Tag Archives: Public Health

Almost Inconceivable

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I can’t believe this could have happened a few years ago. But then our politics was infected by a dangerously demented narcissist. From Susan Glasser of The New Yorker:

[President Biden] came into office promising an end to the pandemic and a return to competent, commonsense governance. . . . . But his first nine months in office have shown pretty conclusively that it is not possible to beat covid in a political environment that has arguably gotten worse, not better, since January.

Consider the news that now one in five hundred Americans has died in the pandemic; total deaths in the country approach seven hundred thousand. What’s worse, covid deaths—the vast majority of them preventable, avoidable deaths, now that science and the federal government have provided us with free vaccines—are continuing to rise across large swaths of vaccine-resistant T____ country.

This is not a tragic mistake but a calculated choice by many Republicans who have made vaccine resistance synonymous with resistance to Biden and the Democrats. The current average of more than nineteen hundred dead a day means that a 9/11’s worth of Americans are perishing from covid roughly every thirty-eight hours. To my mind, this is the biggest news of the Biden Presidency so far, and it has nothing to do with Afghanistan, or the fate of the budget-reconciliation bill, or Bob Woodward’s new book.

America spent twenty years fighting wars in Afghanistan and the Middle East because of 9/11. The 2001 attacks reordered American foreign-policy and national-security thinking for a generation. Does anyone believe that something comparable will happen as a result of the pandemic’s catastrophic death toll, which is far vaster than that of any other crisis in the modern era? It’s hard to imagine, especially because the continuing loss of life is a result of [Republican] political strategies that intentionally undermine the success of Biden’s policies. How can this President, or any President, reset from that?

Biden’s challenge seems all the more clear to me after spending a few weeks away from the daily noise of politics to work on a book about his divisive predecessor. T____ is out of office, but T____-style politics have decisively won over the Republican Party. A new CNN poll this week found that seventy-eight per cent of Republicans subscribe to T____’s Big Lie that Biden was not legitimately elected—more than in some polls in the immediate aftermath of T____’s traumatic exit. . . . [although I wonder how many of them really believe that vs. choosing to tell the pollsters that and thereby spread the lie further].

The partisan split has also translated into a deadly divide in vaccination rates—a tragedy given that vaccines are, for now, the only real way out of this mess. And no wonder this divide persists. It is not an accident or an immutable fact of American political life; it’s a fire built and stoked by T____ and his supporters.

Among the top stories on Fox News’ home page [last week], I could not find a single reference to the pandemic, and little sense that covid even existed, beyond a link to a video headlined “Liberal host torched for labeling GOP ‘COVID-loving death cult’ in bizarre rant.” As I was writing this column, I received an e-mail from one D____ J. T____. The subject was “Biden’s vaccine mandate.” “I totally OPPOSE this liberal overreach that requires Americans to be vaccinated,” T____ wrote. “The Left is working overtime to CONTROL you, Friend,” he warned. Biden, he added, “doesn’t care about you or your freedoms.”

As a matter of politics, of course, this is not necessarily a winning strategy for the Republicans. In California on Tuesday, Governor Gavin Newsom defeated a Republican effort to recall him by running a campaign painting the G.O.P. candidate as a T____-loving extremist who would undo public-health measures to fight the pandemic. . . . Then again, California is consistently among the most Democratic of Democratic states. . . .

The tragic triumph of T____ism is not that he has persuaded all Americans, or even a majority of Americans, to reject their way out of the pandemic; it’s that he has persuaded just enough of them to keep the disease wreaking havoc on the country.

The [Republican Party’s] desire to see Biden fail has become a willingness to let the country fail. Nine months into Biden’s Presidency, the bottom line is that the Republican war on Biden’s legitimacy and the war on Biden’s covid policies are now inextricably linked. The consequences of this are so hard to contemplate that we often do not do so: a politics so broken that it is now killing Americans on an industrial scale.

Unquote. 

It’s hard to find a lighter note on this topic. However:

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The Problem Is Facebook and Twitter Themselves

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From The Washington Post:

Facebook said Saturday evening that an article raising concerns that the coronavirus vaccine could lead to death was the top performing link in the United States on its platform from January through March of this year, acknowledging the widespread reach of such material for the first time. It also said another site that pushed covid-19 misinformation was also among the top 20 most visited pages on the platform.

In related news, the German Marshall Fund issued a study of interactions on Facebook. The study found that sites that share news in misleading ways attracted a record-level percentage of Facebook users:

More than 1 in 5 interactions — such as shares, likes or comments — with U.S. sites from April to June happened on “outlets that gather and present information irresponsibly,” according to [the study].

This includes outlets such as the Daily Wire, TMZ, the Epoch Times and Breitbart that researchers say “distort or misrepresent information to make an argument or report on a subject,” a metric determined by NewsGuard, a website cited in the study that rates the credibility of news sources. Researchers say these sources, which they argue spread subtler but still harmful forms of misinformation, are decidedly different from sites that publish overtly false news.

