Fauci has been an example of conscience and courage.

https://www.washingtonpost.com/opinions/fauci-has-been-an-example-of-conscience-and-courage-trump-has-been-nothing-but-weak/2020/07/13/7c9a7578-c52b-11ea-8ffe-372be8d82298_story.html?fbclid=IwAR0n0o67FMhhUjxqU11cfrd4daMkW0ZWZtIg–I1P3ioLPA7ka7Ew0XT_EA&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Opinion | Fauci has been an example of conscience and courage ...

When historians try to identify the most shameful documents from the Trump administration, a few are likely to stand out. For unconstitutional bigotry, it is hard to beat the initial executive order banning travel to the United States from Muslim countries. For cruelty and smallness, there is the “zero tolerance” directive to federal prosecutors that led to family separations at the border. For naked corruption, there is the transcript of the quid-pro-quo conversation between President Trump and the president of Ukraine.

But for rash, foolish irresponsibility, I’d nominate the opposition research paper recently circulated by the White House in an attempt to discredit the National Institute of Allergy and Infectious Diseases’ Anthony S. Fauci. As reported by The Post, the document recounted a number of instances — on community transmission, asymptomatic transmission and mask wearing in particular — where Fauci’s views have shifted over time. As far as I know, this official record is unique: A White House attack on the government’s leading infectious-disease specialist during a raging pandemic. It indicates an administration so far gone in rage, bitterness and paranoia that it can no longer be trusted to preserve American lives.

From a purely political standpoint, it is understandable that the administration would want to divert attention from its covid-19 record. Trump’s policy of reopening at any cost is exacting a mounting cost. Five months into the greatest health crisis of modern U.S. history, there are still serious problems with supply chains for protective equipment. There are still long wait times for testing results in many places. The contact tracing process in many communities remains (as one health expert described it to me) “a joke.” More than 132,000 Americans have died.

Rather than addressing these failures, Trump has chosen to sabotage a public official who admits their existence. Rather than confronting these problems, Trump wants to ensure his whole administration lies about them in unison. The president has surveyed America’s massive spike in new infections and thinks the most urgent matter is . . . message discipline.

It is true that a number of Fauci’s views on the novel coronavirus have evolved (though some of the administration’s charges against him are distorted). But attacking a scientist for making such shifts is to willfully misunderstand the role of science in the fight against disease. We do not trust public health officials during an emerging pandemic because they have fully formed scientific views from the beginning. We trust them because 1) they are making judgments based on the best available information and 2) they have no other motive than the health of the public. If, say, health officials were initially mistaken about the possibility of asymptomatic transmission, it is not failure when they change their views according to better data. It is the nature of the scientific method and the definition of their duty.

In the inch-deep world of politics, amending your view based on new information is a flip-flop. In epidemiology, it is known as, well, epidemiology.

Meanwhile, the president is failing according to both requirements of public trust. Trump is not making judgments based on the best available information. And he clearly has political goals that compete with (and often override) his commitment to public health. The president is hoping against hope that the public will forget about the virus until November, or at least about the federal role in fighting it. To apply a veneer of normalcy, he is holding public events that endanger his staff and his audience and is planning a Republican convention that will double as a petri dish.

It now seems likely that the most decisive moment of the American pandemic took place in mid-April when new cases began to stabilize around 25,000 a day. Even four or six more weeks of firm presidential leadership — urging the tough, sacrificial application of stay-at-home orders — might have reduced the burden of disease to more sustainable levels, as happened in Western Europe. And this would have relieved stress on systems of testing, tracing and treatment.

But Trump’s nerve failed him. Instead of holding firm, he began siding with populist demands for immediate opening, pressuring governors to take precipitous steps and encouraging skepticism about basic public health information and measures. This may well have been the defining moment of the Trump presidency. And he was weak, weak, weak.

It is typical for Trump to shift blame. But in this case, the president has selected his fall guy poorly. Fauci has been an example of conscience and courage in an administration that values neither. When Trump encourages a contrast to his own selfishness and cravenness, he only damages himself.

 

 

 

 

Americans aren’t pushing to reopen the schools

https://www.axios.com/newsletters/axios-vitals-285240f4-9110-4c86-ad7e-e0c37085a957.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Classroom concerns: WCSD families asked to weigh in on school ...

Most U.S. parents say it would be risky to send their children back to school in the fall — including a slim majority of Republicans and a staggering nine in 10 Black Americans — in this week’s installment of the Axios-Ipsos Coronavirus Index, Axios’ Margaret Talev reports.

Why it matters: President Trump and Education Secretary Betsy DeVos have threatened to withhold federal funds from schools that don’t reopen. The new findings suggest that this pressure campaign could backfire with many of the voters to whom Trump is trying to appeal ahead of the election.

What they’re saying: “Americans at this point, and parents more specifically, can’t be force-fed policies that go against what they think,” says Cliff Young, president of Ipsos U.S. Public Affairs.

