The High Stakes of Low Scientific Standards

Posted on by • Posted in 2020 Election Issues, Communication, Coronavirus, Crisis, Crisis Management, False Hope, Health Policy, Hydroxychloroquine, Infection Control, Infectious Virus, Misinformation, Mislead, Misleading, Pandemic, Public Health, Public Safety, Scientists, Social Distancing, Wishful Thinking • Leave a comment

https://www.axios.com/coronavirus-pandemic-science-problems-e6e619b8-c1a8-4e06-97d9-c328d4d0400e.html

The Lucky Seven States Already Pursuing Gambling Legislation In 2018

In the midst of this pandemic, science is suffering from low standards for some research, a new study argues.

The big picture: Science — which is slow, methodical and redundant — isn’t necessarily made for the immediacy and acute public interest brought on by a health crisis.

  • Scientists rely on peer review and back and forth exchange that leads to a more polished final study. But a health crisis like the current pandemic, or the Ebola outbreak, creates a sense of urgency that can be antithetical to the scientific process.

What’s happening: A new study out today in the journal Science warns many of the clinical trials and studies first published about treatments and other issues involving the current pandemic were designed poorly or had other issues that affected their outcomes.

  • Studies that have yet to go through peer-review — like a recent, flawed study of the use of hydroxychloroquine to treat coronavirus — have found their way into news stories thanks to pre-print services, leading to problematic reporting and real-time peer review through Twitter.
  • More than 18 clinical trials testing hydroxychloroquine to treat the novel coronavirus have enrolled more than 75,000 patients in North America.
  • “This massive commitment concentrates resources on nearly identical clinical hypotheses, creates competition for recruitment, and neglects opportunities to test other clinical hypotheses,” the study says.
  • Early, flawed work has potentially increased the risk that later results may have gotten false positives and more media attention than they deserved, the new study says.

Yes, but: While the pandemic is exacerbating these problems with misinformation and lax research standards, it isn’t the cause of them.

  • “Some of the problems that we’re seeing right now are actually not that exceptional compared to the problems that we have under normal conditions as well, just that maybe they’re a little bit more amplified and have a little more visibility,” Jonathan Kimmelman, director of the Biomedical Ethics Unit at McGill University and one of the authors of the new paper, told Axios.
  • These kinds of issues cropped up during previous health crises, and while the authors of the new study argue that some of those problems around information sharing and standards of research have improved, there’s still a long way to go.

What’s next: Many of these issues around varying standards of research and communication could be remedied through better communication among researchers and the agencies funding their work.

  • Instead of having a number of fragmented studies competing for resources and looking for effective treatments, the researchers say it would make more sense to bring them under one umbrella, allowing them to coordinate.
  • “You could reduce variation, and you might get answers more quickly,” Alex John London, the director of the Center for Ethics and Policy at Carnegie Mellon and one of the authors of the new study, told Axios.
  • The authors are also calling on clinicians to resist performing their own small studies, instead opting to join up with larger trials.
  • They also say agencies need to help build those larger studies and avoid making statements to the public about unvalidated treatments that may or may not work, instead opting to elevate larger studies in their various stages to the public.

 

 

 

 

 

The South is vulnerable to a coronavirus nightmare

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Partisanship, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing, Vulnerable Populations • Leave a comment

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COVID-19 vulnerability index, by county

Arrow

 

The South is at risk of being devastated by the coronavirus.

Why it matters: Southern states tend to have at-risk populations and weak health care systems — and they’re the ones moving fastest to loosen social distancing rules. That puts them at risk for the worst-case coronavirus scenarios.

The big picture: To stop the spread of the coronavirus, there are really only two options: stringent social distancing, or stringent public health measures.

Driving the news: Several southern states including Georgia, Tennessee and South Carolina have recently announced that they’re starting to back off of social distancing.

  • Our national testing capacity is still nowhere near where experts say it needs to be, and only some communities have announced efforts to build up contact tracing.

Between the lines: The Surgo Foundation created a coronavirus community vulnerability index that takes into account factors like socioeconomic status, minority status, housing type, epidemiologic factors and health care system factors.

The bottom line: The South is already worse off in almost every way, partially due to policy choices made in these states. Its comparatively unhealthy population is vulnerable to more serious illness, and looser social distancing will enable the virus’ spread.

