White House officials weigh replacement of HHS Secretary Alex Azar

Azar drew Trump’s ire again last week over his removal of a top vaccine official

Health and Human Services Secretary Alex Azar speaks during a briefing about the coronavirus on March 15. (Alex Brandon/AP)

By Yasmeen Abutaleb and Josh Dawsey April 26, 2020 at 11:08 a.m. EDT

White House officials are discussing whether to replace Health and Human Services Secretary Alex Azar as frustrations have grown over his handling of the coronavirus crisis earlier this year, as well as over his removal last week of a top vaccine official in his agency, which created an uproar.

Several top White House aides are discussing Azar’s removal and have mused over possible successors, but President Trump has not weighed in, said five people familiar with the talks who spoke on the condition of anonymity to be candid. It remains unclear whether the president will want to replace his top health official amid a pandemic, because it could signal more chaos and turmoil in the administration’s response, which has come under repeated fire. More than 53,000 Americans have died of covid-19, the disease caused by the coronavirus, and more than 900,000 U.S. cases have been reported as of Sunday.

During the past several weeks, Azar has rarely appeared at the daily White House coronavirus news briefings and has been largely sidelined from the response. He oversaw that effort until Feb. 26, when he was replaced by Vice President Pence amid anger over the continued lack of coronavirus testing and conflicting messages from health officials about the threat of the virus. His agency, however, is still responsible for crucial aspects of the pandemic response, such as leading the search for treatments and vaccines, and distributing $100 billion worth of relief to hospitals that was allocated by Congress.AD

One senior administration official with knowledge of the discussions said Trump has no deep affection for Azar but is unlikely to change secretaries as the coronavirus continues to rage. There is also concern about having a nomination fight in an election year on an issue — health care — that many Trump advisers see as a political weakness. Spokesmen for the White House and HHS denied Azar’s job was in jeopardy.

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PANDEMIC AT SEA

The cruise industry’s decision to keep sailing for weeks after the coronavirus was first detected on a ship helped carry the virus around the globe and contributed to the mounting toll, health experts and passengers say.

 


Story by Rosalind S. HeldermanHannah SampsonDalton Bennett,  Andrew Ba Tran
Video by Sarah Cahlan, Joyce Lee, Atthar Mirza and Elyse Samuels 

Washington Post April 25, 2020  

On land, more than 300,000 people worldwide had contracted the deadly coronavirus, and the governor of California had just ordered all 39 million residents to stay at home. But as the Celebrity Eclipse cruise ship steamed north across the Pacific Ocean on March 21, hundreds of passengers crammed together on the ship’s pool deck and overlooking gangways.

As they stood shoulder-to-shoulder and crowded around pool chairs, the captain led the ship in a special salute to health-care workers of the world, an onboard version of the nightly applause adopted by some cities to honor medical professionals battling the novel coronavirus.

The Eclipse and the Coral Princess were among scores of ships that continued voyages even after early outbreaks on other vessels, carrying thousands of international passengers to far-flung ports and helping seed the virus around the globe, health officials say.

Five days later and thousands of miles away in the Atlantic, a group of British passengers aboard another ship, Coral Princess, likewise gathered elbow-to-elbow to cheer the United Kingdom’s National Health Service.

The celebratory mood did not last long. Soon, passengers on both ships were contending with flu-like symptoms.

There have been 150 coronavirus cases and six deaths reported so far among passengers of the two vessels, which finally docked weeks after the virus was declared a global health crisis, according to a Washington Post tally. Two people died on the Coral Princess before passengers could even come ashore in Miami.

Hundreds of Celebrity Eclipse passengers participate in an event March 21 to honor health-care workers. (Photo by Vivian Miller)

A Post review of cruise line statements, government announcements and media reports found that the coronavirus infected passengers and crew on at least 55 ships that sailed in the waters off nearly every continent, about a fifth of the total global fleet.

The industry’s decision to keep sailing for weeks after the coronavirus was first detected in early February on a cruise ship off the coast of Japan, despite the efforts by top U.S. health officials to curtail voyages, was among a number of decisions that health experts and passengers say contributed to the mounting toll.

The virus affected travelers on 55 ships and killed at least 65 people, though the full scope is unknown.

