A top vaccine doctor who was ousted from his position in April is expected to testify Thursday that the Trump administration was unprepared for the coronavirus, and that the U.S. could face the “darkest winter in modern history” if it doesn’t develop a national coordinated response, according to prepared testimony first obtained by CNN.
The big picture: Rick Bright, the former head of the Biomedical Advanced Research and Development Authority (BARDA), will tell Congress that leadership at the Department of Health and Human Services ignored his warnings in January, February and March about a potential shortage of medical supplies.
He will testify that HHS “missed early warning signals” and “forgot important pages from our pandemic playbook” early on — but that “for now, we need to focus on getting things right going forward.”
Bright’s testimony also reiterates claims from a whistleblower report he filed last week that alleges he was ousted over his attempts to limit the use of hydroxychloroquine — an unproven drug touted by President Trump — to treat the coronavirus.
What he’s saying: Bright will testify he urged HHS to ramp upproduction of
masks, respirators and medical supplies as far back as January. Those warnings were dismissed, Bright says, and he was “cut out of key high-level meetings to combat COVID-19.”
“I continue to believe that we must act urgently to effectively combat this deadly disease. Our window of opportunity is closing. If we fail to develop a national coordinated response, based in science, I fear the pandemic will get far worse and be prolonged, causing unprecedented illness and fatalities.”
Bright will call for a national strategy to combat the virus, including “tests that are accurate, rapid, easy to use, low cost, and available to everyone who needs them.”
“Without clear planning and implementation of the steps that I and other experts have outlined, 2020 will be darkest winter in modern history.”
President Trump claimed at a press briefing Monday that any American who “wants” a coronavirus test can get one — contradicting his testing coordinator Adm. Brett Giroir, who just moments earlier said that tests are mostly reserved for people who “need” one because they present symptoms or are participating in contact tracing.
Why it matters: Trump used the briefing largely to celebrate the country’s success in ramping up testing capacity, at one point boasting that “we have met the moment and we have prevailed” in regards to testing. But questions still remain about how Americans will be able to safely return to work if asymptomatic people don’t have access to testing.
Between the lines: The White House, meanwhile, has proven to be a microcosm of what a country with high-quality testing, surveillance and isolation capability can look like.
Giroir explained that people who are in close contact with the president are tested regularly using the 15-minute Abbotts lab device, even if they’re asymptomatic.
This is how the White House was able to diagnose Pence press secretary Katie Miller and isolate officials like Anthony Fauci who came into contact with her.
What they’re saying: “Right now in America, anybody who needs a test gets a test in America, with the numbers we have,” Giroir said. “If you’re symptomatic with a respiratory illness, that is an indication for a test and you can get a test. If you need to be contact traced, you can get a test.”
“And we hope — not hope — we are starting to have asymptomatic surveillance, which is very important. Again, that’s over 3 million tests per week. That is sufficient for everyone who needs a test — symptomatic, contact tracing and, to our best projections, the asymptomatic surveillance we need.”
“I think we have been clear all along that we believe and the data indicate we have enough testing to do the phase one gradual reopening that has been supported in the president’s plan and the task force’s plan. It has to be a phased reopening.”
Earlier in the briefing, when asked when Americans can get tested every day like White House senior staff can, Trump responded: “Very soon.”
He later said: “If people want to get tested, they get tested. We have the greatest capacity in the world, not even close. If people want to get tested they get tested, but for the most part, they shouldn’t want to get tested.”
“There is no reason. They feel good. They don’t have sniffles. They don’t have sore throats. They don’t have any problem.”
The bottom line: Trump and Giroir’s statements blurred the line between two different concepts, as The Daily Beast’s Sam Stein points out. People who “need” a test because they have symptoms or were in contact with an infected person can get one, but the number of tests “needed” to safely reopen the country is not yet sufficient.
Ubiquity of social media has made it easier to spread or even create COVID-19 falsehoods, making the work of public health officials harder.
This is part of our Coronavirus Update series in which Harvard specialists in epidemiology, infectious disease, economics, politics, and other disciplines offer insights into what the latest developments in the COVID-19 outbreak may bring.
When a disease outbreak grabs the public’s attention, formal recommendations from medical experts are often muffled by a barrage of half-baked advice, sketchy remedies, and misguided theories that circulate as anxious people rush to understand a new health risk.
