The Trump Administration — yet again — has sowed confusion, frustration, and anger over the federal response to the Covid-19 pandemic, creating potentially harmful credibility issues for a prospective coronavirus vaccine, the scientific concept of “herd immunity,” a possible blood-based treatment for the illness, as well as testing, contact tracing, and quarantines for the disease.
The White House follies would be considered bad farce, save for the reality that the U.S. death toll races toward 200,000 and infections have skyrocketed past 6 million. The U.S. has 22 percent of the world’s Covid death toll, but only 4 percent of the world’s population.
With schools reopening, infections, hospitalizations, and deaths among children are on the rise.
More than 51,000 infections have been reported at more than 1,000 colleges and universities across the country, with the University of Maryland suspending athletic activities after a spike in cases and hot spots or flareups reported at Indiana, South Carolina, Alabama, Kentucky, Iowa, and Arizona State.
Midwestern states are showing signs of the latest, worrisome coronavirus surge.
Vaccine confusion and consternation
While many Americans had high hopes that a “warp speed” federal campaign to develop a Covid-19 vaccine might be a game changer in the battle against the disease, the Centers for Disease Control and Prevention — with the prodding of White House — damaged public confidence in this effort by suggesting the rigorous testing for the inoculation’s safety and effectiveness would be rushed.
Dr. Stephen Hahn, the embattled head of the federal Food and Drug Administration, told the Financial Times in an interview that his agency would consider granting an emergency exception to allow the use of a prospective coronavirus vaccine, if incomplete clinical trials generated strong evidence to support this expedited approval.
The CDC recently wrote to state health departments, telling them to be prepared by Nov. 1 and to report to the federal government how they would conduct a nationwide vaccination campaign.
States and public health officials reacted with dismay and anger to the CDC demand, not only because it was poorly communicated and high-handed. But also, because the Trump Administration has failed to partner with experts in the conduct of vaccination campaigns on elemental aspects of federal plans, creating worry the nation is unprepared to carry it out: Who will pay for the vaccination program, especially the cost of the people to carry it out? Who will run it — the military, states, private interests, including hospitals and Big Pharma? Who will provide the vaccine, equipment, protective gear, and inoculation sites? Who will coordinate the big demands the coronavirus vaccine requires, including tracking and scheduling patients and their need for probably two shots, as well as maintaining vaccine supplies, notably keeping them in frigid storage?
A blue-chip panel, in the midst of the angst over the vaccine, weighed in with its recommendations on how officials should prioritize who gets a coronavirus vaccine.
Top federal leaders involved with the pell-mell push for the vaccine, including Dr. Anthony Fauci, the nation’s top infectious disease expert, had to smooth over yet another gaffe by Dr. Tom Redfield and the CDC. Fauci and other experts, as well as Big Pharma officials (!), hastened to say that careful clinical trials of possible coronavirus vaccines will not be hurried, and independent experts would study the data produced to determine if the shots are safe and they work.
It is theoretically possible a vaccine could show such overpowering positive results in a stringent test, so that experts would be wowed and would recommend its widespread public use, as I have written in a recent newsletter describing the rush to develop a coronavirus vaccine. Despite cheery White House promotion of the vaccine, it is far from the point where it seems even relatively possible for a pre-election roll out, officials stressed. Just consider: The vaccine candidates that have made it into the decisive round of clinical testing still have not fully enrolled the tens of thousands of participants required to assure a trial’s scientific credibility. If the vaccine requires two injections, and, typically, a few weeks for the body to react to it to generate protection, it would be credulity-stretching to be talking now about clinical trial results, right? Plus, those who have been vaccinated, twice, besides taking time to acquire protection, would also need some time in which researchers could know with certainty that they had been exposed to possible infection (and averted it).
Giving the CDC the benefit of the doubt, the agency might have aimed to express the urgency of preparation for a potential vaccine, without setting a schedule subject to snark and attack because of its timing toward the presidential vote. That still does not explain if, indeed, the administration — once again — is demanding action by states while failing to take a bigger, broader federal responsibility or a role in yet another pandemic response. Local officials have gotten burned by this approach before and they have reasons to loathe it, as the Wall Street Journal reported.
A neuroradiologist catches the president’s ear
The issue got mired further in politics because of the prominence in federal pandemic discussions these days of Dr. Scott Atlas (shown above). He has become the latest source of dubious information to catch the president’s attention, pushing doubts about coronavirus measures like stay-at-home orders, testing and face covering while also propounding the notion that the nation may wish to give greater credence to promoting the rise of a natural herd immunity.
