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I was a grad student in theoretical physics at Caltech when I first became seriously interested in the problem of the “Feynman sprinkler” (which really shouldn’t be called that, as it didn’t originate with Feynman and Feynman himself never published a solution to it, at one point even refusing to write on the subject for the Physics Teacher). I ended up publishing three papers on the subject. I’ll give the references later, in case you’re interested in the details, but let me try to keep things short and simple here on Quora.Let’s start with the experimental facts. Most people who’ve attempted to build such a device find that it doesn’t move at all when made to suck in the surrounding water or air. This is what Ernst Mach reports in his well known textbook on The Science of Mechanics, first published in 1883. There’s also a public demo of this that you can walk up to and activate with a button at MIT’s Edgerton Center (see here).You may even try a very simple experiment at home that amounts to the same thing: Take a bendy straw and bend it into a L-shape. Put the end of the long arm into your mouth. If you blow air out, you’ll readily see the straw turn against the outgoing air. If you suck air in, you won’t see it move at all.Feynman never explained publicly what happened in the test that he conducted as a grad student in the early 1940s at the Princeton Cyclotron, which caused his name to be associated with this problem. But the man in charge of the cyclotron at that time, Ed Creutz, revealed in a 2004 letter to the editor of the American Journal of Physics (and written in response to an article that I’d published on the subject in that journal) that the “sprinkler” head inside the large glass bottle vibrated a little when Feynman first turned on the air pressure, causing water to flow into it, but then didn’t move at all as Feynman cranked the pressure up and up, finally causing the bottle to explode, spraying water and broken glass all over the place and getting the young Feynman banned from the cyclotron premises.On the other hand, more recent and more carefully built experiments, in which the sprinkler is mounted on a genuine bearing with sufficiently low friction, report that device does turn against the incoming fluid (i.e., in the opposite direction to the normal sprinkler) when operated in suction mode. But this turning is far weaker than the turning of the ordinary sprinkler that expels fluid. This is what’s demonstrated in the videos that are linked to in the comments to this question. Those videos are certainly not hoaxes and the same effect has been independently reported by many experimentalists over several decades.Here on Quora, Paul Mainwood has used the explanation, popularized by James Gleick’s biography of Feynman, that when water is expelled from a regular sprinkler it makes jets, whereas when it it sucks in water the water comes in from all direction in a sink-like flow. This observation is correct and it does establish that sucking in water will not simply time-reverse the dynamics of the regular sprinkler. But I personally don’t like to see it invoked as a solution to the problem, because it doesn’t tell you that much about how the reverse sprinkler ought to behave. Moreover, it’s not even clear (in Gleick’s book or in similar accounts that I’ve found elsewhere) why jets form only when water is expelled. (I’ll return to that at the end of this answer.)I think that the simplest correct observation that can lead to a genuine understanding to the fundamentals of this problem is that in the regular sprinkler the outgoing water carries momentum away with it. This must be counteracted by an opposite motion of the sprinkler arms, in such a way that linear momentum and angular momentum are conserved.On the other hand, in a reverse sprinkler the water far from the device starts out at rest (i.e., with no linear or angular momentum). It’s then accelerated by a pressure difference, but the resulting momentum is not carried away by the flow. The flow soon impinges on the sprinkler’s insides, giving up its momentum to the solid device. This is the gist of my first publication on the subject, “An Elementary Treatment of the Reverse Sprinkler” (2004), which attracted attention from Prof. Creutz.There’s a lovely toy called a “putt-putt boat” that used to be very popular back when children were still allowed to play with candles. In this device, the heat from a candle causes the level of liquid water inside the toy boat’s tank to self-oscillate. When the level goes down, water is expelled through the submerged exhausts and the boat is pushed forward. When the level goes up, water is sucked back into the tank. The boat doesn’t move backwards appreciably during this aspiration phase. Here’s a video of a home-made putt-putt boat as it jerkily negotiates the turn at the end of bathtub in my house:The operation of the putt-putt boat can be understood in terms of the same principles that I invoked above to account for Feynman sprinkler’s behavior. The outgoing water carries momentum away with it, which must be compensated by the boat’s forward acceleration. The incoming water soon impinges on the walls of the boat’s insides. The fluid therefore gives up its momentum to the solid structure. This is why the boat doesn’t accelerate backwards appreciably during the aspiration phase of the heat-powered self-oscillation.