The current crisis is no exception. The sudden onset of a new, highly contagious coronavirus has unleashed what U.N. Secretary-General António Guterres last week called a “pandemic of misinformation,” a phenomenon that has not gone unnoticed as nearly two-thirds of Americans said they have seen news and information about the disease that seemed completely made up, according to a recent Pew Research Center study.
What distinguishes the proliferation of bad information surrounding the current crisis, though, is social media. Kasisomayajula “Vish” Viswanath, Lee Kum Kee Professor of Health Communication at the Harvard T.H. Chan School of Public Health, said the popularity and ubiquity of the various platforms means the public is no longer merely passively consuming inaccuracies and falsehoods. It’s disseminating and even creating them, which is a “very different” dynamic than what took place during prior pandemics MERS and H1N1.
The sheer volume of COVID-19 misinformation and disinformation online is “crowding out” the accurate public health guidance, “making our work a bit more difficult,” he said.
“Misinformation could be an honest mistake or the intentions are not to blatantly mislead people,” like advising others to eat garlic or gargle with salt water as protection against COVID-19, he said. Disinformation campaigns, usually propagated for political gain by state actors, party operatives, or activists, deliberately spread falsehoods or create fake content, like a video purporting to show the Chinese government executing residents in Wuhan with COVID-19 or “Plandemic,” a film claiming the pandemic is a ruse to coerce mass vaccinations, which most major social media platforms recently banned.
In order to be effective, especially during a crisis, public health communicators have to be seen as credible, transparent, and trustworthy. And there, officials are falling short, said Viswanath.
“People are hungry for information, hungry for certitude, and when there is a lack of consensus-oriented information and when everything is being contested in public, that creates confusion among people,” he said.
“When the president says disinfectants … or anti-malaria drugs are one way to treat COVID-19, and other people say, ‘No, that’s not the case,’ the public is hard-pressed to start wondering, ‘If the authorities cannot agree, cannot make up their minds, why should I trust anybody?’”
Mainstream media coverage has added to the problem, analysts say. At many major news outlets, reporters and editors with no medical or public health training were reassigned to cover the unfolding pandemic and are scrambling to get up to speed with complex scientific terminology, methodologies, and research, and then identify, as well as vet, a roster of credible sources. Because many are not yet knowledgeable enough to report critically and authoritatively on the science, they can sometimes lean too heavily on traditional journalism values like balance, novelty, and conflict. In doing so, they lift up outlier and inaccurate counterarguments and hypotheses, unnecessarily muddying the water.
“People are hungry for information, hungry for certitude, and when there is a lack of consensus-oriented information and when everything is being contested in public, that creates confusion among people.”
— Kasisomayajula Viswanath
“What I have found is a remarkable degree of consensus among people who understand the science of this disease around what the fundamental issues are and then disagreements about trade-offs and policies,” said Jha, who is a frequent commentator on news programs. “The idea of covering the science in a two-sided way on areas where there really isn’t any disagreement has struck me as very, very odd, and it keeps coming up over and over again.”
Then there is the problem of political bias. This has been especially true at right-leaning media outlets, which have largely repeated news angles and viewpoints promoted by the White House and the president on the progress of the pandemic and the efficacy of the administration’s response, boosting unproven COVID-19 treatments and exaggerating the availability of testing and safety equipment and prospects for speedy vaccine development.
Tara Setmayer, a spring 2020 Resident Fellow at the Institute of Politics and former Republican Party communications director, said what’s coming from Fox News and other pro-Trump media goes well beyond misinformation. Whether downplaying the views of government experts on COVID-19’s lethality, blaming China or philanthropist Bill Gates for its spread, or cheering shutdown protests funded by Republican political groups, it’s all part of “an active disinformation campaign,” she said, aimed at deflecting the president’s responsibility as he wages a reelection campaign.
But turning around those who buy into false information is not as simple as piercing epistemic bubbles with facts, said Christopher Robichaud, senior lecturer in ethics and public policy at Harvard Kennedy School (HKS) who teaches the Gen Ed course “Ignorance, Lies, Hogwash and Humbug: The Value of Truth and Knowledge in Democracies.”
Over time, bubble dwellers can become cocooned in a media echo chamber that not only feeds faulty information to audiences, but anticipates criticisms in order to “prebut” potential counterarguments that audience members may encounter from outsiders, much the way cult leaders do.
“It’s not enough to introduce new pieces of evidence. You have to break through their strategies to diminish that counterevidence, and that’s a much harder thing to do than merely exposing people to different perspectives,” he said.
