Archives for category: Health

In a story in TIME magazine, two Swedish writers declare that Sweden’s approach to the Coronovirus has been a disaster. The authors are KELLY BJORKLUND AND ANDREW EWING. Kelly Bjorklund is a writer and human rights activist who has worked on public policy and advocacy with elected officials, civil society and media for two decades. Andrew Ewing is a professor of molecular biology and chemistry at the University of Gothenburg and a member of the Swedish Academy of Sciences.

Unlike other European nations, Sweden decided not to lockdown the economy, not to close schools, and to count on people to wear masks and practice social distancing. Their public health officials predicted that the nation would quickly achieve “herd immunity” by exposing people to the virus.

The authors write:

The Swedish COVID-19 experiment of not implementing early and strong measures to safeguard the population has been hotly debated around the world, but at this point we can predict it is almost certain to result in a net failure in terms of death and suffering. As of Oct. 13, Sweden’s per capita death rate is 58.4 per 100,000 people, according to Johns Hopkins University data, 12th highest in the world (not including tiny Andorra and San Marino). But perhaps more striking are the findings of a study published Oct. 12 in the Journal of the American Medical Association, which pointed out that, of the countries the researchers investigated, Sweden and the U.S. essentially make up a category of two: they are the only countries with high overall mortality rates that have failed to rapidly reduce those numbers as the pandemic has progressed.

Yet the architects of the Swedish plan are selling it as a success to the rest of the world. And officials in other countries, including at the top level of the U.S. government, are discussing the strategy as one to emulate—despite the reality that doing so will almost certainly increase the rates of death and misery.

Countries that locked down early and/or used extensive test and tracing—including Denmark, Finland, Norway, South Korea, Japan, Taiwan, Vietnam and New Zealand—saved lives and limited damage to their economies. Countries that locked down late, came out of lock down too early, did not effectively test and quarantine, or only used a partial lockdown—including Brazil, Mexico, Netherlands, Peru, Spain, Sweden, the U.S. and the U.K.—have almost uniformly done worse in rates of infection and death.

Read the article in full to see the graphs and accompanying evidence for the failure of Sweden to achieve “herd immunity.”

Tom Frieden, a physician, is former director of the Center for Disease Control and Prevention (CDC). His article appeared in the Washington Post.

He writes:

As the covid-19 pandemic continues in the United States and many parts of the world, millions of Americans are increasingly impatient for the economy and society to regain a more normal footing. Some “maverick scientists” with “an audience inside the White House,” as The Post reported last week, argue for “allowing the coronavirus to spread freely at ‘natural’ rates among healthy young people while keeping most aspects of the economy up and running.”

Their aim is to achieve “herd immunity,” the concept that if enough people are immune, those without immunity can be protected. Usually this refers to immunity gained from vaccination; the goal of herd immunity has typically not been applied to a disease for which there is no vaccine.

There is a saying that for every complicated problem, a solution exists that is quick, simple — and wrong. That applies here: Pursuing herd immunity is the wrong, dead wrong, solution for the pandemic. Discussing such a reckless approach shouldn’t be necessary, except that it echoes the misguided ideas of neuroradiologist Scott Atlas, who in recent months has become an influential medical adviser to President Trump.

Atlas, The Post reported, has relied on similar-minded scientists “to bolster his in-house arguments.”

Less than 15 percent of Americans have been infected by the virus that causes covid-19. If immunity among those who have been infected and survived is strong and long-lasting (and it may well be neither), and if herd immunity kicks in at 60 percent infection of the population (and it might be higher), with a fatality rate of 0.5 percent among those infected, then at least another half-million Americans — in addition to the 220,000 who have already died — would have to die for the country to achieve herd immunity. And that’s the best-case scenario. The number of deaths to get there could be twice as high.

The route to herd immunity would run through graveyards filled with Americans who did not have to die, because what starts in young adults doesn’t stay in young adults. “Protecting the vulnerable,” however appealing it may sound, isn’t plausible if the virus is allowed to freely spread among younger people. We’ve seen this in families, communities and entire regions of the country. First come cases in young adults. Then the virus spreads to older adults and medically vulnerable people. Hospitalizations increase. And then deaths increase.

