“Dying In A Leaderless Vacuum”, NEJM
“The New England Journal of Medicine Breaks two centuries of precedent to take an electoral stand,” Medpage Today, Shannon Firth, October 9, 2020
Angry Bear Readers: I am stealing the NEJM’s title as it states all of the issues we are faced with today with the Covid Pandemic. “Dying in a Leaderless Vacuum.” The NEJM is not known for being political. Yet today, the NEJM is taking a stand on what is happening in the United States for the first time in 200 years, with the regard to the lack of leadership by our government during the Covid19 pandemic. I have not included the whole editorial and have only C&Ped two paragraphs which I believe captures much of the argument being made by the NEJM. The entire article is not a long read and I hope and expect you will follow the link to it and read the editorial in entirety.
I have also attached three links to other articles. One is by Internal Medicine Physician and BMJ columnist Abraar Karan, the second is a copy of a letter by renowned epidemiologist William Foege who led the eradication of smallpox and a former CDC Director, and the last is the USA Today article about Foeege letter to Redfield and the events leading up to the letter. Again, all are easy reads in entirety and by taking a few minutes of reading you will be much further ahead of the others around you in information.
“Dying in a Leaderless Vacuum,” The New England Journal of Medicine, The Editors, October 8, 2020
“The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized, appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.
Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”
“Politics and public health in America – taking a stand for what is right” is another article and is written by Dr. Abraar Karan at The BMJ.
The world is watching America.
We are living in a time when our government is run by a demagogue and our scientific, medical, and public health institutions are trying to desperately stay afloat long enough to survive with any shred of credibility or global respect.
William Foege letter to Robert Redfield
Dear Bob
I start each day thinking about the terrible burden you bear. I do not know what I would actually do, if in your position, but I do know what I wish I would do.
The first thing is to face the truth. You and I both know that:
‘It is a slaughter’: Public health champion asks CDC director to expose White House, orchestrate his own firing, USA Today, Brett Murphy and Letitia Stein, October 7, 2020
A former director of the Centers for Disease Control and Prevention and public health titan who led the eradication of smallpox asked the embattled, current CDC leader to expose the failed U.S. response to the coronavirus, calling on him to orchestrate his own firing to protest White House interference.
Run, Unfortunately nothing new here. It really comes down to the intellect of the people who vote even with all of the misinformation, disinformation, Russian troll farms and Fox News out there. The NEJM is not saying anything that reasonably intelligent, moderately educated, independent people do not know. As Senator Harris put it Wednesday night, this has been the worst failure of leadership by a president of the United States in history. The only issue I would take with the NEJM is that it is not incompetence—it was a sociopathic attempt to gain advantage from a difficult situation. That it has failed is evidence of incompetence but in no way lessens or excuses the response which should lead to prosecutions. The MIC is whining that Obama and Biden are guilty of the greatest crime in American history but this is just the latest projection by Mad President Donnie.
@Terry,
Word.
You guys!!!
I am supply chain, the guy that coordinates all that stuff they are screaming about and plans the manufacture of medical product such as CF Dialyzers and flying the 747s of Cuprofen in from Germany or plans the distribution of Dialysates when capacity is limited due to plant take down. I know what is going on here because I was the turn to guy in many cases.
It is a lost competence and I am taking a lot of that knowledge with me. My alma mater Loyola Chicago thinks they can plug in a computer program to supply algorithms. If you do not know the process how the hell do you plan it? Demmings kind of said the same thing as did Drucker. Before trump arrived on the scene we were in trouble. It was just a matter of time. trump just accelerated the process.
Two of my favorite people show up and suddenly I am incompetent. Set aside dumb ass and the Reverend Henry Kane who was opposite Harris. The real question is how do we get back? Mostly, I agree with you two. Joel, don’t go giving Terry a swelled head.
Trump vs Biden on Health Care
via @JAMA Health Forum – September 3
There was always an expectation that health care would be one of the biggest issues in this year’s presidential campaign, as was the case in the 2018 mid-term elections.
That is definitely the case, but not in the way anyone saw coming. In a surprise plot twist, a pandemic has eclipsed other issues like the Affordable Care Act (ACA), though do not expect those other issues to fade entirely.
The notion of “issues” in this campaign is, to be sure, something of a misnomer. The election is likely to be largely a referendum on President Trump. And Trump has never been a conventional candidate with conventional policy proposals. He governs and campaigns more through 280 character tweets than 10-point plans.
