Dr. Carter Evan Mecher (born 1956)

2015, Blue Ribbon Study Panel on Biodefense / Biological and Chemical Threat Preparedness, Emergency ResponseAPRIL 1, 2015Panelists talked about biological and chemical threat preparedness, response, and recovery. They spoke about lessons learned from the Oklahoma City bombing, natural disasters, and the recent Ebola cases in the U.S. They recommended integration of federal and local governments during an emergency response, and stressed the importance of making nurses aware of hospital emergency plans.[HM0022][GDrive]

Wikipedia 🌐 Carter Mecher

born 13 Jan 1956 - [HD0039][GDrive]

Full name - "Carter Evan Mecher" [HD003A][GDrive]

ASSOCIATIONS

Dr. Lisa Marlene Koonin (born 1955) ( Note collaboration/assistance provided by Dr. Carter Evan Mecher (born 1956) for the 2013 UNC dissertation by Dr. Lisa Marlene Koonin (born 1955) (titled "ACCEPTABILITY OF PHARMACIES SERVING AS PRIMARY DISPENSERS OF ANTIVIRAL DRUGS DURING AN INFLUENZA PANDEMIC: PERSPECTIVES OF PHARMACY EXECUTIVES" - PDF at [HE004Y][GDrive] ) )
Dr. Andrew George Huff (born 1982) - Not clear how much they have collaborated directly, but Dr. Andrew George Huff (born 1982) did note in his 2015 Resume/CV ( Link to PDF : [HX003N][GDrive] ) that in 2014 he had an unpublished manuscript co-written with [Dr. Carter Evan Mecher (born 1956)] :
- - "[Dr. Andrew George Huff (born 1982)], Lambert, G. L., Finley, P. D., Evans, L. [Dr. Carter Evan Mecher (born 1956)], & Davey, V. J. (2014). Ranking of pandemic influenza mitigation strategies: Why local population demographics matter. Unpublished manuscript."
...
The "Red Dawn" Group ( Dr. Carter Evan Mecher (born 1956) was a top contributor to The "Red Dawn" Group emails in Jan-April of 2020 )
....

Saved Wikipedia (July 08, 2021) - "Carter Mecher"

2021-07-08-wikipedia-org-carter-mecher.pdf

https://en.wikipedia.org/wiki/Carter_Mecher

https://drive.google.com/file/d/1EKBbIme3ZKGf-9jV3EGrwOmdoSNWzkjH/view?usp=sharing

Carter Mecher is an American epidemiologist. He is an advisor at the Public Health Company.[1]

Career

He was Senior Medical Advisor at the Veterans Administration.[2][3] He was Director for Medical Preparedness Policy on the White House Homeland Security Council.[4]

In January 2020, he warned about Covid-19.[5][6][7][8]

References

^ "The PHC Team". www.phc.health. Retrieved 2021-06-19.
^ "Biographies of Public Health Senior Officials - Public Health". www.publichealth.va.gov. Retrieved 2021-06-19.
^ "They Sounded the Alarm, Evacuated Americans and Started Working on a Vaccine". Government Executive. Retrieved 2021-06-19.
^ Events, Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic (2008). Biographical Sketches of Invited Speakers, Panelists, Workshop Planning Committee, Forum Members, and Staff. National Academies Press (US).
^ Lipton, Eric; Sanger, David E.; Haberman, Maggie; Shear, Michael D.; Mazzetti, Mark; Barnes, Julian E. (2020-04-11). "He Could Have Seen What Was Coming: Behind Trump's Failure on the Virus". The New York Times. ISSN 0362-4331. Retrieved 2021-06-19.
^ Freyne, Patrick. "Michael Lewis: My pandemic prediction 'was only partly right'". The Irish Times. Retrieved 2021-06-19.
^ "Doctors, scientists who warned officials about oncoming pandemic focus of new Michael Lewis book". www.cbsnews.com. Retrieved 2021-06-19.
^ Kime, Patricia (2020-04-13). "'Any Way You Cut It, This Is Going to Be Bad:' VA Official Sounded Early COVID-19 Warning". Military.com. Retrieved 2021-06-19.

Biography

Dr. Carter Mecher serves as the Medical Advisor for the Public Health Company (PHC). Prior to joining PHC, Carter served as a Senior Medical Advisor for Office of Public Health in the U.S. Department of Veterans Affairs. In this position, Dr. Mecher played a key role in the COVID-19 outbreak response. From 2005 to 2011, he served as the Director of Medical Preparedness Policy at the White House Homeland Security Council and National Security Staff. He was a principal author of the National Strategy for Pandemic Influenza Implementation Plan. In this capacity, he helped set policy and devise strategies to mitigate the consequences of a pandemic and promote pandemic preparedness. Prior to serving at the White House, Dr. Mecher was the Chief Medical Officer for the Southeast VA Network in Atlanta from 1996 to 2005. In this role he oversaw the healthcare delivery for veterans in Alabama, Georgia, and South Carolina. Dr. Mecher completed a residency in internal medicine and a fellowship in critical care medicine at Los Angeles County/USC Medical Center.

https://www.phc.health/team-member/carter-mecher-md

2021-phc-health-team-member-carter-mecher-md.pdf

http://biology.unm.edu/PIBBS/_backups/classes/readings/Sandia%20Lab%20Readings.pdf

