The Failure of the Public Health Establishment
Prof. Peter Dorman of Evergreen College writes at EconoSpeak and portrays Matt Yglesias’s retrospective on how the healthcare establishment failed the public when passing information on facemasks, hand-washing, distancing, etc., and how Covid is transmitted.
The direct result of not following these practices or casting doubt upon them is an elevation of Covid cases which strains the capacity and logistics of healthcare facilities, the equipment used on patients, and the supply of medicines.
Matt Yglesias has an excellent retrospective on the absurd reversals over mask usage that arose in the early stages of the pandemic. You will recall that the public health establishment, amplified by mainstream media outlets like the New York Times, told us all to ditch our masks and concentrate instead on frequent, vigorous hand-washing. This was transparently absurd at the time, since from the beginning it appeared that coronavirus transmission had something to do with airborne virus exposure.
We were told masking didn’t protect us.
We were told only N95 masks worked, and only if they were taken on and off just so, in a complex procedure us untrained mortals could never execute.
And we were told we had to save these precious masks so health care workers could protect themselves, even though that was in direct contradiction to argument #1. (Later, Anthony Fauci told us that conserving the inadequate supply of N95’s was the underlying motivation, and the rest was mostly persuasion.)
By mid-spring the story had changed, and now we were all supposed to wear masks at least some of the time, although the WHO and the CDC were reluctant to go the full distance and admit that aerosol transmission was widespread and justified routine use of masks in social settings. Today we have arrived at the point where reluctance to wear a mask is cause for shaming and shunning—as if the initial mask guidance and its repetition in the media had never happened.
But the mask fiasco was only a part of it. Yglesias also mentions the shifting and contradictory policies regarding distancing: the immediate shutdown of outdoor activities even though indoors was more dangerous and the “hygiene theater” of deep cleaning while air filtration languished. He says we should have a serious, critical examination of America’s response to the virus once the worst of the pandemic is over.
I agree, but I want to add a further observation and hypothesis. Every failure of guidance and regulation had a common theme, protection of the health care system. We should abjure masks because the health care workers needed them. We can’t base messaging or policy on aerosol transmission because that would require expensive retrofitting of health care facilities. We can’t restrict travel because medical supply chains and the movement of health care resources can’t be disrupted. The objective is to “flatten the curve”, not eradicate the virus, because the important thing is to not run out of ventilators or ICU capacity—even though flattening has no visible endgame and itself contradicts the messaging about how awful it is to get covid. Put it all together, and it’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system.
This is how it looks to me, but it’s still a hypothesis. We could benefit from scrutiny of public health schools in universities, not least their funding, and public health agencies at the state and federal levels—and also the WHO. Has public health been redefined this way in practice and even in theory? If so, what would it take to redirect it so the health status of the public and not the burden on health service providers is their guiding concern?
“it’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system”
Well yeah, if the system breaks down the death rate spirals up, the policy goal across most of the country seems to self-consciously be to try and open as much of the economy as possible without crossing that line too far.
It is quite clear in Brown county Wisconsin that school openings were also manipulated by the “greater” public health community. Green Bay Catholic schools have been mostly open all school year. But there came a time in late September when the public health community demanded that they shutdown. Here the major voice in the matter was not an actual public official, but the CEO of Prevea, a very large provider. His problem turned out to not be that schools were loci of high infection, but that the stringent rules that the schools institutied (at the urging of health officials) was putting a lot of provider’s medical staff out into isolation based on some kid with the sniffles (but never COVID) in their daughter’s 5th grade class. Better to have the kids stay home and muddle through childcare than to have Mom or Dad (or both) committed to staying at home through x days while they wait out whatever period the rules established. Schools were not much in the way of infection risks, but they were an inconvenient source of tight restrictions. Well that lasted 2 weeks and parents revolted and schools reopened.
while we can complain that they were trying to keep the hospitals from being over whelmed, and we could point at more than just the public hospitals, it includes the private ones too, they all have the same problems (just an example…the old days you wouldnt happen on a ER doctor that didnt work for the hospital…today you can barely find one that does…does wonders for billing…cause many of these providers…dont negotiate with insurers…and its really hard to do that in an ER…also seems to work the same way for planned surgeries too…but you have to be vigilant …cause all it takes is a doctor not in network…to make a really huge bill… ). does this ‘system’ mean that hospitals avoid doing any ‘investment’ in their facilities? sure…unless it make them look good. for example, i have a very minor procedure needing to be done, because the doctor works for a large hospital chain (private hospital chain. the procedure is going to be done at the hospital (where he works as it turns out)..the doctors bill (he is in network)….will be less than $400 …my part of the hospital bill ($5000). thats after the insurance pays about $12000. had hospitals ‘invested’ in the facilities…maybe they would be larger…but its hard to do that when demand is at a pretty consistent level…but a pandemic blows up demand to the point that it has little relation to what was ‘normal’. today you will have trouble getting a ICU bed…when you have that major accident……and while maybe we would like to have the early knowledge faster….problem this isnt the 23rd century…and a TV show,,,where they can solve the unknown in a very short time…reality doesnt act the same way…course if you actually looked at the way our ‘health system’. Supposedly works…you find that counties…are the source for all the data….and many (ok…maybe a majority)..dont have health departments…and may not have doctors..or hospitals….so given all of that…it becomes a crap shoot that we even figure out there is a pandemic….and no there was a plan…before 2017…it just wasnt used
https://www.dallasnews.com/opinion/commentary/2020/07/04/trumps-five-major-failures-on-coronavirus/
Trump’s five major failures on coronavirus
The reckoning is now.
