Sunday, April 12, 2020

The coronavirus chaos: who is to blame?

“WE'RE NUMBER ONE 1!” I guess that is supposed to be something to make Americans proud. However, on April 11 that meant the United States had passed Italy in registering the greatest number of reported deaths from COVID-19. Worldwide, there are now over 1.7 million confirmed cases and over 104,000 deaths. The United States, with a bit over 4% of the world’s population, had some 501,700 cases and 18,860 deaths.

IN THE RICHEST COUNTRY ON PLANET EARTH, the vice president is suggesting that doctors "recycle gowns" because hospitals don't have enough; states are sending ventilators to other states when this disease seems to recede because the medical devices are scarce; a fund meant to rescue small business is running out of money and Congress can't figure out how to fix it; the president said "we have the best" system for testing people for the coronavirus, even though other nations have tested a far higher percentage of their population; and a debate is raging among politicians about opening the economy, even though medical professionals say the disease is not yet controlled.

Contrast the U.S. with South Korea, an advanced economy of some 51.5 million, not nearly as wealthy as the U.S., nor blessed with the wealth of scientific and medical resources. Both South Korea and the U.S. reported their first COVID-19 cases on January 20. From that point, things dramatically diverged. If South Korea had cases and deaths in the same proportion of their population, they would have registered 79,635 cases and 2994 deaths. The actual numbers? 10,480 cases and 211 deaths! You cannot explain this away by different counting methods. South Korea has been much more aggressive in testing than the U.S., so we are much more likely to be undercounting than are the Koreans.

Who is to blame for the fiasco that is the U.S. response to COVID-19? There is blame enough for many, but the federal government bears the lion’s share.

China must take some share. When the first cases of the novel pneumonia appeared in Wuhan, the Chinese desire to save face and avoid scrutiny from Beijing led the political leaders of Hubei Province to downplay it and try to silence the messenger: Dr. Li Wenliang issued a warning about a strange new virus. Then the authorities summoned him for questioning. He was told to be silent. Dr. Li died of COVID-19, a true martyr. Precious weeks of preparation were lost.

Our health care system has in places responded with speed and cooperation, but in others has not covered itself with glory. We are all aware of the lack of personal protective equipment (PPE) that puts our doctors and nurses at risk. In several well-publicized cases, doctors and nurses who went public with their concerns or even started a GoFundMe campaign to obtain the needed gear were fired by their hospitals! Shades of Dr. Li. Not only does lack of PPE put front-line health care personnel at risk, it harms patients by making the physicians and nurses see them less often and/or transmit virus between patients. More and more physicians now work for venture capital firms. In NY, many of these responded to the COVID epidemic by cutting down the doctors’ shifts; after all, many of these patients are uninsured and not profitable. This epidemic has shown it is time to take direction of health care away from “the suits” and put it in the hands of those who understand patient care.

By far the biggest failure is the incompetence of the federal response. When word of the novel coronavirus spread, South Korea sprang into action with early mass testing, tracking and isolating all contacts of those infected. It started developing and stockpiling test kits in early January, as soon as Chinese scientists released the virus's genetic code and before a single Korean had been infected. The U.S. could have done the same. As far back as 2005, George Bush, having read a book about the 1918-1919 Spanish flu, tasked the CDC with gearing up to respond to pandemics. The Obama administration refined this during the Ebola crisis, and had a pandemic unit within the National Security Council. In 2018, as part of “reorganizing” the NSC, the pandemic unit was eliminated. While South Korea mobilized to prepare, and despite multiple warnings from within his administration, Trump insisted that “this is no worse than the flu,” and that “it will magically disappear by April.”

Shortages of supplies for our hospitals and health-care providers continue to plague our response to the novel coronavirus. As late as March 2, the administration was urging American businesses to take advantage of the booming market to export such supplies to other countries. If Trump had invoked the Defense Production Act earlier, he could have kept masks, ventilators, and PPEs at home. In February 2020, the value of U.S. mask exports to China was 1094% higher than the 2019 monthly average.

Even more disturbing are investigations into what is happening to the supplies hospitals and states are ordering. In the absence of federal masks, PPEs, ventilators, and so on, the president urged states to get what they needed themselves. They have bought supplies on the open market, only to have the federal government confiscate them. Federal supplies are being disproportionally distributed to states that vote Republican rather than states which most need them. It seems likely that at least some of the confusion is simply poor management, but the suggestion that leading administration officials are trying to create political capital out of this crisis seems in keeping with their usual patterns.

Testing, despite Trump’s claims, remains far behind that done in Korea, Singapore and other countries. Unproven therapies with potential for harm are being pushed by non-medical administration figures, from the President down. The Trump administration seems fixated on his image and the economy, public health be damned. This goes back to Trump’s insistence that a cruise ship with coronavirus-infected passengers not be allowed to dock in California lest U.S. numbers look worse and continues as he fixates on his TV ratings rather than competent management.

When we come out of this, let us resolve to do better. Let us resolve to have a President who believes in science rather than “his gut.” Let us resolve to have a President who puts the safety and health of the American people above his political future. Let us insist that our medical care system focus on patients before profits.

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