I noted in the last post that the U.S. federal stockpile of medical protective gear is almost empty as coronavirus spreads. And everybody is screaming for ventilators. But Trump seems to have his own private stash.

Josh Marshall:

As we work to find out the scope and goals of the White House’s seizure of medical goods across the United States, a simpler pattern is coming into view: the White House seizes goods from public officials and hospitals across the country while doling them out as favors to political allies and favorites, often to great fanfare to boost the popularity of those allies. The Denver Post today editorialized about one of the most egregious examples. Last week, as we reported, a shipment of 500 ventilators to the state of Colorado was intercepted and rerouted by the federal government. Gov. Jared Polis (D) sent a letter pleading for the return of the equipment. Then yesterday President Trump went on Twitter to announce that he was awarding 100 ventilators to Colorado at the behest of Republican Senator Cory Gardner, one of the most endangered Republicans on the ballot this year. As the Post put it, “President Donald Trump is treating life-saving medical equipment as emoluments he can dole out as favors to loyalists. It’s the worst imaginable form of corruption — playing political games with lives.”

We don’t know if the ventilators sent by Trump were part of the shipment that was seized. But there have been reports from several sources of the federal government seizing shipments of medical equipment, and nobody knows what’s happening to it. I mentioned this in a post a couple of days ago. And see Are the Trumps Engaged in Profiteering?

Back to Josh Marshall:

For all the confusion, what is clear is that the federal government is demanding that states, localities and hospital systems find their own supplies while systematically interdicting those they do purchase and rerouting them in other directions while providing no explanation of what standards are being used to distribute them. At the same time, Republican officeholders keep turning up announcing windfalls of medical supplies courtesy of the President. In many cases, like Gardner, they’re Republicans within blue or purple states.

Josh Marshall again, from another post today:

This morning I heard from a board member of a regional private hospital system who said these seizures aren’t just happening. They’re commonplace. Seemingly bordering on routine. To paraphrase this person’s account it’s searching high and low everywhere to find supplies and on those rare occasions when you strike gold the feds are likely to jump in and grab your stuff anyway. Hearing this my sense – not the source’s words – is that it’s almost like FEMA and whatever other agencies are doing this are using these desperate buyers as their involuntary lead generators. Let them find the stuff and when you see a shipping order surface, grab it.

I was struck by something in this Paul Waldman column, quoting Washington Governor Jay Inslee, about shortages of medical supplies:

I’ve assumed Joe Biden would be the nominee for several weeks now, so it wasn’t that much of a letdown when Bernie Sanders announced he was ending his campaign. Yes, it’s too bad that an absolute mess of a nomination process has given us just about the least-suited nominee for our political moment from among the field that started out. A damn shame. But let’s go on.

I suspect Biden will win — or, at least, that Trump will lose — barring unforeseen events. Let us not forget that Trump won the electoral college with only 80,000 votes in three states. Trump hasn’t expanded his base, and he’s not going to get all of his original voters back. Current polls have Biden slightly ahead in Wisconsin, Michigan, Pennsylvania, and Florida, states that were critical to Trump’s win in 2016.

It’s no time to be complacent, of course, especially considering the tricks Republicans are going to pull to suppress the vote.

Trump’s approval numbers improved in mid-March as the pandemic crisis heated up, but now they are tumbling back to earth. Quinnipiac released a new poll today:

A plurality of voters gives the president a failing grade on the way he has communicated information about the coronavirus to the American people:

25 percent give Trump an A;

17 percent give him a B;

14 percent give him a C;

12 percent give him a D;

31 percent give him an F.

Dr. Anthony Fauci received the highest approval rating, followed by “your state’s governor.” Who did worse than Trump? Congress.

Right now there are still large parts of the country — mostly rural, mostly southern and midwestern, mostly Trump voting — that aren’t fully accepting the seriousness of our situation. But that is changing fast.

A new wave of coronavirus cases is spreading deep into rural corners of the country where people once hoped their communities might be shielded because of their isolation from hard-hit urban centers and the natural social distancing of life in the countryside.

The coronavirus has officially reached more than two-thirds of the country’s rural counties, with one in 10 reporting at least one death. Doctors and elected officials are warning that a late-arriving wave of illness could overwhelm rural communities that are older, poorer and sicker than much of the country, and already dangerously short on medical help.

It appears that just as the urban areas will begin to see fewer new cases, the rest of the U.S. will be seeing more and more cases. And rural America especially is not equipped for this. Hospitals are far apart. A majority of rural counties don’t have a single ICU bed.

“We’re behind the curve in rural America,” said Senator Jon Tester, Democrat of Montana, who said his state needs hundreds of thousands of masks, visors and gowns. “If they don’t have the protective equipment and somebody goes down and gets sick, that could close the hospital.”