While Facebook, Twitter, and YouTube have all recently ramped up efforts to take down COVID-19 misinformation following public outcry, social media platforms “fall short” when it comes to curbing the flow, said Joan Donovan, who leads the Technology and Social Change Project at HKS.
Since the national shift to remote work, many social media firms are relying more heavily on artificial intelligence to patrol misinformation on their platforms, instead of human moderators, who tend to be more effective, said Donovan. So many users suddenly searching and posting about one specific topic can “signal jam search algorithms, which cannot tell the difference usually between truth and lies.”
These firms are reluctant to spark a regulatory backlash by policing their platforms too tightly and angering one or both political parties.
“So they are careful to take action on content that is deemed immediately harmful (like posts that say to drink chemicals), but are reticent to enforce moderation on calls for people to break the stay-at-home orders,” said Donovan.
Viswanath said public health officials cannot, and should not, chase down and debunk every bit of misinformation or conspiracy theory, lest the attention lends them some credence. The public needs to more closely scrutinize and be “much more skeptical” about what they’re reading and hearing, particularly online, and not try to keep up with the very latest COVID-19 research. “You don’t need to know everything,” he said.
Putting the onus entirely on the public, however, is “unfair and it won’t work,” said Viswanath. Institutions, like social media platforms, have to take more responsibility for what’s out there.
Public health organizations should be running effective communication surveillance of social media to monitor which rumors, ideas, and issues most worry the public, what is understood and misunderstood about various diseases and treatments, and what myths are circulating or being actively promoted in the community. And they need to have a strategy in place to counter what they’re picking up. “You cannot control this, but you can at least manage some of this,” Viswanath said.
Though some COVID-19 misinformation and conspiracy theories are outlandish or even dangerously inaccurate, Robichaud said it’s a mistake to dismiss those who believe them as people who don’t care about the truth.
Many cognitive biases get in the way of even the best truth-seeking strategies, so perhaps we could all benefit from a little more intellectual humility in this time of such great uncertainty, he said.
“Most of us are, at best, experts in a tiny, tiny area. But we don’t navigate the world as if that were true. We navigate the world as if we’re experts about a whole bunch of things that we’re not,” he said. “A little intellectual humility can go a long way. And I say that as a professor: It’s true of us, and it’s also true of the public at large.”
The president of the Federal Reserve Bank of Minneapolis said Sunday that the “worst is yet to come” after a record of 20 million people lost their jobs amid furloughs and layoffs sparked by the coronavirus pandemic in April.
“I mean the worst is yet to come on the job front, unfortunately,” Neel Kashkari said on ABC’s “This Week.”
“We may be in an environment of gradual relaxing and then having to clamp back down again around the country as the virus continues to spread,” he added. “To solve the economy, we must solve the virus. Let’s never lose sight of that fact.”
Kashkari also contradicted White House economic adviser Larry Kudlow’s prediction for a financially strong half of 2020 and full 2021 when ABC’s George Stephanopoulos asked if that was realistic.
“You know, I wish it were,” he responded. “What I’ve learned in the last few months, unfortunately, this is more likely to be a slow, more gradual recovery.”
President of Minneapolis Federal Reserve Neel Kashkari says economic recovery in the U.S. "is more likely to be a slow, more gradual recovery."
The Minneapolis Fed president said a “robust economy” would require a breakthrough in vaccines, testing and therapies.
“I don’t know when we’re going to have that confidence,” he said, adding, “and ultimately, the American people are going to decide how long the shutdown is.”
The Department of Labor reported last week that the unemployment rate had reached 14.7 percent, which is the highest since the U.S. began tracking in 1948. More than 33 million people have applied for unemployment claims since mid-March.
Speaking earlier Sunday on “This Week,” Kudlow acknowledged that “very difficult” unemployment numbers could likely be reported in May. But he added that there is a “glimmer of hope” within the unemployment data, with 80 percent of the claims involving those who were furloughed or going through temporary layoffs.
Columbia University infectious diseases expert Jeffrey Shaman predicted Sunday that the U.S. will see a growth in coronavirus cases in coming weeks as some states loosen restrictions.
Shaman said on NBC’s “Meet the Press” that Trump administration officials have not taken full advantage of the past eight weeks of near-total lockdowns, saying that the period would have “benefitted enormously from consistent messaging” from the White House.
“We do need to start picking ourselves up where we are” he said, pointing to countries that appear to have successfully contained the spread of the virus, such as South Korea, Germany and New Zealand.