(I should add that I first learned about the putt-putt boat and its connection to the Feynman sprinkler from a list of references compiled by Richard E. Berg et al. for the University of Maryland’s instructional physics labs.)So how come the most careful experiments do see the reverse sprinkler turn against the incoming fluid? In my first publication on the subject I proposed this simple explanation: viscosity in an ordinary (Newtonian) fluid, like water or air, is associated with diffusion of momentum. So, if the viscosity of the aspirated fluid is taken into account, we may expect that not all of the momentum developed by the flow would make it into the mouth of the sprinkler tube and then be transferred to the solid structure. A bit of the momentum would be diffused away by viscosity, missing the tube mouth and escaping away to infinity. This small momentum diffusion would have to be compensated by a weak acceleration of the reverse sprinkler towards the incoming flow.However, it now seems that this explanation is insufficient in the face of the results from the most careful experiments, carried out after my first article on the subject was published. Wolfgang Rueckner, who was in charge for many years of the physics lecture demos and teaching labs at Harvard and with whom I’ve discussed the subject at length, found that a vortex develops in the hub of his reverse sprinkler and that the angular momentum in this vortex is probably what compensates for most of the turning of the reverse sprinkler against the incoming flow. These results are carefully reported here: “The puzzle of the steady-state rotation of a reverse sprinkler” (2014).However, the mechanism behind the generation of this vortex is unclear. Wolf claims in his paper (rather implausibly, in my own opinion) that it’s a sort of spontaneous symmetry breaking and that it’s basically a coincidence that the vortex is generally seen to turn in same direction as the regular sprinkler (which is what makes the reverse sprinkler itself turn opposite to the regular sprinkler, by conservation of angular momentum).Note that the formation of the vortex can only be understood if the fluid’s viscosity is taken into account (see Kelvin's circulation theorem). More recent work published by Joseph Beals claims (quite reasonably, in my view) that that direction of the vortex isn’t accidental, but the details are still far from clear. See: “New angles on the reverse sprinkler: Reconciling theory and experiment” (2017).So that’s the answer to your question, as far as it goes: The Feynman sprinkler certainly doesn’t behave as a time-reversed regular sprinkler. Simple experiments find that the Feynman sprinkler does not turn at all, as Feynman himself saw (but never reported) in his ill-fated experiment at the Princeton Cyclotron. The most careful experiments, in which the sprinkler is mounted on a low-friction bearing, do find that the reverse sprinkler turns in the opposite direction to the regular sprinkler, but far more weakly. This can only be understood if the fluid’s viscosity is taken into consideration.Post-script: I said above that I’ve published three papers on the subject. I’ve already cited and summarized the first one, which appeared in the American Journal of Physics in 2004. But I was later troubled by the prevalence of the explanation in terms of the the (non) formation of jets, and I came to see that the issue of the shapes of the flows in the regular and inverse sprinklers was an interesting one, deserving further clarification. The result was this paper: “Sprinkler Head Revisited: Momentum, Forces, and Flows in Machian Propulsion” (2011), which is more technical and has been cited a few times in the mechanical engineering literature.Incidentally, string theorist David Berman told me that he finally understood the absence of time-reversal symmetry in the problem after putting his hand first in front of a large fan, and then behind it. You feel the wind rushing in front of the fan, but you can hardly feel the air flow behind it.Something else that bothered me about Gleick’s treatment of the subject in his Feynman bio was the connection that he draws between the absence of time-reversal symmetry in this sprinkler problem and the irreversibility of thermodynamics. This eventually motivated me to write this other pedagogical article: “Irreversibility in an ideal fluid” (2014). This work has attracted almost no attention, but I think that it might help a student of physics to understand better how macroscopic irreversibility may emerge from microscopically reversible laws.

To my knowledge, no US graduate program requires an SAT test.I am going to quote (extensively, perhaps too extensively) from my state’s directional university. It is the fourth largest college in the state, the oldest, started as a teacher’s college, and offers master’s degrees, but not the PhD.Many of its programs DO NOT require the GRE.Some important points: for this university, you need to take a graduate exam to receive the degree. However, you don’t need to take the test BEFORE you start the program. You can matriculate, then take the test, which is not necessarily the GRE.Also, you need to take a test. You do not need to get a high score. If you are pursuing a master’s degree in French, the university will essentially ignore the math portion of your GRE, or will accept the MAT.Quit worrying so much.I quote here, so that international students can see what is required at many US colleges. I will point out in italics particular issues of interest to the OP.(Quote commences, italics emphasis is mine):Admission to Graduate CollegesThe minimum requirements for regular admission to the Graduate College are:An earned bachelor’s degree from an accredited college or university;A grade point average of 2.5 based on a 4.0 scale on all undergraduate course work attempted; or a 2.75 based on a 4.0 scale in the last 60 semester hours of undergraduate coursework attempted; or a minimum score on the appropriate graduate entrance exam. A student who is a graduate of a fully accredited institution which does not indicate grade points on transcripts must submit scores on the Miller Analogy Test or the aptitude section of the Graduate Record Examination before being considered for admission to the Graduate College. The scores must place the student in the upper three-fourths of college graduates according to national norms.All master’s degree candidates must take one of the following entrance exam tests MAT, GRE, or GMAT before the close of the first semester of enrollment in graduate studies. The degree program being pursued determines the test to be taken and the minimum score that is required.Proof of citizenship for a U.S. citizen born outside of the United States and for a resident