The COVID Tracking Project

https://covidtracking.com/data/charts/us-daily-positive

The public deserves the most complete data available about COVID-19 in the US. No official source is providing it, so we are.

Every day, our volunteers compile the latest numbers on tests, cases, hospitalizations, and patient outcomes from every US state and territory.

https://covidtracking.com/

Patchwork approach to contact tracing hampers national recovery

https://thehill.com/homenews/state-watch/514233-patchwork-approach-to-contact-tracing-hampers-national-recovery

Patchwork approach to contact tracing hampers national recovery | TheHill

A patchwork approach to contact tracing across state health departments is making it increasingly difficult to know where people are getting exposed to COVID-19.

While some states like Louisiana and Washington state publicly track detailed data related to COVID-19 cases in bars, camps, daycares, churches, worksites and restaurants, most states do not, creating obstacles to preventing future cases.

The extensive spread of the virus, combined with the country’s 50-state approach to pandemic response, has led to a dearth of information about where transmissions are occurring. Those shortcomings are in turn complicating efforts to safely open the economy and to understand the risks associated with certain activities and settings.

Experts know COVID-19 spreads in crowded indoor spaces, but more specifics could help state and local lawmakers strike a better balance between public health needs and those of the economy.

“If you want to take a more targeted approach to public health measures, the more information you have the better,” said Joshua Michaud, an associate director for global health policy at the Kaiser Family Foundation and an infectious disease epidemiologist.

“Rather than have a blunt, close-everything-down approach, you could be a bit more targeted and surgical about how you implement certain measures,” he added.

The Hill asked every state for information about the data they collect and share as part of their contact tracing programs, one of the main tools public health officials have to slow the spread of COVID-19.

Most states release information about outbreaks and cases at congregate settings like nursing homes, meatpacking plants, and prisons, which comprise the majority of cases. But there is less information publicly available about the numbers of cases or outbreaks tied to other settings commonly visited by people.

A handful of states including ArkansasColoradoKansasLouisianaMaryland, Michigan, Ohio, Rhode Island and Washington track and publicly release data on the settings where COVID-19 outbreaks are occurring, according to responses from state health departments.

For example, Louisiana has tied 468 cases to bars in the state, but most of the new cases in the past week have been tied to food processing plants.

In The Hill’s review of publicly available state data, other settings for COVID-19 transmission include restaurants, childcare centers, gyms, colleges and schools, churches, retailers, weddings and other private social events. It is not clear how widely those settings contributed to infections because widespread transmission of the virus means many people who get sick do not get interviewed by contact tracers — over the past week, there has been an average of 42,000 confirmed cases, though many more are likely going undetected.

State health departments in Idaho, Illinois, Massachusetts, Mississippi, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, Virginia and West Virginia told The Hill they don’t track location data.

Utah tracks outbreaks and cases tied to workplaces and schools, but not restaurants or bars.

Arizona, California, Delaware, Indiana, Oregon and Pennsylvania track infection locations, but don’t release it to the public.

“The number of people getting COVID-19 from isolated, identifiable outbreaks, such as those in long term care facilities, is decreasing, and more people are contracting COVID-19 from being out and about in their community, such as when visiting restaurants and bars,” said Maggi Mumma, a spokeswoman for the Pennsylvania Department of Health.

Bars, indoor dining and gyms are still closed in most of New York and New Jersey, so there is no current data to track for those settings.

But the state health departments also don’t release data on outbreaks or cases tied to other settings like childcare or retail stores.

MinnesotaMontanaNorth Dakota and Wisconsin release the number of cases tied to outbreaks in the community but do not go into specifics about possible transmission sites.

For example, Minnesota lists nearly 7,000 cases as being tied to “community” exposure, but that includes settings like restaurants, bars and workspaces.

In Iowa, a state health department spokesperson said the agency is working on extracting and sharing this type of data on its website, while Maine would not say if they track by specific location.

The remaining state health departments did not respond to multiple requests for comment from The Hill and don’t have information about outbreaks or exposure settings on their websites.

Several states said local health departments may be tracking infection locations even if the state is not.

Experts said such a decentralized approach can miss outbreaks if local departments aren’t communicating with each other, meaning any data should be public.

“I do think it would be very valuable for states to make that information public,” said Crystal Watson, assistant professor at Johns Hopkins Bloomberg School of Public Health.

“It helps us collectively get a better understanding as policymakers, as people trying to help in the response. It can also help with personal decision making for people to understand … where it’s most dangerous to go related to getting infected,” Watson said.

The disparities between state health departments are partially due to a lack of federal guidance.

There are no federal requirements on the information contact tracers collect; guidelines vary from state to state, and sometimes from county to county.

Tracking data about where people are getting sick would allow states to take a “cluster busting” approach, experts said, by working backwards from confirmed cases to find where patients might have first contracted the disease, potentially stopping future outbreaks.

That approach requires a change in mindset for contact tracers, who typically focus on reaching close contacts of confirmed cases who might have been exposed to the virus. But research shows between 10 and 20 percent of people are responsible for about 80 percent of new infections, mostly through so-called super-spreader events.

“We know that the way this virus has transmitted is highly clustered groups and anytime you have settings where a lot of people are together in one place,” said Kaiser’s Michaud.

“Collecting good information on this — the cluster busting approach — is a good way to find out where your prevention efforts can have the best bang for your buck,” he said.

At the same time, some state programs are still not operating at full force and are struggling to keep up with widespread infections.

“I think that many parts of the country, especially outside of the Northeast … simply have too many cases to use contact tracing as the primary public health measure to control cases,”  said Stephen Kissler, a research fellow at the Harvard T.H. School of Public Health.

“It’s just not enough,” he said. “We just don’t have enough resources, and in a lot of these places enough contact tracers, to follow up on all of the cases.”

 

 

 

 

 

Convalescent Plasma: The Unanswered Questions

https://www.medpagetoday.com/infectiousdisease/covid19/88264?xid=fb_o&trw=no&fbclid=IwAR0F6xiRAQ7ngBz4pNozJ2VqWm0-UJqGdlQojfOeyXbPJjbAeYtGL8jbAiw

“The data don’t show anything useful”

Problems with the government’s rationale for authorizing use of convalescent plasma in COVID-19 patients go far beyond the dustup over the purported 35% survival benefit cited by top officials on Sunday, numerous researchers say.

That figure quickly came under fire, leading to an apology from Commissioner Stephen Hahn, MD — but that’s not the only criticism leveled at the FDA’s analysis of the available data.