“They did this because they tested so aggressively and they used contact tracing and they were able to quarantine people who were becoming infectious,” he said. “Once you’ve done that, then you’re in this position of strength where reopening the economy is not going to lead necessarily to the rebound in cases that I’m expecting, given this patchwork response that we have right now and the reopenings taking place in some states.”
“What I think we’re probably going to see over coming weeks, probably towards the end of the month, is we’re just going to start to see a growth in cases,” he added. “It’s not going to happen over the next week or two, it’s going to come in with a lag. That built-in delay means any changes we do to social distancing because of reopening, we’re not going to realize for a couple of weeks that we’re already into some period of growth.”
WATCH: Dr. Jeffrey Shaman says "we are going to see a growth in cases" over the next couple of weeks due to loosening restrictions. #MTP@JeffreyShaman: "Any changes we do to social distancing … we are not going to realize until we are already in some period of growth." pic.twitter.com/6NcfTnwjYg
White House adviser Kevin Hassett said Sunday the U.S. unemployment rate could reach 20 percent in May.
“I think just looking at the flow of initial claims, it looks like we’re probably going to get close to 20 percent in the next report,” Hassett said on CNN’s “State of the Union.”
“Just looking at the flow of initial claims that it looks like we’re probably going to get close to 20% in the next report,” senior White House economic adviser Kevin Hassett says about US unemployment. #CNNSOTUpic.twitter.com/bTN85AJaMD
Hassett said on CNN the unemployment rates depend on whether the virus “has really abated” and if economies are “really going again.”
“I would guess middle of summer is when we’re going to start to go into the transition phase,” he said, adding that he hopes there will be “very strong” growth in the third and fourth quarters.
The unemployment in April rate rose to 14.7 percent from 4.4 percent in March, according to the latest jobs report released by the Bureau of Labor Statistics on Friday.
The U.S. lost 20.5 million jobs in April amid the coronavirus pandemic, breaking the record for the largest one-month increase in the unemployment rate.
State governments are building armies of contact tracers in a new phase of the battle against the coronavirus pandemic, returning to a fundamental practice in public health that can at once wrestle the virus under control and put hundreds of thousands of newly jobless people back to work.
California is already conducting contact tracing in 22 counties, and it eventually plans to field a force of 10,000 state employees, who will be given basic training by University of California health experts.
Massachusetts and Ohio have partnered with Partners in Health, a global health nonprofit originally established to support programs in Haiti, to field teams of contact tracers. Maryland will partner with the University of Chicago and NORC, formerly the National Opinion Research Center, to quadruple its contact tracing capacity.
Washington, West Virginia, Iowa, North Dakota and Rhode Island are using their National Guards to trace contacts of those who have been infected with the coronavirus. In Kansas, 400 people have volunteered to trace contacts; in Utah, 1,200 state employees have raised their hands.
Contact tracing is a pillar of basic public health, a critical element in battling infectious disease around the globe. The goal is to identify those who have been infected with a virus and those with whom the infected person has come into contact.
If those contacts then come down with the virus, they can be quickly isolated so they do not spread it further. They can also be treated, making it less likely they develop the most severe symptoms.
The practice works even in areas where health systems are thin at best and nonexistent at worst.
Tracking down those who had the Ebola virus in Guinea, Liberia and Sierra Leone, three of the poorest nations on Earth, was critical to ending the world’s largest outbreak of the deadly hemorrhagic fever in 2015. World Health Organization trackers and health officials in Congo have tracked as many as 25,000 people at a time during an Ebola outbreak that is still simmering in an eastern province, even as they face the threat of what is an almost active war zone.
“Our ability to suppress transmission relates to our ability to detect the virus,” Maria Van Kerkhove, the American who leads the World Health Organization’s technical team studying the coronavirus, told reporters last week.
The focus on contact tracing comes as public health experts warn that the coronavirus will not end as a threat to humankind until so many people have become infected that the virus has nowhere else to turn — a terrifying prospect that conjures images of overwhelmed health systems and death on a mass scale — or until scientists develop and distribute an effective vaccine to billions of people across the globe.
There are more than 100 vaccines in some stage of testing, though determining their effectiveness is still months away, and production at a mass scale is months beyond that. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the country’s most well-known infectious disease expert, has estimated that a vaccine could be as close as 18 months away, though he has acknowledged that would blow the old record for speedy development out of the water.
