Redacted
Redacted
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15 March, 2020
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Redacted
Redacted
15 March, 2020
President Donald J. Trump
The White House
1600 Pennsylvania Ave NW
Washington, DC 20500
Dear Mr. President
There is an old Irish Curse, “May you live in interesting times”. No doubt you are finding the current situation with Covid-19 quite interesting. I see it is starting to weigh on you. I is my wish that this letter will bring you hope and perhaps, a chuckle or two. Hope and humor (moral) will be important in the fight ahead.
Now, I have also taken an interest, starting about the time when our friends in China announced that they were going to build 3 new hospitals in Wuhan in late January followed some several days later, about Monday, 3 February, that 7500 or so tradesmen had completed the first, a 1000 bed unit, in 10 days with the second, a 1600 bed unit due to be finished on the following Wednesday. My thought was that they must have some really good concrete in China. My understanding is that the general rule of thumb for even a slab is 21 days to cure before you put a load on it. In between those two announcements, there was the announcement that the Chinese military was sending in 1400 healthcare workers to assist in fighting the outbreak. (Last count I am aware of was something like 3000 healthcare workers infected and 7 or so dead but that is several days old),
Than came the report 5 February that cremation services in Wuhan had been overwhelmed. That really got my attention. I decided to take a closer look at the numbers and did not like what I saw (I do curves thank you very much). More accurately and to the point, my initial reaction was “OH, followed by a few choice words I would not dare including in a letter to the President of the United States besides the point that they would make my mother blush.
The final straw came on Friday, 7 February when it was announced that the Chinese Military was going door to door, taking anyone with a fever, cough, or the sniffles into custody for relocation to makeshift quarentine facilities (an operation which was supposedly completed 20 February).
Two reactions. The first was “so much for reliable numbers from China.” What they are calling “Makeshift quarentine facilities" could easily be a ditch. The second reaction was that I have to get a piece of this fight. (Have I mentioned that I’m a Texan yet?)
Well, let’s get that out of the way. I’m a Texan who is a student of many things who has lived many lives, some of which I am more proud of than others.
The life that is most relevant to the coming fight is the one where I was awarded United States Patent #Redacted by the Commissioner of Patents and Trademarks, That life ended rather badly so it’s really no brag, just a fact. Maybe it shows more than anything that I have at least two brain cells that shake hands on occasion. Just a little something I whipped up related to interfacing various building systems related to security and access control after receiving my degree in electrical engineering from the University of Radio Shack. I have said I wanted into this fight haven’t I?
I guess it’s about time to share my analysis of the situation. To do so, I’m going to start speaking in military terms as befitting the scope of what we are facing and your position as Commander-in-Chief.
First off, let me say that you have done a fantastic job of defending our borders and fighting a delaying action, buying us critical time (flattening the curve they are calling it) but time is running out, the enemy is massing and has slipped inside the fence in some places. We are trying to fight an all out assault with unsupported light infantry (our health care community). We are already taking casualties that we can ill afford considering the upcoming fight. Point 1. We must find some way to support our infantry in the coming battle, keep as many in the fight for as long as possible until we can bring our forces to bear.
You are also putting maximum effort into preparing for the end battle where the enemy is crushed by overwhelming force, a vaccine.
Problem is, the end battle may never come. A back of the envelope bell curve based on the numbers available to me (which I consider to be so much horse hockey) indicate that start to finish CV-19 will reach 95% saturation in approximately 199 days and burn itself out shortly thereafter. (95% saturation level being the point where group or herd immunity makes it difficult to spread is from a discussion on the importance of vaccination in the recent measles outbreak). Do we really need a Cadillac plan if a Chevy plan will get the job done and can be put into effect earlier and have a greater effect? It's a numbers game.
This assumes a worst case where warmer weather doesn’t stop or slow down the spread and I have heard a lot of comments that CV-19 is not acting like a typical corona virus in a lot of ways, case in point local transmission in Singapore and Australia.
Which brings us to the mid battle, everything that happens after the early efforts fail and the end battle.
In a nutshell, it will be short and brutal, quickly overwhelming our resources and our light infantry, the health care system. Anti virals will help but only so much. They do nothing to protect the health care system. It can at best be considered as light artillery.
What we need is heavy artillery, big guns for the mid battle, Good news, you have some at your disposal.
Let’s digress a moment.
First, a mental image. A man makes it out of a burning building, we call him lucky. If a man makes it out of a burning building and manages to bring 4 or 5 other people out with him, we call him a hero. Now, what would you call a man who makes it out of a burning building, bringing 4 or 5 other people with him and those people were doctors and nurses. Going further, what would you call a man who makes it out of a burning building, bringing 4 or 5 doctors and nurses with him and than builds a couple of hospital beds and a couple of ventilators. I don’t know myself but it is possible that this could happen. Talk about flatten a curve? How about mangle it, stomp on it and grind it into the dirt.