alien. An international applicant for whom English was the first language and is the spoken language in the home must sign a statement to that affect.A score of 550 on the Test of English as a Foreign Language (TOEFL) or a score of 213 on the computer-based TOEFL for all applicants, U.S. citizens or international applicants for whom English is a second language.An applicant who is a graduate of a fully accredited institution but does not possess the minimum undergraduate grade point average for admission may be admitted on a regular basis, provided the score(s) from the appropriate aptitude test of the degree program are met. Because the minimum test scores vary according to program, please see the specific program admission requirements for more information.Graduates from universities which are not fully accredited by the appropriate regional accrediting association will be admitted to graduate study in academic areas in which all undergraduate prerequisites have been met through validation of credit or through the earning of credit at a fully accredited institution. In addition, applicants must submit test scores of the Miller Analogies Test or the aptitude section of the Graduate Record Examination. MBA applicants must submit scores of the Graduate Management Admission Test. The test results must place the student in the upper three-fourths of college graduates according to national norms.The catalog in effect at the time the student completes a degree plan will govern the degree requirements provided that the student has had continuous enrollment. A graduate student who misses two consecutive, regular semesters(fall/spring) is subject to current admission criteria and program standards upon re-entering.Conditional AdmissionA person with an earned bachelor’s degree from an accredited college or university may be admitted conditionally for graduate studies with a 2.3 overall grade point average in all undergraduate course work attempted or a 2.5 in the last 60 semester hours attempted based on a 4.0 scale. The individual who is given conditional admission must maintain a 3.0 grade point average in the first twelve hours of graduate course work attempted to continue in graduate studies.Provisional AdmissionAn NSU senior who is enrolled in sufficient work to complete requirements for the bachelor’s degree but who is not enrolled for a normal study load may be admitted on a provisional basis for graduate studies. Students must be admitted to the Graduate College before they may enroll in graduate courses. The student may enroll in courses for graduate credit, provided the total enrollment does not exceed sixteen hours in a semester or nine hours in a summer term and provided the student meets regular admission requirements. Graduate credit will not be applicable to a graduate degree for such students unless the bachelor’s degree requirements are satisfied at the end of the semester of concurrent enrollment.International Student AdmissionThe Office of International Programs is dedicated to making students’ transition to the U.S. as easy and uncomplicated as possible. With student from over 50 countries throughout the world, NSU takes great care to provide a safe, engaging and academically-relevant experience for all international students. Admission to Northeastern State University is competitive, so international students are encouraged to apply early. International students should access the Office of International Programs website for applications and detailed information. http://offices.nsuok.edu/international/InternationalHome.aspxThe application for admission and all supporting documents other than transcripts and test scores must be received directly from the student. Transcripts from other institutions must be received directly from the registrars of the institutions. Test scores must be received directly from the testing center.Applications cannot be accepted from third parties, agents, or agencies acting for the student. The student must correspond directly with the University.In addition to the requirements for admission to the Graduate College, an international student must also satisfy the following:Knowledge of English LanguageThe State Regents require a minimum TOEFL or IELTS score for admission to a State System institution. Those not meeting these standards must have a minimum score on TOEFL or IELTS and must successfully complete a minimum of 12 weeks of study at an approved intensive English program (IEP). The requirements are as follows: Graduate (minimum scores): 550 or higher on paper based TOEFL or 79 on Internet-based TOEFL or 6.5 on IELTS OR 500 or higher on paper based TOEFL or 61 on Internet based TOEFL or 5.5 or higher on IELTS AND completion of 12 weeks of intensive English Study.An individual not eligible for admission under this standard may be admitted conditionally for one semester at a state system institution if the individual presents a TOEFL minimum internet score of 61 and has subsequently completed twelve weeks of study at an English language school operated by an institution of higher learning or a private school approved by the Oklahoma State Regents for Higher Education.An international applicant for whom English was the first and is the spoken language in the home must sign a statement to that effect.Application and Supporting Documents: complete Application for Graduate Admission to http://Northeastern.An official transcript of college or university records for all schools previously attended. In addition, complete and official English translations must be furnished with the original documents. All academic records must be signed by the appropriate school or government official and must include the seal of the school or government. The transcript must be sent directly from the schools to NSU. Three letters of reference from school officials of schools attended showing applicant’s rank in class, comparison with classmates, and length of time the writer has known the student.Aptitude test scores no more than five years old. Additional documents as program requires.Financial SupportSubmit written