A Mind-Boggling Indictment Of Trump And His GOP Enablers From, Among Others, The New England Journal Of Medicine

 

I'm not an epidemiologist but I watch the COVID numbers every day and it looks like Wave II has kicked in. It's worse in the U.S. than anywhere but the only countries where nothing much is happening are the countries where people have no problem with wearing masks. yesterday there were more than 4,000 new cases reported in each of 16 countries:

• India +78,809 (4,939 cases per million residents)
• USA +48,715 (23,493 cases per million residents)
• Brazil +29,741 (23,482 cases per million residents)
• France +18,746 (10,006 cases per million residents)
• Argentina +16,447 (18,561 cases per million residents)
• UK +14,162 (8,006 cases per million residents)
• Russia +11,615 (8,479 cases per million residents)
• Colombia +7,875 (17,200 cases per million residents)
• Spain +6,645 (18,654 cases per million residents)
• Netherlands +4,989 (8,748 cases per million residents)
• Mexico +4,828 (6,146 cases per million residents)
• Ukraine +4,753 (5,482 cases per million residents)
• Indonesia +4,538 (1,151 cases per million residents)
• Israel +4,455 (30,604 cases per million residents)
• Iran +4,019 (5,741 cases per million residents)

In the U.S., some states have started stabilizing but others are being hit hard, some for the first time but, alarmingly, some states that had stabilized are slipping back into pandemic hell, particularly Illinois and New York. Right from the start, I said it would take a million or 2 million deaths before right-wingers start taking the pandemic seriously-- or a few very high profile deaths, not Herman Cain, but Trump on a national level and governors and senators in states. As I sat down to write this post, rumors were starting to circulate from some members of the White House domestic staff that Trump, who hasn't been seen in almost 45 hours, is in the family quarters in what now amounts to an at-home top of the line ICU (intensive care unit) and is getting oxygen therapy several times an hour.






Among the states that haven't had bad outbreaks until now but that are now experiencing the horrors of what Trump is still saying is "like the flu," include these 5 with their new cases from yesterday:

• Missouri +1,522 (23,294 cases per million residents)
• Wisconsin +2,319 (23,821 cases per million residents)
• Tennessee +2,080 (30,378 cases per million residents)
• Oklahoma +1,006 (23,845 cases per million residents)
• Kentucky +926 (17,142 cases per million residents)

Meanwhile, USA Today noted that U.S. coronavirus cases surpassed 7.5 million on Wednesday with most states seeing a rise in cases-- nine months into the pandemic-- and a startling nine states setting ominous, seven-day records for infections. A USA Today analysis of Johns Hopkins data through late Tuesday shows Alaska, Indiana, Kansas, Kentucky, Minnesota, Montana, North Dakota, Utah and Wyoming all set state records in the seven-day period. In all, 39 states reported more coronavirus cases in the last week than they had in the week before. More than 210,000 Americans have died, and Wisconsin and Hawaii reported record numbers of deaths in their states for a seven-day period.

Trump's assertion that Americans need not worry because "some really great drugs and knowledge" have been developed under his administration has prompted dismay for many in the medical community.

Lucy McBride, an internal medicine physician at Foxhall Internists in Washington, D.C., said that more than nine months after the virus was discovered in China, no treatments are available for patients suffering mild to moderate illness from the virus.

"We only have treatments for our sickest, hospitalized patients," she told USA Today. "Currently there is no proven (treatments) for the majority of patients with COVID-19.

"Our best and only defense against viral transmission," she adds, "is our own behavior. Masks, distancing, avoiding crowded spaces, and hand-washing as we buy time for drug development."

Trump's treatment: President's COVID-19 treatment is similar to the average American hospitalized with coronavirus. Only faster.

In Wisconsin, which set a seven-day record for fatalities, indoor bars and restaurants were capped at 25% of capacity starting Thursday. The state is struggling with some of the worst COVID-19 outbreaks in the country, and Gov. Tony Evers, a Democrat, ordered the limits despite repeated legal challenges from Republicans to such measures.

"We’re in a crisis right now and need to immediately change our behavior to save lives," said Evers. "There's no other way to put it, we are overwhelmed."

Cases in Wisconsin have more than doubled over about a month, with outbreaks spreading to college campuses but also to rural areas. In northern regions of the state, hospitalizations quadrupled in that time.

"I believe limiting indoor public gatherings will help slow the spread of this virus," Evers said. "The sooner we get control of this virus, the sooner our economy, communities, and state can bounce back.”

In Kentucky, Gov. Andy Beshear extended the statewide mask mandate for another 30 days and said the state would be "stepping up the enforcement." Businesses that serve customers not wearing masks face the possibility of being fined and shut down for a period of time, Beshear said.

The state has now seen 74,194 positive cases since the start of the pandemic, including record weekly totals three weeks in a row.

"It's going to be a hard month with all the cases we've seen," Beshear said. "It's going to be a hard October, and it's going to be a hard November, too, because deaths trail cases."

New York state, once the global hotspot for the virus, is working to smother flareups with Gov. Andrew Cuomo's "Cluster Action Initiative." Some areas will see schools and nonessential businesses and even houses of worship shut down as soon as Friday. Others face limits on indoor restaurant capacity and other gatherings.

The plan immediately drew fire from the Orthodox Jewish organization Agudath Israel of America, which issued a statement saying it "intends to explore all appropriate measures to undo this deeply offensive" action by the governor.

"We establish clear limits for areas where we see high positivity," Cuomo said on Twitter. "The severity of the problem will determine the response."

Cases in the United States have been rising for the last three weeks, the USA Today analysis revealed. The country has been adding about 44,000 cases per day lately, more than double the low seen in June and halfway between that mark and the worst of July's devastating peak.

..."COVID-19 is still very much a threat today," said Ogbonnaya Omenka, an associate professor and public health specialist at Butler University. "If it seems otherwise, then that is mainly (because) we have implemented public health measures and improved our capabilities regarding mitigating the threat of the virus."

But the unprecedented editorial in the brand new New England Journal of Medicine is shocking: Dying in a Leadership Vacuum. "COVID-19," they wrote, "has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy. The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering, the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.

We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States. Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.

Why has the United States handled this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have. Moreover, a lack of emphasis on developing capacity has meant that U.S. test results are often long delayed, rendering the results useless for disease control.





Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.

The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized, appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely. Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.

Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.

As long as I'm doing lists, these are the east Asian countries where the pandemic began and where there is no mask-phobia-- with their new cases yesterday (and their cases per million residents).

• Japan +496 (685 cases per million residents)
• Malaysia +489 (431 cases per million residents)
• South Korea +114 (475 cases per million residents)
• Thailand +15 (52 cases per million residents)
• Hong Kong +11 (685 cases per million residents)
• Singapore +10 (9,866 cases per million residents)
• China +7 (59 cases per million residents)
• Taiwan +2 (22 cases per million residents)
• Vietnam +1 (0.4 cases per million residents)
• Cambodia- no new cases (17 cases per million residents)
• Laos- no new cases (3 cases per million residents)

Would have it been different-- more like east Asia-- if Trump wasn't president and McConnell didn't control the Senate? Absolutely... There is a problem, of course, with the paranoid and crackpot right-wing mindset, but without Trump encouraging them... imagine 475 cases per million residents in South Korea instead of Florida's 33,649 cases per million or Mississippi's 34,353 cases per million or North Dakota's 32,618 cases per million.