Rural nurses and doctors, scarce in normal times, are already calling out sick and being quarantined. Clinics are scrambling to find couriers who can speed their coronavirus tests to labs hundreds of miles away. The loss of 120 rural hospitals over the past decade has left many towns defenseless, and more hospitals are closing even as the pandemic spreads.

Coronavirus illnesses and deaths are still overwhelmingly concentrated in cities and suburbs, and new rural cases have not exploded at the same rate as in some cities. But they are growing fast. This week, the case rate in rural areas was more than double what it was six days earlier.

Meanwhile, Trump’s “leadership” of the coronavirus continues to consist of temper tantrums, blame, and shilling hydroxychloroquine. I agree with Paul Waldman that the real reasons for Trump’s fixation on the unproven coronavirus therapy have more to do with politics than profit.

The most important factor is that he’s desperate, he wants to come out of this a hero and it’s the only drug he’s heard of that might give him the opportunity.

The election is seven months away. We’re facing a public health crisis that could kill hundreds of thousands of Americans, and the economy has been put into a medically induced coma. Even if our social distancing measures are successful and we can restart somewhat normal life in a couple of months, it may take years for the economy to fully recover.

And even before the pandemic, Trump’s chances at reelection were probably 50-50, given his historic unpopularity and the steady demographic shifts that have made the country even younger and more diverse than it was four years ago when he squeaked out an electoral college victory despite getting 3 million fewer votes than his opponent. …

…If Trump can claim that he personally defeated covid-19, then he might just win. If hydroxychloroquine somehow turns out to be an effective treatment, he can point to all the time he spent promoting it while others were skeptical and say, “I did it, America. I saved all your lives, because I’m a genius and the so-called experts are idiots.”

There’s a lot about Biden that is objectionable, but the two factors Republicans will try to smear him with — that he suffering dementia and HUNTER BIDEN MADE MONEY IN UKRAINE are not likely do the same damage as the damn emails. One, Joe Biden can still speak in complete sentences, a skill that eludes Trump. Two, besides the fact that I think the Hunter Biden claims are old and tired, the self-dealing adventures of Ivanka, Jared, Junior, and Eric make Hunter seem a model of financial rectitude. And I dare Republicans to make anything of the recent accusations of sexual assault, given Trump’s history in that area.

So, while I have no enthusiasm for Biden whatsoever, neither am I too concerned that he’s a weak candidate compared to Trump. Biden’s strength is that he can exude empathy and nice-guyness, which may be just the thing people will be hungry for after four years of Trump. Second, I think by November a majority of Americans will vote for a bleeping gerbil to get rid of Trump. Maybe not a big majority, but a big-enough majority.

I can’t even.

Today in Wisconsin, people are risking their lives to vote, and the U.S. Supreme Courtis okay with this.

Paul Waldman:

Wisconsin Gov. Tony Evers attempted to postpone the state’s primary scheduled for Tuesday, issuing a last-minute executive order after failing to get the Republican-controlled state legislature to agree to a delay. Because the state had been deluged with absentee ballot requests — causing some voters not to get their ballots in time — a federal judge had ordered the state to accept ballots postmarked for an additional six days. Republicans sued to get that ruling overturned and to force the election to go on as scheduled.

This Vox article provides more background on the Wisconsin debacle. Back to Paul Waldman:

Why were they so eager to have the election in the middle of this pandemic? The key race was for a seat on the state supreme court, which will help them solidify their conservative majority, which is in turn vital to maintaining the system of minority rule in Wisconsin. That includes the extraordinary partisan gerrymander of state legislative districts engineered by Republicans, a gerrymander so brutally effective that in the 2018 state assembly elections, Democrats won 53 percent of the votes but Republicans won 63 of the 99 seats.

Republicans know their voters are more likely to have already voted absentee or live in less-populated areas where they can vote safely at a less-crowded polling place. Democrats, on the other hand, are being forced to literally risk their lives to vote. In Milwaukee, a city of 600,000 people, the number of polling places was reduced from 180 to five.

Late Monday, the state Supreme Court ruled that the governor did not have the authority to postpone the election. And then the U.S. Supreme Court overruled the previous decision that allowed six additional days for the absentee ballots. Only ballots postmarked by Tuesday can be counted. So right now people are standing in five-hour-long lines in the middle of a pandemic to try to vote.

Back to Paul Waldman:

This is a very ominous sign for what will happen in November. There will be battles across the country over how the upcoming election will be conducted — whether it will be fair, whether everyone will have access to the ballot and whether we’ll be able to trust the result.

And the Supreme Court will be there to put a thumb on the scales for the Republican Party.

Mark Joseph Stern, in Slate:

On Monday, by a 5–4 vote, the U.S. Supreme Court approved one of the most brazen acts of voter suppression in modern history. The court will nullify the votes of citizens who mailed in their ballots late—not because they forgot, but because they did not receive ballots until after Election Day due to the coronavirus pandemic. As Justice Ruth Bader Ginsburg wrote in dissent, the court’s order “will result in massive disenfranchisement.” The conservative majority claimed that its decision would help protect “the integrity of the election process.” In reality, it calls into question the legitimacy of the election itself.