CRITICAL PATHS: The first path was through Dr. Carter Mecher, the VA’s representative on the White House (WH) Homeland Security Council (HSC) Pandemic Implementation Plan (PIP) Writing Team. He responded immediately. This was the first thing he had seen that held a possible solution, wasn’t just hand wringing over the lack of vaccine and pharmaceuticals. He sent it to Dr. Richard Hatchett, the team lead, and Dr. Hatchett contacted me. This was the first 12 See press release: http://georgewbush-whitehouse.archives.gov/news/releases/2005/12/20051210-2.html. 11 thing that the he had seen that gave a direction and hope. I was then contacted by Dr. Rajeev Venkayya, the Senior Director for Biodefense Policy, HSC, and Special Assistant to the President for Biodefense: a meeting was scheduled for three weeks later when I would be in Washington DC on another project. The second path was through Vicky Davey, the Deputy Chief, Office of Public Health and Environmental Hazards (OPHEH) at the Veterans Administration (VA). Working on a doctorate degree at the Uniformed Services University of Health Sciences in addition to her normal duties, Vicky saw the usefulness of modeling in the formulation of policy. Vicky contacted me immediately. She wanted to define a set of critical issues surrounding the implementation of pandemic mitigation strategies and use our Loki model to evaluate them. We also set up a meeting while I would be in town.

https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1106&context=publicpolicypublications

2007 The Public Engagement Project on Community Control Measures for Pandemic Influenza Findings and Recommendations from Citizen and Stakeholder Deliberation Days

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6404a1.htm

https://economic-historian.com/2020/11/1918-flu/

EVIDENCE TIMELINE

1973 (April) - Honors student?

https://www.newspapers.com/image/306405359/?terms=%22carter%20mecher%22&match=1

1987

https://link.springer.com/article/10.1007/BF00770888

Published: January 1987

Elevated pulmonary capillary wedge pressure in a patient with hypovolemia

James Tuchschmidt MD, Carter Mecher MD, Park Wagers MD & Ralph Jung MD

Journal of Clinical Monitoring volume 3, pages67–69 (1987)Cite this article

Abstract

Since its introduction in 1969, the balloon-tipped pulmonary artery catheter has become widely accepted. Pulmonary capillary wedge pressures have been used diagnostically to determine left ventricular preload and volume status. We report on a patient with noncardiogenic pulmonary edema, secondary to a heroin overdose, who was hypovolemic and had an elevated pulmonary capillary wedge pressure. We discuss possible explanations and present evidence that the pulmonary capillary wedge pressure does not always accurately reflect volume status.

1988 -

CRITICAL CARE MEDICINE: PDF ONLY

IMPROVED SURVIVAL IN PATIENTS WITH AIDS, PNEUMOCYSTIS CARINII PNEUMONIA, AND RESPIRATORY FAILURE

Friedman, Yaakov; Franklin, Cory; Mecher, Carter; Rackow, Eric C.; Weil, Max H.

Critical Care Medicine: April 1988 - Volume 16 - Issue 4 - p 403

https://journals.lww.com/ccmjournal/Citation/1988/04000/Improved_Survival_in_Patients_With_AIDS,.89.aspx

1991 (Published Jul 25 1991) - Research : "The HA-1A monoclonal antibody for gram-negative sepsis"

https://jhu.pure.elsevier.com/en/publications/the-ha-1a-monoclonal-antibody-for-gram-negative-sepsis-1-3

https://sci-hub.se/10.1056/NEJM199107253250411

1991-07-25-new-england-journal-of-medicine-the-ha1a-monoclonal-antibody-for-gramnegative-sepsis1.pdf

1991-07-25-new-england-journal-of-medicine-the-ha1a-monoclonal-antibody-for-gramnegative-sepsis1-pg-01

1991-07-25-new-england-journal-of-medicine-the-ha1a-monoclonal-antibody-for-gramnegative-sepsis1-pg-02

Dr. Max Henry Weil - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334731/ - Died 2911

Raul J. Gazmuri, Carter Mecher, Max Harry Weil, Craig P. Tanio, Harold I. Feldman, J. Carlet, G. Offenstadt, C. Chastang, F. Doyon, C. Brun-Buisson, J. F. Dhainaut, B. Schlemmer, L. Gutmann, Gregory A. Schmidt, Harry B. Peled, S. Mackenzie, J. Kinsella, Lowell S. Young, Kenneth J. Gorelick, Jean Daniel BaumgartnerShow lessDidier Heumann, Michel Pierre Glauser, Elizabeth J. Ziegler, Charles J. Fisher, Charles L. Sprung, Craig R. Smith, Richard C. Straube, Jerald C. Sadoff, R. Phillip Dellinger, Sheldon M. Wolff

Abstract

To the Editor: Ziegler and collaborators (Feb. 14 issue)1 recently reported on an impressive reduction in 28-day mortality, from 49 percent to 30 percent, in a subgroup of patients who had bacteremia due to gram-negative bacilli. The patients were treated with human anti—lipid A monoclonal antibody early in the course after the onset of symptoms. Patients with sepsis or bacteremia caused by microorganisms other than gram-negative bacilli received no measurable benefit. These results prompted the investigators to recommend the therapy as routine treatment for patients with clinical signs of bacteremia, provided that a gram-negative organism was suspected as the cause.

Original language : English (US)
Pages (from-to) : 279-283
Number of pages : 5
Journal : New England Journal of Medicine
Volume : 325
Issue number : 4
State : Published - Jul 25 1991

1994 ?

https://journals.lww.com/ccmjournal/toc/1994/01000

1997

https://www.newspapers.com/image/261206201/?terms=%22carter%20mecher%22&match=1

2001 (Sep 11) - Dr. Carter Mecher flew into Washington DC on an 8:15AM flight, for a VA meeting.