Voters will no doubt judge Trump based on the tone of his public statements and his conduct in office, but also on his policy actions and inactions and how they contrast with what former Vice President Biden is proposing. Much of that policy making has revolved around health care, especially as the coronavirus disease 2019 (COVID-19) pandemic continues to hit the US much harder than the rest of the world. Polling shows the public has an increasingly negative view of Trump’s response to the public health crisis, which could prove to be an important barometer for the campaign. …
Trump … has supported failed Congressional proposals to repeal and replace the ACA with weakened protections for preexisting conditions, reduced premium assistance, elimination of the Medicaid expansion, and a cap on all federal funding for Medicaid. He supports a lawsuit currently before the Supreme Court to overturn the ACA in its entirety, and expanded the availability of short-term insurance plans that have lower premiums but can exclude coverage of preexisting conditions and ACA-required benefits. In addition, he ended cost-sharing subsidy payments to insurers, suggesting they would cause the ACA to be “dead” and “gone.” Insurers, however, largely offset the terminated federal payments by increasing premiums, which in turn increased federal premium subsidies. He also signed legislation to repeal the individual mandate penalty. …
The NEJM seems a bit off base in its understanding of federalism. The states have much greater authority than does the federal government over what at least seems to me to be the main area of pandemic response disagreements, which I’d describe as social distancing issues. Can the bowling alley stay open? Should indoor dining be permitted? Should schools be in-person? Should there be restrictions on religious observations? Should mask usage be obligatory in certain circumstances? Here in Wisconsin, the Governor struggles with the legislature over these issues, but neither contends that Congress or the President have this kind of authority. For example, what does it mean to say the the “(t)he federal government has largely abandoned disease control to the states”? Not on vaccine development. Not on ventilator production. Not on international travel restrictions. Not on deploying federal hospital assets to help states. If Wisconsin is in some kind of crisis right now, it is not at all from federal inaction, but from spread occurring at state-regulated bars for the most part. This is why I do not expect the Presidential election to have many important COVID consequences. The things a President can do on his or her authority are pretty far along and mainly successful already.
eric:
What is going on in Wisconsin this very moment?
Wisconsin a state of 5.8 million people surpassed Florida (400 people /sq. mile) a state of 21.4 million with a population density greater than Wisconsin (107 people /sq mile) in the number of new cases of Covid. Area of each state in square miles is the same. How do you surpass the rate of infection in Florida with 25% of the number of people in Wisconsin? How do you do this? Enlighten me with some of your liberty BS for you which you are espousing here for you alone without regard to your practice of it endangering the people around you. The I got mine, screw you attitude. Wisconsin Republican legislature and Court has certainly shown how you handle a pandemic, haven’t they?
Did the people in Wisconsin suddenly become stupid from when I lived there? No, they have not; the Republicans have made this a liberty issue and lied to them. Your liberties shall not endanger me.
The president leads and establishes a central authority to plan supplies for the nation. States should nor be competing for supplies or trying to order from manufacturers. You are deflecting just like the sick idiot in the White House and you know better. You lock down in the beginning, no supper clubs, no schools, limited travel, etc. You know this too and you are being an ass right now and typical of a republican trying to find ground to support his words after what they did fails. How do you surpass another state of the same size with 4 times the number of people? You do stupid things. Republicans own this.
Did the people in Wisconsin suddenly become stupid from when I lived there?
“The things a President can do on his or her authority are pretty far along and mainly successful already.”
About social distancing, yes. But the things the POTUS can and should be doing in terms of getting equipment and supplies to hospitals were sabotaged by the Trump administration. Repeatedly telling people it’s no worse than the flu and will go away on its own sabotaged the state messaging. Endorsing hydroxychloroquine as a therapy/panacea sabotaged genuine efforts at treatment and created artificial shortages.
While prevention of infection, which is what social distancing is meant to do, is huge, it is only one dimension of the pandemic response. Let’s not pretend that Trump was acting in good faith. He wasn’t and he still isn’t.
Eric,
What US death rate justifies POTUS to invoke war powers?
Joel,
POTUS Trump was acting in good wraith. Unhappy Halloween.
There are things Trump did on his own authority that prevented federal agencies from helping states. For example:
https://www.nytimes.com/2020/10/09/health/coronavirus-covid-masks-cdc.html?smid=fb-nytimes&smtyp=cur&fbclid=IwAR3ZXXiXWLxmdKBhoygViiMYLvtM4cPhEVgTEwq79LXKQZ03vno6BRQVNpM&fbclid=IwAR0Z1hbpNT8bGSccaY1UUvIOL4uJ8P2sdwopM0X9FTuLgy8lwxH7w2rYWkw
wraith
/rāTH/
a ghost or ghostlike image of someone, especially one seen shortly before or after their death.
[In fond memory of HP Lovecraft. This is his celebratory month.]
https://cthulhu.fandom.com/wiki/The_Moon_Bog
The Moon Bog
by H. P. Lovecraft
Somewhere, to what remote and fearsome region I know not, Denys Barry has gone. I was with him the last night he lived among men, and heard his screams when the thing came to him; but all the peasants and police in County Meath could never find him, or the others, though they searched long and far. And now I shudder when I hear the frogs piping in swamps, or see the moon in lonely places.