The vulnerable are not just a sliver of society. The 65-and-over population of the United States in 2018 was 52 million. As many as 60 percent of adults have a medical condition that increases their risk of death from covid-19 — with many unaware of their condition, which can include undiagnosed kidney disease, diabetes or cancer. The plain truth is that we cannot protect the vulnerable without protecting all of us.

A one-two punch is needed to knock out the virus — a combination approach, just as multiple drugs are used to treat infections such as HIV and tuberculosis. That in turn will allow the accelerated resumption of economic and social activity.

First, knock down the spread of the virus. The best way to do this is — as the country has been trying to do, with uneven success — to reduce close contact with others, especially in crowded indoor spaces with poor ventilation. Increase adherence to the Three W’s: wear a mask, watch your distance and wash your hands (or use sanitizer). Where restrictions have been loosened, track early-warning triggers and activate strategic closures to prevent an explosive spread.

Second, box the virus in to stop cases from becoming clusters and clusters from becoming outbreaks. Rapid testing should focus on those at greatest risk of having been exposed. The sooner people who are infectious get isolated, the fewer secondary cases there will be. That means rapid testing and rapid action when tests are positive. Close contacts need to be quarantined so that if they develop infection, the chain of transmission will stop with them.

A safe and effective vaccine may become available in the coming months — or it may not. Yet even if it were widely administered (a big if), it wouldn’t end the pandemic. Even if a vaccine that’s 70 percent effective is taken by 70 percent of people — optimistic estimates — that leaves half of the population unprotected. For the foreseeable future, masks will be in, at least indoors, and handshakes will be out.

Although there’s no quick fix, this pandemic will end one day. In the interim, there are actions individuals, families and communities across the country can take to reduce risk. The sooner the virus is under control, the quicker and more complete the recovery will be.

In recent months, Trump has increasingly turned to Dr. Scott Atlas for advice on the coronavirus, even though Dr. Atlas is a radiologist with no experience in epidemiology or infectious diseases.

A few days ago, Dr. Atlas tweeted that masks don’t work, and Twitter blocked his tweet because it is inaccurate and misleading. People’s lives are at stake.

MarketWatch reported:

Twitter Inc. on Sunday blocked a post by Dr. Scott Atlas, one of President Donald Trump’s top health advisers, after he claimed face masks were ineffective in preventing the spread of the coronavirus.

“Masks work? NO” he tweeted Sunday, following by a thread of posts that misrepresented scientific findings on masks.

Twitter TWTR blocked the post citing a violation of its policy against sharing false or harmful information.

Atlas’s tweet also contradicts the official guidance from the U.S. Centers for Disease Control and Prevention, which recommends wearing a mask when outside one’s home. There is widespread agreement among health experts that wearing face masks is the simplest and most effective way to curtail the spread of COVID-19 until a vaccine is developed.

Atlas, a Stanford radiologist with no background in infectious diseases, joined the White House coronavirus task force in August. He has been a vocal supporter of Trump and opposes lockdowns in favor of pursuing a strategy of herd immunity. 

Also Sunday, Dr. Michael Osterholm, an infectious-disease expert, told NBC’s “Meet the Press” that Atlas’ herd-immunity theory “is the most amazing combination of pixie dust and pseudoscience I’ve ever seen.” Osterholm said herd immunity requires 50%-70% of the population getting infected — far more than Atlas claims — which would likely cause tens of thousands of preventable deaths.

Others have been similarly dismissive of Atlas. Last month, CDC Director Robert Redfield was overheard on a phone call saying of Atlas:  “Everything he says is false.”

Trump saw Dr. Scott Atlas on FOX News and decided to bring him onto the administration’s coronavirus task force. Since Atlas’s arrival, the task force has been riven with dissent. Drs. Birk and Fauci have fallen out of favor. Atlas has been accused of favoring “herd immunity,” which he denies. But he is close to Trump, and Trump listens to his advice.