Much of it came from the Mayo Clinic and FDA expanded access program (EAP), at this point published only as a preprint manuscript. Although a large number of patients were included, the study was observational only, with no untreated control group. That makes the findings merely hypothesis-generating, and can’t offer any firm conclusions.

That’s fine for issuing an emergency use authorization (EUA), but not so much for making claims about survival benefit, independent researchers said.

“It’s not even a question of overstating,” Adam Gaffney, MD, MPH, a critical care doctor and health policy researcher at Harvard Medical School, told MedPage Today. “You can’t state much at all when you don’t have a randomized controlled trial.”

“People have made a big deal of Hahn referring to relative versus absolute risk reduction, but I think that’s less of a big deal,” Gaffney said. “The biggest problem is that the data they are citing … is not randomized. That’s the source of all the problems.”

Hahn took heat for saying that a “35% improvement in survival is a pretty substantial clinical benefit” further explaining that of “100 people who are sick with COVID-19, 35 would have been saved because of the administration of plasma.”

Critics rapidly took to Twitter, stating that the interpretation was incorrect. Hahn was referring to relative risk reduction, not absolute risk reduction. Thus, calculating the number of lives saved — which isn’t something experts recommend doing based on observational data in the first place — would have translated to somewhere more in the ballpark of 5 out of 100.

Moreover, the “risk reduction” came from a comparison of patients treated with high-titer plasma versus those receiving lower-titer preparations. The study offered no basis for concluding how many patients may have been “saved” relative to standard care.

And the 35% reduction in that analysis was for 7-day mortality; the relative reduction at 30 days was only 23%.

Hahn’s recital of the 35% figure “was just PART of the error,” tweeted Vinay Prasad, MD, MPH, of the University of California San Francisco. “The entire comparison is flawed. It is not a suitable control. The data don’t show anything useful.”

“The much broader problem here is the lack of commitment to performing large, national randomized controlled trials,” Gaffney said. “We could have done it for convalescent plasma. Instead, we did the EAP. I understand why people wanted it, but now we don’t know [if convalescent plasma works]. We have a question mark instead of a period.”

Undermining Trust in FDA?

Critics have charged that serious mistakes like Hahn’s misstatement could undermine FDA’s credibility, especially as it faces challenging decisions about potentially approving a vaccine this fall.

“This is playing out in the context of a hyper-politicized moment,” Gaffney said. “It behooves everyone to be extremely cautious in speaking about these things to avoid the appearance of politicization.”

On CBS This Morning on Tuesday, Hahn addressed concerns about politicization by offering reassurance to the “American people that this decision was made based upon sound science and data.”

In response to questions about the timing of the EUA announcement — it came just a day after President Donald Trump tweeted allegations that the “deep state” was holding back access to COVID-19 treatments with Hahn’s Twitter handle cited, and a day before the Republican National Convention got underway — Hahn said the agency had been working on the application for 3 or 4 weeks and was waiting on additional validation data, which were received at the end of last week and over the weekend.

“We’re going to continue to get data and as we’ve done with any other authorization, we will update that decision as new data come,” Hahn said on the news program. His agency initially issued an EUA for hydroxychloroquine, for instance, but later revoked it when the negative randomized trial data became available.

Lack of Access to FDA’s Data Review

Whether the public will ever see the full convalescent plasma data underlying the EUA is another matter. The “Clinical Memorandum” issued as the evidence behind the FDA’s decision glossed over the statistical analysis conducted by the agency; in particular, it made no mention of the 35% relative reduction in deaths.

Another problem with that is the 35% figure’s source isn’t fully clear. Although the EAP preprint manuscript is the most obvious source, Gaffney noted that HHS Secretary Alex Azar said it referred to a subgroup of patients under age 80 who were not on a ventilator. That is not found in the publicly available data. He also pointed to a tweet by FDA spokesperson Emily Miller that contains an agency slide showing a 37% reduction in mortality for non-intubated patients age 80 or under treated within 72 hours who got high-titer convalescent plasma, compared with low-titer product. Neither of those figures is reflected in the EAP manuscript.

The FDA did not return a request by MedPage Today for the full summary of data reviewed by FDA and any independent statistical analysis done by the agency.

Shmuel Shoham, MD, of Johns Hopkins University in Baltimore, said during a press briefing organized by the Infectious Diseases Society of America that “enormous amounts of data have been generated” from the EAP, in which more than 70,000 patients have been treated.

“Some data have been reported in articles and at meetings, but that’s only part of what the FDA — this is their program — has access to,” he said. “The stuff in the public domain is only a fraction of the data they have collected.”

Shoham is on the scientific advisory board of the EAP and is involved in two convalescent plasma clinical trials at Johns Hopkins.

Gaffney said Mayo researchers and FDA reviewers have noted that physicians were blinded to the dose of antibody given in plasma infusions, which he described as a “pseudo-randomization effect. We could use that to make more causal inferences about the effectiveness of antibody titers.”

However, he said there were some significant differences between those who received high-titer versus low-titer antibody, including differences in P-to-F ratio (a measure of inhaled oxygen to blood oxygen) and in those with five or more severe risk factors, suggesting the low-titer group was sicker to begin with than the high-titer group.

Also, patients in the EAP received a variety of other treatments: about half got steroids and 40% were given remdesivir.

“This is why we do randomized controlled trials,” Gaffney said. “Without them it’s very difficult to ensure that the effect you see is the result of the drug, and not the result of patient characteristics.”

Is an Answer Forthcoming?

Several randomized controlled trials of convalescent plasma are underway in the U.S., but the big concern is that wider access to convalescent plasma will limit enrollment. Will clinicians recommend that their patients enroll in a trial in which they might receive placebo? Will patients agree?

For the Hopkins studies, the prevention trial has enrolled 25 people out of a goal of 500, and its outpatient trial has enrolled 50 people of its 600-patient goal.

Liise-anne Pirofski, MD, of Montefiore Medical Center in New York, started a study at the end of April, looking to enroll 300 people. She said the team enrolled the first 150 people quickly, but “then the pandemic began to wane in New York.” With subsequent funding from the NIH, the trial has managed to enroll 190 patients, and has now expanded to four additional sites: New York University, Yale, the University of Miami, and the University of Texas Houston.

Clifton Callaway, MD, PhD, of the University of Pittsburgh Medical Center and lead investigator on the C3PO trial looking at outpatient convalescent plasma, said he hopes the EUA doesn’t discourage participation.