  • “You can’t wish away or scare away a virus,” Young says. “And right now, they’re not feeling safe in putting their children back in school.”
  • “There’s political risks as well — serious political risks for Trump and Republicans. Because even the Republican base sees a risk in putting kids back into the school in the fall.”

Driving the news: Officials on Monday began announcing decisions impacting schools in some major metro areas, erring on the side of caution in response to health concerns and parents’ anxieties.

  • In California, school officials announced that public schools in Los Angeles and San Diego will hold online classes only.
  • Gov. Andrew Cuomo said Monday that New York schools will open only if the daily infection rates in their region are below 5% over a 14-day average, and that “we’re not going to use our children as guinea pigs.”

 

 

AdventHealth CEO amid Florida COVID-19 surge: ‘I wouldn’t hesitate to go to Disney’

https://www.beckershospitalreview.com/hospital-management-administration/adventhealth-ceo-amid-florida-covid-19-surge-i-wouldn-t-hesitate-to-go-to-disney.html?utm_medium=email

Record 15,000 new coronavirus cases in Florida as Disney World ...

As Florida recorded more than 15,000 new cases of COVID-19, the CEO of Altamonte Springs, Fla.-based AdventHealth said July 12 he would feel comfortable visiting Walt Disney World Resort, which has opened up two of its parks, according to CBS News.

In an interview on CBS’ “Face the Nation,”  AdventHealth CEO Terry Shaw was asked about the resort’s reopening given that 48 Florida hospitals reached capacity as of July 10.

He told moderator Margaret Brennan: “So as a healthcare provider, my job is to help people do things safely. Whether it’s NASCAR or Disney, we have strategic alliances with those organizations. We work very closely with them to help them determine a way to reopen and do that safely.”

“I will tell you, based upon the way Disney is approaching this — with limiting people in, doing all the screenings that they’re doing, I’m — I personally am a Disney season ticket holder. I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” he said.

Mr. Shaw’s interview occurred the same day Florida reported 15,299 new COVID-19 cases, the largest daily case count set by any state since the beginning of the pandemic, according to NPR .

AdventHealth has about 30 hospitals in the state, and its physicians and sports medicine experts provide support to help racers who are part of runDisney races through Disney theme parks, according to the health system website. The organization has been providing this support for runDisney races for more than 25 years.

AdventHealth also confirmed health system employees are taking temperatures at the gates of the theme parks and the entrances to Disney Springs.

Access Mr. Shaw’s full interview here.

 

 

 

White House goes public with attacks on Fauci

White House goes public with attacks on Fauci

Dr. Anthony Fauci describes his 'very different' relationships ...

Tensions between the White House and Anthony Fauci, the government’s top infectious diseases expert, are spilling into the open as officials openly attack the doctor for his public health advice during the coronavirus pandemic. 

Fauci’s advice has often run contrary to President Trump’s views, and the attacks on Fauci have begun to look like a traditional negative political campaign against an opponent. Yet this time, the opponent is a public health expert and career civil servant working within the administration. 

Dan Scavino, deputy chief of staff for communications, shared a cartoon on his Facebook page late Sunday that depicted Fauci as a faucet flushing the U.S. economy down the drain with overzealous health guidance to slow the spread of the pandemic.

The cartoon, which shows Fauci declaring schools should remain closed and calling for “indefinite lockdowns,” did not accurately portray what Fauci has advised in public.

Adm. Brett Giroir, the administration’s testing czar, downplayed any riff within the White House coronavirus task force before offering some criticism of Fauci.

“I respect Dr. Fauci a lot, but Dr. Fauci is not 100 percent right and he also doesn’t necessarily, and he admits that, have the whole national interest in mind,” Giroir told “Meet the Press” on Sunday. “He looks at it from a very narrow public health point of view.”

There have been tensions between Trump and Fauci throughout the pandemic. The president has repeatedly downplayed the severity of the virus, broken with the advice of his own public health experts and painted rosy but at times misleading pictures of the U.S. response. Fauci, who has served four decades in his current post, has offered blunt talk on the dangers of the pandemic that has directly contradicted the president from time to time.

But the latest criticisms mark a shift as the White House has begun publicly undermining one of the leading public health voices in the administration at a time when multiple states are struggling to get new outbreaks under control.

White House trade adviser Peter Navarro, whom the president tapped to manage the use of the Defense Production Act, said he personally proceeds with caution before heeding Fauci’s advice.

Trump said last week that Fauci is a nice man but that he’s “made a lot of mistakes.”

A White House official this weekend sent media outlets a lengthy list of “mistakes” Fauci has made since the pandemic began, like his comment in March that there is no need for people to wear masks.

That comment came before scientists knew people could spread the virus without showing symptoms, and Fauci, the Centers for Disease Control and Prevention (CDC) and other experts now urge people to use face coverings in public.