As summer faded into autumn and the novel coronavirus continued to ravage the nation unabated, Scott Atlas, a neuroradiologist whose commentary on Fox News led President Trump to recruit him to the White House, consolidated his power over the government’s pandemic response.

Atlas shot down attempts to expand testing. He openly feuded with other doctors on the coronavirus task force and succeeded in largely sidelining them. He advanced fringe theories, such as that social distancing and mask-wearing were meaningless and would not have changed the course of the virus in several hard-hit areas. And he advocated allowing infections to spread naturally among most of the population while protecting the most vulnerable and those in nursing homes until the United States reaches herd immunity, which experts say would cause excess deaths, according to three current and former senior administration officials.

Atlas also cultivated Trump’s affection with his public assertions that the pandemic is nearly over, despite death and infection counts showing otherwise, and his willingness to tell the public that a vaccine could be developed before the Nov. 3 election, despite clear indications of a slower timetable.

Atlas’s ascendancy was apparent during a recent Oval Office meeting. After Trump left the room, Atlas startled other aides by walking behind the Resolute Desk and occupying the president’s personal space to keep the meeting going, according to one senior administration official. Atlas called this account “false and laughable.”

Discord on the coronavirus task force has worsened since the arrival in late summer of Atlas, whom colleagues said they regard as ill-informed, manipulative and at times dishonest. As the White House coronavirus response coordinator, Deborah Birx is tasked with collecting and analyzing infection data and compiling charts detailing upticks and other trends. But Atlas routinely has challenged Birx’s analysis and those of other doctors, including Anthony S. Fauci, Centers for Disease Control and Prevention Director Robert Redfield, and Food and Drug Administration Commissioner Stephen Hahn, with what the other doctors considered junk science, according to three senior administration officials.

Birx recently confronted the office of Vice President Pence, who chairs the task force, about the acrimony, according to two people familiar with the meeting. Birx, whose profile and influence has eroded considerably since Atlas’s arrival, told Pence’s office that she does not trust Atlas, does not believe he is giving Trump sound advice and wants him removed from the task force, the two people said.

In one recent encounter, Pence did not take sides between Atlas and Birx, but rather told them to bring data bolstering their perspectives to the task force and to work out their disagreements themselves, according to two senior administration officials.

The result has been a U.S. response increasingly plagued by distrust, infighting and lethargy, just as experts predict coronavirus cases could surge this winter and deaths could reach 400,000 by year’s end.

This assessment is based on interviews with 41 administration officials, advisers to the president, public health leaders and other people with knowledge of internal government deliberations, some of whom spoke on the condition of anonymity to provide candid assessments or confidential information.

Atlas defended his views and conduct in a series of statements sent through a spokesperson and condemned The Washington Post’s reporting as “another story filled with overt lies and distortions to undermine the President and the expert advice he is being given.”

Atlas said he has always stressed “all appropriate mitigation measures to save lives,” and he responded to accounts of dissent on the task force by saying, “Any policy discussion where data isn’t being challenged isn’t a policy discussion.”

On the issue of herd immunity, Atlas said, “We emphatically deny that the White House, the President, the Administration, or anyone advising the President has pursued or advocated for a wide-open strategy of achieving herd immunity by letting the infection proceed through the community.”

The doctor’s denial conflicts with his previous public and private statements, including his recent endorsement of the “Great Barrington Declaration,” which effectively promotes a herd immunity strategy.

On Saturday, Atlas wrote on Twitter that masks do not work, prompting the social media site to remove the tweet for violating its safety rules for spreading misinformation. Several medical and public health experts flagged the tweet as dangerous misinformation coming from a primary adviser to the president.

“Masks work? NO,” Atlas wrote in the tweet, followed by other misrepresentations about the science behind masks. He linked to an article from the American Institute for Economic Research — a libertarian think tank behind the Barrington effort — that argued against masks and dismissed the threat of the virus as overblown.

Trump and many of his advisers have come to believe that the key to a revived economy and a return to normality is a vaccine.

“They’ve given up on everything else,” said a senior administration official involved in the pandemic response. “It’s too hard of a slog.”

Infectious-disease and other public health experts said the friction inside the White House has impaired the government’s response.