 

 

US hits grim milestone: 50,000 coronavirus deaths

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Food and Drug Administration (FDA), Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

US hits grim milestone: 50,000 coronavirus deaths

US hits grim milestone: 50,000 coronavirus deaths | TheHill

More than 50,000 people in the United States have died of the COVID-19 disease, a grim milestone in a global pandemic that shows few signs of slowing even as pressure mounts to reopen parts of the U.S. economy.

The death toll is 16 times greater than the number of Americans who died in the 9/11 terrorist attacks and about one-and-a-half times larger than the number of U.S. soldiers who died in the Korean War. At the current pace, the number of coronavirus deaths is likely to surpass the number of Americans who died in the Vietnam War by the middle of next week.

The true number of deaths is likely higher than official figures. Coroners in California this week reclassified the death of a woman in Santa Clara on Feb. 6 as a coronavirus victim, the first known death from the disease in the United States and one that occurred three weeks before what had previously been thought to be the first known death.

About 900,000 people in the United States have tested positive for the virus that causes the disease, according to the most recent figures. That number has doubled in the past two weeks, climbing by 25,000 or more cases per day.

The richest nation in the world now accounts for about one-third of the planet’s 2.7 million cases.

The number of U.S. deaths has increased at a rate of about 2,000 per day in recent weeks as scientists race to understand the new pathogen and health systems in hard-hit areas like New York, Boston, New Orleans and Detroit struggle under the strain placed on hospitals and frontline health care workers.

More than a quarter of a million New Yorkers have tested positive for the virus, as have more than 100,000 residents of New Jersey. There are at least 35,000 cases in California, Illinois, Massachusetts, Michigan and Pennsylvania, and at least 20,000 cases in Connecticut, Florida, Georgia, Louisiana and Texas.

Though the virus was first detected in China, where the authoritarian government locked down entire cities in January, the United States is now home to the largest number of known cases in the world. The number of cases on American soil is nearly four times as high as the second-worst hit country, Spain, and higher than the total case counts in Spain, Italy, France, Germany and the United Kingdom combined, according to data compiled by Johns Hopkins University.

America’s disastrously slow response has stumbled over a number of hurdles other countries cleared easily. President Trump and his administration routinely claimed the virus was under control — he claimed the coronavirus would have “a very good ending for us” on Jan. 30, the same day the World Health Organization declared the virus a public health emergency of international concern.

Scientists now believe the virus began circulating in the United States in early to mid-January, a period when the country had little capacity to test its residents. An early test created by the Centers for Disease Control and Prevention and sent to public health laboratories across the country turned out to have a fatal flaw, setting back crucial testing capacity that could have uncovered the extent of the virus’s spread even as other countries deployed their own tests.

Companies that could have filled that backlog were also slow to develop their own diagnostic tests, and several ran into roadblocks at the Food and Drug Administration, which did not move to approve tests on an emergency basis until late February.

The United States only seemed to begin to take the threat of the outbreak seriously in early March. Almost two weeks later, the first state — California — announced stay-at-home orders.

As a consequence, the slow response has meant the United States has not bent its case curve downward as fast as other nations. The hardest-hit European nations have all seen daily case and death counts bending downward; the United States has, at best, reached a daunting plateau. And though countries like Italy, Spain and France have suffered more deaths per capita, their trajectories are down, while figures in the United States trend up.

There is still no known medicinal treatment for those suffering from COVID-19. And while dozens of laboratories across the globe race to develop a vaccine, experts warn that a finished product will not be available on a mass scale for more than a year — a schedule that would mark the fastest such development in human history. Until those vaccines are ready and widely available, the virus will remain in control.

Left leaderless at the federal level, state governments responded to the mounting crisis in their own ways. A bipartisan roster of governors in New York, California, Washington, Massachusetts, Maryland, Ohio and elsewhere have won praise for quick, decisive action and informative briefings that stand in stark contrast to Trump’s daily appearances at White House press conferences.

California Gov. Gavin Newsom‘s (D) order was followed by most other states, though eight states have yet to require residents to avoid nonessential activities. Even as some states took unprecedented steps to lock down their economies, banning residents from beaches and public parks and shuttering non-essential businesses, others were slow to act.

There is now mounting evidence that dozens of coronavirus cases are tied to an April election in Wisconsin, and to packed beaches during Spring Break in Florida the previous month. At least one man who attended what was dubbed a coronavirus party in Kentucky came down with the disease. Several pastors who defied recommendations against holding church services have died.