Public health experts have leaped to Fauci’s defense on Twitter, noting that Fauci is one of the most respected health experts in the world, having worked for six presidents and researched HIV/AIDS, Ebola, Zika and a variety of other infectious diseases.

“When studies show that, opposite from SARS & MERS, COVID19 is most infectious soon after infection & less infectious later, we recognize asymptomatic transmission and importance of masks,” tweeted Tom Frieden, the former director of the CDC.

“That’s called science, not a mistake. The real, deadly mistake is not listening to science.” 

Ashish Jha, director of the Harvard Global Health Institute, tweeted, “His track record isn’t perfect. It’s just better than anyone else I know. Sidelining Dr. Fauci makes the federal response worse. And it’s the American people who suffer.”

Polls still show the public trusts Fauci more than Trump for accurate information on the virus, with Democrats more likely than Republicans to believe the infectious diseases expert.

White House press secretary Kayleigh McEnany during a “Fox & Friends” interview Monday insisted Fauci’s recommendations were reaching Trump, while saying he represented only “one viewpoint” among many considered by the president.

“The point of the task force is to be a whole of government look at what is best for this country,” McEnany said when asked about the status of the relationship between Trump and Fauci. “Dr. Fauci is one member of a team, but rest assured, his viewpoint is represented and the information gets to the president through the task force.”

Still, Fauci’s public appearances became few and far between as his dire warnings about the state of the pandemic in the U.S. increasingly clashed from more hopeful messages coming from the White House. 

Fauci also told the Financial Times last week that he hadn’t briefed Trump in two months, in which time a growing number of states have experienced significant surges in cases.

Fauci was not present at the White House coronavirus task force media briefing last week, events that have become rarer even as the COVID crisis grows worse.

And while he was a regular on cable news in the early days of the pandemic, his appearances have dwindled, a fact he said last week could be because of his “honesty.” 

While Fauci has warned that the U.S. could hit 100,000 new COVID-19 cases per day if steps aren’t taken to alter the trajectory of the outbreaks, Trump has tied the rise in cases to increased testing. 

While Fauci attributed outbreaks in some states to reopening too quickly after the spring lockdowns, Trump and his top allies have mostly stood by their decision to push governors to jump over checkpoints set by the White House.

Fauci has refuted the president’s claims that the rise in cases is solely tied to increased testing and that 99 percent of cases are “totally harmless.” 

And as Trump touted a falling COVID-19 death rate, which is actually now increasing, Fauci has said the U.S. shouldn’t take comfort in the “false narrative,” noting the disease can cause other severe health outcomes. 

Fauci’s warnings grew more urgent last week when he warned that the U.S. is “facing a serious problem” and the pandemic has become politicized. 

“And you know from experience historically that when you don’t have unanimity in an approach to something, you’re not as effective in how you handle it,” Fauci said in an interview with FiveThirtyEight. “So I think you’d have to make the assumption that if there wasn’t such divisiveness, that we would have a more coordinated approach.”

 

 

 

 

We’re losing the war on the coronavirus

https://www.axios.com/coronavirus-losing-war-b36632fb-33b0-4cb0-84b2-14000841d89c.html

We're losing the war on the coronavirus - Axios

By any standard, no matter how you look at it, the U.S. is losing its war against the coronavirus.

Why it matters: The pandemic is not an abstraction, and it is not something that’s simmering in the background. It is an ongoing emergency ravaging nearly the entire country, with a loss of life equivalent to a Sept. 11 every three days — for four months and counting.

The big picture: “The part that really baffles me is the complete lack of interest in doing anything to achieve the goals we all agree on,” said Ashish Jha, the director of the Global Health Institute at Harvard.

  • Everyone wants to be able to safely reopen schools and see their friends and leave the house. To do those things safely, you have to get the virus under control. But much of America is talking and planning like victors at the precise moment we’re in the throes of defeat.

Seven times over the last two weeks, the U.S. has set a new record for the most cases in a single day. Cases are increasing in 33 states, and several of those states are seeing such staggering increases that they may soon overwhelm their hospitals.

  • No, those increases are not just a reflection of better testing. And though testing has dramatically improved, it’s still not enough to meet demand.
  • The peak of the U.S.’ coronavirus vigilance is in the past, but the peak of the virus’ actual spread is happening right now.

Yes, but: Public health experts say they’re optimistic that we’ll get our act together.

  • “It’s certainly within our power to turn things around. Whether or not we will depends on whether our political leaders will commit themselves to it,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. “If they’re able to get on the same page as the evidence, then I think they can avoid shutdowns.”

It’s true — and it’s good — that the percentage of all coronavirus patients who die seems to be falling. And experts hope that will hold, as the pool of infected people is skewing younger.