Experts know that infections can be pushed down when a high percentage of a given population has protections against a disease — because individuals have had the illness and their bodies have developed defenses against it, or because a vaccine safeguards them. Researchers do not know the thresholds at which the United States would have seen Covid-19 spread so dramatically that the nation would experience herd immunity.
The experts in the field, however, caution that achieving herd immunity — even with the terrible toll that Covid-19 already has taken — might mean that as many as 2 million or more Americans would die before this protection kicked in. That figure might be lower with a safe, effective, and widely adopted vaccine.
There isn’t one yet, so Atlas has found himself spending a lot of time explaining details of his disputed views about herd immunity. But in doing so, he set off new alarms about his background and views.
Yes, Atlas is a doctor, but he is a Stanford neuroradiologist —an expert who “specializes in diagnosis and characterization of abnormalities of the central and peripheral nervous system, spine, and head and neck using neuroimaging techniques …[like] computed tomography (CT) and magnetic resonance imaging (MRI).” He has not spent his career dealing with infectious diseases, epidemiology, or public health. He was part of a partisan think tank and was a regular TV talking head on Fox News.
Critics have ripped him anew for arguing against widespread testing, especially of the asymptomatic, so experts can know where coronavirus infections are occurring and how severe they might be, so that public health measures can be taken. Atlas says testing should be used only to detect and treat known illness in singular cases, especially among high risk groups like the elderly — a notion that angers and frustrates experts who say it is akin to the small, quaint view of a GP treating a handful of patients in a tiny farm town at the turn of the century.
The president, however, likes to hear what he wants, and he has put a priority for months now on driving the federal pandemic response on his gut, intuition, unfounded belief, and evidence-free comments or remarks he hears from the TV or people he knows. This has given the powerful White House influence to: the debunked administration of the anti-malarial drug hydroxychloroquine; presidential speculation on patients taking disinfectants or sunlight internally; the fact-free assertion of the value against Covid-19 of a poisonous oleander extract; and the widespread use of convalescent plasma therapy as a treatment.
Trump twisted arms to get federal health officials to alter their coronavirus testing guidelines and to grant emergency approval to plasma therapies — generally believed to be safe but, thus far, without the clinical rigor to command wide use. Dozens of hospitals, however, may defy the White House and the federal Food and Drug Administration, declining to treat patients broadly with the antibody-rich plasma.
The hospitals and medical scientists say they hope to conduct the needed, stringent clinical trials to determine if convalescent plasma is helpful in treating Covid-19, as the treatment has not undergone sufficient testing to prove its now suggested value, especially in emergency use, as the FDA allowed.
Clinical trials show benefits of steroids in coronavirus care
This is a difference in medical processes with distinction, as clinicians could plainly see when the World Health Organization rolled out its guidance about the safety and effectiveness of treating coronavirus cases with common, available, and relatively inexpensive steroidal drugs. As the New York Times reported of the study this treatment underwent:
“’Clearly, now steroids are the standard of care,” said Dr. Howard C. Bauchner, the editor-in-chief of JAMA, which published five papers about the treatment. The new studies include an analysis that pooled data from seven randomized clinical trials evaluating three steroids in more than 1,700 patients. The study concluded that each of the three drugs reduced the risk of death. JAMA published that paper and three related studies, along with an editorial describing the research as an ‘important step forward in the treatment of patients with Covid-19.’”
With carefully tested steroids and the drug remdesivir (which also underwent clinical trials), as well as with hard-won experience in improving coronavirus direct care, patients and doctors both may have greater confidence in how medicine may better treat the array of harms inflicted by Covid-19.
This is the way it should be, with haste not leading to waste. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This was an ordeal before the pandemic, driven by the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Covid-19 has added a significant level of challenge and complexity to U.S. health care. But Americans will not benefit from and will be harmed by political meddling and further seat-of-the-pants, gut instinct policy making from federal authorities. The coronavirus is a natural menace for which no politician may be blamed. But voters will hold accountable those responsible for the shambolic federal response to the pandemic. It has been unhelpful to the sick and dead, as well as too many people left jobless, hungry, and losing their homes. We have much work to do to put our country in a better place and to end the kowtowing to calamitous leadership that is so cavalier about Americans’ health and well-being.