Things are going to get a bit choppy here, please bear with me.
First, lets address immunity. There are basically two types. The first is permanent which is what you get when you have an illness and recover or when you are vaccinated. The other is temporary or acquired immunity. One well known example of this is the immunity that a baby gets from the antibodies in it’s mothers milk. This is actually more accurately called temporary passive immunity. There is another way to get temporary passive immunity (TPI) and therein lies our solution. Not bright, not flashy but I’ve been aware of it since my teens. (My mother was a registered nurse who took her training during World War 2 and the daughter of a nurse who took her training during the First World War, so many Heros of Medicine type books around the house
I like to think I have completed a minor in medicine from the University of Readsalot). Frankly, I’m surprised I have only seen 3 mentions of it in my reading about the current situation, 2 by doctors in China and one by WHO.
Perhaps it will be easier to visualize the first part of the solution if we do what Albert Einstein called a thought experiment. For our experiment, we have three people, you, your brother and myself. We are in the middle of an outbreak of bad, bad, disease. I am a doctor, you are a patient who I have nursed thru the bad, bad, disease and your brother is starting to show symptoms. I draw a unit of blood from you (about a pint), extract the plasma (about a half a pint) and give your brother a therapeutic inoculation and myself a prophalactic inoculation. (Hey now, chuckles yes, giggles no) I can now work around my other patients without fear of catching the bad, bad disease and, if I time it right, I have allowed your brother’s own immune system to kick in and than given it a kick in the pants, Now your brother suffers less and gets out of bed a day earlier than you did, lets call it 10% earlier. As part of my personal fight against CV-19 I ran that by my doctor. He said he wasn’t an infectious disease specialist but the concept sounded about right and the 10% was as good a guess as any, might even be a little overly conservative. Continuing our experiment, 8 weeks later, I can safely extract another pint of blood and do it again, Another person out of the burning building and another person out of bed a day earlier than expected.
Expanding our experiment to the numbers we are looking at, 330 million people at risk, 100,000 intensive care beds (a number I saw on last night’s news) plus lets say 9 critical care beds for each hospital bed and what do we have. Not much, we’ve burned thru 4 months and have barely even moved the needle much less flattened the curve much. The hospitals just can’t handle it and we’re not getting enough return on the effort. At least according to my Doctor.
Three miles from my doctor’s office is a plasma center. They use an automated machine which can collect 2 units of plasma from a 175 pound man in a little under an hour because they are returning the red blood cells back to the donor. According to our model of 2 inoculations per ½ unit of plasma that works out to 8 inoculations per donation. It gets better, a plasma donor can donate twice a week for 16 inoculations per donor per week. Here we have it, one man escaping from a burning building rescuing 1 doctors, 3 nurses, 1 sanitation worker (gotta keep the garbage picked up or we have other problems), 1 soldier (don’t want anybody taking advantage) and building 2 ICU units complete with ventilators each week. Another way to look at it, on what we would call a war emergency footing, given enough donors, these machines would crank out 40 units of plasma per day each. That would be what, 160 inoculations per day. These things are regular plasma cannons. Now, at this point, we need to slow down a bit. These are just imaginary numbers. Unfortunately, I don’t have enough juice to even ask the questions much less get good enough estimates to do a real model.
Continuing with our model, the local plasma center has maybe 30 of these machines and there are perhaps as many as 300 of these plasma centers scattered across the country for a total of 9000 machines. Again, just wild guesses, but running at full capacity with sufficient donors we might be looking at as many as 1.4M inoculations per day. We would be protecting our health care system through the worst of it, building virtual hospitals by reducing the time patients are in critical care and making good progress towards that magic 95% herd immunity number. If we could immunize just one person for each person that contracts CV19 we would cut this thing in half. That would put a dent in the curve.
As I write this, the WHO SitRep (55) show 41 deaths in the United States. The last time I saw a John Hopkins report back on 17 Feb the ratio of deaths to recovered was about 6 recovered for each death so we are probably looking at a potential donor pool of about 240 from among the critical cases. If the 80% mild case estimate is correct, that would add another 1200 but not all of them would pass screening. We are right at the start of the plasma curve so the time to act is now.
I feel that Redacted is the perfect city to develop a far ranging response to CV-19. It is small at Redacted people (once CV-19 hits it will be over fairly quickly) with two good hospital systems, we have 5 schools with nursing programs (development of a Pandemic Response Nursing program, a 2 or 3 week nursing boot camp to train PRNs drawn from the pool of those who have recovered from CV-19 and can thus move freely among the infected), a high school for sale to be converted to ambulatory wards which will be staffed by PRN’s under the supervision of traditional RN’s, a brand new approximately 120 room hotel about 2 blocks from the high school which could be converted to a 200 bed critical care facility and light manufacturing which can build whatever is needed to secure the plasma supply line should the need arise. Redacted is also a strategic asset having a port facility which ships 1.4 million tons of Redacted each year. Redacted is centrally located and is also in what has been a firmly blue state and thus will signal that we’re all in this together.