  • But “I don’t know that I take much comfort in this, knowing that thousands of people are going to die in the coming days and weeks and it was all preventable,” Jha said.
  • The virus has already killed over 130,000 people in the U.S. — roughly the population of Charleston, S.C. And deaths are now beginning to rise in the places experiencing big outbreaks.
  • Patients who don’t die can still experience lasting, painful symptoms, including damage to the lungs, heart, immune system and even the brain, after they leave the hospital.

What’s next: The optimistic view is that the pandemic just had to get worse before it gets better — that people outside of the New York region may not have taken it seriously enough in the early days when it was concentrated there, but that they will now.

The bottom line: “I think there’s a lot we can still do to turn around, and i’m still hopeful we are going to get more leadership to fight this thing,” Jha said. “I think we’re going to have to relearn the lessons of March and April and New York, without the ability to say, ‘Oh that was just New York.’ “It’s going to be a painful summer.”

 

 

 

 

COVID-19 surge pushes US toward deadly cliff

COVID-19 surge pushes US toward deadly cliff

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The coronavirus is spreading at ever-faster rates in a broad array of states, putting the U.S. on the precipice of an explosion of illness that threatens to overwhelm the nation’s health care system.

The painful economic lockdowns imposed in March gave the country time to flatten the epidemiological curve and contain the virus. But that window of opportunity, which came at great economic cost, is quickly slamming shut. Health experts say all signs point to a deadly summer and fall unless government leaders implement a much more robust national strategy.

The breadth of the spread is staggering. Forty-three states have seen the number of cases confirmed on an average day increase in the last two weeks. The number of patients in hospitals has risen over the same period in 29 states. More than 80 percent of intensive care beds are occupied in Alabama, Arizona and Georgia.

The same models that predicted surges in Phoenix, Houston and Miami now show a new and broader round of cities as the likely next epicenters. The number of confirmed cases is likely to rise substantially in places like Atlanta, Kansas City, Mo., Tulsa, Okla., and Greenville, S.C.

The virus also appears to be traveling north along the I-95 corridor. Cities like Philadelphia and Baltimore, which struggled through earlier peaks of viral transmission, are now seeing early signs of a second wave. Transmissions even appear to be rising in New York City.

On the other side of the country, outbreaks in California have grown to unprecedented proportions. The Golden State is now averaging more than 7,900 new cases a day, substantially more than its seven-day average just two weeks ago.

Public health experts warn that the U.S. has only a fleeting window in which to wrestle the virus back under some form of control. Without a stronger national response, including restrictions on large gatherings and requirements that people wear masks in public, the risk of a second peak could bring new lockdowns and more economic harm, derail the beginning of the new school year and even overwhelm local health systems.

“Our projections show that without immediate actions to significantly reduce travel and social distancing nationwide, this virus will not only threaten our ability to reopen schools in the coming weeks, but our capacity to care for the sickest individuals,” said David Rubin, director of PolicyLab at the Children’s Hospital of Philadelphia whose models forecast higher case counts.

More than 3.1 million Americans have tested positive for the virus, though the Centers for Disease Control and Prevention estimate that as many as 25 million people in the U.S. may have contracted it. More than 133,000 people have died, almost twice as many victims as in Brazil, the second-hardest hit country.

Cities that successfully avoided early explosions of cases are now in the crosshairs after the loosening of restrictions in some states and regions that helped avoid what studies have suggested would have been tens of millions of infections.

“I would be lying if I didn’t say I was concerned,” Kansas City, Mo., Mayor Quintin Lucas said in an interview. “We have looked at the trends out of Texas, Arizona and Florida. Those states kind of reflect the political choices that were made statewide in Missouri, and that does give us concern.”

The Kansas City metropolitan area has confirmed more than 10,000 coronavirus cases. The PolicyLab model shows Jackson County, Mo., is likely to experience more than 200 new cases every day by the beginning of August.

Rubin warned that smaller cities are likely to experience significant outbreaks in the coming weeks, potentially straining health systems that are not as prepared to handle a high volume of patients in need of intensive care. College towns like South Bend, Ind., and Tuscaloosa, Ala., are beginning to see case counts rise even with most students gone.

“We’re starting to see a mild uptick,” said James Mueller, South Bend’s mayor. “We’re in a much better position now than we were for the first increase or the first peak.”

At other levels of government, some who have sought to downplay the severity of the American outbreak have pointed to an increasing number of tests being conducted across the country, which they say will naturally lead to identification of those who have only minor symptoms or asymptomatic cases. But the number of cases is rising faster than would be accounted for by the increase in testing; the share of tests coming back positive is rising in 38 states.

More than a quarter of tests conducted in Arizona are coming back positive, according to state data. More than 15 percent of tests are coming back positive in Alabama, Florida, Mississippi, South Carolina and Texas.

Governors in 23 states have ordered residents to wear masks in public, though President Trump has refused to order a nationwide mask mandate. Trump has instead focused on reopening the economy, insisting that schools operate as normal in the months before he faces voters in November.

