A Shameful Act in Four Parts
No one interested in science or fact-based reality testing even remotely expects much anymore from Trump.45, who has an indelible and persistent lifelong record of fudging, obfuscation, and denial.
It is no surprise that his hand-picked loyalist bureaucrats like HHS Secretary Azar bend over and toe the line in public, and on TV. Trump.45’s toxic infection has spread widely to the upper echelons of what has been a proud professional corps of dedicated, apolitical public health servants of the American public for more than 100 years, like the CDC Director.
The novel Corona virus threat (COVID-19) emerged at the beginning of December 2019 in China. The World Health Organization was notified at the end of December 2019. The virus breached the U.S by January 21, 2020. However ignorant or dismissive the President has been, our public health apparatus has had fully 60 days, and more likely 90 days (NSA: are you listening to China and intercepting communications?) during which to estimate, plan, and prepare a competent, robust, and full-throated response to protect America, and all her citizens.
Those are the facts.
Here is what the official CDC public presence conveys at noon on Wednesday March 4, 2020.
Act 01
We have a new day and transparency prevails. Through last week, the CDC lazily and arrogantly updated at 4 PM, Monday Wednesday and Friday. As if the virus spread took a Mexican-style siesta each day and then vacationed over the weekend. How droll. However, hope springs, and progress is progress. 5-Daily is better than thrice weekly. Still, those now seeking official U.S. public health tracking advice can just chill over the weekends. Catch your breath, so to speak. And no new targets for the Sunday show warriors to have to defend against.
You can’t put all the facts in a summary; otherwise it wouldn’t be a summary. On the other hand, scientists are trained to put the critical pertinent information as up-front as possible. The pablum “growing number of other locations internationally” is flack speak, not science information. How about incorporating simple official data from the WHO’s “Coronavirus disease 2019 (COVID-19) Situation Report – 43”, as of March 3, 2020 for example?
Here’s the summary sentence a scientist, or expert public health communicator might write: “Cases have been reported to the World Health Organization from 72 countries, including 8 new ones in the last 24 hours.”
Act 02
Seems straight forward enough for news reporting. Watch out for the * fine print. This official U.S summary doesn’t count the cases repatriated from China and Japan (49 total). What, they are not Americans anymore, since they got sick on foreign soil? If they are back in the United States, they should be counted. Some may have been released from quarantine too soon (see the San Antonio too early release case). They and their families may be subject to ignorant social isolation or discrimination by other Americans now they’re back, so their potential social costs need to be included in assessing the final burden of disease on America as a whole. And so on.
A week ago, during Trump’s Fantasy-15 Tour presser, there was a defensible argument that the 49 non-US generated cases be identified as a subset of the total US toll of 61 at that time, since it was a majority of US cases up until then. But that time is long ago, and so far away.
As of 2 PM today there are 148 US cases, according to the JHU Coronavirus tracker, a critically important reliable data source. So, the repatriated cases are now just 1/3 of the total (dropping every day), and no longer justify any special treatment as if they represent a special class of hyper susceptible Americans, compared to everyone else in the country. Americans don’t have any special immunity powers. If you get exposed, you can get sick. Just ask the Americans who traveled to Italy and Iran who are back here now and have the disease (and are counted by CDC). We are all in this together.
Such technical distinctions might make some sense considered in a scientifically literate circumstance, but we have already seen a shockingly uninformed Trump.45 leap to unwarranted and perseverant misstatements, despite repeated attempts by well-informed experts to correct him and cool his jets (cases prevalence, vaccine, treatment options, safe to travel advice, immunity of rally crowds, etc.). This is America, and Trump.45 is free to believe whatever sophistic nonsense he chooses in private about scientific matters. That said, when he speaks to and on behalf of 330 million Americans, he should be minimally accurate or just shut his mouth.
But the worst of Act 2 is CDC’s fine print statement that the 50 states are now publicly reporting cases, and in the event of a discrepancy, state counts are considered more up to date. Whoa Nellie. What are you guys saying? America’s official and premier national information source on Coronavirus is taking the bench, and the states (only able to really participate in the last week after intense media and public pressure criticism of Federal fumbles) are now the information gold standard. Talk about dropping the ball.
That is bureaucratic gobbledygook of the first order. It is a very shrunken fig leaf of respectability for the scientist workers at CDC informatics, but where is American to get total US summary results? Do we now have to monitor 50 different state health departments every day to find out what’s going on? The CDC is the only official national public health resource, and they are signaling here that they are standing down and sitting on their manicured informational hands.
What do you want to bet that Pence & Cronies flackville have something to do with this? Americans deserve better than this. In the end, such a cravenly decision will only come back and bite them deeply on the proverbial ass. Count on it.
Act 03
A case of double fine print. The first * caveat replays the techno-dodge from Act 2 about the states now being the more accurate counting authority. CDC’s prior Public Health Information Preeminence, Rest in Peace. Shameful and cowardly.
The second and larger † cross (Latin cross) to bear is that CDC is retiring from the PUI fights. An unfortunate term (Person Under Investigation), but the bottom line is that this was the critical metric of how many people had even been tested for coronavirus infection.
There is no current way to diagnose the infection for sure clinically, or by means of x-rays or scans, or on physical examination. It requires a lab test. No lab test, you’re shooting in the dark, especially to determine if someone doesn’t have the disease.
Arguably the greatest scandal so far in the Administration’s bumblement of the Corona virus epidemic, is the horrendous CDC testing fiasco, while the rest of the developed world marched on and got the job done. As of last Friday, the CDC had managed to test less than 500 people in our country. This was a result of ridiculously pedantic screening criteria for a limited availability test (a bottleneck entirely of CDC’s own ostrich-like creation) and the initial quality control and manufacturing foul up, also resting squarely on the Trump.45 doorstep through his “Best People” agency leaders- Azar and Redfield, among others. The bubble burst.