“To the contrary, I believe it should reassure persons considering participation that the FDA feels that convalescent plasma is safe and potentially useful and that the FDA specifically comments: ‘Current data suggest the largest clinical benefit is associated with high-titer units of CCP administered early in the course of disease.’ Giving high-titer convalescent plasma earlier (before you are sick enough to be in the hospital) is exactly what C3PO is testing.”

In addition to determining whether earlier or prophylactic treatment works, Shoham said other unanswered questions include identifying whether other components in plasma are useful therapies and whether low-titer plasma can work at all.

“What everyone agrees on is that the gaps in knowledge that exist can best be addressed by high-quality randomized controlled trials,” he said.

Pirofski said the science and data should be the focus, “rather than the decision and what drove the decision…. I don’t think anyone knows what drove that decision other than the people in that room. Hopefully they know.”

 

 

 

 

Covid-19 Data in the US Is an ‘Information Catastrophe’

https://www.wired.com/story/covid-19-data-in-the-us-is-an-information-catastrophe/#intcid=recommendations_wired-bottom-recirc-personalized_31e95638-88d6-439c-85a2-db8f6235da26_text2vec1-mab

Covid-19 Data in the US Is an 'Information Catastrophe' | WIRED

The order to reroute CDC hospitalization figures raised accuracy concerns. But that’s just one of the problems with how the country collects health data.

TWO WEEKS AGO, the Department of Health and Human Services stripped the Centers for Disease Control and Prevention of control of national data on Covid-19 infections in hospitalized patients. Instead of sending the data to the CDC’s public National Healthcare Safety Network (NHSN), the department ordered hospitals to send it to a new data system, run for the agency by a little-known firm in Tennessee.

The change took effect immediately. First, the hospitalization data collected up until July 13 vanished from the CDC’s site. One day later, it was republished—but topped by a note that the NHSN Covid-19 dashboard would no longer be updated.

Fury over the move was immediate. All the major organizations that represent US public health professionals objected vociferously. A quickly written protest letter addressed to Vice President Mike Pence, HHS secretary Alex Azar, and Deborah Birx, the coordinator of the White House’s Coronavirus Task Force, garnered signatures from more than 100 health associations and research groups. The reactions made visible the groups’ concerns that data could be lost or duplicated, and underlined their continual worry that the CDC is being undercut and sidelined. But it had no other effect. The new HHS portal, called HHS Protect, is up and running.

Behind the crisis lies a difficult reality: Covid-19 data in the US—in fact, almost all public health data—is chaotic: not one pipe, but a tangle. If the nation had a single, seamless system for collecting, storing, and analyzing health data, HHS and the Coronavirus Task Force would have had a much harder time prying the CDC’s Covid-19 data loose. Not having a comprehensive system made the HHS move possible, and however well or badly the department handles the data it will now receive, the lack of a comprehensive data system is harming the US coronavirus response.

“Every health system, every public health department, every jurisdiction really has their own ways of going about things,” says Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. “It’s very difficult to get an accurate and timely and geographically resolved picture of what’s happening in the US, because there’s such a jumble of data.”

Data systems are wonky objects, so it may help to step back and explain a little history. First, there’s a reason why hospitalization data is important: Knowing whether the demand for beds is rising or falling can help illuminate how hard-hit any area is, and whether reopening in that region is safe.

Second, what the NHSN does is important too. It’s a 15-year-old database, organized in 2005 out of several streams of information that were already flowing to the CDC, which receives data from hospitals and other health care facilities about anything that affects the occurrence of infections once someone is admitted. That includes rates of pneumonia from use of ventilators, infections after surgery, and urinary tract infections from catheters, for instance—but also statistics about usage of antibiotics, adherence to hand hygiene, complications from dialysis, occurrence of the ravaging intestinal infection C. difficile, and rates of health care workers getting flu shots. Broadly, it assembles a portrait of the safety of hospitals, nursing homes, and chronic care institutions in the US, and it shares that data with researchers and with other statistical dashboards published by other HHS agencies such as the Center for Medicare and Medicaid Services.

Because NHSN only collects institutional data, and Covid-19 infections occur both inside institutions such as nursing homes and hospitals, and in the outside world, HHS officials claimed the database was a bad fit for the coronavirus pandemic. But people who have worked with it argue that since the network had already devised channels for receiving all that data from health care systems, it ought to continue to do so—especially since that data isn’t easy to abstract.

“If you are lucky enough to work in a large health care system that has a sophisticated electronic medical record, then possibly you can push one button and have all the data flow up to NHSN,” says Angela Vassallo, an epidemiologist who formerly worked at HHS and is now chief clinical adviser to the infection-prevention firm Covid Smart. “But that’s a rare experience. Most hospitals have an infection preventionist, usually an entire team, responsible for transferring that data by hand.”

There lies the core problem. Despite big efforts back during the Obama administration to funnel all US health care data into one large-bore pipeline, what exists now resembles what you’d find behind the walls of an old house: pipes going everywhere, patched at improbable angles, some of them leaky, and some of them dead ends. To take some examples from the coronavirus response: Covid-19 hospital admissions were measured by the NHSN (before HHS intervened), but cases coming to emergency departments were reported in a different database, and test results were reported first to local or state health departments, and then sent up to the CDC.

Covid-19 data in particular has been so messy that volunteer efforts have sprung up to fix it. These include the COVID Tracking Project—compiled from multiple sources and currently the most comprehensive set of statistics, used by media organizations and apparently by the White House—and Covid Exit Strategy, which uses data from the COVID Tracking Project and the CDC.

Last week, the American Public Health Association, the Johns Hopkins Center, and Resolve to Save Lives, a nonprofit led by former CDC director Tom Frieden, released a comprehensive report on Covid-19 data collection. Pulling no punches, they called the current situation an “information catastrophe.”

The US, they found, does not have national-, state-, county-, or city-level standards for Covid-19 data. Every state maintains some form of coronavirus dashboard (and some have several), but every dashboard is different; no two states present the same data categories, nor visualize them the same way. The data presented by states is “inconsistent, incomplete, and inaccessible,” the group found: Out of 15 key pieces of data that each state should be presenting—things such as new confirmed and probable cases, new tests performed, and percentage of tests that are positive—only 38 percent of the indicators are reported in some way, with limitations, and 60 percent are not reported at all.

“This is not the fault of the states—there was no federal leadership,” Frieden emphasized in an interview with WIRED. “And this is legitimately difficult. But it’s not impossible. It just requires commitment.”

But the problem of incomplete, messy data is older and deeper than this pandemic. Four scholars from the health-policy think tank the Commonwealth Fund called out the broader problem just last week in an essay in The New England Journal of Medicine, naming health data as one of four interlocking health care crises exposed by Covid-19. (The others were reliance on employer-provided health care, financial losses in rural and primary-care practices, and the effect of the pandemic on racial and ethinic minorities.)