I had known Denys Barry well in America, where he had grown rich, and had congratulated him when he bought back the old castle by the bog at sleepy Kilderry. It was from Kilderry that his father had come, and it was there that he wished to enjoy his wealth among ancestral scenes. Men of his blood had once ruled over Kilderry and built and dwelt in the castle, but those days were very remote, so that for generations the castle had been empty and decaying. After he went to Ireland, Barry wrote me often, and told me how under his care the gray castle was rising tower by tower to its ancient splendor, how the ivy was climbing slowly over the restored walls as it had climbed so many centuries ago, and how the peasants blessed him for bringing back the old days with his gold from over the sea. But in time there came troubles, and the peasants ceased to bless him, and fled away instead as from a doom. And then he sent a letter and asked me to visit him, for he was lonely in the castle with no one to speak to save the new servants and laborers he had brought from the North…
What is going on in Wisconsin leaves me more certain that this upcoming election for President will have little consequence for the public health aspects of coronavirus in the United States. If you listen attentively in Wisconsin, even at this moment of high coronavirus infection, you’ll hear next to nothing about policy actions that the executive branch of the federal government is responsible for. I do not at all mind arguments like “I’ll vote Biden because I think Trump ought to have done better” or “I’ll vote Biden because Trump is a Republican and Wisconsin Republicans are hamstringing Governor Evers efforts to control coronavirus”. But those arguments do not lead one to think that what Biden actually is likely to do if inaugurated in January will be a significant change for Wisconsin or any other place in the country. If you believe that bars, for example, are the most important environment for the community spread in Wisconsin, then the elections for the Assembly and Senate will be more important to arresting community spread than Biden would be. If the fundamental approach to this pandemic is to keep infections as low as possible waiting on the distribution of an effective vaccine, well the President is going to have little to do with the measures that might be needed, no matter who that may be.
Things like not issuing a national mask requirement for public transportation are diversions. Everyone on every airplane is wearing a mask today. Everyone on every train is. In Green Bay, everyone on every bus is, and that likely is the case in ever other city as well. So if the major object is to codify this on a national basis, well okay then this might do it. But real impact? Very small.
My sense is that a lot of public health officials and central government fans (NEJM, maybe on both counts) regret that America does not have an exceptionally powerful national government like France and Germans or Austrians or Singaporeans as our citizens.
Oh BS Eric, still afraid to own what your Republican party sponsored leader did?
To wit; Wisconsin a state of 5.8 million people surpassed Florida (400 people /sq. mile) a state of 21.4 million with a population density greater than Wisconsin (107 people /sq mile) in the number of new cases of Covid. Area of each state in square miles is the same. How do you surpass the rate of infection in Florida with 25% of the number of people in Wisconsin? How do you do this? Enlighten me with some of your liberty BS which you are espousing here for you alone without regard to your practice of it endangering the people around you. The I got mine, screw you attitude. Wisconsin Republican legislature and Court has certainly shown how you handle a pandemic, haven’t they?
In the beginning, not everyone wore a mask on airplanes, in stores, etc. Some airlines purposely packed planes with no space between the passengers and stores were too afraid to toss belligerent customers on the fear of being shot. Even today, people flaunt the wearing of the masks and social distancing. You have a convenient memory and the seeds of the pandemic growth were already sown by those of you who wish to force the practice of their liberties upon others whose physical well being and life are endangered by such practices. You can contest the numbers I cited by detailing what is “really” happening in Wisconsin. After all, you did not open up the bars and the supper clubs I am so used to partaking of then.
The harsh reality is to approach something appearing to be dangerous early on with the measures necessary to control it which means precisely what was “asked” of Americans and opposed by Republicans and lied about by this president and some of which was mentioned in the Woodward interviews. We knew nothing of Covid other than watching China struggle to control its rapid spread amongst a denser population than anywhere in the US. During other epidemics where we have opened up the doors, the country experienced similar increases in cases. This was and is known to political leaders and yet they failed to heed it in Wisconsin and the US and such actions was plotted against by dimwitted radicals in Michigan.
Biden is not of issue here because his reactions to a similar pandemic are unknown at this time.
Did the people in Wisconsin suddenly become stupid from when I lived there? No, they have not; the Republicans have made this a liberty issue and lied to them. Your liberties shall not endanger mine and your practice of such should be controlled as it endangers the nation as a whole.
I don’t know Run, when did you leave Wisconsin?
@Eric377,
[You are not entirely wrong about what you wrote here. What is entirely wrong is what no one wrote here – until now.]
pandemic plan was in place. Trump abandoned it — and science — in the face of Covid-19
By Jason Karlawish
May 17, 2020
resident Obama was bothered. It was the summer of 2009 and he was in a meeting at the White House to talk about preparations for an expected autumn outbreak of swine flu. Elbows on the table, he thumbed through the pages of a report on preparations for it.