See also Leah Litman, The Supreme Court’s Wisconsin Decision Is a Terrible Sign for November, in Atlantic.

And this takes us to the larger question — thanks to Trump appointees, much of the federal judiciary has been larded with loyalist party hacks who are years away from retirement. Dealing with this is going to be a huge problem.

In other news:

CNBC:

President Donald Trump has removed the lead watchdog overseeing the $2 trillion coronavirus package, just days after the official, Glenn Fine, was appointed to the role.

The move came as Trump pursued similar action in recent weeks against independent inspectors general across the federal government.

CNN:

Acting Navy Secretary Thomas Modly resigned on Tuesday, a day after leaked audio revealed he called the ousted commander of the USS Theodore Roosevelt “stupid” in an address to the ship’s crew, according to a US official and a former senior military official.

So, the news isn’t all bad.

People lined up to vote outside Riverside High School in Milwaukee on Tuesday.Credit…Mike De Sisti/Milwaukee Journal Sentinel, via Reuters

Hydroxychloroquine is a prescription drug used to tread lupus, rheumatoid arthritis, and malaria. Like a lot of presciption drugs it can cause nasty side effect, including possibly fatal heart damage and permanent vision loss. It is known to interact badly with some other drugs, such as insulin and other diabetes drugs; drugs that treat common heart problems; and antiseizure and immunosuppresant drugs. So it’s not something you should take without close medical supervision, and you should take it only if you really need it.

Hydroxychloroquine also is thought to have anti-viral properties, and there have been studies for using it to treat viral diseases going back 40 years, according to the Lancet. However,

Hydroxychloroquine has shown activity in vitro against many viruses, including influenza and coronaviruses, but that has largely failed to translate into success in either animals or humans. In 2005, the drug showed in vitro activity against SARS-CoV, which is closely related to the current pandemic virus, but it failed to decrease viral load in mice, and clinical interest drifted away, says Christopher Tignanelli, a surgeon at the University of Minnesota in Minneapolis, who is involved in clinical trials of COVID-19 treatments.

“There is not a huge amount of pre-clinical data for this drug,” says Tignanelli. “It’s mostly test-tube and anecdote.”

In other words, while it’s not impossible that hydroxychloroquine would be useful to treat our current coronavirus, that’s a long shot. Claims about patients it helped might just be a placebo effect. And given the drug’s risks, it’s not something to hand out to people indiscriminately in case it might help.

So when Donald Trump, who is hyping hydroxychloroquine, says “What do you have to lose? Take it,” the answer to his question is that you could lose your eyesight or your life. You could also lose your hair and develop ringing in the ears, nasty rashes, and suicidal thoughts.

But the degree to which elements in the Trump administration are pushing hydroxychloroquine as the magic bullet that will get us out of this pandemic mess suggests either desperation or avarice, or both. Suddenly there are shortages, which also suggests hoarding and a lot of the pills being diverted into a black market. It’s also the case that much of the hydroxychloroquine sold in the U.S. comes from India, which has stopped exports to the U.S.

A website called Sludge that may or may not be reliable claims that the Trump administration is being aggressivly lobbied to promote hydroxychloroquine by conservative groups with ties to the pharmaceutical industry. So there’s that.

CNN reported on a tense encounter among White House advisers over the weekend:

While discussing the latest on hydroxychloroquine this weekend, an exasperated Navarro lashed out at Dr. Anthony Fauci, one of the advisers who has urged caution about the drug, a person familiar with the meeting told CNN.

Navarro had brought a stack of paperwork with him into the Situation Room on the drug, arguing it was proof that it could work to treat coronavirus, which Fauci, the nation’s top infectious disease expert, disagreed with because it was not data.

“What are you talking about?” Fauci asked — a question that set Navarro off. He became indignant, and at one point, accused Fauci of opposing Trump’s travel restrictions on China, which confused many in the room, given Fauci was one of the initial few to agree with Trump on the move, the source said.

Navarro, allegedly an economist, was mostly known for advising Trump on trade policy before the pandemic turned him into a medical expert. Be afraid. But Trump himself is the biggest salesman for the drug. Back to CNN:

Without citing evidence, Trump said at Sunday’s briefing that hydroxychloroquine is a “great” and “powerful” anti-malaria drug “and there are signs that it works on this, some very strong signs.”

For people without heart problems, Trump recommended combining hydroxychloroquine with azithromycin, a common antibiotic. He said azithromycin “will kill certain things that you don’t want living within your body.”

Yet there is little reliable evidence that the drugs — either alone or in combination — are effective at treating the novel coronavirus.

Still, Trump said: “What do you have to lose? What do you have to lose?”

For doctors, nurses and first responders, Trump suggested the drugs could be taken as a preventative. “They say taking it before the fact is good, but what do you have to lose?”