“There is no national public health information system—electronic or otherwise—that enables authorities to identify regional variation in the demand for, and supply of, resources critical to managing Covid-19,” they wrote. The fix they recommended: a national public health information system that would record diagnoses in real time, monitor the materials hospitals need, and link hospitals and outpatient care, state and local health departments, and laboratories and manufacturers to maintain real-time reporting on disease occurrence, preventive measures, and equipment production.

They are not the first to say this is needed. In February, 2019, the Council of State and Territorial Epidemiologists launched a campaign to get Congress to appropriate $1 billion in new federal funding over 10 years specifically to improve data flows. “The nation’s public health data systems are antiquated, rely on obsolete surveillance methods, and are in dire need of security upgrades,” the group wrote in its launch statement. “Sluggish, manual processes—paper records, spreadsheets, faxes, and phone calls—still in widespread use, have consequences, most notably delayed detection and response to public health threats.”

Defenders of the HHS decision to switch data away from the CDC say that improving problems like that is what the department was aiming for. (“The CDC’s old hospital data-gathering operation once worked well monitoring hospital information across the country, but it’s an inadequate system today,” HHS assistant secretary for public affairs Michael Caputo told CNN.) If that’s an accurate claim, during a global pandemic is a challenging time to do it.

“We were opposed to this, because trying to do this in the middle of a disaster is not the time,” says Georges Benjamin, a physician and executive director of the American Public Health Association, which was a signatory to the letter protesting moving data from the NHSN. “It was just clearly done without a lot of foresight. I don’t think they understand the way data moves into and through the system.”

The past week has shown how correct that concern was. Immediately after the switch, according to CNBC, states were blacked out from receiving data on their own hospitals, because the hospitals were not able to manage the changeover from the CDC to the HHS system. On Tuesday, Ryan Panchadsaram, cofounder of Covid Exit Strategy and former deputy chief technology officer for the US, highlighted on Twitter that data on the HHS dashboard, advertised as updating daily, was five days old. And Tuesday night, the COVID Tracking Project staff warned in a long analysis: “Hospitalization data from states that was highly stable a few weeks ago is currently fragmented, and appears to be a significant undercount.”

When the Covid-19 crisis is over, as everyone hopes it will be someday, the US will still have to wrestle with the questions it raised. One of those will be how the richest country on the planet, with some of the best clinical care in the world, was content with a health information system that left it so uninformed about a disease affecting so many of its citizens. The answer could involve tearing the public-health data system down and building it again from scratch.

“This is a deeply entrenched problem, where there is no single person who has not done their job,” Rivers says. “Our systems are old. They were not updated. We haven’t invested in them. If you’re trying to imagine a system where everyone reports the same information in the same way and we can push a button and have all the information we might want, that will take a complete overhaul of what we have.”

 

 

 

 

The Fed’s independence helped it save the US economy in 2008 – the CDC needs the same authority today

https://theconversation.com/the-feds-independence-helped-it-save-the-us-economy-in-2008-the-cdc-needs-the-same-authority-today-142593

Centers for Disease Control and Prevention

The image of scientists standing beside governors, mayors or the president has become common during the pandemic. Even the most cynical politician knows this public health emergency cannot be properly addressed without relying on the scientific knowledge possessed by these experts.

Yet, ultimately, U.S. government health experts have limited power. They work at the discretion of the White House, leaving their guidance subject to the whims of politicians and them less able to take urgent action to contain the pandemic.

The Centers for Disease Control and Prevention has issued guidelines only to later revise them after the White House intervened. The administration has also undermined its top infectious disease expert, Dr. Anthony Fauci, over his blunt warnings that the pandemic is getting worse – a view that contradicts White House talking points.

And most recently, the White House stripped the CDC of control of coronavirus data, alarming health experts who fear it will be politicized or withheld.

In the realm of monetary policy, however, there is an agency with experts trusted to make decisions on their own in the best interests of the U.S. economy: the Federal Reserve. As I describe in my recent book, “Stewards of the Market,” the Fed’s independence allowed it to take politically risky actions that helped rescue the economy during the financial crisis of 2008.

That’s why I believe we should give the CDC the same type of authority as the Fed so that it can effectively guide the public through health emergencies without fear of running afoul of politicians.

 

The paradox of expertise

There is a paradox inherent in the relationship between political leaders and technical experts in government.

Experts have the training and skill to apply scientific knowledge in complex biological and economic systems, yet democratically elected political leaders may overrule or ignore their advice for ill or good.

This happened in May when the CDC, the federal agency charged with controlling the spread of disease, removed advice regarding the dangers of singing in church choirs from its website. It did not do so because of new evidence. Rather, it was because of political pressure from the White House to water down the guidance for religious groups.

Similarly, the White House undermined the CDC’s guidance on school reopenings and has pressured it to revise them. So far, it seems the CDC has rebuffed the request.

The ability of elected leaders to ignore scientists – or the scientists’ acquiescence to policies they believe are detrimental to public welfare – is facilitated by many politicians’ penchant for confident assertion of knowledge and the scientist’s trained reluctance to do so.

Compare Fauci’s repeated comment that “there is much we don’t know about the virus” with President Donald Trump’s confident assertion that “we have it totally under control.”

 

Experts with independence

Given these constraints on technical expertise, the performance of the Fed in the financial crisis of 2008 offers an informative example that may be usefully applied to the CDC today.

The Federal Reserve is not an executive agency under the president, though it is chartered and overseen by Congress. It was created in 1913 to provide economic stability, and its powers have expanded to guard against both depression and crippling inflation.

At its founding, the structure of the Fed was a political compromise designed make it independent within the government in order to de-politicize its economic policy decisions. Today its decisions are made by a seven-member board of governors and a 12-member Federal Open Market Committee. The members, almost all Ph.D. economists, have had careers in academia, business and government. They come together to analyze economic data, develop a common understanding of what they believe is happening and create policy that matches their shared analysisThis group policymaking is optimal when circumstances are highly uncertain, such as in 2008 when the global financial system was melting down.

The Fed was the lead actor in preventing the system’s collapse and spent several trillion dollars buying risky financial assets and lending to foreign central banks – decisions that were pivotal in calming financial markets but would have been much harder or may not have happened at all without its independent authority.

The Fed’s independence is sufficiently ingrained in our political culture that its chair can have a running disagreement with the president yet keep his job and authority.