Source : Comments in a 2015 Blue Ribbon Panel : https://www.youtube.com/watch?v=-Sj0FGgaI7Y / Saved copy (320P) : [HV00I1][GDrive] / Image of download page : [HV00I2][GDrive]

2007 ?

https://www.veterans.senate.gov/imo/media/doc/schoomaker_082807.pdf

The FY 2003 National Defense Authorization Act required a number of health care resource sharing and coordination projects. These included coordinated management systems in Budget & Financial Management System; Coordinated Personnel Staffing; and Medical Information/IT Systems. Augusta VAMC and DDEAMC successfully competed for funding for a project in Coordinated Personnel Staffing. The proposal focused on hiring of Registered Nurses for critical care. It was subsequently expanded to neurosurgery when both Army neurosurgeons at DDEAMC retired from active duty and those positions were not backfilled by the Department of the Army. Funds from the demonstration project were approved for the use of paying salaries of two neurosurgeons to continue the joint Augusta VAMC/DDEAMC neurosurgery program. The demonstration project expires at the end of FY 2007. Augusta VAMC and DDEAMC officials are in discussions on how the neurosurgery program will continue. In 2004, new guidance was given to VA and DoD health care facilities regarding the sharing of resources. Bartering of services was no longer allowed, and an agreed upon rate of CHAMPUS Maximal Allowable Charges (CMAC) minus 10 percent was established for outpatient services provided by one department to the other. In view of this a blanket sharing agreement was established between the Veterans Integrated Service Network 7 (VISN 7) and the Southeastern Regional Medical Command (SERMC). This agreement provided guidance to VISN 7 and SERMC facilities on billing of outpatient and inpatient services. Inpatient rates of exchange are based upon the interagency exchange rate or locally agreed upon rates to insure coverage of facility costs. This agreement was subsequently updated in FY 2007.

So the ground was fertile for a close working relationship between our two facilities at the outset of the GWOT. We in the Army Medical Department, in DDEAMC and in SERMC had grown confident in and respectful of what the Augusta VAMC and VISN 7 could offer our patients and our VA colleagues had grown more familiar with our culture and patient needs. It is important to note that two key conditions were present: 1) An essential precondition was a large cooperative team of healthcare leaders in VISN 7, especially the then-VISN Director, Ms. Linda Watson, and her chief medical officer, Dr. Carter Mecher; leaders at the Augusta VAMC, notably the then-Director, Mr. Jim Trusley, and the Chief of Staff, Dr. Thomas Kiernan; leaders on my SERMC staff-our Chief of Staff, Colonel (now retired) Sam Franco and our chief regional physician, Colonel (Dr.) Mike Stapleton (now retired and working for the VA); and clinicians and administrators at both hospitals, especially Dr. Rose Trincher and Dr. Dennis Hollins at the Augusta VAMC. This unique and very successful partnership is principally about a very visionary and industrious team working together with one goal in mind: to provide the best care for Soldiers, Sailors, Airmen and Marines at a site closest to their home or home unit.

2011 - Fukushima Response - See USA's Nuclear Regulatory Commission's public doc archive ( ML13109A344.pdf )

2011-2012-usa-nuclear-regulatory-commission-137-documents-ML13109A344-137documents-group-ah.pdf

https://www.nrc.gov/docs/ML1310/ML13109A344.pdf

Nuclear Regulatory Commission
; Mecher, Carter E.; Panketh, Eric J. (NSC); Reed, Richard A.; Tribble, Ahsha; Zelvin, Lawrence K.; Holgate, Laura Sent: Mon Mar 14 16:32:13 2011 Subject: RE: 8 NRC people to Japan ASAP TJ -- we're moving DOE AMS and Consequence M

HEAVY HEAVY REDA TIONS ??

From: Mecher, Carter E. (b)(6) To: Milligan, Patricia Sent: Thu Mar 17 19:56:13 2011 Subject: RE: Plan Looks like folks are going to be tied up tomorrow morning. Could we try for Monday (afternoon)?

also https://www.nrc.gov/docs/ML1215/ML12156A142.pdf

https://www.nrc.gov/docs/ML1220/ML12201B452.pdf

2012 (Oct) - INFORMS 2012 : "Mitigating Infectious Disease Outbreaks in Medical Facilities with Incomplete Vaccination"

October 17, 2012

https://www.sandia.gov/CasosEngineering/_assets/documents/INFORMS2012_Varicella_2012_8815.pdf

2012-informs2012-varicella-2012-8815.pdf

2012-informs2012-varicella-2012-8815-slide-01.jpg

2012-informs2012-varicella-2012-8815-slide-03.jpg

2013 - Assistance provided to Dr. Lisa Koonin dissertation at UNC : "ACCEPTABILITY OF PHARMACIES SERVING AS PRIMARY DISPENSERS OF ANTIVIRAL DRUGS DURING AN INFLUENZA PANDEMIC: PERSPECTIVES OF PHARMACY EXECUTIVES"

A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Public Health in the Gillings School of Global Public Health, Department of Health Policy and Management. Chapel Hill 2013

Full PDF : [HE004Y][GDrive] / DOI : https://doi.org/10.17615/50xj-7337

Abstract - https://sph.unc.edu/wp-content/uploads/sites/112/2013/12/koonin_drph_abstract.pdf

Page i / [HE004Z][GDrive]

Page ii / [HE0050][GDrive]

Page iii / [HE0051][GDrive]

Page v (Highlighted Dr. Carter Evan Mecher (born 1956) ) / [HE0052][GDrive]

2014 (June 23)

House Hearing, 113 Congress]

[From the U.S. Government Publishing Office]

EVALUATING THE CAPACITY OF THE VA

TO CARE FOR VETERAN PATIENTS

=======================================================================

HEARING before the of the

COMMITTEE ON VETERANS' AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRTEENTH CONGRESS

SECOND SESSION

__________

Monday June 23, 2014

__________

Serial No. 113-76

https://www.govinfo.gov/content/pkg/CHRG-113hhrg89375/html/CHRG-113hhrg89375.htm

...

WITNESSES

Thomas Lynch M.D., Assistant Deputy Under Secretary for Health

for Clinical Operations Veterans Health Administration, U.S.

Department of Veteran Affairs

Statement.................................................... 5

Opening Statement............................................ 8

Prepared Statement........................................... 12

....

OPENING STATEMENT OF DR. LYNCH

Dr. Lynch. Good evening, Chairman Miller, Ranking Member

Michaud and members of the committee.

Thank you for the opportunity to discuss the provision of

timely, accessible and quality care for veterans. I am

accompanied today by Dr. Carolyn Clancy, Assistant Deputy Under

Secretary for Health, for Quality, Safety and Value.