“We have to fundamentally do everything possible to get a safe and effective vaccine as quickly as possible. At the same time, we have to assume that it’s not around the corner,” said Tom Frieden, former director of the Centers for Disease Control and Prevention who now runs Resolve to Save Lives, a global health nonprofit.
In the meantime, the federal government has largely left it up to the states to build their contact tracing capacity.
Sen. Elizabeth Warren (D-Mass.) and Rep. Andy Levin (D-Mich.) have proposed adding a massive nationwide federal contact tracing program to the next round of coronavirus-related relief funding. In a nod to the New Deal-style scale such a program would require, they call the program the Coronavirus Containment Corps.
“Establishing a nationwide contact tracing program is the only way we can truly know the progress we’ve made in containing the virus, and how far we have left to go before we can transition back to normal life,” Levin said in a statement.
But contact tracing can work only if the number of new cases the United States confirms every day begins to bend down to a manageable number. The number of cases confirmed in the United States has grown by at least 25,000 on all but two of the first eight days of May.
And tracing will become an effective tool only when those who are conducting the tracing have the ability to test people broadly and to get the results of those tests back quickly. The Food and Drug Administration said Friday it had approved both the first diagnostic test that could be conducted using home-collected saliva samples and the first antigen test, a type of test that delivers results much faster than others on the market.
The lack of available tests at the earliest stages of the coronavirus outbreak has hidden the true extent of the virus’s spread around the United States. While some countries have the capacity to test huge percentages of their population on a given day, the United States is still testing only about 250,000 people per day, a level far short of the capacity necessary to conduct widespread contact tracing.
“Right from the start there has been a tremendous undercounting of cases, and that had to do with our now infamous slow testing rollout,” said Paul Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston.
President Trump has touted the raw number of tests performed — he rightly claims that the United States conducts more tests on a given day than any other country. But on a per capita basis, the United States is testing fewer of its residents than countries such as the United Kingdom, Italy and Estonia.
Until that changes, public health experts worry the United States will be stuck at a dangerous plateau.
“We’re doing deeply inadequate testing and functionally no tracing,” said Jeremy Konyndyk, a former head of the Office of Foreign Disaster Assistance at the U.S. Agency for International Development and now a senior fellow at the Center for Global Development. “We’re not going to half-ass our way out of a pandemic, and that’s where we are, and that’s why we’re stuck.”
Philanthropist Melinda Gates on Thursday sharply criticized the U.S. response to the coronavirus outbreak, telling Yahoo Finance that the country is “lacking leadership at the federal level” and as a result has endured unnecessary deaths and economic pain.
“It’s highly distressing and disappointing,” says Gates, co-chair of the Bill and Melinda Gates Foundation, which she said has donated $300 million to organizations involved in the coronavirus response.
“To have 50 state-grown solutions is inefficient, it makes no sense, and it’s costing people their lives,” she adds.
President Donald Trump said on Tuesday “there’ll be more death” as states lift stay-at-home measures but has urged a path toward reopening the economy in order to blunt job loss and other damaging effects caused by the mandates.
“The lack of action is really causing harm and hurt unnecessarily in this country,” Gates says. “I’m incredibly disappointed to see that.”
The White House recently declined to take up guidelines written by the Centers for Disease Control and Prevention for how schools, restaurants, and other institutions can safely reopen, the Associated Press reported on Thursday.
The Trump administration did release a set of conditions for coronavirus containment that it recommends states meet before they reopen, including a 14-day downward trajectory in new cases or positive test rates. However, many states that remain short of that benchmark have started to reopen or will do it soon, among them Kentucky, Ohio, and Utah, the AP reported on Thursday.
On Friday, the monthly jobs report showed the U.S. economy cut 20.5 million payrolls in April, and the unemployment rate jumped to 14.7%.
The severity of economic pain is a direct result of inaction from the federal government, Gates said.
“It is impacting families now, because if we had a good testing and tracing system like Germany has, we would have started to reopen slowly more places in the economy, people wouldn’t be struggling so much to put a meal on their table,” says Gates, who released a book last year entitled “The Moment of Lift: How Empowering Women Changes the World.”
‘Difficult tension’ faced by parents at home
She said the U.S. must bolster its benefits for paid sick, medical, and family leave in order to mitigate some of the economic pain and reopen the economy, since some workers will return to their jobs while others will need to remain home to care for sick family members or children educated remotely.
“Congress made a first step that is in one of the stimulus packages, they really did put in sick days and paid leave,” she says. “The problem is, it doesn’t go far enough.”
HENRY KOTULA 