 

Putting experts at the wheel

A health crisis needs trusted experts to guide decision-making no less than an economic one does. This suggests the CDC or some re-imagined version of it should be made into an independent agency.

Like the Fed, the CDC is run by technical experts who are often among the best minds in their fields. Like the Fed, the CDC is responsible for both analysis and crisis response. Like the Fed, the domain of the CDC is prone to politicization that may interfere with rational response. And like the Fed, the CDC is responsible for decisions that affect fundamental aspects of the quality of life in the United States.

Were the CDC independent right now, we would likely see a centralized crisis management effort that relies on the best science, as opposed to the current patchwork approach that has failed to contain the outbreak nationally. We would also likely see stronger and consistent recommendations on masks, social distancing and the safest way to reopen the economy and schools.

Independence will not eliminate the paradox of technical expertise in government. The Fed itself has at times succumbed to political pressure. And Trump would likely try to undermine an independent CDC’s legitimacy if its policies conflicted with his political agenda – as he has tried to do with the central bank.

But independence provides a strong shield that would make it much more likely that when political calculations are at odds with science, science wins.

 

 

 

 

How Many People in the U.S. Are Hospitalized With COVID-19? Who Knows?

https://www.propublica.org/article/how-many-people-in-the-us-are-hospitalized-with-covid-19-who-knows?utm_source=sailthru&utm_medium=email&utm_campaign=dailynewsletter&utm_content=feature

 

The Trump administration told hospitals to stop reporting data to the CDC, and report it to HHS instead. Vice President Mike Pence said the information would continue to be released publicly. It hasn’t worked out as promised.

In mid-July, the Trump administration instructed hospitals to change the way they reported data on their coronavirus patients, promising the new approach would provide better, more up-to-the-minute information about the virus’s toll and allow resources and supplies to be quickly dispatched across the country.

Instead, the move has created widespread confusion, leaving some states in the dark about their hospitals’ remaining bed and intensive care capacity and, at least temporarily, removing this information from public view. As a result, it has been unclear how many people are in hospitals being treated for COVID-19 at a time when the number of infected patients nationally has been soaring.

Hospitalizations for COVID-19 have been seen as a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.

Since early in the pandemic, hospitals had been reporting data on COVID-19 patients to the U.S. Centers for Disease Control and Prevention through its National Healthcare Safety Network, which traditionally tracks hospital-acquired infections.

In a memo dated July 10, the U.S. Department of Health and Human Services told hospitals to abruptly change course — to stop reporting their data to the CDC and instead to submit it to HHS through a new portal run by a company called TeleTracking. The change took effect within days. Vice President Mike Pence said the administration would continue releasing the data publicly, as the CDC had done.

Almost immediately, the CDC pulled its historical data offline, only to repost it under pressure a couple days later. Meanwhile the website for the administration’s new portal promised to update numbers on a daily basis, but, as of Friday morning, the site hadn’t been updated since July 23. (HHS is posting some data daily on a different federal website but not representative estimates for each state.)

“The most pernicious portion of it is that at the state level and at the regional level we lost our situational awareness,” said Dave Dillon, spokesman for the Missouri Hospital Association. “At the end of this, we may have a fantastic data product out of HHS. I will not beat them up for trying to do something positive about the data, but the rollout of this has been absolutely a catastrophe.”

The Missouri Hospital Association had taken the daily data submitted by its hospitals to the CDC and created a state dashboard. The transition knocked that offline. The dashboard came back online this week, but Dillon said in a follow-up email, “the data is only as good as our ability to know that everyone is reporting the same data, in the correct way, for tracking and comparison purposes at the state level.”

Other states, including Idaho and South Carolina, also experienced temporary information blackouts. And The COVID Tracking Project, which has been following the pandemic’s toll across the country based on state data, noted issues with its figures. “These problems mean that our hospitalization data — a crucial metric of the COVID-19 pandemic — is, for now, unreliable, and likely an undercount. We do not think that either the state-level hospitalization data or the new federal data is reliable in isolation,” according to a blog post Tuesday on the group’s website.

Making matters more complicated, the administration has changed the information that it is requiring hospitals to report, adding many elements, such as the age range of admitted COVID-19 patients, and removing others. As of this week, for instance, HHS told hospitals to stop reporting the total number of deaths they’ve had since Jan. 1, the total number of COVID-19 deaths and the total number of COVID-19 admissions. (Hospitals still report daily figures, just not historical ones.)

“Massachusetts hospitals are continuing to navigate the dramatic increase of daily data requirements,” the Massachusetts Health and Hospital Association said in a newsletter on Monday. “MHA and other state health officials continue to raise concerns about the administrative burden and questionable usefulness of some of the data.”

“Hospitals across the country were given little time to adjust to the unnecessary and seismic changes put forth by the U.S. Department of Health and Human Services, which fundamentally shift both the volume of data and the platforms through which data is submitted,” the association’s CEO, Steve Walsh, said in the newsletter.

A number of state websites also noted problems with hospital data. For days, the Texas Department of State Health Services included a note on its dashboard that it was “reporting incomplete hospitalization numbers … due to a transition in reporting to comply with new federal requirements.” That came just as the state was experiencing a peak in COVID-19 hospitalizations.

California likewise noted problems.

A spokesperson for HHS acknowledged some bumps in the transition but said in an email: “We are pleased with the progress we have made during this transition and the actionable data it is providing. We have had some states and hospital associations report difficulty with the new collection system. When HHS identifies errors in the data submissions, we work directly with the state or hospital association to quickly resolve them.

“Our objective with this new approach is to collaborate with the states and the healthcare system. The goal of full transparency is to acknowledge when we find discrepancies in the data and correct them.”

Last week, HHS noted, 93% of its prioritized list of hospitals, excluding psychiatric, rehabilitation and religious nonmedical facilities, reported data at least once during the week. (The guidance to hospitals asks them to report every day.)

Asked about the lack of timely data on its public website, HHS said it will update the site to “make it clear that the estimates are only updated weekly.” HHS is now posting a date file each day on healthdata.gov with aggregate information on hospitalizations by state.

But unlike the prior releases from CDC, which provided estimates on hospital capacity based on the responses, this file only gives totals for the hospitals that reported data. It’s unclear which hospitals did not report, how large they are, or whether the reported data is representative.

It’s also unclear if it’s accurate. New York state, for instance, reported that fewer than 600 people were currently hospitalized with COVID-19, as of Friday. Federal data released the same day pegged the number of suspected and confirmed COVID-19 hospitalizations at around 1,800.