Experts do not suggest taking hydroxychloroquine as a preventive for Covid-19 because there is no evidence yet to suggest it protects against contracting the virus.

“They say take it,” said Trump, without citing any experts or sources. “I’m not looking at it one way or the other, but we want to get out of this. If it does work, it would be a shame if we didn’t do it early. But we have some very good signs.”

Trump also said the US Food and Drug Administration gave hydroxychloroquine “rapid approval,” but in fact, the FDA has not approved it for the treatment of Covid-19.

Talk like this is going to ramp up black market sales, big time, and probably kill a lot of people.

Peter Wade writes in Rolling Stone,

What exactly Trump’s motives are to get behind the unproven coronavirus remedies remains to be seen. But between this weekend’s reported argument coming out of the White House, sending out Navarro to undermine Fauci’s advice on the topic is disturbing. Adding to that, Trump himself did not allow Dr. Fauci to comment on hydroxychloroquine when reporters asked about the administration’s insistence to promote the drug during a recent briefing and new reporting by the Washington Post tells of Rudy Giuliani’s involvement in the chloroquines game while attempting to “cast himself in a new role: as personal science adviser.” The whiff of a new grift is strong.

It might be that Trump just wants there to be an easy cure for the coronavirus in order to get the pandemic out of the way, and the stock market back up, before the November election. He seems susceptible to magical thinking, in particular the notion that if he says something often enough and forcefully enough reality will bend to his will. But it’s also the case that somebody must smell money to be made.

Charles Pierce:

So a lot of people are going to be taking lordy-knows-what sold to them as hydroxychloroquine, and maybe it’ll just be sugar pills that don’t do any harm, but it could give them a false sense of security leading to reckless behavior. Or, worse, it might really be hydroxychloroquine, and they could be hit with the dangerous side effects. If doctors want to try it as a last-ditch therapy on the sickest coronavirus patients that’s one thing, but you know it’s not going to stop with that.

In other news — Josh Marshall has been noting instances of our federal government seizing shipments of medical supplies heading to states or hospitals, and sometimes to other countries. See, for example, What’s Up with the Feds Seizing PPE Shipments to States and Hospitals?

According to the Kaiser Family Foundation, the Trump Administration is buying up a lot of the medical supplies being produced in the U.S. right now, but it’s not clear where these supplies are going.

The Trump administration quietly invoked the Defense Production Act to force medical suppliers in Texas and Colorado to sell to it first — ahead of states, hospitals or foreign countries.

It took this action more than a week before it announced Thursday that it would use the little-known aspect of the law to force 3M to fill its contract to the U.S. first. Firms face fines or jail time if they don’t comply.

The Cold War-era law gives federal officials the power to edge out the competition and force contractors to provide supplies to them before filling orders for other customers.

While it’s unclear how many times the power has been used during the coronavirus pandemic, federal contracting records examined by Kaiser Health News show that federal authorities staked first rights to $137 million in medical supplies. The orders in late March flew under the radar, even as dog-eat-dog bidding wars raged among states and nations for desperately needed medical protective gear.

“It’s like ‘Lord of the Flies’ out there for states and hospitals as they bid against each other for critical medical supplies and equipment,” Sen. Chris Murphy (D-Conn.) said in a statement to KHN. “Plus, there’s no transparency about what the federal government is doing with the equipment that they purchase when they outbid states and hospitals.”

The article continues to describe a chaotic situation in which orders are being cancelled because the federal government is claiming first dibs on production, but it’s not clear where all this material is going. FEMA appears to be involved, but exactly what FEMA is doing isn’t clear, either.

There could be a perfectly good explanation for the federal supplies-grab, but this is the Trump Administration we’re talking about, so that’s unlikely. And it’s probably Jared Kushner we’re talking about, since he has inserted himself into this mess and has established a headquarters at FEMA. Kushner’s pronouncement that the federal stockpile of medical supplies is “our stockpile,” not the states’, raised the question of who “our” is. Perhaps he meant he and his team, or the Trump family business. Who knows?

But here’s another odd little story that has been mostly overlooked. On March 27 Politico reported that a prominent DC-based Republican fundraiser had just notified his clients that he would not be working to raise funds for them after April 1. And why not? Because he’s going into the medical supplies business.

The fundraiser, Mike Gula, didn’t specify his new line of work in the email. But in an interview, he said he’d started a new company selling medical equipment that’s been in short supply during the coronavirus pandemic.

The company, Blue Flame Medical LLC, was formed Monday in Delaware, according to state records. Its website says it sells coronavirus testing kits, N95 respirator masks, “a wide selection” of personal protective equipment and other “hard to find medical supplies to beat the outbreak.”

Asked how he’d managed to procure such equipment when there are shortages in hospitals across the country, Gula said, “I have relationships with a lot of people.” …

…“I don’t want to overstate, but we probably represent the largest global supply chain for Covid-19 supplies right now,” he said. “We are getting ready to fill 100 million-unit mask orders.”