At the outset, let me address the significant issue that

has been the focus of the committee, the VA and the American

public: that is, the issue of wait times. No veteran should

ever have to wait an unreasonable amount of time to receive the

care that they have earned through their service and their

sacrifice. America's veterans should know they will receive the

highest quality healthcare from VA. While we realize the

timeliness of these services is in question, VA acknowledges

and is committed to correcting the unacceptable practices in

patient scheduling. As my colleague, Philip Matkovsky, stated

on June 9th, this is a breach of trust. It is irresponsible, it

is indefensible and it is unacceptable.

I also apologize, as he did, to our veterans, their

families and loved ones, members of Congress, the Veterans

Service Organization, our employees, and the American people.

These practices are not consistent with our values as a

Department, and we are working to fix the problem.

VA has a physician workforce of more than 25,000 physicians

representing over 30 specialties. VA now has comprehensive

information about the staffing levels at each medical center,

as well as the productivity of our physician workforce,

utilizing a standard healthcare measure of relative value

units, or RVUs. RVUs consider the time and the intensity of

medical services delivered.

Optimizing physician productivity is critical to our

ability to determine clinical capacity and mobilize our

clinical assets to rapidly address unacceptable delays in

service.

Supporting a productive workforce requires appropriate

support staff ratios as well as the necessary capital

infrastructure to ensure that the clinics run as efficiently as

possible. The difference between the estimated capacity and our

current workload represents the amount of additional care we

could provide to address veterans waiting for care. VA has

accelerated the adoption of productivity standards because they

are critical in determining VHA's capacity and improving timely

access to quality care for veterans.

We are about a year ahead of schedule in completing action

plans based on the recommendations of the OIG in late 2012. We

will have productivity standards in place for all physicians in

VHA by the end of this fiscal year.

Like all of healthcare, VA has transitioned to a system in

which outpatient care is increasingly important, especially for

the management of chronic conditions. VA has established the

Nation's largest medical home approach to primary care, in

which people receive care from teams, and in addition, to face-

to-face visits, they receive advice and consultation, which can

be provided through technology, through telephone calls, secure

emails and tele-health.

Leveraging these capabilities to deliver veteran-centric

care requires investments in education, training, and the

ongoing evaluation to assure that services are focused on the

needs and preferences of individual veterans. Since the

majority of U.S. physicians receive some training in a VA

facility, we have also invested in contemporary approaches to

undergraduate and graduate training that reinforce the

importance of teamwork and technological skills, and leverage

research investments to assure that the promise of these new

models achieves the goal of personalized veteran-centric care.

Mr. Chairman, the health and well-being of the men and

women who have bravely and selflessly served this Nation

remains VA's highest priority. The work continues, and we will

not be finished until VA can assess capacity, productivity and

staffing standards for all specialties, and provide ready

access to high quality, efficient care available to our

Nation's veterans. We must regain the trust of the veterans we

serve. VA leadership and our dedicated workforce are fully

engaged.

This concludes my testimony. My colleague and I are

prepared to answer any questions you and the other members of

the committee may have.

Dr. Lynch. They are about a year ahead of schedule.

Mr. Benishek. Well, I would like to -- can you please

provide that? You know, in December 2012, there was a report by

the IG that said that all the five facilities that the IG

visited, were operating contrary to VA policy, which requires

medical facilities to develop staffing plans that address

performance measures, patient outcomes and other care

indicators. So in December of 2012, they said that all the

facilities they visited didn't operate according to VA policy;

what has been done to change that?

Dr. Lynch. That is what the Office of Productivity,

Efficiency and Staffing has been working on. Since the IG made

those recommendations in late 2012, they have been developing

the standards for each of our medical specialties.

Mr. Benishek. Do you know who is in charge of that?

Dr. Lynch. It is run by Dr. Carter Mecher works in that

unit.

Mr. Benishek. Carter?

Dr. Lynch. Mecher.

Mr. Benishek. Mecher.

Dr. Lynch. M-e-c-h-e-r, and Eileen Moran.

Mr. Benishek. Okay.

Dr. Lynch. I believe they have been down and have

testified, or not testified, but briefed some of the physicians

of this committee.

Mr. Wenstrup. And Dr. Benishek brought up a very good point

when he said, how much are you spending per RVU? So if you take

all the money that you are spending on these patients and then

tally up how many RVUs that have been built up, how much are

you spending per RVU? Because I can tell you, Medicare knows

how much they spend per RVU because it is already established.

So your budget is out there. You are measuring RVUs, but not

how much you are spending per RVU, and I think that is key. And

I also think it is key that you look at how many patients a

doctor is seeing each day, or a facility is seeing each day.

There is more than one way to measure these types of things.

In our practice, if one doctor is seeing 60 patients and a

similar doctor is seeing 30, we are talking to the one with 30

and see how we can help them get that up and continue the

quality that they have to have. But when you are comparing to

yourself, I don't think you are getting anywhere. And that is

part of the problem.

So my next question is, when you talk about doing these

evaluations of efficiency, who is doing this? Because if it is

somebody that has been in the VA system their whole life they

don't know what they are measuring, they don't compare to

successful, healthy healthcare systems. So who is doing this

currently?

Dr. Lynch. Right now it is being done by Dr. Carter Mecher

and Eileen Moran.

Mr. Wenstrup. And are they from the private sector? Have

they been in academia? Have they been in the VA? Where have

they been through their careers that make them qualified to be

very good at this?

Dr. Lynch. I don't know Dr. Mecher's history. I know that

he has met with the physicians on this committee, so I think

you have talked with him.

Mr. Wenstrup. Yes.

Dr. Lynch. I think he does have a good handle and a good

understanding of the RVU system and productivity. I think he

has some very innovative concepts of how we can use that to

resource our system and to look at rightsizing the number of

physicians and the capacity that we have.