proof on the appropriate certification form (provided in the admission packet) of the student’s ability to take care of at least one year’s education-related expenses in any one of the following forms:Official confirmation by the student’s government of an adequate grant, scholarship, fellowship, or loan made available for the specific purpose of educational expenses of the student.Official confirmation by an educational or other organization or agency of adequate funds made available for the specific purpose of the students study in the United States;Official confirmation by the student’s government, through a central bank, for permission to transfer adequate funds to the United States for the specific purpose of education;Official confirmation by the student’s parents, through a central bank, of adequate funds committed to support payment of all educational expenses; Any other source of financial support is considered not satisfactory.Accident, Health, and Hospitalization InsuranceSubmit an official copy of a document showing the student has an accident and hospitalization insurance policy in force for the period of the first years attendance at the University. Information on student insurance is available at the Office of Student Affairs and must be purchased for at least one year.Other DocumentsAt the time of enrollment, the student must present a valid passport with an F-1 visa and 1-94 form showing the date for stay in the United States.Conditions one, two and three must be met and documents received in the Graduate College before admission to the University can be considered. All of these conditions must be met prior to the student’s departure from the student’s home country.If the student meets all requirements for admission including proficiency in English, a notice of acceptance for admission and a Certificate of Eligibility (Form I-20) will be sent to the student. The student must then take the Certificate of Eligibility (Form I-20) to the United States Consulate and apply for a United States Student Visa.Conditions four and five must be completed upon arrival in the United States and before enrolling.Once a student has been admitted under “International Student Admission”, s/he will be issued an “I-20” and NSU will be considered their home institute. If for any reason, the student transfers the I-20 to another institution; his/her status at NSU will become inactive or non-degree seeking. Written permission from the new home institution will be required if an international student wished to enroll in any classes at NSU after making the transfer. To return to NSU, a complete international application packet must be submitted for review and consideration. All international students must be continuously enrolled and must take a minimum of nine hours of graduate course work each semester, with the exception of summer session, to stay in status. Students must also have a Degree Plan and Statement of Understanding on file in the Graduate College office before the close of the first semester of graduate studies.It is the student’s responsibility to stay abreast of the federal regulation changes as they are made by INS. You may review these regulations by visiting the website of http://www.uscis.gov.A change of address must be submitted within ten days to both the attending college and to INS using INS from AR-11. The form is available at the website of http://www.uscis.gov.Non-Academic CriteriaIn addition to academic requirements for admission, students must be in good standing and eligible to re-enroll at a college attended and,a. not expelled, suspended, denied admission or readmission,b. not convicted of a felony or lesser crime or moral turpitude,c. not acted in a manner that would be grounds for expulsion, suspension, dismissal or denial of readmission.And, if the institution finds than an applicant falls into a category above, then the institution shall deny admission if it decides that any of the events described in a, b, or c indicates unfitness. If an applicant is denied admission on any of the foregoing grounds, there must be substantial evidence supporting the basis for denial. In addition, the applicant must be afforded adequate procedural safeguards, including the following:1. be advised of the grounds of the denial;2. be informed of the facts which form a basis of the denial, and3. be afforded an opportunity to be heard.Physical, emotional and mental status of the student must be such that no danger is presented to him or others while attending the university. If there is any question of the status of the student, the university may require a diagnostic examination.Graduate Admission ExaminationsAll graduate programs require a graduate admission examination, such as the Graduate Record Examination, the Miller Analogies Test, or the Graduate Management Admission Test. The program which the applicant is pursuing determines the test to be taken and the score needed. Test scores must be no more than five years old at the time of application for admission. More information on graduate admission examinations may be found on the NSU Graduate College website.(End quote) Source: Apply for Graduate CollegeTakeaway:No US grad program requires the SAT.You may or may not need to take the GRE.You may or may not need to submit the GRE prior to matriculation.You don’t need to get high scores to be admitted to or graduate from a US master’s program (most programs are not Stanford; you need to pick your program.)You can petition the dean’s office for a waiver so that you don’t need to take a test.RELAX, YOU CAN DO THIS!