Gula is a veteran fundraiser who’s raised money for more than two dozen lawmakers in this cycle alone, including Sens. Steve Daines of Montana, Tim Scott of South Carolina, Pat Toomey of Pennsylvania, Ron Johnson of Wisconsin, Martha McSally of Arizona and Kevin Cramer of North Dakota.

Here’s more about Mike Gula from a New York Times article published March 28:

Neither Mr. Gula nor his partner in the business, a fellow Republican operative named John Thomas, had much experience in the medical supply field.

But Mr. Thomas said in an interview on Saturday that the connections they made through their work in politics helped them find suppliers and connect to customers, including large medical systems and law enforcement agencies around the world, including in the Middle East.

“In politics — especially if you’re at a high enough level — you are one phone call away from anybody in the world,” Mr. Thomas said, adding that his new company had partnered with firms to sell and distribute its products. “It’s not about the financial motivations,” he said of his new venture, which was revealed Friday by Politico. “We’re here to solve a need to help people.”

“Partnered with firms” is as specific as Gula gets about his suppliers. Basically, he jumped into the medical supplies biz because he knows a guy who knows a guy.

But there’s another angle to this. You may have seen the clip on television from a couple of days ago in which an admiral announces that by means of an airbridge of flights from abroad the U.S. had procured tons of masks, gowns, and other supplies. But under questioning by Weijia Jiang of CBS News, the admiral admits that the supplies are not going to the cities, or to hospitals, or even to FEMA.

This is remarkable. The US has set up an airbridge for PPE & med supplies to the US from abroad. But in answer to question from @cbsnews @weijia the Admiral explains that this is going through private companies, which explains why states are having to bid to get the stuff. pic.twitter.com/eO646wAeNF

— Josh Marshall (@joshtpm) April 3, 2020

Josh Marshall writes that it may make sense to use private sector supply chains to distribute the material. However …

But this doesn’t sound like it’s just distribution. The Admiral seems pretty clear that this is being distributed as private sector transactions. As then Admiral put it: “That’s normally how things work, right? I’m not here to disrupt a [commercial] supply chain.”

We’ve heard different governors complaining that it’s like bidding on eBay, with the different governors have to bid against each other to get access to these live saving products that are in desperately short supply. That only doesn’t distribute them according to need. It also makes the price for everyone higher.

Who is making money from this? If the U.S. gathering  these supplies, is it then selling the material to the private sector for resale (at a markup) to hospitals and others who need them? Nobody is saying exactly how this is working. And Josh Marshall also noted Mike Gula —

Possibly unrelated but maybe not, BW flagged this article from a couple days ago which describes a GOP fundraiser and political operative who abruptly shuttered his business and announced he was opening a new firm (Blue Flame) which is in the COVID medical supply business. “Over the last 14 days I have built another business outside politics and will be focusing my full attention there,” he told colleagues in an email.

There’s no evidence the fundraiser/operative Mike Gula is in the mix with these airbridge flights. But it at least hints at the kind of corruption and profiteering that is possible in such a crisis.

And if there is corruption and profiteering going on, does anyone think that the Trump family is not getting a cut?

In other news —

Inspectors general are supposed to be apolitical and nonpartisan. The Senate will no doubt rubber stamp this appointment, however, because Senate Republicans can’t learn.

Y’all will remember Senator Kelly Loeffler (R-GA) who appeared to trade stock based on information we was getting at Senate briefings about the pandemic. Loeffler is marred to Jeffrey Sprecher, chairman of the New York Stock Exchange. See Loeffler reports more stock sales, denies wrongdoing —

During the same time period reflected on reports filed late Tuesday, the couple also sold shares in retail stores such as Lululemon and T.J. Maxx and invested in a company that makes COVID-19 protective garments.

— and Questions remain about who is handling Kelly Loeffler’s stock transactions —

Loeffler says that financial consultants acting independently conduct all transactions on her behalf.

To this day, however, Loeffler has not provided details about how her portfolio is managed and who does that work. She won’t name her advisers or say what company they work for or disclose what kind of agreement she has with them.

— both in the Atlanta Journal-Constitution.

Greg Sargent discusses some of the same overlapping trends I wrote about yesterday. For example, yesterday I said that you look at the map of where people have been doing the least sheltering in place, it looks remarkably like the map of where Medicaid hasn’t been expanded.

Americans have widely obeyed guidance to stay home to stop the spread of coronavirus. But not equally.https://t.co/F8oMVvXWBU

— Lauren Leatherby (@LaurenLeatherby) April 2, 2020

This map of the status of the Medicaid expansion, from @kff, looms large right now:https://t.co/U0r8Ss4hFd pic.twitter.com/fnIFw4f827

— Greg Sargent (@ThePlumLineGS) April 3, 2020

Sargent writes,

What’s coming is a kind of perfect storm, according to experts I spoke with: Soaring unemployment risks pushing huge numbers of people into the ranks of the uninsured. Many of those people will probably seek Medicaid coverage, further straining state budgets.