Louisiana says more than 1,500 people are currently hospitalized with COVID-19. The federal data puts the figure at fewer than 700.

Nationally, The COVID Tracking Project reports that more than 56,000 people were hospitalized around the country with the virus, as of Thursday.

The data released by HHS on Friday puts the figure at more than 70,000.

NPR reported this week that it had found irregularities in the process used by the Trump administration to award the contract to manage the hospital data. Among other things, HHS directly contacted TeleTracking about the contract and the agency used a process that is more often used for innovative scientific research, NPR reported.

An HHS spokesperson told NPR that the contract process it used is a “common mechanism … for areas of research interest,” and said that the system used by the CDC was “fraught with challenges.”

Ryan Panchadsaram, co-founder of the tracking website CovidExitStrategy.org, has been critical of the problems created by the hospital data changeover.

“Without real-time accurate monitoring, you can’t make quick and fast and accurate decisions in a crisis,” he said in an interview. “This is just so important. This indicator that’s gone shows how the health system in a state is doing.”

Dillon of the Missouri Hospital Association said the administration could have handled this differently. For big technology projects, he noted, there is often a well-publicized transition with information sessions, an educational program and, perhaps, running the old system and the new one in parallel.

This “was extremely abrupt,” he said. “That is not akin to anything you would expect from HHS about how you would implement a program.”

 

Misinformation on coronavirus is proving highly contagious

https://apnews.com/86f61f3ffb6173c29bc7db201c10f141?utm_source=Sailthru&utm_medium=email&utm_campaign=Newsletter%20Weekly%20Roundup:%20Healthcare%20Dive:%20Daily%20Dive%2008-01-2020&utm_term=Healthcare%20Dive%20Weekender

Misinformation on the coronavirus is proving highly contagious ...

As the world races to find a vaccine and a treatment for COVID-19, there is seemingly no antidote in sight for the burgeoning outbreak of coronavirus conspiracy theories, hoaxes, anti-mask myths and sham cures.

The phenomenon, unfolding largely on social media, escalated this week when President Donald Trump retweeted a false video about an anti-malaria drug being a cure for the virus and it was revealed that Russian intelligence is spreading disinformation about the crisis through English-language websites.

Experts worry the torrent of bad information is dangerously undermining efforts to slow the virus, whose death toll in the U.S. hit 150,000 Wednesday, by far the highest in the world, according to the tally kept by Johns Hopkins University. Over a half-million people have died in the rest of the world.

For most people, the virus causes only mild or moderate symptoms, such as fever and cough. For some older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

Hard-hit Florida reported 216 deaths, breaking the single-day record it set a day earlier. Texas confirmed 313 additional deaths, pushing its total to 6,190, while South Carolina’s death toll passed 1,500 this week, more than doubling over the past month. In Georgia, hospitalizations have more than doubled since July 1.

“It is a real challenge in terms of trying to get the message to the public about what they can really do to protect themselves and what the facts are behind the problem,” said Michael Osterholm, head of the University of Minnesota’s Center for Infectious Disease Research and Policy.

He said the fear is that “people are putting themselves in harm’s way because they don’t believe the virus is something they have to deal with.”

Rather than fade away in the face of new evidence, the claims have flourished, fed by mixed messages from officials, transmitted by social media, amplified by leaders like Trump and mutating when confronted with contradictory facts.

“You don’t need masks. There is a cure,” Dr. Stella Immanuel promised in a video that promoted hydroxychloroquine. “You don’t need people to be locked down.”

The truth: Federal regulators last month revoked their authorization of the drug as an emergency treatment amid growing evidence it doesn’t work and can have deadly side effects. Even if it were effective, it wouldn’t negate the need for masks and other measures to contain the outbreak.

None of that stopped Trump, who has repeatedly praised the drug, from retweeting the video. Twitter and Facebook began removing the video Monday for violating policies on COVID-19 misinformation, but it had already been seen more than 20 million times.

Many of the claims in Immanuel’s video are widely disputed by medical experts. She has made even more bizarre pronouncements in the past, saying that cysts, fibroids and some other conditions can be caused by having sex with demons, that McDonald’s and Pokemon promote witchcraft, that alien DNA is used in medical treatments, and that half-human “reptilians” work in the government.

Other baseless theories and hoaxes have alleged that the virus isn’t real or that it’s a bioweapon created by the U.S. or its adversaries. One hoax from the outbreak’s early months claimed new 5G towers were spreading the virus through microwaves. Another popular story held that Microsoft founder Bill Gates plans to use COVID-19 vaccines to implant microchips in all 7 billion people on the planet.

Then there are the political theories — that doctors, journalists and federal officials are conspiring to lie about the threat of the virus to hurt Trump politically.

Social media has amplified the claims and helped believers find each other. The flood of misinformation has posed a challenge for Facebook, Twitter and other platforms, which have found themselves accused of censorship for taking down virus misinformation.

Facebook CEO Mark Zuckerberg was questioned about Immanuel’s video during an often-contentious congressional hearing Wednesday.

“We did take it down because it violates our policies,” Zuckerberg said.

U.S. Rep. David Cicilline, a Rhode Island Democrat leading the hearing, responded by noting that 20 million people saw the video before Facebook acted.

“Doesn’t that suggest that your platform is so big, that even with the right policies in place, you can’t contain deadly content?” Cicilline asked Zuckerberg.

It wasn’t the first video containing misinformation about the virus, and experts say it’s not likely to be the last.

A professionally made 26-minute video that alleges the government’s top infectious-disease expert, Dr. Anthony Fauci, manufactured the virus and shipped it to China was watched more than 8 million times before the platforms took action. The video, titled “Plandemic,” also warned that masks could make you sick — the false claim Facebook cited when it removed the video down from its site.

Judy Mikovits, the discredited doctor behind “Plandemic,” had been set to appear on the show “America This Week” on the Sinclair Broadcast Group. But the company, which operates TV stations in 81 U.S. markets, canned the segment, saying it was “not appropriate” to air.

This week, U.S. government officials speaking on condition of anonymity cited what they said was a clear link between Russian intelligence and websites with stories designed to spread disinformation on the coronavirus in the West. Russian officials rejected the accusations.

Of all the bizarre and myriad claims about the virus, those regarding masks are proving to be among the most stubborn.

New York City resident Carlos Lopez said he wears a mask when required to do so but doesn’t believe it is necessary.

“They’re politicizing it as a tool,” he said. “I think it’s more to try to get Trump to lose. It’s more a scare tactic.”

He is in the minority. A recent AP/NORC poll said 3 in 4 Americans — Democrats and Republicans alike — support a national mask mandate.