Mr. Wenstrup. And that is helpful, but I would definitely

look at someone who has had great success in these areas, and

they exist throughout our country without a doubt.

Dr. Clancy. I would just add that we are speaking to Kaiser

and a number of leaders from private sector systems, and if you

had other suggestions we would be all ears.

Mr. Wenstrup. Well, and those are good suggestions. And I

would also suggest that you encourage the President and the

Senate to confirm someone who has some administrative

experience in the private sector in these areas. I think it

would be a great benefit to our veterans and to our country.

And lastly, I do want to point out that the Cincinnati VA,

2015

https://www.ecohealthalliance.org/wp-content/uploads/2016/03/A-National-Blueprint-for-Biodefense-October-2015.pdf

2015 (April 08) - Blue Ribbon Study Panel on Biodefense: Response and Recovery (Dr. Carter Mecher on a panel with G. Keith Bryant and Dr. Matthew Minson

NOTE - Also available on CSPAN, and with closer video of the panelists - https://www.c-span.org/video/?325122-2/blue-ribbon-study-panel-biodefense-response-readiness

NOTE - Dr. Mecher mentions he flew into Washington DC and landed at 8:15AM, for a VA meeting. Last plane into DC, probably.

https://www.youtube.com/watch?v=-Sj0FGgaI7Y / Saved copy (320P) : [HV00I1][GDrive] / Image of download page : [HV00I2][GDrive]

1:07:08 ... start of intro/statement by Dr. Carter Mecher

Apr 8, 2015 / Hudson Institute

Objective of event - Provide panelists with an understanding of the biodefense requirements for effective preparedness, response and recovery from biological and chemical threats that can inflict potentially catastrophic consequences.

Agenda

9:30 Congressional Perspective / Former Representative Mike J. Rogers, Distinguished Fellow, Hudson Institute
10:15 Panel One: Pre-event Activities and Emergency Response / Discussion of pre-event activities (e.g., planning and exercises) and emergency response, including the challenges faced by first responders and hospitals, and the role of DOD and other Federal agencies.
- - Ms. Myra Socher, Adjunct Assistant Professor, Vanderbilt University
  - Chief G. Keith Bryant, Fire Chief, Oklahoma City Fire Department; President and Chairman of the Board of the International Association of Fire Chiefs
  - Dr. Matthew Minson, Senior Advisor for Health Affairs, Texas A&M University
  - Dr. Carter Mecher, Senior Medical Advisor, Office of Public Health, Department of Veterans Affairs; former Director for Medical Preparedness Policy, Homeland Security Council and National Security Staff (President George W. Bush and President Barack H. Obama)

2018 (Nov published) - "Post-Hurricane Maria Surveillance for Infectious Diseases in the Veterans Affairs San Juan Medical Center, Puerto Rico"

https://academic.oup.com/ofid/article/5/suppl_1/S168/5207468?login=true

Gina Oda, MS, Almea Matanock, MD, Jennifer C Hunter, MPH, DrPH, Anita Patel, PharmD, MS, Satish Pillai, MD, MPH, Timothy Styles, MD, MPH, Sonia Saavedra, MD, Mirsonia Martinez, CIC, Makoto Jones, MD, MS, Carter Mecher, MD ... Show more

Open Forum Infectious Diseases, Volume 5, Issue suppl_1, November 2018, Pages S168–S169, https://doi.org/10.1093/ofid/ofy210.458

Published: 26 November 2018

2018-11-open-forum-infectious-diseases-vol-5-pages-s168-s169-post-hurricant-maria-surveillance-for-id-in-va-puerto-rico.pdf

https://drive.google.com/file/d/1anNzkAs6SdHjscMa7aztbI_VmL53nTkK/view?usp=sharing

2018-11-open-forum-infectious-diseases-vol-5-pages-s168-s169-post-hurricant-maria-surveillance-for-id-in-va-puerto-rico-01

https://drive.google.com/file/d/1SwLQRqHhTiiBmeUikf3Glmn8VWHpoW6V/view?usp=sharing

2018-11-open-forum-infectious-diseases-vol-5-pages-s168-s169-post-hurricant-maria-surveillance-for-id-in-va-puerto-rico-02.jpg

https://drive.google.com/file/d/17KV54NhV79B1mdtrpl2bbI4lBITtMP-i/view?usp=sharing

Abstract

Background
- - On September 20, 2017 Category 4 Hurricane Maria made landfall in Puerto Rico (PR), causing widespread flooding, power outages, and lack of water service. Given the potential for infectious disease outbreaks, the Department of Veterans Affairs (VA) and Centers for Disease Control and Prevention established enhanced surveillance to actively monitor priority infections at VA facilities.
Methods
- - We queried VA data sources from August 27, 2017 to February 3, 2018 (pre-storm dates included to establish baselines). Trends in infectious disease ICD-10 syndrome groupings (respiratory illness/pneumonia, Influenza-like illness (ILI), gastrointestinal illness, conjunctivitis, rash-like Illness, jaundice) as a percent of total emergency department (ED) visits were tracked. The total number of laboratory tests performed, and percent positive per week, for influenza, hepatitis A, dengue (DENV), zika (ZIKV), leptospirosis, and chikungunya (CHIKV) were calculated.
Results
- - ILI increased from 9.3% to 12.6% during the surveillance period (peak epi week 52: 15.7%) (Figure 1), while other ICD-10–based syndromes remained relatively stable. Weekly influenza testing increased shortly after landfall averaging 105 rapid influenza tests per week (epi weeks 41–4) (Figure 2). Influenza positivity increased in epi weeks 41 and 42 (7%), dropping the following weeks, and peaked at 15% in epi week 2 (Figure 3). Four acute infections were detected: 2 + leptospirosis DNA, 1 + CHIKV RNA, and 1 + Hepatitis A IgM. The remaining 34 positive tests were ZIKV, CHIKV, or DENV IgM positive or equivocal, awaiting confirmation (Figure 3).
Conclusion
- - We quickly established a simple surveillance system to monitor trends in priority infectious diseases. Increases in ILI, weekly influenza testing volume, and percent positive of influenza tests coincided with onset of influenza season. Diseases of public health importance were identified through laboratory-based surveillance. The impact of Maria on VA healthcare operations, including clinic closures, power outages, and disrupted care seeking patterns limited this system. However, the timeliness and flexibility of this surveillance system provides a model for disease monitoring following future natural disasters.