“These are the kinds of sites that will cherry pick anecdotes and are giving rise to vaccine hesitancy and other kinds of conspiracy theories,” said [the study’s director].

Researchers highlighted articles that they say “disproportionately amplify vaccine-hesitant voices over experts” and “fail to mention risks of not being vaccinated against covid-19″ . . .

While platforms have cracked down on black-and-white cases of fiction masquerading as fact, they are still grappling with how to handle murky yet wide-reaching cases that stop short of falsehood. . . . 

The ratio of misleading content marks a five-year high for Facebook, where “false content producers” have received a higher share of engagement in the past, according to the findings (The Washington Post).

Unquote.

What should we do about a company like Facebook that seems hell-bent on spreading harmful misinformation? One answer is to prosecute Mark Zuckerberg and his ilk as dangers to public health.

However, Vinay Prasad, a professor at the University of California medical school, suggests a more measured approach: we should deal with social media companies the way we dealt with tobacco companies thirty years ago. From Medpage Today: 

Many Americans, and especially healthcare providers, are frustrated as we watch yet another rise in COVID-19 cases. Severely ill and hospitalized patients are often unvaccinated, which is particularly disheartening, given the widespread availability — surplus — of mRNA vaccines in the U.S. . . .

One potential reason why a sizable fraction of Americans are reluctant to be vaccinated is the widespread availability of inaccurate, unbalanced, or irrational rhetoric. This speech falls across a spectrum from overtly delusional — vaccines contain microchips so Bill Gates can track you — to lesser degrees of pejorative and doubtful comments. . . .

[But] regulating or policing medical misinformation is doomed. It’s easy for most (sensible) people to recognize that mRNA vaccines do not contain microchips that allow Bill Gates to track you. But very quickly we find statements about vaccines that are unknown, disputed, and worthy of further dialogue. Lines between legitimate debate and misinformation become scientifically impossible to draw. . . .

Even on a social media website for medical professionals that restricts who can comment and regulates comments, as Doximity does, there are a number of erroneous statements, mis-statements and ill-informed comments, suggesting that regulating speakers is not an effective solution either. Some doctors may say incorrect things, and some lay people may be spot on. Policing speakers can’t solve the content issue.

. . . It is easy to feel that some erroneous views should not be permitted on social media, but the hard part is to define what should not be allowed. Notably, despite the Surgeon General’s report and much debate on the issue, no one has actually delineated what counts as misinformation. I suspect that it cannot be done. No one can create a rule book that separates black and white because the world we live in is only gray. You can’t outlaw what you can’t define.

The problem is Facebook and Twitter themselves.

In 50 years, social media in 2021 will look like the tobacco industry in 1960 — they knowingly offered an addictive product, and, worse, hid the damage the addiction caused, while actively tried to deepen the dependency. Social media companies try to keep you using the platform longer, baiting you with content to trigger your rage, disgust, lust, or hatred. These companies offer products that have been linked to anxiety and depression among users. . . .
When it comes to information, social media does three things.

First, it drives people into irrational poles. On one side are folks who think SARS-CoV-2 is not real or just another seasonal flu. These individuals are often suspicious of vaccination as a path out of the pandemic. On the other side are folks who believe we should lock down until there isn’t a single case of COVID left. . . . The very nature of social media drives individuals into further extreme positions, possibly aided by bots, sock-puppet accounts, or foreign intelligence agencies. The middle ground is lost.

Second, a good or bad idea on these platforms can reach millions of individuals. An anecdote (of dubious validity) of a vaccinated individual suffering a bizarre harm, or one of an unvaccinated person begging for vaccination before the endotracheal tube is placed . . . are both powerful psychological stories that reach millions. This is heroin of the mind.

Third, social media causes deterioration of discourse and harsh proposals. . . . We no longer see individuals with whom we have policy disagreements as people.

The solution is inevitable. Social media of 2021 must be dismantled and crippled like the tobacco industry. These digital tools have hijacked our neurotransmitters, just like tobacco. Denying the pernicious role of these platforms on our society is similar to those who denied the harms of tobacco. Just like tobacco, social media offers pleasures. But, just like tobacco, the industry that supports it has pushed too far, lusting for profits and domination.

. . . Our leaders offer toothless solutions like policing or removing information they view as particularly egregious. This introduces countless problems and immense potential for abuse. . . .

Instead, the platforms need to be crushed, broken up, and regulated. Rather than just censoring specific ideas, measuring attention and trying to capture more of it must be prohibited. . . . The platforms must be brought to their knees, just like Big Tobacco, while human ideas — good, bad, sublime, horrible, true, false, and everything in – between must be free.

So Where’s the Vaccine?