At least 65 people who traveled or worked on the ships have since died, according to The Post tally, although the full scope of deaths is unknown. A similar review by the Miami Herald also identified 65 deaths linked to ships.

“We here on land, we were seeing all the news, all the ships,” said Jennifer Paul-Slater, whose brother Gerald Paul, a 72-year-old retiree from Atlanta, died of covid-19, the disease caused by the coronavirus, three days after disembarking the Celebrity Eclipse. “They could have taken more precautions.”

Public health experts say that a number of factors contributed to the rapid spread of the virus around the world, predominantly air travel; an estimated 4.54 billion people flew last year, compared with the 30 million passengers who traveled on cruise ships worldwide. But with hundreds of people dining, swimming and dancing together over a sustained period of time, the ships provide unique environments for disease to spread, they say.

“People on a large ship, all together, at the same time, all the time — you couldn’t ask for a better incubator for infection,” Anthony S. Fauci, the nation’s top infectious-diseases expert, said in February.

For their part, U.S. agencies struggled to manage the escalating crisis, initially deferring to the industry’s own plan to manage the pandemic. Until early this month, federal health officials also allowed passengers who left infected ships but appeared healthy to board commercial airlines home.

Even as the virus exploded into a global story, cruise officials failed to immediately recognize flu-like outbreaks as possible signs of the coronavirus, passengers said. In many instances, they did not immediately isolate passengers in their cabins when sickness broke out. In some cases, such as on the Celebrity Eclipse and the Coral Princess, those aboard said they were reassured by company officials there was no coronavirus infection on their ships — even as some travelers were wracked with fevers and coughs.

[Cruise ships kept sailing as coronavirus spread. Travelers and health experts question why.]

David Nystrom, 75, said he spent the last four days of the Eclipse voyage with his wife, Susan, in the medical clinic, wiping her brow and watching the ship’s crew administer her oxygen.

From her bedside, the Boca Raton, Fla., resident said he heard regular announcements from the ship’s captain, assuring passengers that the Eclipse was a “healthy ship” with no coronavirus on board.

“If they honestly thought that all these people who were getting sick had colds and bronchitis and pneumonia, I don’t know what to say,” Nystrom said.

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Young and middle-aged people, barely sick with covid-19, are dying from strokes

Doctors sound alarm about patients in their 30s and 40s left debilitated or dead. Some didn’t even know they were infected.

People walk around Times Square as screens are illuminated as part of the “Light It Blue” initiative to honor health care workers, during the outbreak of the coronavirus disease in New York City on April 23, 2020. (Eduardo Munoz/Reuters)

By Ariana Eunjung Cha of The Washington Post
April 24, 2020 at 6:36 p.m. EDT

Thomas Oxley wasn’t even on call the day he received the page to come to Mount Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors to treat all the emergency stroke patients, and he was needed in the operating room.

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head.

Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

Stroke surge

Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of its connected disease, covid-19. Even as the virus has infected nearly 2.8 million people worldwide and killed about 195,000 as of Friday, its biological mechanisms continue to elude top scientific minds. Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body.

Until recently, there was little hard data on strokes and covid-19.

There was one report out of Wuhan, China, that showed that some hospitalized patients had experienced strokes, with many being seriously ill and elderly. But the linkage was considered more of “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a University of Pittsburgh Medical Center neurologist and critical care doctor.

Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. The numbers are small, only a few dozen per location, but they provide new insights into what the virus does to our bodies.

Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere.

A stroke, which is a sudden interruption the blood supply, is a complex problem with numerous causes and presentations. It can be caused by heart problems, clogged arteries due to cholesterol, even substance abuse. Mini-strokes often don’t cause permanent damage and can resolve on their own within 24 hours. But bigger ones can be catastrophic.

The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.

Many researchers suspect strokes in covid-19 patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.

Clots that form on vessel walls fly upward. One that started in the calves might migrate to the lungs, causing a blockage called a pulmonary embolism that arrests breathing — a known cause of death in covid-19 patients. Clots in or near the heart might lead to a heart attack, another common cause of death. Anything above that would probably go to the brain, leading to a stroke.

Robert Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore, called strokes “one of the most dramatic manifestations” of the blood-clotting issues. “We’ve also taken care of patients in their 30s with stroke and covid, and this was extremely surprising,” he said.