On Monday, CDC stopped reporting on this website the actual numbers, but Trump.45 did permit a deputy CDC official to mention to Congress that the number of tests performed might be 3,600. That number has not been vetted, nor an explanation of how it magically septulpled in three days while the CDC information apparatus was on weekend vacation, but never mind. Today, just two days later CDC adds to its public obligation and informational retreat another weasel back-out that the states are getting involved, so CDC’s numbers are not representative nationwide, i.e. don’t matter. So, sayonara Federal test counts. Just trust us. There are 1 million tests delivered Monday or today, or the end of this week, or anyway whenever they are actually needed. Why? Because Pence and Azar said so on TV.
Mais non! Au contraire, mes amis! The VCDC has national responsibility for tracking and responding to the coronavirus epidemic. That’s what we pay them for. That’s what we deserve and expect. No taking your ball and going home, cause the score looks bad, and your coach is having a snit on the sidelines.
It has been said that there is little new under the sun. COVID-19 is certainly an exception, but CDC’s inglorious retreat from the informational battlefield is typical of an old diversion. In public health parlance (shoptalk), we speak of the similar tactics as slice and dice.
If you don’t like what the statistics are telling you, subset it and multiply the categories to analyze. Confuses the public, makes oversight more complicated and burdensome, and reduces the likelihood of ugly statistical significance being waved in your face. Governments and private organizations have all been known to indulge at some time or to some degree in this subterfuge, nearly always to avoid responsibility and deflect blame.
Here the government is rejiggering the reporting category from national to state specific, and then going dark, as if it is somehow beyond their capacity to keep up. A slice and dice double whammy, as it were. Here, it is a thinly disguised form of scientifically flavored coverup, in the middle of an active public health crisis.
CDC’s Act 03 rationalizations are bitter weak tea.
Act 04
Mapping the outbreak extent with a fine print redux of Act 1, Act 2, and Act 3 revs up Act 4’s fine print in pictures. CDC in its lagging indicator admits to infection in 13 states. This is not so. As of 2 PM today the actual number is 16 states, or 1/3 of the country, folks.
They have left out Nebraska, Texas, and Utah. Both Texas and Nebraska are US hotspots with more than 10 cases each. CDC’s informational fig leaf is a restrictive case definition for mapping. Technically so, but fundamentally misleading.
Here’s one example. There are 13 quarantined cases at a special purpose Nebraska medical facility. Those guys are pros. Bless them and Amen. The cases came right off the cruise ship. There are doctors and nurses and hospital aides, cleaning staff and kitchen workers, laboratory and x-ray personnel, and security staff who work there. Dozens of them They have families and close local friends: hundreds of them.
No viral containment system of protocol is 100% absolutely guaranteed perfect. The chances of leakage or mistakes are low, perhaps even ultra-low, but with a novel infection and a concentration of more than 10 patients in one place and dozens of care givers directly at risk, there should be careful, mindful surveillance by the hospital and community and state health staff as well, not to mention Federal investigators. Is CDC working in Nebraska now? I hope so. Perhaps I just missed it in the blizzard of public health concern and publicity emanating from the White House and Pence’s Cres in the last week.
For its national statistical case reporting CDC is turning a blind eye to Nebraska, as if there is nothing going on. Ignoring it doesn’t make patients or the community any safer, or make the virus go away. The citizens of Nebraska will not be pleased if containment fails and they are surprised. Panic is foolish, not paying attention is worse.
We are living in the age of facile conspiracy theorists, and we shouldn’t be party to wild improbable conspiracy creation myths. However, as a technical matter I would note the following. Look at the Map Legend for March 4 from CDC. To a scientist there is a mildly jarring note present. The categories are discontinuous and do not flow naturally or smoothly from one to the next. The first two: none, and 1-5 are as expected. The next category expected should be either 5-10, or 5-20, depending on how many colors you want to map. A relevant category is missing. Free the 10-20 Hotspots! Going forward, elsewhere in the country, that size group will be the engines of infection and cradles of spread.
What do we know about the silent state locations absent from CDC’s mapping effort? Texas (11) and Nebraska (13) would both be listed as moderate hotspots in the CDC’s rendering. In point of fact they are hotspots three and four for the entre US, if you consider the real world.
Those are indisputable facts.
To extend it tenuously into Trump World’s vision panorama, both Texas and Nebraska are Red States, so an unwelcome map addition at best. Some devoted Trumpettes on social media have already joked about Democrats giving themselves Coronavirus to embarrass Trump.45, and state authorities in Alabama went to court to block exposed patients from being sent to a federally funded health facility in their state (Viral NIMBY, but give me the money anyway). I assert no such definitive motivation.
I am curious why two specific sites, comprising 1/6 of all the US cases are not on the map with a funky legend. Is this a semi-respectable way for CDC professional to please the boss, and not screw the pooch reputationally? Just a perplexed musing.
Summary
I have been privileged to be a public health physician and professional for more than 40 years. I have served two stints totaling nearly a decade as a proud Federal employee in two different Cabinet departments, including Labor and HHS, under both Republican and Democratic administrations, and four Presidents. There have always been competing interests in translating complex medical and technical issues for accurate public information, especially where there are potential adverse political concerns among top appointed leadership figures.
I am ashamed for my former colleagues and the proud legacy of public health service to America hard-earned over 100 years by the professionals of the Agencies they temporarily represent, that they have been co-opted in such a venal and scientifically indefensible way. There are no adequate words.
Where are Dorothy and the Tin Man?
Please America, Not Over the Rainbow.