Add into that combustible mix a coming wave of coronavirus cases, and you have what health economist Austin Frakt described to me as a “looming catastrophe.”

This may be felt with great intensity in the south. That’s because in that region, there is a developing situation that could prove very distressing in coming weeks. On one hand, there hasn’t been enough social distancing in these places. On the other, many of those states have not opted into the Medicaid expansion, which could make the health care crisis far more acute.

A great many people right now are losing their jobs and thereby their health insurance. Most probably qualify for COBRA, but the bite with COBRA is that it is grossly expensive, and if you don’t have other income coming in you may not be able to afford it. However, I understand that people who have recently lost jobs have a grace period with which to purchase insurance in the ACA marketplaces, possibly qualifying for subsidies.

But if you didn’t have insurance to begin with, the national ACA marketplace is closed to you. And Trump won’t open it. “Numerous Democratic-leaning states that run their own insurance markets have already reopened enrollment in recent weeks as the coronavirus threat grew,” it says in Politico. The Trump administration oversees enrollment for about two-thirds of states.

(According to this page, the states that completely run their own insurance markets are Washington, Idaho, Nevada, California, Colorado, Minnesota, Vermont, Massachusetts, New York, Connecticut, Rhode Island, Maryland, and the District of Columbia. A few states — Oregon, New Mexico, Maine, Pennsylvania, Virginia, and New Jersey — may be transitioning to a state-based platform. Arkansas and Kentucky have state-based marketplaces on the federal platform which I suspect would stop them from opening the enrollment period now. Everyone else is completely at the mercy of Trump.)

Anyway, put together the soaring unemployment numbers, the huge percentage of the population without health insurance, and the strain on the medical care system, and you’ve got a catastrophe that won’t go away when the pandemic ends. It will be with us for quite a while. And it’s going to hit the south and big chunks of the midwest (see maps above) especially hard.

Back to Greg Sargent:

“What it means is a lot more hardship, health problems and death,” Frakt, the health economist, told me. Frakt noted that the virus is now likely to spread in those regions, which will dovetail in a terrible way with the failure to expand Medicaid.

“People who have lost their jobs and have nowhere else to turn,” if they can’t get on Medicaid, “they’ll have great difficulty affording the care they’ll need,” Frakt said.

Or, as Larry Levitt of the Kaiser Family Foundation bluntly put it, “poor people in states that haven’t expanded Medicaid” will have “no help.” And those ranks will swell. …

…Ominously, in some of these states, cases are mounting. As of now, Florida has over 9,000 confirmed cases; Georgia has nearly 5,500; Texas has nearly 5,000; Tennessee has nearly 3,000; and North Carolina has nearly 2,000.

And then there is the economic hit the nation is taking. Paul Krugman discusses it here, basically saying that it doesn’t necessarily have to be a long-range economic disaster except that the Trump Administration is in charge. So it probably will be.

Other Stuff to Read

Michelle Goldberg, Putting Jared Kushner In Charge Is Utter Madness

Paul Waldman, Trump’s ignorant son-in-law is running the coronavirus response. That’s unacceptable.

Paul Waldman, How this crisis could help us get to health-care reform

Charles Pierce, Robert Kraft Did a Good Thing. Now What Happens to Other States Without an NFL Team?

DALLAS, TX – SEPTEMBER 14: Republican presidential candidate Donald Trump speaks during a campaign rally at the American Airlines Center on September 14, 2015 in Dallas, Texas. More than 20,000 tickets have been distributed for the event. (Photo by Tom Pennington/Getty Images)

This crisis is going to get a lot worse before it gets better, I fear. And even as the effects of the pandemic fade in the rest of the world, they are going to be felt in the U.S. for a long, long time. And that’s because Donald Trump is president.

The Trump administration’s botched coronavirus response, explained by German Lopez at Vox does a good job walking us through all the ways the Trump Administration failed to respond to the pandemic when it would have made a difference.  We’re past that point now. Even if the Trumpers get everything else right going forward, there will be tremendous misery, and lots of people will die who didn’t have to die. And the economy will be thoroughly bleeped for a long, long time.

“This will go down in history as profound failure of our national government,” Illinois Governor J.B. Pritzker said today. And the failure continues.

New York Governor Andrew Cuomo asked the federal government to put military logistics experts in charge of procuring and distributing medical supplies. Instead, right now pandemic response is being managed by Jared Kushner. I’m serious. Having already screwed up negotiating a bleeping contract with General Motors, Mr. Ivanka is now the nation’s ventilator czar.

