As the November elections draw near, let’s not lose sight of the flurry of developments in response to the politicization of the pandemic and the assaults by the Trump administration on medical science. Among them:
- Vaccine makers disclosed secret details about their plans to test the safety and effectiveness of a coronavirus inoculation on tens of thousands of Americans.
- Leading medical experts stepped to the fore again to insist that clinical trials of the prospective shot would not be meddled with by politicians, and the vaccine would be unlikely to become available to the public before Nov. 3.
- The federal agency that provides guidelines on Covid-19 care reversed itself, declaring that, yes, indeed, individuals without symptoms but who had exposure to the infected should be tested.
This last policy flip occurred amid news reports that the federal Centers for Disease Control and Prevention had been ordered to change earlier testing guidelines over experts’ objections.
The daily chaos created by the administration’s claims and counter claims, experts and public polling say, only creates public confusion and distrust of fundamentals required to deal with an unchecked disease that has killed more than 200,000 Americans and infected more than 6.7 million of us.
Trump and his officials have been undeterred in bickering with and undercutting medical and scientific experts with whom they disagree — and not with fact or evidence.
Azar declares his new rule on rules
Alex Azar, the head of the huge Health and Human Services department, has told the many agencies reporting to him, including the Food and Drug Administration, that power from now to issue any new rules regarding foods, medicines, medical devices and other products, including vaccines is “reserved to the Secretary,” meaning him.
He insists that this is a “housekeeping matter,” but it sends a clear signal, critics say, that Azar, as a political appointee, is ready and willing to not only intervene in but potentially to have his say in processes that have been run by medical and scientific experts. This includes judgments on rigorous clinical trials, which are conducted to test the safety and effectiveness of prescription drugs, medical devices, and, yes, vaccines. Republicans long have attacked the involvement of medical and scientific experts in approving prescription drug approval and medical devices, arguing market forces should have more sway. Critics say this is an invitation for consumers to be injured or killed by dangerous and defective products. It is worth recalling that Azar was a Big Pharma executive before joining the administration and he has a business, not a medical or scientific, background.
The president undercuts the CDC, again
In the meantime, Trump has bickered yet again with Dr. Robert Redfield (shown above) and the CDC, the disease-fighting agency the career virus expert heads. Redfield testified to Congress that a prospective coronavirus vaccine would not be widely available to Americans by Nov. 3 and more likely would open up next year. He also gave a big endorsement for face covering as one of several ways for members of the public to protect themselves. Coverings exist and are easy to use now, which makes them a more effective infection-fighting means than a still unproven vaccine, said Redfield, who is under increasing fire for allowing political meddling at the once highly respected CDC.
Trump then undercut his own appointee, asserting several times without evidence that millions of vaccine doses would be available and in use by year’s end, with approval of the shot occurring as early as October. He also continued his flip-flopping on face masks, now attacking Redfield’s advocacy and asserting in a broadcast town hall that the protective value of coverings in his mind was disproven “by many.” He backed up his assertion not with studies or expertise but with an anecdote —about waiters who serve him his meals and his observation about their discomfort in wearing face covers.
Mark Meadows, the White House chief of staff, called out Redfield and asserted he was out of the loop on the preparation for the rollout of a prospective coronavirus vaccine — a claim hard to square since the CDC was the federal agency that issued the national guidelines on the distribution of the shots.
Volatile leaders out at HHS
The administration’s credibility on health policy matters took its own whacks, with the implosion of Trump appointees who were high-level internal critics of federal scientists, physicians, and public health experts. Michael Caputo, the top communications official at Azar’s HHS, took a medical leave after apologizing to colleagues for a bizarre, conspiracy-spouting outburst attacking them. Dr. Paul Alexander, his deputy, also departed the agency, as critics, among other things, began to question his resume.
Caputo and Alexander both were blamed for their aggressive efforts to muzzle federal experts, including Dr. Anthony Fauci, the nation’s leading infectious disease researcher, and to substitute White House-approved views over those of medical scientists, including by altering CDC reports relied on by a global medical-scientific community. The duo took aim at, among many at the CDC, Dr. Anne Schuchat. She has served with distinction at the agency for more than three decades, and many have argued that rather than heading the CDC on an interim basis, as she has, that she should have been its permanent chief. Caputo, by the way, had no background in health or science and was a longtime political operative before his HHS appointment. Critics say he was brusque, arrogant, and installed poorly credentialed cronies throughout the agency during his tenure. Alexander made aggressive comments about his agency colleagues, even though he was an obscure Canadian researcher and part-time university teacher before Caputo seized on him and elevated him far beyond any previous position he had held.
The president’s obsession with a seeming drama of the day, politics aside, continues to make the federal pandemic response an incoherent mess. The White House strategy of blaming others and pushing responsibility everywhere else except in the most powerful office on the planet, has seen the coronavirus deaths and infections rise in relentless fashion.
A fall plateau, winter dread
The pandemic, though, has hit a plateau of sorts, with the nation averaging a steady and unacceptable 40,000 infections per day. Doctors and hospitals keep making headway in the front-line treatment of the disease, lessening its early lethality — though hundreds of Americans die daily of the coronavirus.
Still, not only is the election rushing on the country, so, too, is winter. Americans, with already palpable signs of pandemic exhaustion, may not get the outdoor respite that has allowed the resumption of restaurants, robust exercise, and the relief from staying mostly in their homes.
The coronavirus, without sustained efforts to smash it back, has shown itself to be resilient and relentless in countries that have acted more aggressively than the United States. Will this country, with more kids back at school or college, grownups back at work, and crowded by the cold into close quarters, find itself ripped in a few months by another brutal wave of coronavirus infections and deaths? Will history repeat itself and will the later phases of this pandemic be worse, as occurred with the 1918 flu disaster?
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the high value they can experience by staying as healthy as they can — and outside of the U.S. health care system. That system had its big problems before the pandemic, including with infections acquired in care giving institutions (hospitals and nursing homes), misdiagnoses, and medical errors — the third leading cause of death in the nation, by some expert estimates.
That said, we need to protect and improve the health system more than ever, notably with big support for public health and medicine based in science and evidence. It will be difficult to tune out the craven partisanship in the days ahead and to focus on how we battle the coronavirus and ensure the nation emerges not in the old normal but a better place.
This will mean rejecting time-tested fear mongering and fact-free assaults on evidence-based, rigorous science and medicine. We will find that statements repeated with fervor don’t magically become accurate and true. We may learn the hard way to be skeptical of and to dig into research and expertise, while also accepting that, yes, learned people who invest a lifetime of work in an area really know something and have invaluable experience and knowledge to benefit us all. We’ve got a lot of work to do.