But public health experts argue action is needed now to avoid a second peak of tsunami-like proportions.

“We never gave communities a real chance at success as we lacked a national strategy around masking and limiting gathering sizes to act as a buffer as places reopened,” Rubin and his colleagues Gregory Tasian and Jing Huang wrote.

“So, do we admit that we’ve failed and try to salvage the reopening of our schools in fall by quickly enacting a national approach to pause all reopenings and try to get our country back onto stable footing?” he asked. “It may not be what people want to hear, but the situation is that dire that we need to consider this.”

 

 

 

 

More young people are getting — and spreading — the coronavirus

https://www.axios.com/coronavirus-young-people-spread-5a0cd9e0-1b25-4c42-9ef9-da9d9ebce367.html

More young people are getting — and spreading — the coronavirus ...

More young people are being infected with the coronavirus, and even though they’re less likely to die from it, experts warn the virus’ spread among young adults may further fuel outbreaks across the United States.

Why it matters: Some people in their 20s and 30s face serious health complications from COVID-19, and a surge in cases among young people gives the virus a bigger foothold, increasing the risk of infection for more vulnerable people.

  • We may see a pattern of younger people being affected initially, but then, in a number of weeks from now, we’re going to see a more deadly pandemic spreading to elderly people,” says Alison Galvani, an epidemiologist at Yale University.

People can transmit the virus without knowing they have it, and younger people, in particular, could be unknowingly spreading the disease.

  • A study in Italy, yet to be peer reviewed, found the probability of having symptoms increased with age and that among 20–39-year-olds only about 22% had a fever or respiratory symptoms (compared to about 35% of 60–79-year-olds).
  • About half of the clusters in a study in Japan were traced back to people ages 20–39 at karaoke bars, offices and restaurants — and 41% of them did not have symptoms at the time.
  • “Younger people are at lower risk for serious COVID outcomes but are disproportionately responsible for asymptomatic transmission,” says Galvani, who published a study earlier this week that found the majority of COVID-19 transmission is from silent carriers who are pre-symptomatic or asymptomatic.

By the numbers: From Arizona to Allegheny County, Pa., young people increasingly account for COVID-19 cases.

  • In the county of Los Angeles, nearly 50% of cases are now in people under 40 (compared to about 30% in April), per the LA Times.
  • In Harris County, Texas, home to Houston, 43% of the 40,000 cases are in people ages 20–39, as of yesterday.
  • In Florida, the median age of confirmed cases is hovering in the mid- to late-30s, compared to age 65 in March.

And the proportion of young people hospitalized for COVID-19 has also grown.

  • 40% of hospitalizations for COVID-19 at the end of June were for people 18–49-years-old, compared to 26% at the end of March, according to the COVID-NET database of hospitalizations in 14 states that represent about 10% of the U.S. population.

Between the lines: Yes, young people are going to bars and parties — but also to work.

  • 42% of people ages 18–39 said they had socialized without social distancing compared to 26% of people over 40, in a survey last month from the Democracy Fund + UCLA Nationscape.
  • 64% of frontline workers (grocery store clerks, health care workers, delivery drivers and other essential workers) are under 50.
  • There’s a need for better education so that young people choose to take steps to prevent infection, says Lauren Ancel Meyers, a mathematical epidemiologist at UT Austin.
  • “But it also might come down to policies or regulations that get employers to ensure they are providing a safe workplace or resources to protect 20, 30 and other age groups that are working for them.”

Where it stands: Young people are still much less likely to be hospitalized or die from the virus than people older than 60.

  • Yes, but: They can and do get very sick with the disease — from dangerous blood clots in their lungs to inflammation of the heart, lungs and even brain.
  • And the long-term consequences are unknown.
  • The risk is higher for young people of color: For example, the majority of coronavirus hospitalizations among Latino/Hispanic Americans are in people ages 18–49, my Axios colleague Caitlin Owens reported.

“The death rate among the young is not zero, and it is particularly not zero for people who have at least one co-morbid condition. This is not a completely benign disease of the young.”

— Joshua Schiffer, of the Fred Hutchinson Cancer Center

What to watch: “If hospitals are strained now dealing with younger cases, they are going to be all the more taxed when the age distribution of infections shifts to the elderly,” Galvani says.

 

 

 

 

 

Our new default coronavirus strategy: herd immunity

https://www.axios.com/newsletters/axios-vitals-8f089110-bdd3-440e-9f8a-d8e431e2e18e.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

The U.S.'s new default coronavirus strategy: herd immunity - Axios

By letting the coronavirus surge through the population with only minimal social distancing measures in place, the U.S. has accidentally become the world’s largest experiment in herd immunity.

Why it matters: Letting the virus spread while minimizing human loss is doable, in theory. But it requires very strict protections for vulnerable people, almost none of which the U.S. has established.

