De VS is veel minder druk bevolkt en heeft veel minder besmette en overleden mensen. Volgens mij hebben we hier een groter probleem. Nee. De VS is qua zorg een derdewereldland en heeft dus een groter probleem. Dit probleem kun je namelijk niet oplossen door het leger erop af te sturen, dollars te printen of met je vuist op tafel te slaan.
Salina	maandag 2 maart 2020 @ 15:24
	Diabetes, leven van paycheck naar paycheck, weinig tot slechte verzekering, dure gezondheidszorg, weinig testen. Lees al verhalen dat mensen zich erg moeilijk ziek melden juist omdat ze leven van salaris naar salaris. Ziekmelden kan niet iedereen zich veroorloven. Sommigen hebben alleen onbetaald ziekteverlof, anderen 5 dagen ziekteverlof. Allemaal bron voor grote problemen lijkt mij.