“So,” he asked no one in particular, “if you guys are so smart, how come you’re still making this in eggs?” he asked, referring to the nearly century-old process for making vaccines in chicken eggs.
Those around the table erupted into laughter. The president’s quip was a moment of levity at an otherwise serious meeting.
The “smart guys” the president was jesting with were the members of the President’s Council of Advisors on Science and Technology, or PCAST. Founded in 1990 by President George H. W. Bush, the council, administered by the White House Office of Science and Technology Policy (OSTP), is an advisory group of scientists and engineers appointed by the president to augment the science advice he receives from other White House advisors, departments, and agencies.
In June 2009, the recently inaugurated Obama had given his PCAST advisors their first assignment: What does the president need to do to prepare for an influenza pandemic? Five weeks later, on Aug. 7, they gave him their answers at a meeting in the White House’s State Dining Room.
The story of this meeting and the ensuing eight years of science-informed policy making, which I have drawn from interviews with members of PCAST and internet archives of documents, show a president comfortable with having back-and-forth discussions with an assembly of the some of the nation’s top scientific minds. The president was committed to integrating science into his day-to-day decisions. One of those decisions was how to plan for and respond to the outbreak of a pandemic illness.
Over the course of the Obama presidency, a pandemic infrastructure was put in place. It included recommendations for a top-level White House official devoted to planning and responding to emerging infectious threats and, to guide that person’s work, the “Playbook for early response to high-consequence emerging infectious disease threats and biological incidents.”
And then on Jan. 21, 2017, Donald Trump became president.
Beginning the morning after his inauguration, a spectacular science-related tragedy has unfolded. The Trump administration has systematically dismantled the executive branch’s science infrastructure and rejected the role of science to inform policy, essentially reversing both Republican and Democrat presidential administrations since World War II, when Vannevar Bush, an engineer, advised Presidents Franklin D. Roosevelt and Harry S. Truman.
President Trump’s pursuit of anti-science policy has been so effective that as the first cases of Covid-19 were breaking out in Wuhan, China, no meaningful science policy infrastructure was in place to advise him. As a consequence, America is suffering from a pandemic without a plan. Our responses are ineffectual and inconsistent. We are increasingly divided by misinformation and invidious messaging. And it’s not even over.
To understand how Trump walked America into this mess, and that his recent claim he “inherited practically nothing” in pandemic preparedness from the previous administration is plainly wrong, it helps to have a picture of the infrastructure he neglected and ignored.
Facts will drive scientific decisions, not the other way around
On April 27, 2009, on the eve of his 100th day in office, Obama made a five-block trip from the White House to 2101 Constitution Ave. There, in the Great Hall of the National Academy of Sciences, he spoke about his administration’s commitment to science.
“Science is more essential for our prosperity, our security, our health, our environment, and our quality of life than it has ever been before,” he announced. He introduced the members of PCAST and explained how his administration would engage the scientific community directly in the work of public policy.
“I want to be sure that facts are driving scientific decisions — and not the other way around,” the president said. The audience broke into laughter.
Obama explained that his science advisers were already briefing him daily on the emerging threat of swine flu, which some were projecting could kill thousands of Americans.
The day before this speech, which came just 12 days after the first case of swine flu had been reported in the U.S., Obama had declared a public health emergency. Three days after the speech he asked Congress for $1.5 billion to address this emergency.
In the weeks that followed, the White House science policy infrastructure he had introduced at the National Academy of Sciences set to work.
Memos and meetings with the president at any time
Although every president since Franklin Roosevelt has had some engagement with science policy making, the degree of the contact between the president and his science advisers has varied.
George H.W. Bush met frequently with his head of OSTP, Allan Bromley, a physicist and former Yale classmate of the president. George W. Bush, in contrast, met just seven times with the head of his Office of Science Technology and Policy, John H. Marburger III, and eliminated two associate directors from the office. Obama’s engagement with his science policy apparatus was singular. He met with his OSTP director, John Holdren, as often as seven times a week.
Holdren, a plasma physicist whose scientific career included 23 years co-directing the Energy and Resources Group at the University of California, Berkeley, had this regular and close contact with Obama because, in addition to leading the OSTP and acting as co-director of the President’s Council of Advisors on Science and Technology, he was the assistant to the president for science and technology…
*
[It is a very long and detailed article, but that is what links are for. Fat Donnie should have been crucified by the media daily for his existential error on preparedness for a global pandemic. The poor soul that gets elected POTUS on November 3 will have his work cut out for him carrying the responsibility and ultimately the ongoing blame for the untenable situations that will unfold at the intersection of global pandemic and anthropogenic climate change rolling disasters. If you think it really sucks, now then buckle up buttercup because you are going to be in for a very rough ride for years to come.]