Figure 1https://academic.oup.com/view-large/figure/129937909/ofidis_ofy210_f0144.jpg 2018-11-open-forum-infectious-diseases-vol-5-pages-s168-s169-post-hurricant-maria-surveillance-for-id-in-va-puerto-rico-img-1.jpghttps://drive.google.com/file/d/1ms_Mhm_FAxJPj8UCfOihB8YGiVvZjtQN/view?usp=sharing

Figure 2https://academic.oup.com/view-large/figure/129937909/ofidis_ofy210_f0145.jpg 2018-11-open-forum-infectious-diseases-vol-5-pages-s168-s169-post-hurricant-maria-surveillance-for-id-in-va-puerto-rico-img-2.jpghttps://drive.google.com/file/d/1UZsgAHyWXPC73eVuU8pY4dVfnIxJ8fs9/view?usp=sharing

Figure 32018-11-open-forum-infectious-diseases-vol-5-pages-s168-s169-post-hurricant-maria-surveillance-for-id-in-va-puerto-rico-img-3.jpghttps://academic.oup.com/view-large/figure/129937909/ofidis_ofy210_f0146.jpghttps://drive.google.com/file/d/1ajjviscArCBEy8Uk0eHDMRGF2eOIQZ9e/view?usp=sharing

2020 (March 14)

https://www.newspapers.com/image/679326966/?terms=%22Carter%20E.%20Mecher%22&match=1

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2020 (March 14)

https://www.newspapers.com/image/646345497/?terms=%22Carter%20Mecher%22&match=1

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2020 (April 26)

also see - https://www.nytimes.com/2020/04/22/us/politics/social-distancing-coronavirus.html?searchResultPosition=4

https://www.newspapers.com/image/658967396/?terms=%22Carter%20Mecher%22&match=1

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2021 (May 21)

https://www.newspapers.com/image/736865411/?terms=%22Carter%20Mecher%22&match=1

Geeks who saw Covid coming: They were a team of virus experts hired by George W Bush after he read about 1918's flu pandemic. Disbanded by Obama, they secretly acted after hearing about Wuhan - and could have saved many lives if Trump hadn't ignored them

By MICHAEL LEWIS FOR THE MAIL ON SUNDAY / Source : [HM0023][GDrive]

PUBLISHED: 17:05 EDT, 8 May 2021 | UPDATED: 16:02 EDT, 10 May 2021

Carter Mecher had only ever wanted to be a doctor. He'd grown up in a big, working-class family in Chicago where his toolmaker father had encouraged him to tackle problems with the same confidence that he shaped steel.

Carter's mind would lock into a problem in the same way it did when he was fixing a car engine. That was when he was at his best.

An inability to pay attention to anything except that which you find totally riveting might not sound the most promising trait in a medical student. But almost by process of elimination, it led Carter to his calling: critical care.

From the moment he walked into an intensive care unit, he sensed it was where he was meant to be.

If you didn't allow yourself to become numb, the place kept you alive to the complexity of life, and its sanctity.

In October 2005, the US government wanted someone who could think 'outside the box' to join a small team devoted to pandemic planning. To staff at the Department of Veterans' Affairs, one name came to mind: their colleague Carter Mecher.

From the moment he walked into an intensive care unit, he sensed it was where he was meant to be. (Stock image)

He was surprised by the call from the White House, and even more surprised by what they wanted him to do.

Carter had learned a lot about infectious disease by treating it in various intensive care units. Yet he knew nothing about pandemics.

'But it was the White House calling,' he said. 'I figured, 'Yeah, yeah, what the hell.' '

The pandemic planning team had been set up in the wake of President George W. Bush's 2005 summer holiday reading – The Great Influenza, a book by historian John Barry about the 1918 flu pandemic.

Bush was determined that America would be better prepared next time there was a major virus outbreak. He demanded to see his government's sketchy pandemic plan – and immediately dismissed it as 'bulls**t'.

After commissioning a report by Rajeev Venkayya, a young doctor in the Department of Homeland Security, Bush went to Congress and got $7.1 billion to spend on pandemic preparedness.

RAJEEV said: 'The US took this on as a national priority before anyone else. We invented pandemic planning.'

Rajeev, Carter and five others set up their base in Washington.

The solution would be a layering of multiple strategies – like the way you lay slices of Swiss cheese on a sandwich, so that the holes don't align.

Carter had no formal training in epidemiology, but he had a nose for data, an ability to squeeze meaning from it and a gift for quickly figuring out what to do in a crisis.

He was always the first to identify, and make sense of, a new infectious outbreak.

When not in Washington, his emails were typed from a desk just off his bedroom. Quite possibly in his underpants.

For more than a decade, these seven doctors came together behind the scenes each time the world faced a biological threat.

In flurries of phone calls and emails, they sought to figure out what was going on and decide what each of the group might do to save lives.

'Most of our calls start with: 'Carter, what are you thinking?' said Duane Caneva, who, in January last year, was chief medical officer of the US Department of Homeland Security. 'He's like a savant on all this stuff.'

WOLVERETTE: Dr Charity Dean, California's deputy head of public health

Sure enough, it was Carter who first mentioned the existence of coronavirus in Wuhan in an email to colleague Richard Hatchett on January 9 last year.

Just days later, their colleague James Lawler, a Navy doctor who ran the Global Center for Health Security at the University of Nebraska, wrote to the others, asking: 'Is it likely that the virus outbreak was much larger than what we are seeing?'