Many doctors expressed worry that as the New York City Fire Department was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because few autopsies were conducted.

Chou said one question is whether the clotting is because of a direct attack on the blood vessels, or a “a friendly-fire problem” caused by the patient’s immune response.

“In your body’s attempt to fight off the virus, does the immune response end up hurting your brain?” she asked. Chou is hoping to answer such questions through a review of strokes and other neurological complications in thousands of covid-19 patients treated at 68 medical centers in 17 countries.

Thomas Jefferson University Hospitals, which operates 14 medical centers in Philadelphia, and NYU Langone Health in New York City, found that 12 of their patients treated for large blood blockages in their brains during a three-week period had the virus. Forty percent were under 50, and they had few or no risk factors. Their paper is under review by a medical journal, said Pascal Jabbour, a neurosurgeon at Thomas Jefferson.

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Philadelphia, Goldman Sachs announce $10M PPP fund for small businesses

By Kennedy Rose  – Digital Producer, Philadelphia Business Journal

The City of Philadelphia and Goldman Sachs announced a $10 million initiative to provide Paycheck Protection Program (PPP) loans for local small businesses. 

The loans will be focused on small businesses in the region’s urban communities, including non-profit organizations, that have been unable to submit an application with an approved PPP lender. The loans will be offered through the initiative’s partnership with community development financial institution Lendistry. Businesses can apply for the loans here.

Minority-owned businesses are often underbanked in Philadelphia, and diverse chamber leaders said many of their members have had difficulty applying for PPP loans because of a lack of a relationship with lenders. PPP offers low-interest, forgivable loans from the U.S. Small Business Administration to assist businesses with payroll and other vital expenses during the coronavirus crisis. Congress approved an additional $320 billion in funding for the program this week after PPP’s initial $349 billion pool was exhausted amid intense demand.

“I’m grateful that, thanks to this partnership, Philadelphia’s small business owners will have more opportunities to secure vital funding needed to navigate this crisis and eventually rebound,” Mayor Jim Kenney said in a statement. 

Goldman Sachs brought its 10,000 Small Businesses Program to Philadelphia in 2013. The program helps small businesses grow and provides support through its cohort network. More than 500 Philadelphia businesses have graduated from the program.

Goldman Sachs and Lendistry announced a similar partnership with the City of Baltimore earlier this month. The bank committed $550 million to Covid-19 relief, including $500 million in capital to fund PPP loans and a $25 million grant to support community development financial institutions.

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Coronavirus cases surge in NJ to 102,196, with 5,617 deaths reported statewide.

Food giveaway, April 22, 2020
Food is packed in boxes and loaded into vehicles during a food giveaway for Atlantic City casino workers in Egg Harbor Township on April 22. Casino employees have been out of work since the government shut the casinos down because of the coronavirus outbreak.Lori M. Nichols | NJ Advance Media for NJ.com

By Brent Johnson and Len Melisurgo | NJ Advance Media for NJ.com

New Jersey hit a grim milestone Friday afternoon, surpassing 100,000 confirmed cases of the coronavirus as the pandemic continues to claim more lives and strain hospitals across the state. Officials announced the Garden State has now seen at least 102,196 positive tests and 5,617 COVID-19 deaths in less than two months.

The state reported another 3,047 positive tests and 253 corona-related fatalities in the last 24 hours, even as Gov. Phil Murphy continues to say data shows the rate of infection is slowing and hospitalizations are stabilizing after more than a month of tough lockdown restrictions.

“As we cross 100,000 cases, we must keep in mind tens of thousands of New Jerseyans who have tested positive and beaten COVID-19,” Murphy said during his afternoon press briefing.

Murphy said the state must remember those who have died. “Bless their hearts… They cannot and will not be forgotten,” he said. “For them, we will move forward and we will come out of this unequivocally stronger than ever before.”

The state has also been hit record unemployment and business losses, and Murphy has warned about mass public-worker layoffs looming.

New Jersey, a densely populated state of 9 million people, continues to have the second-most COVID-19 cases and deaths among American states, second only to neighboring New York.

Although the curve in coronavirus cases is flattening, Murphy noted several counties have “slid backwards,” with the number of days it takes for cases to double going back to seven days or less.