The big picture: Cases are skyrocketing, with hospitalizations and deaths following suit in hotspots. Not a single state has ordered another lockdown, even though per capita cases in Florida and Arizona have reached levels similar to New York and New Jersey’s in April.

  • Most states never built up the testing, contact tracing and isolation systems it would take to prevent the virus from spreading widely.
  • The Trump administration is generally ignoring or downplaying soaring caseloads across the South and West, and is pushing schools to fully reopen in the fall.
  • In Florida, where infections, hospitalizations and deaths are surging, Gov. Ron DeSantis “has repeatedly ruled out a sweeping mask mandate or taking the state back into a lockdown to stem the virus, although local governments have acted on their own,” per Bloomberg.

Between the lines: Separating older, sicker people from younger, healthier ones while the virus burns through the latter group could be a way to achieve herd immunity — assuming immunity exists — without hundreds of thousands of people dying.

  • But the U.S. hasn’t adopted such a strategy with any planning or foresight. Although younger people make up a larger portion of coronavirus cases now than they did earlier in the pandemic, vulnerable people still go to work or live with non-vulnerable people.

Yes, but: Some cities and states, particularly in the Northeast, are focused on containing the virus rather than living with it.

 

 

 

 

Trump sidelines public health advisers in growing rift over coronavirus response

https://www.washingtonpost.com/health/trump-sidelines-public-health-advisers-in-growing-rift-over-coronavirus-response/2020/07/09/ad803218-c12a-11ea-9fdd-b7ac6b051dc8_story.html?fbclid=IwAR0MI5VGiJQmUsyEpzYDj09Q0VVxxYMlHwx-UjfHdmMu1PdGD6uIzv8R2fM&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

The Health 202: Health officials promise to ramp up pandemic ...

The June 28 email to the director of the Centers for Disease Control and Prevention was ominous: A senior adviser to a top Health and Human Services Department official accused the CDC of “undermining the President” by putting out a report about the potential risks of the coronavirus to pregnant women.

The adviser, Paul Alexander, criticized the agency’s methods, and said its warning to pregnant women “reads in a way to frighten women . . . as if the President and his administration can’t fix this and it is getting worse.”

As the country enters a frightening phase of the pandemic with new daily cases surpassing 62,000 on Wednesday, the CDC, the nation’s top public health agency, is coming under intense pressure from President Trump and his allies, who are downplaying the dangers in a bid to revive the economy ahead of the Nov. 3 election. In a White House guided by the president’s instincts, rather than by evidence-based policy, the CDC finds itself forced constantly to backtrack or sidelined from pivotal decisions.

The latest clash between the White House and its top public health advisers erupted Wednesday, when the president slammed the agency’s recommendation that schools planning to reopen should keep students’ desks six feet apart, among other steps to reduce infection risks. In a tweet, Trump — who has demanded schools at all levels hold in-person classes this fall — called the advice “very tough & expensive.”

“While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!” Trump tweeted Wednesday. Within hours, Vice President Pence had asserted the agency would release new guidance next week.

“The president said today we just don’t want the guidance to be too tough,” Pence told reporters. “And that’s the reason next week the CDC is going to be issuing a new set of tools.”

Analysts say the deepening divide is undermining the authority of one of the world’s premier public health agencies, which previously led fights against malaria, smallpox and HIV/AIDS. Amid the worst public health crisis in a century, the CDC has in recent months altered or rescinded recommendations on topics including wearing masks and safely reopening restaurants and houses of worship as a result of conflicts with top administration officials.

“At a time when our country needs an orchestrated, all-hands-on deck response, there is simply no hand on the tiller,” said Beth Cameron, former senior director for global health security and biodefense on the White House National Security Council.

In the absence of strong federal leadership, state and local officials have been left to figure things out for themselves, leading to conflicting messaging and chaotic responses. Trump’s decision to pull the U.S. out of the World Health Organization further undermined efforts to influence global strategies against the coronavirus, including how vaccines will be distributed.

The CDC, meanwhile, is increasingly isolated — a function both of its growing differences with the White House and of its own significant missteps earlier in the outbreak.

Those stumbles include the botched rollout of test kits likely contaminated at a CDC lab in late January, which led to critical delays in states’ ability to know where the virus was circulating. And the CDC’s initial decision to test only a narrow set of people gave the virus a head start spreading undetected across the country.

During a May lunch with Senate Republicans, Trump told the group the CDC “blew it” on the coronavirus test and that he’d installed a team of “geniuses” led by his son-in-law Jared Kushner to handle much of the response,” according to two people familiar with the lunch who spoke on the condition of anonymity.

“There is a view the CDC is staffed with deep state Democrats that are trying to tweak the administration,” said one adviser who also spoke on the condition of anonymity to reveal private conversations.

White House officials, who see the president’s reelection prospects tied to economic recovery, also say they’ve been deeply frustrated by what they view as career staffers at the agency determined “to keep things closed,” according to a senior administration official who spoke on the condition of anonymity to reveal internal deliberations.