The team had a nickname – the Wolverines, after the resistance group in the 1980s dystopian Cold War film Red Dawn, in which the Soviets successfully invade the US.

With the Wolverine approach, you don't worry about finding the perfect answer. There might never be a perfect answer.

To this day, no one knows how many people in Wuhan were infected on January 18, 2020. But the calculation made by the Wolverines was more or less correct.

And, most crucially, it allowed them to be able to act.

The next day, the first American tested positive for Covid-19, a man who had flown from Wuhan to Seattle. 'It's one person coming in from China, we have it under control,' said President Donald Trump. 'It's going to be just fine.'

Fast-forward to February this year and 450,000 Americans are dead from Covid-19. With four per cent of the world population, the US has suffered 20 per cent of coronavirus deaths.

The Lancet said that if the Covid death rate suffered in the US had tracked the average of other G7 nations, 180,000 Americans would still be alive.

So what went wrong?

During the Obama administration, the biodefence team had been dissolved because a false sense of confidence had been created with the containment of an outbreak of swine flu in 2009.

Yet the Wolverines kept in touch. Indeed, Carter Mecher and Richard Hatchett never really stopped working together.

With Trump's election as president, his national security adviser, John Bolton, believed that the only serious threat to the American way of life was from other nation states.

The Bush and Obama administrations' concern with natural disasters or disease was banished.

'In a world of limited resources, you have to pick and choose,' an anonymous White House source told The Washington Post.

For three years, the Trump administration got lucky. And then their luck ran out.

The US had some of the best scientists in the world – but it had ignored them.

Meanwhile, from his desk at home in Georgia, Carter Mecher collected information, cutting and pasting Chinese reports into Google Translate to make sense of them.

From newspaper obituaries, he gleaned that people were dying much earlier than the Beijing government had admitted. Furthermore, the Chinese had reported only a handful of cases but were behaving as if there had been many more.

'Reading tea leaves, I see that China is building a 1,000-bed quarantine hospital in Wuhan – in five days. They also called in the military to assist… Reminds me of the military called in to Chernobyl,' he said.

All the Wolverines chipped in. Carter accepted that no one would have a full, clear picture of the speed at which Covid might spread until it was too late, and he set out to generate as many partial, fuzzy ones as he could.

His approach was a peculiar combination of analysis and analogies – 'the equivalent of deductive wormholes that take me very quickly from A to B'.

In effect, he was asking which known virus did Covid most closely resemble? The obvious answer was its closest genetic relative, the SARS bug of 2003.

Carter worked all night on a spreadsheet that showed Covid spreading much more quickly than SARS and eliciting very different behaviour from the Chinese government than in 2003 – with Wuhan being quarantined on January 23, 2020.

On January 24, America had its second case, a woman who had also travelled from Wuhan. A day later, China reported 2,298 cases – up from 446 four days earlier.

'Epidemics don't behave like this,' Carter wrote to his fellow Wolverines. The newly infected did not quintuple in five days.

He noted that another giant 1,300-bed hospital had been built in Wuhan. The death of a prominent doctor in the city suggested even people in protective gear could be infected.

Carter found another article, about a Chinese man identified as the source of the infection in several others who had himself experienced no symptoms. If true, cases were going undetected. Warning lights were flashing that explained why the Chinese government was acting so quickly.

What Carter couldn't understand was why the US government lacked the same urgency. He quickly realised he had to widen his model beyond SARS, and that the new virus would infect, and kill, vastly more people than SARS.

'Yesterday [January 26] we had 2,700 cases and 80 deaths,' wrote Carter. 'Let's assume the real number of cases is 18 to 40 times greater, or 48,600 to 108,000.'

Assuming the disease takes two weeks to kill, he calculated how many cases there would have been two weeks earlier. This allowed him to crudely estimate the fatality rate at 0.3 to 1.5 per cent.

Carter was under no illusion he was engaged in scholarship. He was simply trying to learn enough to make informed judgments, such as whether, in his role as medical adviser to the Department of Veterans' Affairs, to prepare the nation's largest hospital system for an onslaught.

Other Wolverines had decisions to make, too.

Matt Hepburn, who'd spent the previous decade working on vaccine development at the Defense Advanced Research Projects Agency, needed the group's collective wisdom to decide whether to go all-in for a coronavirus cure.

Richard Hatchett had moved to London in 2017 to run the Coalition for Epidemic Preparedness Innovations (CEPI) which was funded by European governments, the Gates Foundation and others.

Richard had the power to direct hundreds of millions of dollars to companies with new ideas about how to make vaccines more quickly. He noted that the free market had no interest in funding these companies in their early stages.

Matt Hepburn's unit inside the US Department of Defense had provided some funding for most of these firms but now CEPI was able to help them speed their vaccines through trials.

They'd identified the Boston outfit Moderna, a British-Swedish one called AstraZeneca, and several others as promising candidates. The sooner CEPI's money went out the door, the sooner any pandemic would end.

Four days earlier, just after Carter generated his first view of the virus, CEPI had made a grant to Moderna to cover costs of the first two stages of clinical trials.

'I was getting a hell of a lot of heat inside CEPI,' recalled Richard, who was under pressure for the money not to be wasted.

Carter believed the team's decisions should be approached in the way an intensive care unit doctor treats a patient clinging to life. The over-riding principle being: if you are wrong, which decision will cause you the greatest regret?

His rough-and-ready calculations suggested that, unchecked, Covid-19 would kill between 900,000 and 1.8 million Americans. 'I'm certainly no public health expert,' advised Carter, 'but no matter how I look at this, it looks bad.'

Richard agreed and never looked back. CEPI gave more than $1 billion to various vaccine manufacturers.

Under the pandemic plan that the Wolverines had drawn up 14 years previously, such an outbreak would be ranked a 'Category 5' event and require the federal government to implement a full suite of measures: isolate the ill, cancel all public gatherings, encourage working from home, enforce social distancing and close schools.