I guess it’s about time to give this program a name, something long and unwieldy as befits a government program, which describes what it does and has a catchy short name. Since it encompasses such a wide range and will be a model for expansion nation wide it’s a unified model so how about Redacted Unified Model, Profalactic and Sustained Therapeutic Epidemiological Response, Fighting Imminent Regional Emergences. That would be DUMPSTERFIRE or Operation DUMPSTERFIRE. (Yes I’ve been thinking about that one for a while and we take it where we can get it.)
Projected sequence of events:
: Initial phase in Redacted should take about 4 weeks
Week 5 First implementation and Cadre training, El Paso, Texas
Week 6 Second Tier implementation Team 1 as close to DC as possible Team 2 San Diego, Team 3 TBD, Team 4 TBD
Primary to Albuquerque, NM
Week 7 Teams 1-20 TBD Primary TBD
Week 8 Teams 1-104 TBD Primary TBD
*El Paso and San Diego get the Army and Navy involved and also protect the Southern Border, Albuquerque brings in the Air Force. By than we’ll have a chance to locate the other plasma centers and preference will be given to those located near military installations.
* Timing estimates are based on the need to build “bottle washers” to keep the Plasma Centers in the fight, If they are not needed, this can happen sooner, if there are manufacturing issues it could take longer.
My fight so far:
On or about Saturday, 8 Feb. I expressed my concerns to Redacted, Redacted City Council and asked about the City’s plans. She said she would check and a short time later informed me that they were waiting for guidance from the Federal and State governments and directed me to the State’s public health website. Basically “We have a plan, for now, don’t worry, wash your hands and cough into your elbow.” When I pushed a little she said she honestly didn’t know what else she could do. I’m sure that somewhere in our conversations I suggested that the local plasma center could be the Jewel in the Crown of the city’s defences.
On Saturday, 15 Feb. I approached the Special Projects Manager at our local Plasma Center and asked if they had any plans for what was coming. She said that question was really above her pay grade but that she was sure that Corporate would take care of it and not to worry, just wash my hands and cough into my elbow.
On Wednesday, 19 Feb, I approached the Clinic Manager at our local Plasma Center and asked her if they had any plans for what was coming. To better help her visualize my analysis of what they were facing and my concerns about the future availability of consumable supplies I carried with me 2 boxes of Latex Gloves, a box of sterile gauze pads, a small bottle of hand sanitizer, a bottle of Dawn Dish soap and a bottle of Clorox Bleach stating that it might allow an extra 10 donations. She replied that she did not think that they were going to have a problem, Corporate would tell her what, if anything, she needed to do, that she couldn’t have anything in the building that didn’t come from Corporate but perhaps I might try voicing my concerns to the CDC. Then she said I shouldn’t worry, just wash my hands and cough into my elbow. (Starting to get a little frustrated along about here.) Interestingly, bless her heart, she might have taken me more seriously than she let on and passed my concerns up her chain of command. On 4 March, at 12:21 CST there was a call on my caller ID from Redacted, Redacted. They haven’t called back.
Finally, we have my discussion on 11 March with my doctor as detailed above, Of course, it concluded with “Don’t worry, just wash your hands and cough into your elbow” (I’m really getting ready to slap somebody at this point)
That brings us to this correspondence. Have I expressed how badly I want to get into this fight yet? Well I do.
Well, in a nutshell, my thoughts and your personal checkbook. (At least for the initial phase, We don’t want to get bogged down in the swamp and think of the first presser). Expanding on that, I’m going to need:
Some help and some Juice to get my questions answered.
Resources for rolling the program out on a national scale. All three of these can be
covered by creation of an Independent Pandemic Control Command within the Department of the Army, to operate in parallel with any other programs and answerable directly to you, with a direct commission as a Major General. This will give me access to the resources of the US Military, a staff for help and the ability to TDY military personal that have contracted CV-19 and recovered to Firebase D as soon as they ripen for plasma
donation (Estimated 14 days after second negative test. I’ll get a better picture once I can get some answers. For now, thump them in the head. If it sounds hollow, send them.)
This will also give me the juice I need to get the answers I need. A lot of the game is
perception, some call it theatrics and I can’t think of much that will impress the people
I will be dealing with than sending a Brigadier to fetch me a cup of coffee which brings us to Staffing.