By Carl P. Leubsdorf
1:30 AM on Jul 2, 2020 CDT
…Slow start. Throughout the first two months of the year, Trump ignored warnings from administration intelligence and health experts, dismissing initial signs of the pandemic as transient. Some critics believe he relied too heavily on Chinese reassurances because of his eagerness for a big trade deal. The early delay contributed to later testing shortages.
Incomplete travel ban. In an action he touts as showing his strong action, Trump issued a partial ban Jan. 31 on travel from China, the origin of the pandemic. But the ban had loopholes, and his failure to similarly limit travel from Europe for six weeks left the country highly vulnerable to the virus, evidenced by sharp spikes of infections in the New York metropolitan area.
Mixed signals. Even after Trump declared an emergency and ordered a national lockdown in mid-March, he repeatedly sent false signals creating doubts he favored the actions he proposed. When a shortage of COVID-19 tests hampered the response, he said, “I don’t take responsibility at all.” Instead of creating a unified national response to what became the country’s greatest health crisis, he declared action was up to the states and bashed governors seeking more federal help. Within weeks, he prematurely sought to end his own restrictions, pushing to restart economic activity lest a prolonged recession derail his reelection hopes.
Premature reopening. Even before his own April 30 deadline, Trump was urging states to resume economic activity, successfully persuading Republican-led states like Texas, Arizona and Florida to act even though they failed to meet federal guidelines. In a symbolic but significant move, Trump undercut his own administration’s enforcement regimen by refusing to wear the protective mask that scientific advisers like Fauci repeatedly called the best way to curb the virus.
Ignoring reality. As the number of infections plateaued, then resumed to rise, Trump declared victory and switched his focus to economic revival and street protests on police crimes and broader racial issues. When his anti-pandemic task force held its first briefing in two months last Friday, Trump was absent. Vice President Mike Pence presented so optimistic a report that CNN’s Dana Bash likened it to the infamous “five o’clock follies” where military briefers gave misleading accounts of alleged progress in the Vietnam War…
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[That had to hurt. That was from the Dallas Morning News, Dallas, Texas that is.]
[There are just scores of articles bashing Trump on his handling of Covid-19, but this is my favorite smoking gun.]
https://www.reuters.com/article/us-health-coronavirus-china-cdc-exclusiv/exclusive-u-s-slashed-cdc-staff-inside-china-prior-to-coronavirus-outbreak-idUSKBN21C3N5
March 25, 20206:26 PMUpdated 9 months ago
Exclusive: U.S. slashed CDC staff inside China prior to coronavirus outbreak
By Marisa Taylor
WASHINGTON(Reuters) – The Trump administration cut staff by more than two-thirds at a key U.S. public health agency operating inside China, as part of a larger rollback of U.S.-funded health and science experts on the ground there leading up to the coronavirus outbreak, Reuters has learned.
Most of the reductions were made at the Beijing office of the U.S. Centers for Disease Control and Prevention (CDC) and occurred over the past two years, according to public CDC documents viewed by Reuters and interviews with four people familiar with the drawdown.
The Atlanta-based CDC, America’s preeminent disease fighting agency, provides public health assistance to nations around the world and works with them to help stop outbreaks of contagious diseases from spreading globally. It has worked in China for 30 years.
The CDC’s China headcount has shrunk to around 14 staffers, down from approximately 47 people since President Donald Trump took office in January 2017, the documents show. The four people, who spoke on condition of anonymity, said the losses included epidemiologists and other health professionals.
The material reviewed by Reuters shows a breakdown of how many American and local Chinese employees were assigned there. The documents are the CDC’s own descriptions of its headcount, which it posts online…
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[The liberal press really dogs Trump, but Reuters is not liberal press. Reuters is smarter than most of Texas, but about as plugged into the capitalist system as is possible.]
So then if leadership does really matter then what should we have expected from the syndicated capitalist cabals?
When Covid came along our best guesses came from SARS (2003) and MERS (2014) which are also coronaviruses. From the CDC website
I think Dorman and Yglesias fail to discuss how the understanding of asymptomatic transmission changed. I think Fauci should have said “we are changing our guidance because we were wrong”.
told only N95 masks worked, and only if they were taken on and off just so, in a complex procedure us untrained mortals could never execute.
And we were told we had to save these precious masks so health care workers could protect themselves
”
the other misconception being disseminated was that people should not buy the mask with a valve. Propaganda was telling that the valve would allow unfiltered air from the mask wearer to re inoculate the ambient.
If there is no valve on the mask, when the Mask user exhales he loosens all the particles on the outside of the Mask filter, blows them back into the ambient. worse yet, he can do this for week after week by using the same mask everyday.
what should fed Governors do this week? they should drop helicopter credit ratings by easing credit, and pad the balance sheet to spur investment from equity-owner-windfall.
once the virus threat is gone fed governor’s should tighten rates and sell off the balance sheet to reduce investment that crowds out aggregate demand from the worker/caste.
Timing is the
word of the
week
!
@Arne,
Big YEP. After trashing our early warning system then we were struck with a shocking surprise and were grasping at the only straws that we had.