Now, as a few hundred protesters in several states demand a reopened economy, some governors are beginning to loosen restrictions. Georgia Gov. Brian Kemp (R) will allow some businesses to begin opening on Friday, even as the number of COVID-19 cases jumped to 21,883 on Thursday. Nearly 900 Georgians, about 4 percent of confirmed cases, have died.

Some nonessential businesses will begin opening in the coming days in Alaska, Indiana, Tennessee and Texas. Beaches have reopened in parts of Florida and South Carolina, even as public health officials have warned of the consequences of reopening too quickly.

“We have to proceed in a very careful, measured way,” Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said at a White House press briefing Wednesday. “The one way not to reopen the economy is to have a rebound that we can’t take care of.”

But there remain signs of strain even within the highest ranks of government. Fauci contradicted Trump’s claim Wednesday that the virus would not return in the fall.

“We will have coronavirus in the fall. I am convinced of that because of the degree of transmissibility that it has, the global nature,” Fauci said.

Fauci did not appear at the White House briefing Thursday, when Trump said he did not agree with the nation’s leading infectious disease expert that the country’s testing capacity had risen to the level required to stamp out the virus.

“No, I don’t agree with him on that. No, I think we’re doing a great job in testing. I don’t agree. If he said that, I don’t agree with him,” Trump said.

 

 

 

 

 

Interim Coronavirus Relief Bill

Posted on by • Posted in 2020 Election Issues, Bankruptcy, Clinical Testing, Coronavirus, Economic Crisis, Economic Stimulus, Economy, Emergency Preparedness, Employee Furlough, Employee Layoffs, Health Policy, Health System, Hospital, Hospital Industry, Job Market, Job Search, Job Security, Mortality, Pandemic, Partisanship, Physician, Unemployment, Unemployment Insurance • Leave a comment

https://heathercoxrichardson.substack.com/p/april-23-2020

Congress expected to announce deal on latest coronvirus relief bill

Today the House of Representatives passed a new $484 billion coronavirus relief bill by a vote of 388-5. The Senate passed it Tuesday. $381 billion is for small businesses left out in the cold when the money from the previous coronavirus relief package quickly ran dry. Republicans wanted to stop there, but Democrats demanded $75 billion for hospitals, and $25 billion for coronavirus testing, as well as a requirement that the administration figure out a strategy to get tests to states.

The relief bill comes as more than 26 million Americans are out of work and almost 50,000 Americans have died of Covid-19. The representatives had to drive to Washington, D.C., or fly unusual routes because regular flights are canceled. They arrived for the vote in the Capitol building in alphabetical groups of 50 to 60 so they could keep their distance from each other. A number of Republicans refused to wear masks during the vote, while all but one Democrat wore one.

Democrats inserted into the bill a new committee to oversee the administration’s “preparedness for and response to the coronavirus crisis,” chaired by Jim Clyburn (D-SC). The committee has the power to subpoena witnesses and documents. Republicans and Trump objected.

But the Democrats did not get any more aid to states, crippled by the crisis, than the $150 billion previously provided. The bipartisan National Governors Association, headed by Maryland Governor Larry Hogan, a Republican, has asked for $500 billion to help the states replace lost tax revenues. Democrats wanted such aid, but Republicans refused.

Senate Majority Leader Mitch McConnell (R-KY) went on talk radio host Hugh Hewitt’s show on Wednesday and tried to make the question of state aid partisan. He said that he opposed granting money to states whose problems, he said, stemmed from their underfunded state pension plans. Instead, the states should consider bankruptcy. A document put out by McConnell’s office called aid to the states a “blue state bailout.”

In fact, Michael Leachman, the senior director of state fiscal research at the Center on Budget and Policy Priorities, said that McConnell has it wrong. States have not been overspending; their expenses for education and infrastructure are actually significantly below what they were in 2008, despite more inhabitants, and they have put about 7.6% of their budgets into rainy day funds, a historic high, up from the previous high of 5% they held in reserve in 2006 before the Great Recession.

The problem is that states have to balance their budgets annually, and they depend on sales and income taxes for 70% of their revenue. The shutdowns have decimated tax revenues as shopping ends and people lose their jobs. At the same time, unemployment claims are climbing dramatically. States are looking at a $500 billion loss between now and 2022.