Trump believes the CDC is “ineffective” and a “waste of time,” but doesn’t blame CDC Director Robert Redfield and generally likes him, said another official speaking on the condition of anonymity. “He just thinks he is a poor communicator,” the official added.

Joe Grogan, former head of the White House Domestic Policy Council, said Redfield had fans inside the White House who work on “addiction issues, on life issues, on HIV issues,” among other topics.

But he said Redfield has few political appointees to help him run a complex agency. “How do you run a place like that with … [few] appointees?” Grogan asked.

HHS Secretary Alex Azar called the director “a key scientific guide for the President and his administration, a trusted source for the American people, and a closely engaged partner of state and local governments.”

But Redfield is not a voice in coronavirus task force meetings, and “is never really in the Oval [Office] with the president,” said another senior administration official, who also spoke on the condition of anonymity to discuss the internal dynamics.

Even Redfield’s supporters say he has failed to be an effective advocate for the agency.

“Bob Redfield’s commitment to public health is completely strong,” said William Schaffner, a veteran infectious-disease specialist at Vanderbilt University. But he said Redfield lacks the standing, deftness, and communication capacity to persuade skeptical audiences, including those in the White House, that protecting public health and fostering economic recovery are not opposing goals.

Redfield, for his part, downplayed Trump’s criticism of the CDC school reopeniing guidelines after a coronavirus task force briefing Wednesday, saying the agency and the president were “totally aligned.”

“We’re both trying to open the schools,” he said.

White House spokesman Judd Deere also disputed big differences, saying in a statement the White House and the CDC “have been working together in partnership since the very beginning of this pandemic to carry out the President’s highest priority: the health and safety of the American public.

“The CDC is the nation’s trusted health protection agency and its infectious disease and public health experts have helped deliver critical solutions to save lives. We encourage all Americans to continue to follow the CDC’s guidelines and use best-practices they have learned, such as social distancing, face coverings, and good hygiene, to maintain public health and continue our Transition to Greatness.”

But some health experts were indignant the agency had been ordered to rewrite guidance to reopen schools to “make it easier and cost less” — a demand that effectively “turns science on its head,” said Tom Inglesby, director of Johns Hopkins University’s Center for Health Security.

“CDC should be giving their best judgments on how to lower risks to make schools safer,” he said. “That’s their job. If they aren’t allowed to do that, the public will lose confidence in the guidance.”

Why are they ‘not shouting “fire”?’

The diminished role of the 74-year-old agency has bewildered infectious-disease experts, as well as members of the public seeking guidance.

After six states set one-day case records on July 3, Carlos del Rio, executive associate dean at Emory University’s School of Medicine, tweeted at Tom Frieden, a former CDC director, “Tom, where is @CDCgov ? Why are they not out there shouting ‘fire’?”

Frieden shot back: “They are still there, still doing great work, just not being allowed to talk about it, not being allowed to guide policy, not being allowed to develop, standardize, and post information that would give, by state and county, the status of the epidemic and of our control measures.”

Jeffrey Duchin, the health officer at Seattle and King County health department, added: “Agree. Muzzled, neutered and exiled.”

The agency has been largely invisible. After more than three months of silence, it resumed briefings for the public last month. There have been two.

By comparison, when the H1N1 swine flu pandemic hit the United States in the spring of 2009, the CDC held briefings almost every day for six consecutive weeks.

During this outbreak, the agency’s regular briefings ended abruptly after White House officials were angered when a top CDC leader warned that Americans could face “significant disruption” to their lives as a result of the virus’s spread to the United States.

CDC officials say they are still getting their message out, pointing to more than 2,000 documents providing pandemic-related information about reopening and staying safe for dozens of groups and venues, including funeral home directors, amusement parks, and pet owners. Each Friday, the CDC also posts CovidView, a weekly report of selected data and trends on testing, hospitalizations, and reported deaths.

But the information is posted without additional explanation or analysis.

“I want to hear a real person give me three minutes based on these findings,” said del Rio, also a global health and infectious-disease professor at Emory. “I want to see them in the news, being interviewed, giving us the data.”

Scientists at the CDC and former colleagues speak of deep frustration and low morale over its inability to fully share and explain scientific and medical information.

Researchers are fearful for their jobs and want to protect the integrity of the data they release. “If you want to say something, you’re thinking, ‘what’s the White House going to say and how are they going to use it,’ ” said one longtime scientist who spoke on the condition of anonymity for fear of retaliation.

The lack of briefings has fostered misunderstandings at times. In early April, for instance, when the agency reversed its position and recommended the use of cloth face coverings, CDC scientists gave no public briefings explaining why they made the change.

“It’s not rocket science,” said Nancy Cox, a virologist and former CDC official who led the influenza program for 22 years and was part of the agency’s response during the 2009 H1N1 swine flu pandemic. “But the reasoning behind those changes should be explained as clearly as possible and then you can get everyone on board.”