Here is a list of things that would have been very appropriate and intelligent things to do in response to Covid-19, none of which the Trump Administration did.Years before the virus hits, you expand funding for the CDC and NIH (Trump proposed cutting funding and unbelievably, his 2021 budget for both cut CDC and NIH). You absolutely do NOT eliminate the pandemic team within the CDC (like Trump did). You absolutely do NOT keep the pandemic management roles in DHS empty and unfilled (like Trump did). Ideally you have a senior person in DHS who has a strong infectious disease background because there is only going to be greater risk of pandemics now and in the future because of climate change.Did I mention climate change? You put the force of the USG behind efforts to study climate change and its’ impacts. You don’t ban USG research in to it. You don’t unfund or cut offices that do that work. You don’t prevent USG researchers from going to conferences that study climate change and its’ impact. Here’s a reality check for climate change skeptics and deniers: among people who research climate change in great detail, pandemics are a BFD, something that there is a lot of work on. Seriously—there is tremendous amounts of pandemic research and analysis that is occurring through the climate change lens/perspective.You know all of those rules that the Trump Administration has reversed or not enforced dealing with game hunting and cracking down on trafficking of endangered species? Well, it appears the vector location where the Covid-19 virus appeared to emerge is a wildlife market in Wuhan. Yeah, people are pointing at bats—but that’s simplistic. How bats get involved is they poop—and other animals eat it. Or the bat eats a bug (like a mosquito) that sucked some blood off of a creature. Ladies and Gentleman, let me introduce you to the Pangolin. Very endangered, it has a coronavirus internal to most Pangolins that is almost a dead ringer to what is hitting humans now—except it has mutated a bit. And Pangolins (especially from Africa) are very popular in China. Did pangolins spread the China coronavirus to people? I think when all is said and done with this virus in 2–3 years, we’ll likely conclude that Covid-19 did NOT come directly from the pangolin. But they played a role. That’s why the flu stations are in China. Yes, the season starts in that part of the world. But they have so much mixed use farms (ducks and pigs together, eat each other’s scat, viruses intermix, end up in bats or birds and so China is the birthplace for most modern new flu strains—that’s why the Swine flu scare to come out of Mexico was unexpected).Healthcare—woah, this is a biggie. As in: expand the number of people in the US who have healthcare (so they have access to it—and no, I don’t mean “they can always go to the ER!”). What happens with more people getting health insurance? Fewer smokers, more early screening, access to testing, more preventative care, and when people get it (and most cases will be mild) they’ll get better advice on how to avoid spreading it (which increases the chances that you stay healthy). The Trump administration has gone in the complete opposite direction, seeking to kneecap Obamacare, has a court case right now up on appeal that would wipe out Obamacare (doing this in the middle of a pandemic—that’s a perfect storm folks—a fricking perfect storm from an epidemiological or public health perspective).Supplies. If you’re smart, and you realize that because every day the world is getting smaller (more global, more migration, more business travel) combined with climate change produces warmer climates and more extreme weather, you start preparing for pandemics more than we currently were. You have a larger supply of gloves and masks for medical workers and first responders. A larger supply of Tamiflu (and anti-viral) as well as antibiotics (because you don’t know what is going to emerge). You do “what if” scenarios that you war game out with key leaders in industry and government: what would it take to ramp up production of antibiotic X in 2 weeks? What if we had to quarantine a couple of cruise ships? What if a military unit overseas became infected with something communicable? What if the next flu season was a killer? You can’t plan for everything or even most things—but you don’t have to. You work out—how do we handle a pandemic? FEMA does this sh*t all the time with hurricanes and natural disasters—talk to anyone at the state or federal level who does emergency preparedness and they’ll tell you that if you prepare for 3–4 scenarios it enhances your ability to deal with all of them because you get supplies pre-positioned, you get light on your feet organizationally, you develop an emergency response capability. Good lord—look at the fricking Trump Administration—inept at anticipating and then quickly responding to Maria and the other hurricanes that hit Puerto Rico and the USVI. My point is not that they were delayed specifically in preparing for Covid-19, it’s that they don’t prepare for and handle crises well in general. Talk to anyone in disaster planning for organizations and they’ll tell you it all starts with what you do before the crisis ever hits. Oh, and btw, you don’t respond to pandemic risks by slicing funding from one concern to get money for another (I’m talking about Congress cutting Ebola funding to address Zika over the wishes of the Obama Administration—that’s just bassackwards!).Now everything I’ve listed so far is stuff you do BEFORE anyone in the administration even knows how to spell “coronavirus” let alone knowing Wuhan has a crisis. This is all pandemic-101 stuff. And the Trump Administration flunked all of it—every single thing I’ve mentioned.Now let’s talk about what happens when one of the CDC flu spotting stations in China gets a report from a doctor (let’s call him….Li Wenliang) complaining that the government won’t listen to him about this new type of flu. Let me eliminate the suspense and just tell you that everything I’m about to list about what you do once you get a hint this is happening—is stuff the Trump Administration has done poorly on.6. You don’t cut off access to China—you rush people in. You get additional CDC and NIH talent in China. This isn’t a variation on the normal flu. China is the hothouse for this stuff—the flu season starts with them, that’s why CDC has flu spotting stations there—to get a jump on the flu and begin development of a flu shot early. Except this isn’t influenza. But with teams on the ground quickly, getting samples, observing what the Chinese are going, trying to nail down this bad boy as