For Executive Officer, I would like Redacted, Redacted Class of ‘84. If my
information is correct, he is currently working for Redacted. Again, if my information
is correct, he retired from the army as a full colonel but his last posting actually rated
a star. I remember him as a hard worker and he would not have gotten to where he is
if he wasn’t competent. He also won’t have a problem with the coffee run thing if we
can keep the grin off his face. Finally, he is a fellow Texan and we are going to need
that “Can do, hold my beer” spirit. You can recall him to active duty and put a star on him at the first presser.
For GS-2 I would like Congresswoman Redacted. Although I don’t agree with many of her positions she strikes me as a true patriot who will put country first and her military
background makes her more than qualified for the fight ahead. As GS-2 she will be
responsible for leak control and that will be very important until we have the supply issues worked out. The last thing we want is anyone else thinking about plasma and creating a toilet paper situation with the supplies we are going to need. Her posting will also show the nation that this is a united, across the aisle effort and add to the strength of the message we want to send to the nation with the first presser. Since I also envision her being made responsible for community affairs and handling the Press when the time is right she will be doing double duty. I see that she is a Major in the Hawaii ANG and thus can be called to active duty. Since she will be doing double duty, as part of the initial presser you could put a pigeon on her collar, elevating her to full colonel. My thought is that her selection will quiet the “He can’t do anything right” popular press. Besides, her time is not now but she will be better positioned for a run after your second term which, jokes on her, she will be helping you win.
I’ll also need a Software engineer. I’d like to get my hands on the lead designer of
Windows 10 but I’d be equally happy with just his head on a platter.
The rest of the staffing we will leave to Redacted. I imagine we will need to start out with at least one doctor and definitely one nurse although it would help him to have a short list ready.
The Plasma industry also must be protected. Any nurse can stick a needle in someone’s arm but these men and women have special skills concerning the equipment which takes time to develop.
We’ll also need a test for CV-19 antibodies to identify potential donors from among those who had a mild case and were never tested for CV-19. It would make all the difference.
You can hold out as a prize the starting point for finding out what it is about Disease X
that clears the Malaria protozoa from the human body.
If it is necessary to develop a bottle washer an account with W. W. Grainger’s and Home Depot would certainly be necessary but I guess Redacted can be made responsible for handling finance in the short term. Make her earn those eagles. Besides, it would also make for a good show you handing her your checkbook at the first presser.
As for my own personal requirements, I will accept a salary of no less than $1 per month andno more than $2 per month. I don’t want to profit off of the suffering of others. I just want in the fight. An expense account would be nice but at this point not really necessary, there is no place to eat out and no place to spend money anyway. A car and driver would be good because tooling up on a bicycle really doesn’t create the impression we’re shooting for. That can be arranged via the local Air Guard base. And finally, when I fall, because I will fall, if not in the fight than not long after and would rather go out guns blazing with my boots on as opposed to sitting around washing my hands and coughing into my elbow, drag my carcass back to Texas and inter it with full honors smack dab in the middle of the practice drill field of the Fighting Texas Aggie Marching Band at Texas A&M University. It’ll annoy the BQ’s to have to step around me but I’ll be able to hear the bugles till the final trumpet sounds. Well that might be a bit much but a nice shady spot somewhere close would be nice.
But I’m getting way to far out over my skis. I guess I’m just trying to impress on you that the
science is sound, the concept is sound, the numbers are so much horse hockey until we get better numbers and that just maybe I’m the right man, at the right place, at the right time, with the right plan and sound enough to fight this fight by your side.
I guess in closing I had better give you my contact information. I can be reached by phone at
Redacted. By e-mail at . By US Postal Service at the address above.
For references I tender:
Redacted and
Redacted
I look forward to hearing from you and going over final details. In the meantime, remember to wash your hands, cough into your elbow, don’t touch your face (dang, now they have me saying it) and let not your heart be troubled.
"How can a man die better, than when facing fearful odds, for the ashes of his family, and the temples of his gods."
Sincerely yours and ready for the fight
Redacted
One last thing, Mr President, I again stress the need to keep this close to the vest, we don't want to create a "toilet paper" type rush on the supplies we will need before we can secure our lines of suppliy. I call attention to the May incident from World War 2, the Chairman of the Armed Services Committee, Congressman Andrew May, upon his return from a briefing at Pearl Harbor, announced to the press that things were going very well. Our submarines were able to dive deeper than the Japanese could reach them with their depth charges. Adm Lockwood, COMSUBPAC estimated that this boondoggle cost us 8 submarines and 800 submariners.
A second last thing, Mr President, this is not a perfect plan but it is a good enough plan. Again, citing World War Two, this is not a Panther or Tiger tank, (processing and concentration of immune agents with full studies and trials). It is a Sherman or T-34 tank (direct plasma immunization) which is available now and can be deployed on a massive scale as donors ripen.
One more last thing Mr. President (seems to be a lot of these). If you decide you want to do this I have one last request. Would you be so kind as to HOLD MY BEER..