“It seems to me this is policy-based evidence-making rather than evidence-based policymaking,” said Marc Lipsitch, director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health. “In other words, if your goal is to do nothing, then you create a situation in which it looks okay to do nothing [and] you find some experts to make it complicated.”

These days, the task force is dormant relative to its robust activity earlier in the pandemic. Fauci, Birx, Surgeon General Jerome Adams and other members have confided in others that they are dispirited.

Birx and Fauci have advocated dramatically increasing the nation’s testing capacity, especially as experts anticipate a devastating increase in cases this winter. They have urged the government to use unspent money Congress allocated for testing — which amounts to $9 billion, according to a Democratic Senate appropriations aide — so that anyone who needs to can get a test with results returned quickly.

But Atlas, who is opposed to surveillance testing, has repeatedly quashed these proposals. He has argued that young and healthy people do not need to get tested and that testing resources should be allocated to nursing homes and other vulnerable places, such as prisons and meatpacking plants.

White House spokeswoman Sarah Matthews defended Trump and the administration’s management of the crisis.

“President Trump has always listened to the advice of his top public health experts, who have diverse areas of expertise,” Matthews said in a statement. “The President always puts the well-being of the American people first as evidenced by the many bold, data-driven decisions he has made to save millions of lives. Because of his strong leadership, our country can safely reopen with adequate PPE, treatments, and vaccines developed in record time.”

Yet 10 months into a public health crisis that has claimed the lives of more than 219,000 people in the United States — a far higher death toll than any other nation has reported — a consensus has formed within the administration that some measures to mitigate the spread of the virus may not be worth the trouble.

The president gave voice to this mind-set during an NBC News town hall Thursday night, when he declined to answer whether he supported herd immunity. “The cure cannot be worse than the problem itself,” Trump told host Savannah Guthrie.

But medical experts disagreed, saying it is dangerous for government leaders to advocate herd immunity or oppose interventions.

“We’d be foolish to reenter a situation where we know what to do and we’re not doing it,” said Rochelle Walensky, chief of the division of infectious diseases at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. “This thing can take off. All you need to do is look at what’s happened at 1600 Pennsylvania Avenue over the last two weeks to see that this thing is way faster than we’re giving it credit for.”

After Trump came home from the hospital this month, he all but promised Americans that they could soon be cured from the coronavirus just as he claimed to have been. In a video taped at the White House on Oct. 5, he vowed, “The vaccines are coming momentarily.”

Then, at a rally last Tuesday night in Johnstown, Pa., Trump told supporters, “The vaccines are coming soon, the therapeutics and, frankly, the cure. All I know is I took something, whatever the hell it was. I felt good very quickly . . . I felt like Superman.”

Trump’s miraculous timeline has run headlong into reality, however. On the same day that he declared “the cure” was near, Johnson & Johnson became the second pharmaceutical giant, after AstraZeneca, to halt its vaccine trial. A third trial, a government-run test of a monoclonal antibody manufactured by Eli Lilly & Co., was also paused. Each move was prompted by safety concerns.

And on Friday, Pfizer said it will not be able to seek an emergency use authorization from the FDA until the third week of November, at the earliest, seemingly making a vaccine before Election Day all but impossible.

Trump’s notion of a vaccine as a cure-all for the pandemic is similarly miraculous, according to medical experts.

“The vaccines, although they’re wonderful, are not going to make the virus magically disappear,” said Tom Frieden, a former CDC director who is president of Resolve to Save Lives. “There’s no fairy-tale ending to this pandemic. We’re going to be dealing with it at least through 2021, and it’s likely to have implications for how we do everything from work to school, even with vaccines.”

Frieden added: “Remember, we have vaccines against the flu, and we still have flu.”

The article goes on to describe the pressure that Trump and his chief of staff Mark Meadows are putting on the CDC, the FDA, and the NIH to accelerate the approval of a vaccine before November 3, election day. Pence has been assigned the job of smooth-talking the governors and assuring them that a vaccination will soon be available. Meanwhile, the politicization of the vaccine approval process has caused a decline in the proportion of the public that is willing to take a new vaccine if it becomes available.