But so far as Carter could tell, the Trump administration wasn't even keeping track of the virus.

He tried to get messages to Trump, but no one in the White House wanted to hear the word 'pandemic'. 'We were going nuts,' he said.

In desperation, each Wolverine sought to identify and contact people with influence.

Rajeev Venkayya had been at medical school with the director of the Ohio Department of Health. Other Wolverines knew the governors of Maryland and Nebraska. Matt Hepburn knew people at the top of the Department of Defense.

They all knew Bob Kadlec, head of the Office of the Assistant Secretary for Preparedness and Response, who had named them the Wolverines during the Bush administration.

The aim was to find at least one state to take the lead and roll out an aggressive response to the virus, introduce the social interventions outlined in the pandemic plan and create a domino effect.

They targeted Dr Charity Dean, California's deputy head of public health. Wolverine Duane Caneva told her that he was part of a small, almost secret group of doctors, working without the White House's permission to co-ordinate a national pandemic response.

He needed her help to get a message to the governor of the US's most populous state so that it might take the lead for the country, as the White House clearly was not going to.

Charity devoured the string of emails Duane had forwarded 'like a starving person'.

The Wolverines had picked the right woman.

Charity had also been following events in Wuhan and she, too, had made rough calculations from limited information, plotting the likely spread of the disease on the whiteboard in her office.

'The numbers seemed nuts to me,' she said.

By June, if the US government did nothing, 20 million Californians would be infected, two million hospitalised, 100,000 dead. However, her boss didn't want to know, and even banned her from using the word 'pandemic'.

Nevertheless, she sent out a preparedness survey to California's hospitals, looked into the capacity of morgues and thought about the need to establish mass graves.

Reading the email chain she had been sent, one Wolverine stood out. 'They clearly thought this guy Carter was the guru,' she said.

She read echoes of her own thoughts and, just weeks before, she'd printed out his paper on social distancing and stuck it in a binder – her 'nerd bible'.

This contained ammunition for the argument she was being forbidden from making: that the virus had arrived, that it might lead to a pandemic and that if she wanted to prevent a lot of people from dying, she had better start working now. Three days later, Duane asked Charity to join them on a conference call.

'As soon as Carter started talking, I knew I had found my person,' she said.

Two-thirds of the way into the call, Charity figured out why she had been invited. If she made the right moves in California, the state might be used to steer the entire country's response.

She realised, too, that the federal response to Americans returning from China was inept. Many had passed through airports in California without being tested. Now nobody knew where they were.

'We liked her right away,' Carter said. 'She's a spitfire.' Another began to refer to her as 'Wolverette'.

By some mechanism that Charity never fully understood, the things she said on these calls had real effects.

During one call in mid-February, she railed about the idiocy of the requirement that only Americans in intensive care with a history of travel to China would qualify for a Covid test when the disease was already spreading inside the US.

A week later, Carter noted that official policy had been changed, adding: 'Good job, Charity.'

At one point she asked Wolverine James Lawler: 'Who exactly is in charge of this pandemic?'

'Nobody,' he replied. 'But if you want to know who is sort of in charge, it's sort of us.'

The 'sort of' was telling. For every day brought fresh evidence of America's leaders' unwillingness to act. Every moment could be measured in lives lost. What puzzled Carter most was how people who should have known better downplayed the risk.

Stanford University medical professor John Ioannidis became a sensation on US cable news by claiming the virus posed no real threat and that no more than 10,000 Americans would die. The professor condemned social distancing as a hysterical over-reaction.

Meanwhile, Charity, who knew the story would only end with a vaccine or herd immunity, had found an important audience.

In early March, she was laying out her ideas during a joint call about what every state should do, when a new voice came on the line.

It was Ken Cuccinelli, acting deputy secretary of Homeland Security and a member of Trump's coronavirus taskforce. He said: 'Charity, you need to push these things through. You're the only one who can do this.'

She was taken aback by his insistence. 'He wasn't pleading with me to do the right thing. He was yelling at me. He was basically implying that the White House is not going to do the right thing. The White House is not going to protect the country. So California needs to take the lead.'

That was the moment she learned that the White House was listening in on the Wolverines' calls – and also the moment when she realised just how lost and desperate the people at the top were.

Technology entrepreneur Todd Park told Charity that he had noticed a pattern that he'd first identified in the private sector: in any large organisation, the solution to any crisis was usually found not in the officially important people at the top but in some obscure employee six layers down from the people in charge.

A system was groping towards a solution, but the solution required someone in it to be brave, and the system didn't reward bravery.

In late March 2020, Charity made a note in her journal: 'One million excess deaths by May 31, 2021.' Nothing had happened to change her view in June.

Then she had a list of unanswered questions. Maybe the biggest was: Why doesn't the United States have the institutions it needs to save itself?

Last November, Carter Mecher's father tested positive for Covid and after a spell in hospital he arranged for him to return home with a supply of oxygen. 'I don't want him to die alone,' he wrote.

But as his father rallied, his mother contracted Covid. Carter wrote: 'It is hard to fathom all the pain the virus has brought. It is truly a demon from Hell.

I think deep down inside we all sensed this – it was why we tried to get leaders to take early aggressive action to minimise the pain that we knew would come.'

Eighteen days later, his mother died. Carter sat down and wrote a long letter to his family. His theme was gratitude, for the lives they had shared, but his words were suffused with other emotions.

'Over the past several days, I felt like a balloon that lost all its air,' he wrote at the end. 'But I know that with a little time. I will reinflate.'

He was like the surgeon, famously described by a writer, who had inside himself a small cemetery where he buried his failures and, from time to time, went to pray.

And so he went to pray.

Abridged and edited extract from The Premonition: A Pandemic Story, by Michael Lewis, published by Allen Lane at £25. To order a copy for £22.25, including free UK delivery, go to mailshop.co.uk/books or call 020 3308 9193 before May 23.