quickly as possible—that is what you do as soon as you hear a unsubstantiated rumor coming out of Asia. Ditto with Iran (more on this later). Ditto with Italy. It’s critical to get a reliable test nailed down and then start testing like crazy. Why? Because the first most critical step in dealing with pandemics before they become a pandemic is: INFORMATION. We were late on this. The USG didn’t get started on a test until late (we were relying on China, rather than pushing our people out in to the field we were cutting off access) and then when we got a test we only tested people returning from China. Information tells you what kind of beast you’re dealing with, how to deal with it, how widespread it likely is, who’s must vulnerable. It all starts with information and that only happens if, at the first hint of a problem, you push people in to the infected areas rather than cutting them off.7. Set up a task force to coordinate the gathering and sharing of the research from the field plus interact with various agencies (DoD, DHS, CDC, NIH, CIA, DoS, USAID, FBI, Customs, TSA, FDA, USAMRID, US Surgeon General—who has been invisible through all this mess by the way—and I’m sure I’ve left about 12–15 other offices or agencies off the list) to coordinate who is doing what, what supplies are being acquired, begin briefing states and governors and their health directors. This action should have started within a week of the first cases coming out of Wuhan. And the head of this task force should be a research or medical professional. Fauci is a good person to go with—he’s fought this fight before and has bi-partisan credibility. The head of the Center for the National Center for Immunization and Respiratory Diseases (Nancy Messionier) would also be a great choice. I’d probably avoid the head of USAMRID (Col. Darrin Cox) because he’s active duty US military that would feed wild conspiracy rumors that this is somehow a Chinese/American/Israeli bioweapon. But Carl Shaia who retired there back in the Fall was the former Director of Administration (but is now a civilian) and he’d do a bang-up job managing a task force of a lot of government people dealing with complex, unplanned health and medical issues—if you felt like you didn’t want to pull Fauci or Messionier from their organizations (because their supervision of their work was too vital) than Shaia could be a good option. If the head of DHS or HHS was someone with public healthcare expertise then they’d be a fallback option. We don’t currently have an actual DHS head (that position is vacant) and the acting person (formerly of TSA) Chad Wolf has no background in this issue. Alex Azar (HHS) is a lawyer and worked in healthcare organizations but frankly wouldn’t be a strong choice in terms of knowing the public healthcare players. Picking Mike Pence is a poor choice. He double-screwed up the HIV mini-epidemic in Indiana (first cutting support for PP, then refusing to follow the data and wouldn’t do a needle exchange until the cases had exploded). Pence isn’t the worst choice—as a governor he’s got background in dealing with emergencies (in his case: floods and tornados) so that’s a positive plus he’s pretty high up. Still, with a little bit of research (ie: 4 hours) I could give you about 200 names of people who would be a better choice than Pence.8. What Donald Trump says. Now if you really want to know the optimal approach here, it would be that Donald Trump never says or tweets anything about Covid-19 or the Coronavirus at all—when asked about it he refers to the head of the taskforce and then shuts up. That would be optimal. But if we can’t have that, then it would be that he says NOTHING in any media form without clearing it first with a senior healthcare SME (subject matter expert). This post is already too long for me to list all the things he’s said so far that are dumb or false: the virus would go away in April because of temperatures (tell that to Singapore, plus there is a new paper out of the Harvard epidemiology Dept. that says this virus doesn’t seem be affected by warmer temps), that the WHO death rate was wrong (not what he should have said), that Democrats are trying to make this a scare tactic to win the election, that there was nothing to worry about. Donald Trump has added probably not one piece of value to this whole issue—just confusion or wrong information plus delays. I mean, suggesting we should seal the border with Mexico: they have 5 cases as of yesterday and 3 of them came from exposure to foreigners (Italy and America)—I think Mexico might want to seal their border for protection from the US! If you could cut him out of the picture and he’d tolerate that from Day One, things would be so much better now.9. Policy on cruise ships: have one. Right now the US does not and is scrambling. Think about that—there have already been a couple of cases of passengers on cruise ships with Covid-19 signs, why hasn’t the US developed a policy for what to do other than tell the ship to stay offshore? We knew this was an issue a month ago and we’ve got ships off the US coast that we’re trying to figure out what to do because there is no policy in-place. This is exactly what the USG is supposed to do—establish policies. And I said cruise ships because that’s an immediate issue. Someone is going to have a 14 hour plane flight and in the middle of the flight (with air being circulated through the cabin) it will be clear that a passenger is sick with the coronavirus—so what’s the procedure? Have them disembark and stand in line at a crowded customs and immigration portal with hundreds of other incoming passengers? Every single US airport that has an international terminal needs to be setting up infrastructure and implementing USG policy (except there is none) besides setting up hand sanitizer and putting out more tissue dispensers.10. Establish and follow basic risk protocols for individuals who are exposed or possibly exposed re-entering the country. The healthcare workers who met the plane load of sick and at-risk Americans returning to the US—none of them had any kind of protection or