Trumps Unprecedented Attacks on Our Public-Health System – The New Yorker
How worried should we be that the President of the United States recently described as very impressive a woman who claims that doctors make medicine using DNA from aliens? Or that he shows no sign of recognizing the magnitude of the COVID-19 pandemic? Its simply not possible to worry too much.
I thought her voice was an important voice, Donald Trump said, after a reporter asked him why he would retweet the claims of Stella Immanuel, a Houston pediatrician with a long history of bizarre statements about medicine and human sexuality. Immanuel also shares Trumps unfounded enthusiasm for hydroxychloroquine. The drug has been repeatedly discredited as a treatment for this disease. She insists that it is a cure. Its tempting to write off this episode purely as evidence of Trumps disrespect for science. But the problem it represents is much bigger; it is the clearest sign yet that political interests and personal whims have eclipsed the rigor of some of our most important scientific institutions.
Read The New Yorkers complete news coverage and analysis of the coronavirus pandemic.
Twenty years ago, reporting from South Africa, I saw firsthand what happens when a national leader forces his people to subsist on lies and magic. From 2000 to 2005, according to a definitive study by researchers at the Harvard School of Public Health, Thabo Mbeki, then the President of South Africa, let as many as three hundred and thirty thousand of his fellow-citizens die and thirty-five thousand babies be born with H.I.V., by refusing to permit the countrys health service to treat AIDS with antiretroviral drugs. Mbeki and his health minister, Manto Tshabalala-Msimang, insisted that antiviral medicine was the product of a plot by Western pharmaceutical companies to kill Africans. The Harvard study concluded that the drugs were withheld largely because of Mbekis well-known refusal to initially accept that AIDS is caused by a virus, H.I.V.
No single national leader would have been able to prevent the coronavirus pandemic. But Trumps denialism and hostility toward public-health officials has greatly increased Americas share of suffering and death. On Fox & Friends, on Wednesday, he said that the virus is spreading in a relatively small portion of the country, and that children are virtually immune; both statements are false. And, as he has done many times before, he declared at a briefing that the pandemic would just go away.
Trump has had one consistent response to the pandemic: he attacks leading experts when they attempt to tell the truth. Last week, when Deborah Birx, the cordinator of the White House coronavirus task force, characterized the epidemic as extraordinarily widespread, Trump tweeted that she was pathetic. Earlier this year, when Anthony Fauci, the nations leading infectious-disease expert, was asked at a briefing to discuss his view on hydroxychloroquine, Trump prevented him from answering. The Presidents refusal either to lead or to recognize the leadership of others has made it impossible to develop a national plan to combat this virus.
Without such a plan, the nation has been subjected to a giant game of viral roulette. With no coherent system of rapid tests, contact tracing is all but useless. Since we have neither a vaccine nor any general therapy, tests and tracing offer the only near-term hope of controlling the pandemic. States have largely been left to fend for themselves. Last week, seven governors, Republicans and Democrats, formed their own testing coalition.
On Wednesday, Fauci was asked if the United States had the worlds worst COVID-19 outbreak. It is quantitatively, if you look at it, he said. I mean, the numbers dont lie. Trump is asked similar questions nearly every day. And, although the numbers may not lie, the President does. As he put it in a recent tweet, You will never hear this on the Fake News concerning the China Virus, but by comparison to most other countries, who are suffering greatly, we are doing very well. No amount of statistical massaging could make that statement true.
This war on reality has deeply wounded Americas public-health system. In March, under relentless pressure from Trump and his trade adviser, Peter Navarro (who has no medical training), the Food and Drug Administration issued an emergency-use authorization (E.U.A.) for hydroxychloroquine. That allowed doctors to administer the drug to patients who were severely ill, but it was not an approval of the drug for general use. As Janet Woodcock, who runs the F.D.A.s Center for Drug Evaluation and Research, put it in an interview with Stat, We simply said its possible from the in vitro data this may have a beneficial effect and the benefits may outweigh the risks. Few people understood that distinction, and, goaded on by the President, few listened to those who urged caution.
Trump announced on national television that hydroxychloroquine could be a game changer. It wasnt. Former F.D.A. officials were astonished by the rushed action. I understand the desire to find hope, but we need more evidence than is currently available before we encourage widespread use, Margaret A. Hamburg said at the time. She served as the F.D.A. commissioner for six years under Barack Obama.
In June, when the drugs ineffectiveness had become apparent, the F.D.A. revoked the E.U.A. It was a remarkable retreat. While it is reassuring that the agency finally made a decision based on data, the drug should not have been released for this use in the first place. But, when politics takes precedence, facts no longer matter. Rick A. Bright, one of the nations experts on pandemic preparedness and the chief of BARDA (the Biomedical Advanced Research and Development Authority), had objected to the use of the drug and tried to stop it. He was fired. As the Times reported on Monday, Stephen Hahn, the current F.D.A. commissioner, is not allowed to speak to the press unless Michael Caputo, an assistant secretary of the Department of Health and Human Services, or another official, is also on the line. Caputo has long been associated with Trump, once serving as his driver.
We have recently witnessed an even more pernicious example of an American scientific colossus bowing to Trumps ignorance. In May, the Centers for Disease Control and Prevention issued stringent guidelines to determine when and if schools should reopen this fall. Trump has insisted, against all scientific advice, that all schools should open. He tweeted, I disagree with the @CDCgov on their very tough & expensive guidelines for opening schools. While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!
Robert Redfield, the director of the C.D.C., immediately issued an update to the guidelines, announcing that it is critically important for our public health to open schools this fall. The reversal was stunning; past C.D.C. directors were not immune to politics, and they understood that a President might overrule them. But there has always been an understanding at the agency that all public-health decisions made there would have to be governed by data.
No agency or scientist is infallible. Early in the pandemic, the C.D.C. failed to introduce accurate test kits; many of the kits it distributed were contaminated and useless. The agency used highly sensitive tests based on PCR technology, which is a kind of molecular copying machine that makes millions (or billions) of copies of a DNA sample. That makes it much easier for clinicians to detect any specific sequence of DNA, including those in the coronavirus. The technology has been used routinely for more than three decades, but it is sensitive to small errors, and there were several in the C.D.C. kits. The misstep delayed accurate data collection throughout the United States at one of the most critical moments in the pandemic.
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Trumps Unprecedented Attacks on Our Public-Health System - The New Yorker