Speaking of Poor Public Health Policy
Comparing the White House's approach to that of sports leagues on testing.
To follow on from some points noted in my previous post, note the following from the NYT: White House Opposes Expanded Virus Testing, Complicating Stimulus Talks. We see here the utterly feckless approach by this administration to the pandemic.
The piece start discussing an e-mail exchange between Paul Romer, an Nobel laureate in economics and Scott Atlas, a medical doctor with a specialization in radiology who is an adviser to the White House on the coronavirus.
Romer was pushing for widespread testing and isolation of the infected to prevent spread of the disease. Atlas was not on board.
“That’s not appropriate health care policy,” Dr. Atlas wrote.
Dr. Atlas went on to mention a theory that the virus can be arrested once a small percentage of the United States population contracts it. He said there was a “likelihood that only 25 or 20 percent of people need the infection,” an apparent reference to a threshold for so-called herd immunity that epidemiologists have widely disputed.
The call for more widespread testing and isolation, Dr. Atlas wrote, “is grossly misguided.”
Dr. Atlas and other administration officials playing influential roles in the government’s virus response effectively say the opposite: that more widespread testing would infringe on Americans’ privacy and hurt the economy, by keeping potentially infected workers who show no symptoms from reporting to their jobs.
In an interview on Thursday, Dr. Atlas, who is not involved in the stimulus talks, said that the United States had a “massive” testing program over all, but that it should be used strategically to protect vulnerable populations, like nursing home residents — not young, healthy individuals who he said were at low risk of contracting the disease. He said that large-scale government test and isolate programs infringed on civil liberties, and that new research had persuaded him that herd immunity might be achieved once 20 or 40 percent of Americans are infected.
I recognize that Romer is an economist and Atlas is a medical doctor. However, why is the White House taking advice from a radiologist in the middle of the biggest pandemic in decades? Are there no epidemiologists, virologists, or public health experts to consult?
Or is this another case of Trump finding an “expert” to tell him what he wants to hear?
I think we know that answer.
Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.
“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”
Let me focus on this:
more widespread testing would infringe on Americans’ privacy and hurt the economy, by keeping potentially infected workers who show no symptoms from reporting to their jobs.
This is an endorsement of letting infected and asymptomatic persons circulate in the public. That is a recipe for community spread. While I understand the economic cost of having asymptomatic persons staying home for 10 days in isolation, there is also a massive economic cost to be associated with letting that infected person infect many, many others. And the idea that we can then protect more vulnerable persons from the infected but asymptomatic is just magical thinking.
I know the administration is desperate to make things go back to “normal” but setting aside the fact that there is no way to simply return to the status quo ante, this policy recommendation is one that will get people sick, some of whom will die.
“The overwhelming majority of people who get this infection are not at high risk,” Dr. Atlas said in the interview. “And when you start seeking out and testing asymptomatic people, you are destroying the workforce.”
I will confess, I am not a radiologist and while some call me Doctor, I am not a physician, but I am pretty sure that asymptomatic spread is a major reason we can’t get this pandemic under control.
Moreover, the real difficulty with containing this virus: there are no universal cues that a person is infected (otherwise known as “symptoms” in medical circles, or so I am told). If everyone who was infected was also symptomatic, testing would be less of a need and it would be easier to know who needs to be isolated.
Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.
Testing doesn’t solve everything and we still need other public health measures, but the notion that purposefully having less information to work with is a defensible position is ridiculous.
I am continually struck by the fact that an area where we as a nation have seemed to have had some success with controlling to virus has been in the area of sports. The NBA, MLB, NFL, and college football have managed to operate and have avoided massive outbreaks.
I would note that the main way they have done is this through rigorous, continuous testing and contract tracing. They have also practiced mask wearing and various distancing protocols.
The NBA, famously, restarted its season in a bubble with extensive testing. The non-bubble approaches (MLB, NFL, CFB) have all had testing, and isolation of players who are positive (whether asymptomatic or not) and even postponement of games so as to and stop infection from one team to the next (not to mention the collateral damage created by travel and so forth).
If baseball, which got off to a bit of a rough start with several games having to be postponed due to infections, had followed Dr. Atlas’ recommendations and just played as long as players were asymptomatic the odds are that at some point a cluster of infections would have emerged. Eventually, some number of players would have gotten seriously ill. At that point, the MLB season would likely have been canceled.
The Nick Saban story that James posted about is also illustrative. Just think how many tests Saban had to have to first pop the false positive, and then to be tested negative enough times to clear him to coach last night. The odds are that no one reading this has that kind of access to testing. I am lucky enough to have access to testing via my campus health center, but they are not going to test me multiple times a week to make sure I am negative. I have been tested twice, once due to exposure, and once after feeling poorly for a week and wanting to rule out Covid before exposing myself to others. Had I tested positive I would have gone into isolation, symptoms or not. I wouldn’t have kept testing. I know the football team gets tested in ways far different from the student population (and that is true across the country).
As a counterpoint, I have a family member in an assisted living facility and vistors are only allowed in after a negative Covid test. But getting a test, let alone with results in a timley manner, is nearly impossible in the city in which these persons reside.
If sports are more or less working at the moment due to rigorous testing, perhaps that should tell the Dr. Atlases of the world something. (Maybe the sports comparison will resonate more with some than appeals to the way that other countries have responded).