established procedure for processing those individuals. WTF? This sounds like an isolated example. There will be hundreds of thousands of Americans seeking to return back to the US from overseas. Students, business professionals, tourists, retirees, military, diplomats, USG workers, professors. You need a basic protocol for screening and handling them (and it’s not all the same—it will vary with the country they’re coming from, if they’ve been tested, if they have obvious signs, if they’d had contact). That doesn’t exist right now.11. Information is critical at times like this—to avoid panic. You don’t want to downplay it all, you need to be open and honest but put things in perspective. So for instance, people need to be told that you should not be wearing a mask unless you’re sick (wearing a mask INCREASES the likelihood you get infection if you’re exposed to someone) unless you change your mask every hour (or every encounter). In the effort to downplay the spread and infection, there is very little (okay, none) Federal govt. resources talking publicly about “let’s talk through planning for if schools in most of the country shut down for a month—can we get all businesses to give people temporary family leave?” Local governments are working on this (kudos to them) but they’re often having to do this in the dark. The Feds should be driving this and be pre-eminent. What Jay Inslee (gov. of Washington State) had to tell Pence is sad, just appalling but that’s a reflection on the Federal coordination effort to-date. So information not only about “this is what we know, this is what we don’t know, here’s what you should be doing know, here’s what you should plan for just in-case” is critical and it’s not happening. That’s not really happening publicly driven by the Feds, it’s very piecemeal and fragments. Look at the comments from Carson (HUD). He shouldn’t be in the public eye on this except the Trump information shortage/gap has people hungry for information and since he was a surgeon, he got approached by media. So he was asked about the Trump policy on the cruise ship approaching the US and he said it was finalized but it wasn’t going to be revealed yet. Then he said it was formulated but some details were being worked out. Then he said there were no plans as of yet. This is from one senior Administration official within one 24 hour period who shouldn’t even be talking about cruise ships. And this happens because there is no coordination or reliable information source on this issue at the moment. So people are going all over the place seeking information.12. There are a gazillion specialty situations that need to be addressed by government. If you’ve got a kid overseas in an exchange program (say—studying art in Milan, or teaching English in Beijing), can they come back home? Or what if they wait till the end of the semester? What about US military? What about large crowds at sporting events—any policy or recommendations regarding those? I bet every police officer out there is now wondering “hmmm….how does this affect me and possible infected people or areas?” Could you imagine medical professionals or first responders refusing to go out in the field if we have a shortage of gloves and masks? Certain industries (any place like Orlando that does a lot of conventions), cruise ships, airlines, travel, tourism, caterers, restaurants—they’re likely dealing with tremendous business crashes right now or in the near future. Saying “we’ll give you a tax break” is a crappy answer—that’s not what they need right now. Their immediate concern is about safety and a tax break doesn’t address that. They need to be given some direction on what to expect, how the USG is going to intervene, if there will be tests set up when people board/deplane/disembark. These are issues that industry can’t solve or fix and a tax break is irrelevant to. And we aren’t even talking about jobs like TSA that involve touching a lots of things. The latest word I’ve heard is that Covid-19 can live for up to a week on a surface. So any high-traffic screening personnel would be a great risk-2,000 people could come through your shift and it only takes one to pass on something (because of a suitcase they brought from home where an asymptomatic individual—not the traveler—coughed on it).13. This is related to #11 but you need to balance the panic and the information. You should not be trying to “spin” this event or push good news. Right now, the Trump Administration has tried hard to downplay this and say it is something that will go away quickly with little pain. Meanwhile the markets are taking deep dives, Italy is quarantining 15 million people, and the Fed issues an unprecedented emergency rate cut while the President is saying “no biggie.” Let me let you in on something: our numbers on infections in the US are bogus. We’ve mostly been testing only people who were traveling overseas or those immediately next to someone who’s infected. Partially that was lack of planning, partially that was a lack of test availability. Once we expand the number of tests, you’re going to see the number of people with a “positive” result (meaning: they got it or have antibodies so were exposed and may be a carrier) to probably go up 5X the current number (if not higher). That’s to be expected—we had artificially low numbers previously. But to fearful members of the public, it will seem like their government was lying to them or that all of sudden the virus has gotten really bad when it hit the US (neither case was true). That’s why the mis-statements by the Trump Administration and the efforts to downplay this sucker are just stupid, stupid, stupid. You’ve got a balancing act—it’s tough—but it’s critical. You’ve got to level with people, talk about what we know, what we don’t know, talk a little about an unknown future. When you try to downplay or minimize the bad news, and then you suddenly get a bunch of bad news, you lose your credibility. You don’t just look bad, instead you become the bad guy.14. Protecting Asians and Immigrants. The Trump Administration is probably the least credible and