Still, mask skeptics are a vocal minority and have come together to create social media pages where many false claims about mask safety are shared. Facebook has removed some of the pages — such as the group Unmasking America!, which had nearly 10,000 members — but others remain.

Early in the pandemic, medical authorities themselves were the source of much confusion regarding masks. In February, officials like the U.S. surgeon general urged Americans not to stockpile masks because they were needed by medical personnel and might not be effective in everyday situations.

Public health officials changed their tune when it became apparent that the virus could spread among people showing no symptoms.

Yet Trump remained reluctant to use a mask, mocked his rival Joe Biden for wearing one and suggested people might be covering their faces just to hurt him politically. He did an abrupt about-face this month, claiming that he had always supported masks — then later retweeted Immanuel’s video against masks.

The mixed signals hurt, Fauci acknowledged in an interview with NPR this month.

“The message early on became confusing,” he said.

Many of the claims around masks allege harmful effects, such as blocked oxygen flow or even a greater chance of infection. The claims have been widely debunked by doctors.

Dr. Maitiu O Tuathail of Ireland grew so concerned about mask misinformation he posted an online video of himself comfortably wearing a mask while measuring his oxygen levels. The video has been viewed more than 20 million times.

“While face masks don’t lower your oxygen levels. COVID definitely does,” he warned.

Yet trusted medical authorities are often being dismissed by those who say requiring people to wear masks is a step toward authoritarianism.

“Unless you make a stand, you will be wearing a mask for the rest of your life,” tweeted Simon Dolan, a British businessman who has sued the government over its COVID-19 restrictions.

Trump’s reluctant, ambivalent and late embrace of masks hasn’t convinced some of his strongest supporters, who have concocted ever more elaborate theories to explain his change of heart. Some say he was actually speaking in code and doesn’t really support masks.

O Tuathail witnessed just how unshakable COVID-19 misinformation can be when, after broadcasting his video, he received emails from people who said he cheated or didn’t wear the mask long enough to feel the negative effects.

That’s not surprising, according to University of Central Florida psychology professor Chrysalis Wright, who studies misinformation. She said conspiracy theory believers often engage in mental gymnastics to make their beliefs conform with reality.

“People only want to hear what they already think they know,” she said. 

 

 

 

US coronavirus data will now go straight to the White House. Here’s what this means for the world

https://theconversation.com/us-coronavirus-data-will-now-go-straight-to-the-white-house-heres-what-this-means-for-the-world-142814?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20July%2028%202020%20-%201689316298&utm_content=Latest%20from%20The%20Conversation%20for%20July%2028%202020%20-%201689316298+Version+A+CID_abf5f3d50179e225ba3e81ad0fbb430c&utm_source=campaign_monitor_us&utm_term=US%20coronavirus%20data%20will%20now%20go%20straight%20to%20the%20White%20House%20Heres%20what%20this%20means%20for%20the%20world

US coronavirus data will now go straight to the White House ...

Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.

For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.

On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.

Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.

Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”

The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.

In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.

Diminished role

When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.

This diminished role is obvious to former leaders of the CDC, who say their scientific advice has never before been politicised to this extent.

As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.

The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.

The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.

But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.

“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”

What does it mean for the world?

The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.

Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.

This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.

The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources. But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.

This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.

It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.

What happens next?

Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.

In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.

COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.

 

 

 

One question still dogs Administration: Why not try harder to solve the coronavirus crisis?

https://www.washingtonpost.com/politics/trump-not-solve-coronavirus-crisis/2020/07/26/7fca9a92-cdb0-11ea-91f1-28aca4d833a0_story.html?utm_source=ActiveCampaign&utm_medium=email&utm_content=Republicans+Roll+Out+%241+Trillion+Coronavirus+Relief+Plan&utm_campaign=TFT+Newsletter+07272020

Questions to ask students in class to help them deal with the ...

Both President Trump’s advisers and operatives laboring to defeat him increasingly agree on one thing: The best way for him to regain his political footing is to wrest control of the novel coronavirus.

In the six months since the deadly contagion was first reported in the United States, Trump has demanded the economy reopen and children return to school, all while scrambling to salvage his reelection campaign.

But allies and opponents agree he has failed at the one task that could help him achieve all his goals — confronting the pandemic with a clear strategy and consistent leadership.

Trump’s shortcomings have perplexed even some of his most loyal allies, who increasingly have wondered why the president has not at least pantomimed a sense of command over the crisis or conveyed compassion for the millions of Americans hurt by it.

People close to Trump, many speaking on the condition of anonymity to share candid discussions and impressions, say the president’s inability to wholly address the crisis is due to his almost pathological unwillingness to admit error; a positive feedback loop of overly rosy assessments and data from advisers and Fox News; and a penchant for magical thinking that prevented him from fully engaging with the pandemic.

In recent weeks, with more than 145,000 Americans now dead from the virus, the White House has attempted to overhaul — or at least rejigger — its approach. The administration has revived news briefings led by Trump and presented the president with projections showing how the virus is now decimating Republican states full of his voters. Officials have also set up a separate, smaller coronavirus working group led by Deborah Birx, the White House coronavirus response coordinator, along with Trump son-in-law and senior adviser Jared Kushner.

For many, however, the question is why Trump did not adjust sooner, realizing that the path to nearly all his goals — from an economic recovery to an electoral victory in November — runs directly through a healthy nation in control of the virus.

“The irony is that if he’d just performed with minimal competence and just mouthed words about national unity, he actually could be in a pretty strong position right now, where the economy is reopening, where jobs are coming back,” said Ben Rhodes, a deputy national security adviser to former president Barack Obama. “And he just could not do it.”

Many public health experts agree.

“The best thing that we can do to set our economy up for success and rebounding from the last few months is making sure our outbreak is in a good place,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “People are not going to feel comfortable returning to activities in the community — even if it’s allowed from a policy perspective — if they don’t feel the outbreak is under control.”

Some aides and outside advisers have tried to stress to Trump and others in his orbit that before he could move on to reopening the economy and getting the country back to work — and life — he needed to grapple with the reality of the virus.

But until recently, the president was largely unreceptive to that message, they said, not fully grasping the magnitude of the pandemic — and overly preoccupied with his own sense of grievance, beginning many conversations casting himself as the blameless victim of the crisis.

In the past couple of weeks, senior advisers began presenting Trump with maps and data showing spikes in coronavirus cases among “our people” in Republican states, a senior administration official said. They also shared projections predicting that virus surges could soon hit politically important states in the Midwest — including Michigan, Minnesota and Wisconsin, the official said.