“We cannot let that happen,” the governor said. “Stay at home. Stay away from each other… I cannot be more clear or more plain. Everyone has a role to play in slowing the spread of COVID-19. We cannot ease one bit of our social distancing. … We need to see more progress and more slowing.”

As of 10 p.m. Thursday, 6,847 coronavirus patients were hospitalized in the state, officials said Friday afternoon. Of those, 1,933 were in critical care and 1,497 were on ventilators. Plus, 98 patients were at the state’s field medical stations.

New map shows the town-by-town breakdown of coronavirus cases across N.J.

Between 10 p.m. Wednesday and 10 p.m. Thursday, there were 385 new coronavirus patients admitted and 778 patients discharged. Murphy said the three-day average trend line in hospitalization numbers is “generally moving in right direction — down.”

State Health Commissioner Judith Persichilli said coronavirus case increases may not match up with numbers from the day before because officials are working to remove duplicate reports and “reconcile them.”

HELP FOR RENTERS

In addition to announcing the latest virus numbers Friday, Murphy said the state is taking more steps to help renters and homeowners who are struggling to make their monthly payments. Among those steps, he is signing an executive order allowing renters to use their security deposits to help pay their rents.

“Whether that be to make up for a shortfall or pay it in full, renters should have the ability to tap this deposit” during the pandemic, Murphy said.

The state is creating an FAQ section and question portal for tenants and landlords about rights and responsibilities, which can be found on this web page: covid19.nj.gov/forms/renter.

The state is also creating an information page on the website for homeowners taking advantage of mortgage forbearance. And Murphy is urging landlords to waive late fees and continue to work with tenants who cannot pay their rent.

EnviroPolitics Blog is working to keep you informed about all aspects of the coronavirus — the status of confirmed cases, disease spread, death toll–and also how Americans are coping. Like this story, for instance. If you like what we are doing, Click to receive free EP Blog updates and please tell your friends about us.

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Notary public law signed in NJ to deal with Covid-19

Editor’s Note: The following advisory comes from the law firm of Cull;en and Dykman

REMOTE NOTARIZATION 

On April 14, 2020, Governor Murphy signed into law A-3903/S-2336. This newly enacted law allows remote notarizations during the State’s COVID-19 emergency.  The law took effect immediately and temporarily authorizes a notary public or officer authorized to take oaths under R.S.41:2-1 or R.S.46:14-6.1 to remotely notarize documents, subject to specific requirements.

Under the new law, notarial acts using “communication technology” for a remotely located individual can be performed if the notary public or officer administering the oath has:  (1)   personal knowledge of the identity of the individual appearing before the notary public, which is based upon dealings with the individual sufficient to provide reasonable certainty that the individual has the identity claimed; (2) satisfactory evidence of the identity of the remotely located individual by oath or affirmation from a credible witness appearing before the notary public or officer; or (3) obtained satisfactory evidence of the identity of the remotely located individual by using at least two different types of identity proofing.

“Communication technology” is defined in A-3903/S-2336 as an electronic device or process that allows a notary public or official administering the oath and the remotely located individual to communicate with each other simultaneously by sight and sound. Additionally, the notary public or official administering the oath must be reasonably able to confirm that a record being notarized is the same record in which the remotely located individual executed a signature, and must create an audio-visual recording of the performance of the notarial act, a copy of which must be retained for a minimum of ten (10) years. 

A-3903/S-2336 does not permit remote notarizations for the following documents: (1) the Uniform Commercial Code, N.J.S.12A:1-101 et seq., other than N.J.S.12A:1-107, N.J.S.12A:1-206, the provisions of the “Uniform Commercial Code – Sales,” chapter 2 of Title 12A of the New Jersey Statutes, and the provisions of the “Uniform Commercial Code – Leases,” chapter 2A of Title 12A of the New Jersey Statutes; or (2) a statute, regulation or other rule of law governing adoption, divorce or other matters of family law.

The New Jersey State Treasurer also has authority under A-3903/S-2336 to adopt rules necessary to implement the provisions of this new law.  

If you have any questions or concerns regarding this information, please feel free to contact us: 
Amie C. Kalac, Esq., AKalac@cullenllp.com; Herbert B. Bennett, Esq. HBennett@cullenllp.com, or Neil Yoskin, Esq. NYoskin@cullenllp.com. All can be reached at 609-279-0900 

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