I am a physician. Atlas is a fuc&ing idiot radiologist*. He will have no exposure to Covid pts. He has no expertise in the area. This is exactly the kind of “expert” I hate. This is just someone with an MD with no real expertise who is being used, quite happily I suspect, to support political beliefs.
* Just to be clear, there are very bright radiologists who are able to read the literature and have done so. This is not one of those people. Also, I fully understand I am sort of making the chickenhawk argument here, but we are starting to see this at local hospitals. The rabid Trump supporter physicians who think we dont need to mask or distance just seem to always be in specialties where they have very minimal exposure to Covid pts.
Atlas is a hack in this pandemic. The overwhelming majority of biological scientists and health professionals acknowledge that. Why he gets his platform is purely due to political and financial hackery (we can thank Rupert Murdoch’s Fox News Entertainment Services for contributing) not the scientific merit of his claims.
First time someone has ever suggested dealing with an epidemic by having less testing and tracking. Bet that idiot wouldn’t say the same thing if we were dealing with Ebola.
1) You can’t stop this by keeping the leak confined to the other side of the boat.
2) 20% to 25% for herd immunity would mean between 60 and 80 million cases in the US, and around 1.4 to 1.7 billion worldwide. If the mortality rate were 1% overall, that’s between 600,000 and 800,000 deaths in the US, and 14 to 17 million worldwide.
Bet he would, if Trump had decided to do nothing about Ebola. Trump’s first WH physician, Ronny Jackson, is running for the House in TX. Dr. Atlas probably sees this as a chance to get a leg up on a more profitable career than being a radiologist. It’s not ideology that drives Republicans, it’s careerism.
The Trump policy has led to Chris Christy landing in the ICU for several days, Barron Trump getting the disease, Melania getting the disease, and the POTUS getting it. I’m sure that the rest of us can expect the same as those nearest and dearest to Mr. Trump. The only difference will be access to immediate care by teams of doctors and the latest in medications.
@Kathy: Math is clearly not their strongsuit.
I’d like to see this research. This goes against everything I’ve ever heard.
Herd immunity advocates are making a Josef Mengele argument.
What happens when we throw an untermensch in ice water? Let’s measure and find out.
It’s god damned spooky and disgusting and unethical and the antithesis of the Hippocratic Oath.
What have we become?
It strikes me that privilege is deeply embedded in these “herd immunity” arguments. That is, well, we aren’t going to pay for testing, but of course the important people will get all the testing they need.
I bear no ill will to Coach Saban, but why can’t everyone get access to the sort of testing resources he has access to? To this “herd immunity” mindset, it’s because everyone is not as important as Coach Saban, or President Trump, or Mr. CEO or whomever they happen to care about.
What have Trumpers become? Idiots and shitty people. Leave the rest of us out of it.
@Steven L. Taylor:
Perhaps because like reality, it works against them.
It’s not just that Trump handled the pandemic badly, it’s how badly.
The US has about 6.5 times the population of South Korea. If America had handled things as well, there’d be around 200,000 total cases by now, and under 5,000 deaths.
That’s a bit unfair, as South Korea was especially well prepared, given they applied the lessons learned from the SARS epidemic in 2003. But if we compare with Germany, about 1/4 the US population, then the numbers, so far, would be just under 1.5 million cases and about 40,000 deaths. Even if we make the comparison to France, the numbers come out as 4.4 million cases and 170,000 deaths.
The actual numbers for the US as of today are 8.145 million cases and 219,661 deaths.
That’s how much worse Trump has done so far.
They are our neighbors, friends, and family. At the very least they are our co-citizens.
We cannot dismiss this as not our problem.
@de stijl: my objection was to your conflating of “herd immunity advocates” with “we”. Those two groups are not the same.
I think we are two ships passing in the night.
While I deplore them, they are our neighbors therefore we or us.
Our neighbors are creating a problem we all have to address.
My “we” was just definitionally bigger. No worries.
I just realized I said my “we” was bigger.
NOT WHAT I MEANT! Not a measuring – you know where that goes. Not my intent.
Crikey, I am oblivious at times.
The retired luddite spends several evenings a week working at a national chain stupor store. There is an order from our governor that masks are required in venues such as stupor stores. Had a gentleman come in the other night wearing a bright red political hat with matching bandana and shirt, as was his lovely wife. When I offered him a mask, he pointed to his hat and yelled, “This is my mask, and I’m protected.” They both seemed to take great offense when I told him that if that was his mask, then put the bloody thing over his nose and mouth. I may not be destined for a career in retail.
@flat earth luddite:
Did the national chain stupor store bounce the covidiots or let them in after the exchange?
Does the national chain stupor store rhyme with a. Smallbart or b. Flarget? Or c. Other (if so please smeshify with a rhymes with)
Do you watch Superstore and the Cloud9 crew? If so, what is your opinion / feedback?
Every time I have ever gotten x-rays, for whatever reason, I have gotten multiple x-rays. From the front, from the side, sometimes while having a limb twisted into the most unnatural of positions, sometimes with an injection of dye, etc etc etc.
I wonder how “Dr” Atlas would feel if he had to diagnose everything from a single x-ray.
@OzarkHillbilly: And a fuzzy out of focus x-ray at that.