States need money to avoid massive layoffs and deep spending cuts, actions that would make the economic crisis continue much longer than it would if they do not have to make them. They would not use bailout money on pensions, Leachman writes, but put it in state general funds, which are collapsing. Pensions come out of a separate trust fund (although the general fund does put money toward future pensions, that’s less than 5% spending from the general fund). Federal bankruptcy law currently does not allow states to declare bankruptcy, but in any case, Leachman writes, there is no need for it. Bankruptcy relieves high debt levels, but state debt is not high, and once the pandemic passes, the states should be financially sound again.

If Leachman’s explanation was scholarly, New York Governor Andrew Cuomo was blunt. “New York puts into that federal pot $116B more than we take out. Kentucky takes out $148B more than they put in,” he said at a press conference. “Senator McConnell, who’s getting bailed out here? It’s your state that’s living on the money that we generate.” A recent study by the Rockefeller Institute of Government shows that New Yorkers as a group pay in to the federal government $1,792 per capita more than they take out, while for every dollar Kentucky puts in, it gets $2.61 back.

Cuomo called McConnell out for trying to turn the crisis into a political fight: “That’s not what this country is all about,” Cuomo said. “It’s not red and blue, it’s red, white and blue.”

Today’s other big news was Trump’s suggestion at his coronavirus briefing that it would be worth studying whether injecting disinfectant into patients would kill the novel coronavirus. “And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?” he said. “Because, you see, it gets on the lungs, and it does a tremendous number on the lungs. So it’d be interesting to check that. So that you’re going to have to use medical doctors, but it sounds — it sounds interesting to me.” He also suggested using heat and light to kill the virus.

Doctors were horrified at his comment, calling it irresponsible and dangerous. Disinfectants are poisonous and are deadly if they are used inappropriately. “To be clear:” emergency medicine physician Dara Kass tweeted, “Intracavitary UV light and swallowing bleach or isopropyl alcohol can kill you. Don’t do it.”

Trump’s emphasis on dramatic cures for Covid-19 reinforces his disagreement with health experts that we must dramatically increase our testing for the disease so we can identify hot spots and isolate them before they spread. At today’s briefing, Trump disagreed with Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and one of the administration’s top medical advisors about the pandemic, who recently said “We absolutely need to significantly ramp up, not only the number of tests but the capacity to actually perform them.” Today, Trump said: “I don’t agree with him on that, no, I think we’re doing a great job on testing.”

In fact, the U.S. lags behind other nations in per capita tests, and Trump’s continuing reluctance to support getting them seems to me mystifying. It is this odd gap Congress is trying to address with its requirement in the new coronavirus package that the administration must figure out a strategy to get tests to states. The bill now heads to the Oval Office for Trump’s signature.

For all the dark nitty-gritty of politics today, it is also a day that begins a joyous month, and that seems to me a far better way to leave you all tonight than with the day’s troubles. For those who celebrate, Ramadan Mubarak.

 

 

 

4.4 million Americans sought jobless benefits last week, as economic pain continued across the United States

Posted on by • Posted in 2020 Election Issues, Bankruptcy, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Economy, Employee Benefits, Employee Furlough, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health Policy, Job Market, Job Search, Job Security, Out of Pocket Expenses, Pandemic, Paycheck Protection Program, Preexisting Conditions, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

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4.4 million Americans sought jobless benefits last week, as ...

The White House and Congress have tried to arrest the downturn, but the coronavirus pandemic keeps pushing Americans out of the labor force.

More than 4.4 million Americans filed for unemployment benefits last week, according to the Labor Department, a signal the tidal wave of job losses continues to grow during the coronavirus pandemic.

It’s the fifth straight week that job losses were measured in the millions. From March 15 to April 18, 26.5 million people have probably been laid off or furloughed. The number of jobs lost in that brief span effectively erased all jobs created after the 2008 financial crisis. Jobless figures on this scale haven’t been seen since the Great Depression.

The new weekly total comes on top of 22 million Americans who had sought benefits in previous weeks, a volume that has overwhelmed state systems for processing unemployment claims. Economists estimate the national unemployment rate sits between 15 and 20 percent, much higher than it was during the Great Recession in 2008 and 2009. The unemployment rate at the peak of the Great Depression was about 25 percent.

The new weekly jobless claims figure came in around economists’ predictions, which were expected “to be staggering, but not growing, which is a small mercy,” said Julia Pollak, a labor economist at ZipRecruiter. For comparison, 5.2 million people filed unemployment claims for the week ending April 11.