What started two-and-a-half weeks ago as an effort to utilize the private sector to fix early testing failures has become an all-encompassing portfolio for Kushner, who, alongside a kitchen cabinet of outside experts including his former roommate and a suite of McKinsey consultants, has taken charge of the most important challenges facing the federal government: Expanding test access, ramping up industry production of needed medical supplies, and figuring out how to get those supplies to key locations.

Kushner has even obtained a new center of power at the Federal Emergency Management Agency, the crisis-response organization that’s taken over coronavirus strategy and planning — and where Kushner and his deputies ride herd on the health agencies that had been criticized for their slow responses to the pandemic earlier this year.

So we’re screwed. Jonathan Chait writes,

As head of an ad hoc task force, Kushner is “working alongside government officials from FEMA, HHS, and USAID to solve a range of logistical and technical challenges” and “has stepped in to coordinate decision-making at agencies including the Food and Drug Administration and the Centers for Medicare and Medicaid Services,” according to Politico. “I don’t know how our government operates anymore,” one Republican source complains.

For anybody familiar with Kushner’s boundless self-confidence in his ability to master even the thorniest of policy challenges, from modernizing government processes to solving the Israeli–Palestinian conflict, his disposition will come as no surprise. Gabriel Sherman reports that, in one meeting, the presidential son-in-law insisted that he had mastered the problem of ventilator disbursement. “I have all this data about ICU capacity. I’m doing my own projections, and I’ve gotten a lot smarter about this. New York doesn’t need all the ventilators,” Kushner announced, according to someone present.

A lot of people will die who didn’t have to die. See also an old Frank Bruni column from last November, Jared Kushner Fails Up Again.

And just when you might have through the derp couldn’t get any deeper, this happened today.

Georgia Gov. Brian Kemp said he wasn’t aware that asymptomatic people could transmit coronavirus as he announced he was preparing to issue a state-wide shelter-in-place order.

Let us take a moment for a mass facepalm.

It’s a good guess the pandemic is going to hit the southern states especially hard. See Where America Didn’t Stay Home Even as the Virus Spread. The concept of shelter in place was lost on the Deep South until maybe yesterday. See also The Coronavirus’s Unique Threat to the South in The Atlantic. For some reason, mortality rates from coronavirus among middle-aged and younger people are much higher in the South than elsewhere.

Although the majority of coronavirus-related deaths in Louisiana are still among victims over 70 years old, 43 percent of all reported deaths have been people under 70. In Georgia, people under 70 make up 49 percent of reported deaths. By comparison, people under 70 account for only 20 percent of deaths in Colorado. “Under 70” is a broad category, not really useful for understanding what’s going on. But digging deeper reveals more concerning numbers. In Louisiana, people from the ages of 40 to 59 account for 22 percent of all deaths. The same age range in Georgia accounts for 17 percent of all deaths. By comparison, the same age group accounts for only about 10 percent of all deaths in Colorado, and 6 percent of all deaths in Washington State. These statistics suggest that middle-aged and working-age adults in the two southern states are at much greater risk than their counterparts elsewhere; for some reason, they are more likely to die from COVID-19. … Case-fatality rates around the world are notoriously tricky because they are based in part on the extent of testing, but a recent study of the outbreak in Wuhan, China, found a case-fatality rate of 0.5 percent among adults from the ages of 30 to 59. The current estimate of fatality rates in the same age range in Louisiana is about four times that.

The article provides data showing that southerners are less healthy than the rest of us. They have higher rates of hypertension and heart disease at earlier ages.  “Southerners are more likely to suffer from chronic diseases than other Americans—even as Americans are more likely to suffer from chronic disease than citizens of other countries with comparable wealth,” the article says. And a lot of that is because of poverty. And there’s this — the gray states hadn’t expanded Medicaid as of 2019.

If you look at the New York Times map of where people have traveled the most over the past couple of months and then the Medicaid map, you see a close correlation. It’s not a perfect correlation, but close. That probably says something.

And then there’s the economic fallout. There’s an interview of Paul Krugman in Business Insider that’s useful. Among other things, he says that our government so far has produced the weakest economic response of all the G7 countries. And because the states are breaking their budgets to buy gray-market medical supplies now — not to mention losing tax revenue — there is likely to be a mass layoff of state employees next year, which will hurt the economy massively.

So this is not going to end soon, and it probably will haunt the country for a long time. And it didn’t have to be this bad.

The Congresswoman is pissed.

Trump, you incompetent idiot! You sent 18 tons of PPE to China early but ignored warnings & called COVID19 concerns a hoax. You’ve endangered doctors, nurses, aids, orderlies, & janitors – all risking their lives to save ours. Pray 4 forgiveness for the harm that you’re causing!

— Maxine Waters (@RepMaxineWaters) March 30, 2020

Yes, Trump sent 17.8 tons of medical supplies to China early in 2020.

I foresee investigations to come. But with the Trumpers, it’s hard to know where the grift ends and sheer incompetence begins. This is from Politico, yesterday:

Last week, a Trump administration official working to secure much-needed protective gear for doctors and nurses in the United States had a startling encounter with counterparts in Thailand.