In the CDC’s absence, academic medical centers, public health and professional disease groups have filled the void by holding coronavirus briefings and providing analysis of key issues, data and research studies. Frieden, the president of Resolve to Save Lives, a New York nonprofit, has also been posting long Twitter threads analyzing the weekly CDC data released on Fridays.

Speaking ‘with an unfettered voice’

Alarmed at the agency’s diminished role, nearly 350 public health organizations sent a letter Tuesday to Azar urging him to advocate for the CDC. The agency must be allowed to speak based on the best available science “and with an unfettered voice,” said John Auerbach, president and chief executive of Trust for America’s Health, a public health nonprofit that led the effort.

House Democrats echoed those concerns in a separate letter to Azar last month. Reps. Diana DeGette of Colorado and Frank Pallone Jr. of New Jersey, who chairs the House Energy and Commerce Committee, said they were troubled by reports that administration officials are considering narrowing the CDC’s mission and embedding more political appointees at the Atlanta-based agency.

Traditionally the CDC has one political appointee, the director. Now it has Redfield and five other political appointees, including two advisers who were added in recent weeks.

“Now more than ever, the American people need a robust and effective CDC that is not repeatedly undermined by others in the administration, including the President and the Vice President,” the letter said.

White House Chief of Staff Mark Meadows views the agency as a problem and has criticized the CDC repeatedly to other administration officials, said a senior administration official.

White House and HHS officials are discussing what the CDC’s “core mission needs to be,” said one adviser familiar with the talks who spoke on the condition of anonymity to comment on policy deliberations. The discussions were first reported by Politico.

Over the years, the agency that was founded to fight malaria now works on virtually every aspect of public health. “It has tried to be everything to everyone,” the adviser said, suggesting the agency might need to refocus more narrowly.

On the global front, administration officials are also weighing a $2.5 billion initiative called the President’s Response to Outbreaks that would move a significant portion of national and international pandemic responses to the State Department, according to a draft obtained by The Post. Details were first reported by Devex.

“There is no clear leadership role for CDC” in this plan, said Jennifer Kates, a senior vice president for global health and HIV policy at the Kaiser Family Foundation. “In global health, you need an engaged CDC.”

Taken together, the administration efforts seem “designed to position CDC to the margins,” said one federal health official who spoke on the condition of anonymity for fear of retaliation.

‘Boogeyman where there aren’t any’

The report that drew the email attack, accusing the agency of undermining the president, had provided detailed but incomplete information about pregnancy risks related to the coronavirus. It found pregnant women with covid-19 were more likely to be hospitalized, admitted to an intensive care unit, and to need ventilator support than infected women who are not pregnant.

The sender, Alexander, a specialist in health research methods, is a senior adviser to Michael Caputo, a longtime Trump ally who was recently appointed assistant HHS secretary for public affairs , which includes the CDC.

The email was directed to Redfield and Caputo.

Even amid the intense criticism of the agency, the email “crosses the line,” said the official, who was aware of the content.

Like all of the CDC’s reports, the analysis itself noted several limitations. One key one that researchers acknowledged was that they did not have data to indicate whether the pregnant women were hospitalized because of labor and delivery, or because they had covid-19.

Administration officials are “seeing political boogeymen where there aren’t any,” the federal health official said, adding that such narratives could further hamper the U.S. response.

“It could feed the fire to limit the flow of scientific data and communication to the general population,” the official said. “People are getting sick and dying. Can we just focus on the science?”

Alexander said in his email that the lack of data about why women were hospitalized was a “key issue.”

“The CDC is undermining the President by what they put out, this is my opinion and sense, and I am reading it and can see the subtle and direct hits,” he wrote.

Alexander, also a part-time assistant professor at McMaster University in Hamilton, Ontario, did not respond to emails and telephone calls seeking comment.

Caputo said in an interview that he agreed with Alexander. The CDC represents itself as the gold standard for public health agencies, he said, “but in the case of pregnancy analysis, it wasn’t even bronze.”

He called CDC’s track record “spotty” and “questionable,” pointing to Zika diagnostic testing errors in 2016.

“In many cases over the years, regardless of administration, the CDC has undermined presidents and themselves,” Caputo said, referring to leaked drafts of CDC guidances. “Who says the CDC is the sole font of wisdom when it comes to detecting and fighting deadly pathogens?”

Experts say that even with some big unanswered questions, the pregnancy findings represent the best available evidence and are important. The lack of data reflects decades of long-neglected national surveillance on pregnancy.

“I don’t think this is frightening women,” said Denise Jamieson, who heads the obstetrics and gynecology department at Emory University and Emory Healthcare. True, the report “suffers from completeness of data,” she said. But now doctors can be more confident that pregnant women are more likely to have severe disease and use “this really important information” to counsel patients, she said.