As the coronavirus began spreading in the United States earlier this year, many businesses rapidly began to close. Hotels, restaurants, and airlines were hit particularly hard, but few businesses were immune from the economic toll. The problems have only worsened each week, as more Americans reduced their spending and more businesses cut workers because income has fallen so sharply.

Pollack said many businesses quickly “cut to the bone” when they realized how the pandemic would gut sales. Now, many of the new layoffs stem from businesses like news organizations and tech companies that weren’t directly affected by people staying home but are suffering the consequences of vanishing ad revenue and paid subscriptions.

“We see declines across every major industry and state, although the declines hit industries at different times,” Pollak said.

Meanwhile, consumer spending, the engine behind the longest economic expansion in U.S. history, has evaporated. If they’re still operating, many offices are working with skeleton staffs and staring down months of dismal revenue.

The White House and Congress have tried to intervene, but with limited impact so far.

New funding for small businesses in a $2 trillion March emergency spending package quickly dried up in the face of overwhelming demand, prompting the Senate to expand funding by $310 billion on Tuesday. The bill would direct an additional $60 billion to a separate small-business emergency grant and loan program. The House is slated to vote on the measure Thursday afternoon.

Even with all the new government spending, hopes for a sharp economic rebound are fading, overtaken by the public fear of going back to restaurants, movie theaters, schools and gyms. The growing possibility of a “W”-shaped recovery — in which a resurgence of the virus, or a spike in defaults and bankruptcies, triggers another downturn — has analysts reframing what a reopened or rehabilitated economy might look like.

This year defies historical comparison. In 2020, 28.9 million people have filed for unemployment benefits. Halfway through the fourth month of the year, the figure has already eclipsed the full-year totals of every year but 1982 (30.4 million) and 2009 (29.8 million). At this rate, it will overtake both within a week or so.

Less than half of working-age Americans will be earning a wage next month, said James Knightley, ING Chief International Economist.

“In an election year, this means that the call for politicians to reopen the economy is only going to get louder, irrespective of the health advice,” Knightley said.

In five weeks, 9.4 percent of the working-age population has filed for unemployment insurance, said Nick Bunker, Indeed Hiring Lab’s director of economic research. That’s about twice the share of the population that lost a job during the Great Recession. In some states, such as Michigan, about one in four workers has filed an unemployment claim in the past few weeks.

“The numbers detailing the shock to the U.S. labor market are so large, and cover such a short time, that your first reaction is that they’re a typo,” Bunker said.

Employers are also unlikely to be hiring at the same levels they were before the pandemic. As of April 16, job postings on Indeed were down 34 percent compared with last year, Bunker said.

The job losses, like the epidemic itself, haven’t fallen evenly across the country. In three states — Hawaii, Kentucky and Michigan — about 1 in 4 workers have filed for unemployment benefits in the past 5 weeks. In Michigan, plant shutdowns and furloughs have ravaged the manufacturing economy, which had only recently recovered all the jobs it lost in the Great Recession.

On the opposite of the ledger sits South Dakota, where Gov. Kristi L. Noem (R) has resisted calls to lock down the state’s businesses to slow the spread of the coronavirus. Only 6 percent of the state’s labor force has applied for unemployment benefits. It may be a regional trend: Neighboring Wyoming and Nebraska, and nearby Utah, also have unusually low claims numbers.

As part of its sprawling stimulus package, Washington has rolled out relief for millions of households and small businesses struggling to make ends meet. But money for struggling businesses quickly ran dry, and system glitches have prevented $1,200 stimulus checks from reaching some of the neediest.

On Tuesday, the Senate passed a bill to expand the Paycheck Protection Program for small businesses by $310 billion, and flood a separate small-business emergency grant and loan initiative by an additional $60 billion.

Meanwhile, many low-income veterans and Social Security recipients still haven’t received the stimulus money in their bank accounts, while other IRS checks are going to dead people. People who didn’t file tax returns last year or don’t have direct-deposit information may have weeks more to wait.

In the wake of the Great Recession, the number of unemployed — about 15 million — was significantly higher than the number who claimed benefits, and the unemployment rate still peaked at just 10 percent. Economists expect the United States to blow by that figure when April’s jobs data are released on May 8.

Granted, this comes as unemployment eligibility and benefits have been greatly expanded. The government has relied on the unemployment insurance system to deliver relief to out-of-work Americans as it forces millions of businesses to close during temporary stay-at-home orders. The soaring numbers are, for once, a sign of the system working as intended.