competent governmental entity to engage in this. You’re already seeing individuals verbally or physically attacking Asians. People who are 2nd generation US and from Japan or the Philippines are being told to go back to China. After 9–11, George W. Bush gave a very powerful speech where he said we were all Americans, we couldn’t turn on each other, that it should still be safe for someone wearing a hijab to go to a mosque, and it was shameful for us to betray our values by turning on minorities. At a time when there are a ton of rumors, lots of fear, it’s important for our government to do something that they’re very capable of doing—standing up for targeted minorities and letting people know “hey, they’re not the danger here.” Seriously—this is a “no-brainer” kind of action because the USG is well positioned to deal with it, can do it RIGHT NOW, and variations of this come up whenever there is a terrorist attack, a pandemic, a violent crime or something that stereotypes a specific group. And it doesn’t require scientists coming up with a new vaccine or some medical advance. it’s about USG leadership saying “hey—no scapegoating, we’re all in this together, don’t turn on each other.” Has anyone seen anything from Trump or Pence or any senior USG official addressing this issue? I haven’t.15. Do not rely on information from Xi. China has not handled it well, they were initially in denial. Xi basically told Trump “nothing to worry about, it’s going to go away” and then Trump came out with his “it will disappear in April” statement. Let healthcare professionals talk to their foreign counterparts—they’ll be able to decipher what is bullish*t and what is truth.16. South Korea: we should have teams over there right now looking at what they’re doing. ROK isn’t perfect but they’re a great example of getting it “mostly” right. They’ve got drive-in stations for quick tests to see if you’re contagious or not. From the git-go they were testing far more people than just international travelers—making us look like idiots. South Korea hasn’t been perfect but they’ve been pretty darn good. I bet that right now, we’re so focused on the US that any potential lessons or tips we might gain from ROK are going to be ignored until this thing plays itself out and a year or so from now we’re doing a “hot wash” and go “gee, wouldn’t it have been smart if we’d implemented this thing they tried in South Korea?”17. Do not, do not, use the Coronavirus as an excuse to implement other policies you have. The Trump Administration has already tightened immigration rules with Iran (actually, we should be sending CDC teams there to see what we can learn and also identify if it’s the same strain). Trump has talked about closing the border with Mexico (but not Canada which has far more cases—although a significant number came from exposure to Americans—sorry Canada!). Do you hear any talk of closing immigration with Italy (which is attempting to quarantine 15 million of its’ citizens)? Nope, neither have I. You see, the problem when you do stunts like this (sneak in another policy using the rationale of it’s dealing with Covid-19) is it ends up hurting your credibility and perceived confidence across the board. If shutting down borders is “the answer” then why shut off a border with Mexico but not Canada? If shutting down borders is “the answer” then why allow trucks full of auto parts from Mexico to still come in to the US (answer: it would shut down nearly all US auto manufacturing plants and immediately lead to a recession plus kill Trump in a bunch of battleground states like Michigan that he needs to win).18. This last piece is tough to do but it’s now essential: we need to flatten the curve and expand capacity ASAP. Let me explain the concept: the US healthcare system is near capacity. We don’t have a lot of empty beds. We have fewer doctors (especially in rural areas) per capita then places like Italy. Our ICU’s are maxed out mostly (in part due to a very bad flu season). A massive influx of new Covid-19 cases is a healthcare disaster. It doesn’t matter if the case mortality rate for infections is only 1% (or .2%) rather than 3.5%. You end up with not enough ventilators, not enough ICU beds, not enough healthcare providers. And while the extreme Covid-19 cases (about 4–10% of those infected) are in ICUs, other patients are either underserved or don’t get help. Seriously folks, with every epidemic the public healthcare data shows an increase in mortality for healthcare issues not related to the pandemic. So if you’re a healthcare administrator, you should be doing whatever you can to add beds, bring people out of retirement, add interns or admin support to free up nurses from work that someone without a degree can do. In terms of the Trump administration (ie: this question), they should be pushing all strategies to add capacity. And we (as an administration) should be looking at ways to “flatten the curve” by reducing the speed of infection. This chart is from Vox and Christina Animashaun and it illustrates why Covid-19 is got a lot of public healthcare folks alarmed, why you’re seeing so many Universities and localities canceling events and what the Federal Government needs to be focusing on much more than it currently is.I’m sure I’m leaving out a couple of other things but this post is long enough as is. Quite simply, the Trump Administration has done a terrible job preparing for a pandemic and then responding to the initial news and then acting when it hit the US.Let me say one last thing here: some people will write this post off as being “anti-Trump.” Preparing for disasters (diseases, natural emergencies, energy blackouts, rioting, etc.) is a special kind of challenge. We have professionals who do this stuff for a living. It absolutely infuriates me when we violate some of the most basic rules of disaster planning and emergency management—whether it’s with storms or pandemics. If this post comes off as “anti-Trump” it’s only because the Administration has badly bungled their response to the coronavirus. We had a reasonable shot at containing this sucker. No longer.