This new approach seemed to resonate, as he hewed closely to pre-scripted remarks in a trio of coronavirus briefings last week.

“This could have been stopped. It could have been stopped quickly and easily. But for some reason, it wasn’t, and we’ll figure out what that reason was,” Trump said Thursday, seeming to simultaneously acknowledge his predicament while trying to assign blame elsewhere.

In addition to Birx and Kushner, the new coronavirus group guiding Trump includes Kushner advisers Adam Boehler and Brad Smith, according to two administration officials. Marc Short, chief of staff to Vice President Pence, also attends, along with Alyssa Farah, the White House director of strategic communications, and Stephen Miller, Trump’s senior policy adviser.

The working group’s goal is to meet every day, for no more than 30 minutes. It views its mission as half focused on the government’s response to the pandemic and half focused on the White House’s public message, the officials said.

White House spokeswoman Sarah Matthews defended the president’s handling of the crisis, saying he acted “early and decisively.”

“The president has also led an historic, whole-of-America coronavirus response — resulting in 100,000 ventilators procured, sourcing critical PPE for our front-line heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world,” Matthews said in an email statement. “His message has been consistent and his strong leadership will continue as we safely reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate.”

For some, however, the additional effort is too little and far too late.

“This is a situation where if Trump did his job and put in the work to combat the health crisis, it would solve the economic crisis, and it’s an instance where the correct governing move is also the correct political move, and Trump is doing the opposite,” said Josh Schwerin, a senior strategist for Priorities USA, a super PAC supporting former vice president Joe Biden, the presumptive Democratic nominee.

Other anti-Trump operatives agree, saying he could make up lost ground and make his race with Biden far more competitive with a simple course correction.

“He’s staring in the mirror at night: That’s who can fix his political problem,” said John Weaver, one of the Republican strategists leading the Lincoln Project, a group known for its anti-Trump ads.

One of Trump’s biggest obstacles is his refusal to take responsibility and admit error.

In mid-March, as many of the nation’s businesses were shuttering early in the pandemic, Trump proclaimed in the Rose Garden, “I don’t take responsibility at all.” Those six words have neatly summed up Trump’s approach not only to the pandemic, but also to many of the other crises he has faced during his presidency.

“His operating style is to double- and triple-down on positions and to never, ever admit he’s wrong about anything,” said Anthony Scaramucci, a longtime Trump associate who briefly served as White House communications director and is now a critic of the president. “His 50-year track record is to bulldog through whatever he’s doing, whether it’s Atlantic City, which was a failure, or the Plaza Hotel, which was a failure, or Eastern Airlines, which was a failure. He can never just say, ‘I got it wrong and let’s try over again.’ ”

Another self-imposed hurdle for Trump has been his reliance on a positive feedback loop. Rather than sit for briefings by infectious-disease director Anthony S. Fauci and other medical experts, the president consumes much of his information about the virus from Fox News and other conservative media sources, where his on-air boosters put a positive spin on developments.

Consider one example from last week. About 6:15 a.m. that Tuesday on “Fox & Friends,” co-host Steve Doocy told viewers, “There is a lot of good news out there regarding the development of vaccines and therapeutics.” The president appears to have been watching because, 16 minutes later, he tweeted from his iPhone, “Tremendous progress being made on Vaccines and Therapeutics!!!”

It is not just pro-Trump media figures feeding Trump positive information. White House staffers have long made upbeat assessments and projections in an effort to satisfy the president. This, in turn, makes Trump further distrustful of the presentations of scientists and reports in the mainstream news media, according to his advisers and other people familiar with the president’s approach.

This dynamic was on display during an in-depth interview with “Fox News Sunday” anchor Chris Wallace that aired July 19. After the president claimed the United States had one of the lowest coronavirus mortality rates in the world, Wallace interjected to fact-check him: “It’s not true, sir.”

Agitated by Wallace’s persistence, Trump turned off-camera to call for White House press secretary Kayleigh McEnany. “Can you please get me the mortality rates?” he asked. Turning to Wallace, he said, “Kayleigh’s right here. I heard we have one of the lowest, maybe the lowest mortality rate anywhere in the world.”

Trump, relying on cherry-picked White House data, insisted that the United States was “number one low mortality fatality rates.”

Fox then interrupted the taped interview to air a voice-over from Wallace explaining that the White House chart showed Italy and Spain doing worse than the United States but countries like Brazil and South Korea doing better — and other countries that are doing better, including Russia, were not included on the White House chart. By contrast, worldwide data compiled by Johns Hopkins University shows the U.S. mortality rate is far from the lowest.

Trump is also predisposed to magical thinking — an unerring belief, at an almost elemental level, that he can will his goals into existence, through sheer force of personality, according to outside advisers and former White House officials.

The trait is one he shares with his late father and family patriarch, Fred Trump. In her best-selling memoir, “Too Much and Never Enough,” the president’s niece, Mary L. Trump, writes that Fred Trump was instantly taken by the “shallow message of self-sufficiency” he encountered in Norman Vincent Peale’s 1952 bestseller, “The Power of Positive Thinking.”

Some close to the president say that when Trump claims, as he did twice last week, that the virus will simply “disappear,” there is a part of him that actually believes the assessment, making him more reluctant to take the practical steps required to combat the pandemic.

Until recently, Trump also refused to fully engage with the magnitude of the crisis. After appointing Pence head of the coronavirus task force, the president gradually stopped attending task force briefings and was lulled into a false sense of assurance that the group had the virus under control, according to one person familiar with the dynamic.

Trump also maintained such a sense of grievance — about how the virus was personally hurting him, his presidency and his reelection prospects — that aides recount spending valuable time listening to his gripes, rather than focusing on crafting a national strategy to fight the pandemic.

Nonetheless, some White House aides insist the president has always been focused on aggressively responding to the virus. And some advisers are still optimistic that if Trump — who trails Biden in national polls — can sustain at least a modicum of self-discipline and demonstrate real focus on the pandemic, he can still prevail on Election Day.

Others are less certain, including critics who say Trump squandered an obvious solution — good governance and leadership — as the simplest means of achieving his other goals.

“There is quite a high likelihood where people look back and think between February and April was when Trump burned down his own presidency, and he can’t recover from it,” Rhodes said. “The decisions he made then ensured he’d be in his endless cycle of covid spikes and economic disruption because he couldn’t exhibit any medium- or long-term thinking.”

 

 

 

Cartoon – Pandemic Management

Reflections on an Ad Industry at War With Itself | MediaVillage