The official asked the Thais for help—only to be informed by the puzzled voices on the other side of the line that a U.S. shipment of the same supplies, the second of two so far, was already on its way to Bangkok.

The official then went to Mike Pence, who didn’t know about the assistance to Thailand, either. The shipments of supplies to other countries were initiated by the United States Agency for International Development (USAID), an independent government agency with a budget of over $27 billion. It is part of our government’s foreign policy apparatus and is supposed to be overseen by the State Department. The USAID website brags about the assistance U.S. taxpayers are providing to help other countries fight the pandemic. And, really, we should be helping other countries fight the pandemic; this needs to be an internationally coordinated effort and not every country for itself.

But I’m not seeing any coordinating going on. It’s just chaos.

There’s currently a hold on USAID shipments as Trumpers try to figure out what’s going on. Back to Politico:

President Donald Trump seems attuned to the political hazards. During Monday’s task force briefing, he emphasized that the U.S. was sending only “things that we don’t need” to other countries. “We’re going to be sending approximately $100 million worth of things – of surgical and medical and hospital things to Italy,” he announced.

The Politico reporting suggests that the “medical things” really are things we need here, though.

“The problem is, there’s not one person who’s in charge of this, which is why we’re instituting a review process that is led by the White House coronavirus task force,” a person directly involved with the review said.

Officials close to USAID say the ongoing review is more akin to a hold, as the task force examines the aid agency’s procurement of supplies and asks aid officials to alert them if there are other such shipments in the works.

But then if you keep reading the Politico article, it turns out that the State Department knew all about it.

America’s diplomats are also grappling with China’s attempts to exploit the shortages by supplying aid to Western countries, keenly aware of Beijing’s interest in showing it is supplanting the United States as a global leader.

Just days before a load of medical supplies from China arrived in the U.S. for distribution in New York, New Jersey and Connecticut, the State Department boasted in a press release that the United States was “Leading the Humanitarian and Health Assistance Response to COVID-19.”

Secretary of State Mike Pompeo highlighted the aid in a press conference on Tuesday, noting, “We’ve now made available a total of $274 million in funding to as many as 64 countries,” money he said “would go to some of the world’s most at-risk peoples.”

In the last two months, at least five U.S. embassies, including in Myanmar, Tajikistan, Uzbekistan, Kyrgyzstan and Laos, all announced in press releases that the U.S. government had given protective gear to their host countries, sometimes including pictures of boxes of the donations.

So at least some Trumpers did know that these much-needed resources were going overseas, and mostly this was being done so that China couldn’t make us look bad.

It’s crazy out there. There are reports a company in Texas is sitting on 2 million N95 masks and is ready to sell them — at six times the normal price. Meanwhile, medical personnel around the country are reporting that they are risking their lives caring for coronavirus patients without enough personal protection equipment. Hospitals are threatening to fire these same people if they keep talking to reporters. Vox reports that a huge gray market in medical supplies has emerged as all sorts of random people — some hoping to do good, some hoping to make a quick buck — jump into the medical supplies business.

Gee, wouldn’t it be nice if there was a single entity coordinating all this stuff? Like, you know, a government?

And this takes us to Charles Pierce and his must-read All the President*’s Excuses for Not Using the Defense Production Act Were Absolute Moonshine. Pierce begins by pointing to a New York Times report saying that the dreaded Defense Production Act is used all the time.

Chemicals used to construct military missiles. Materials needed to build drones. Body armor for agents patrolling the southwest border. Equipment for natural disaster response.

A Korean War-era law called the Defense Production Act has been used to place hundreds of thousands of orders by President Trump and his administration to ensure the procurement of vital equipment, according to reports submitted to Congress and interviews with former government officials.

Yet as governors and members of Congress plead with the president to use the law to force the production of ventilators and other medical equipment to combat the coronavirus pandemic, he has for weeks treated it like a “break the glass” last resort, to be invoked only when all else fails.

“You know, we’re a country not based on nationalizing our business,” Mr. Trump said earlier this month. “Call a person over in Venezuela, ask them how did nationalization of their businesses work out? Not too well.”

To which Charles Pierce responds,

Therefore, all the excuses that the president* has used for not using the DPA more widely in response to this pandemic, and in response to desperate pleas from the country’s governors, are absolute moonshine. He prefers the way things are working now. He wants governors to compete against FEMA, lose, and then have to beg for ventilators and PPE, which he can dole out like pork-barrel projects to help his re-election campaign.

Yep, one suspects that’s exactly the scam he’s planning. Because Trump doesn’t know how to do anything else.

See also:

Desperate lawmakers hunt for medical supplies as Trump takes hands-off approach, posted today in Politico.

History’s verdict on Trump will be devastating by Michael D’Antonio at CNN.

Greg Sargent, A White House report blows up Trump’s latest coronavirus defense