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Perhaps you’ve been wondering where the vaccine is and how much is on the way. We’d know more if the previous administration hadn’t displayed an extraordinary combination of malevolence and incompetence. The good news is that we’ll know more soon. From The Guardian: 

The Biden administration has spent its first week in office attempting to manually track down 20m vaccine doses in the pipeline between federal distribution and administration at clinic sites, when a dose finally reaches a patient’s arm.

The Trump administration’s strategy pushed the response to the coronavirus pandemic to individual states and omitted pipeline tracking information between distribution and when the shot is actually administered, Biden administration officials told Politico.

The lack of data has now forced federal health department officials to spend hours on the phone tracking down vaccine shipments, the news website reported.

“Nobody had a complete picture,” Dr Julie Morita, a member of the Biden transition team and executive vice-president of the Robert Wood Johnson Foundation, told Politico. “The plans that were being made were being made with the assumption that more information would be available and be revealed once they got into the White House.”

As of Saturday, 49 million doses of vaccine have been distributed by the federal government, but only 27 million administered by states, according to the US Centers for Disease Control and Prevention (CDC).

About two million of those doses are believed to be accounted for by a 72-hour lag in reported administration, Politico reported. That still leaves millions in the pipeline between delivery and patient. At least 16 states have used less than half the vaccine doses distributed to them, USA Today reported this week.

“Much of our work over the next week is going to make sure that we can tighten up the timelines to understand where in the pipeline the vaccine actually is and when exactly it is administered,” Dr Rochelle Walensky, [the new] director of the CDC, told USA Today.

. . . The CDC’s first report on early vaccine rollout is expected in February.

Our COVID Mortality Rate Is Down 85%?

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That’s a statistic in the news, but what does it mean? CNN reported this on Friday:

Friday’s case count of at least 80,005 surpasses the country’s previous one-day high of 77,362, reported July 16, according to Johns Hopkins University.
 
US Surgeon General Dr. Jerome Adams cautioned earlier Friday that hospitalizations are starting to go up in 75% of the jurisdictions across the country, and officials are concerned that in a few weeks, deaths will also start to increase.
 
The good news, Adams said, is that the country’s Covid-19 mortality rate has decreased by about 85% thanks to multiple factors, including the use of remdesivir, steroids and better management of patients.
 
According to CNN, the Surgeon General  made these remarks during an online discussion of global health policy at Meridian Global Leadership Summit. Meridian is a “non-profit, non-partisan diplomacy center” in Washington. I couldn’t find exactly what he said, either from Meridian’s site, the Surgeon General’s site or the Surgeon General’s Twitter account. The Center for Disease Control doesn’t seem to report a mortality rate.
 
Looking at statistics from The New York Times, however, indicates what the Surgeon General was talking about. Back in mid-April, the US was reporting around 2,200 deaths for every 32,000 confirmed cases. Now 800 deaths are being reported for around 68,000 cases. That translates into 6.9% of cases ending in death in April vs. 1.2% now, a decline of 83%. So it’s true that the mortality rate has dropped quite a lot.
 
This is confirmed by two studies reported by National Public Radio:
 
Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.
 
The article mentions other reasons the mortality rate may be dropping:
 
[Researchers] say that factors outside of doctors’ control are also playing a role in driving down mortality. . . . Mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients. . . . Keeping hospitals below their maximum capacity also helps to increase survival rates. When cases surge and hospitals fill up, “staff are stretched, mistakes are made, it’s no one’s fault — it’s that the system isn’t built to operate near 100%”. . . 
 
This hardly means we’ve turned the corner on COVID-19, as one of the presidential candidates claims. A mortality rate of 7% is still high relative to other diseases. Serious illness is never a joy and even patients who survive COVID-19 sometimes suffer long-term effects.
 
In addition, two other numbers recently reported aren’t encouraging. The pandemic is causing significantly more deaths, either directly or indirectly, than are being reported:
 
In the most updated count to date, researchers at the Centers for Disease Control and Prevention have found that nearly 300,000 more people in the United States died from late January to early October this year compared to the average number of people who died in recent years. Just two-thirds of those deaths were counted as Covid-19 fatalities, highlighting how the official U.S. death count — now standing at about 220,000 [or 225,000] — is not fully inclusive [Stat].
 
One model predicts that the next four months will be especially bad in the US:
 
More than 511,000 lives could be lost by 28 February next year, modeling led by scientists from the University of Washington found.

This means that with cases surging in many states, particularly the upper Midwest, what appears to be a third major peak of coronavirus infections in the US could lead to nearly 300,000 people dying in just the next four months.

In fact the University of Washington warned that the situation will be even more disastrous if states continue to ease off on measures designed to restrict the spread of the virus, such as the shuttering of certain businesses and social distancing edicts. If states wind down such protections, the death toll could top 1 million people in America by 28 February, the UW study found [The Guardian].

Finally, the presidential candidate who doesn’t think we’ve turned the corner offered this timely reminder:

President Txxxx’s plan to beat COVID-19. 

Nine days.