Trump and his close advisor Scott Atlas have pointed to the Great Barrington Declaration as evidence for their views; it was allegedly signed by 15,000 scientists. However, the Daily Beast was able to scrutinize some of the signers, and among them were obviously fake names.

The White House has reportedly embraced a declaration by a group of scientists arguing for a “herd immunity” strategy to deal with America’s coronavirus pandemic—days after the validity of the declaration came under question due to a number of apparently fake names among its expert signatories, including “Dr. Johnny Bananas.” According to The New York Times, on a call convened Monday by the White House, two anonymous administration officials cited the petition, titled The Great Barrington Declaration, which argues that COVID-19 should be allowed to spread through the population. The declaration’s website claims the petition has been signed by more than 15,000 scientists, but, last week, Sky News found dozens of fake names on the list of medical signatories, including Dr. I.P. Freely, Dr. Person Fakename, and Dr. Johnny Bananas.

Christen Linke Young explains what would happen if the U.S. Supreme Court strikes down the Affordable Care Act (aka ACA or Obamacare): chaos.

The Supreme Court will hear oral arguments about the future of ACA on November 10. The Republican-controlled Senate is rushing through the confirmation vote on Judge Amy Coney Barrett so that she can be seated before the election. Her writings indicate that she will vote to overturn the ACA.

Young writes:

If the Court strikes down the ACA in its entirety, 20 million people would lose health insurance, a variety of protections for people with pre-existing conditions would be eliminated, and an extensive set of policies affecting Medicare, Medicaid, prescriptions drugs, and other parts of the health care system would be reversed.  Significant attention has been paid to the policy changes that elimination of the ACA would bring when fully implemented, but there has been more limited analysis of how health care stakeholders would cope with the sudden elimination of myriad ACA provisions in the short-term. This piece considers some of the major changes (outside the private insurance market) that would follow in the wake of Supreme Court decision eliminating the ACA and concludes that implementation is likely to be quite chaotic. While Congress could in theory ameliorate some of this chaos by quickly enacting legislation, the political trajectory of the ACA to-date does little to inspire confidence that such action would be forthcoming.

To begin with, she writes, there would be a “payment paralysis” in Medicare.

The ACA made many changes to Medicare, generally designed to reduce unnecessary spending and improve quality of care.  Those new rules are fully “baked in” to Medicare’s policies for making $800 billion in annual payments.  In many instances turning off these ACA provisions would not be straightforward and would require the federal government to conduct a careful legal analysis to understand what the statute requires once the ACA provision is removed. This undertaking would be particularly complex in instances where Congress has passed legislation since 2010 that either amended or presupposed the existence of an ACA provision. It would often raise novel questions of statutory interpretation, which would likely spur additional litigation given the financial stakes involved. These problems would play out in a range of concrete settings:

  • Health care providers and health insurers would face tremendous uncertainty in payments. The ACA made changes to how traditional Medicare pays virtually every category of health care provider, including hospitals, physicians, skilled nursing facilities, and many others, as well as major changes to how Medicare pays private Medicare Advantage plans. Reverting Medicare’s payment rules to a pre-ACA state would require revisiting dozens or even hundreds of policy choices the agency has made since 2010, which would likely take months or years. It might be particularly difficult to determine how Medicare should make payments to physicians since the 2015 Medicare Access and CHIP Reauthorization Act made significant changes to how Medicare pays physicians presupposed the existence of a number of ACA policies. It is unclear how CMS would make payments to providers and insurers while this process was ongoing, as it would face a choice between failing to make timely payments or making payments inconsistent with the law.
  • Re-opening the Medicare “donut hole” would be chaotic for insurance companies, drug manufacturers, pharmacies – and consumers. The ACA closed the Medicare Part D “donut hole.” In doing so, it required drug manufacturers to offer discounts for certain prescriptions to plans and changed the cost-sharing plans could charge enrollees. In the aftermath of a decision to eliminate the ACA, those manufacturer discounts might immediately end, and it would be unclear what beneficiaries in a newly reopened donut hole should be charged when filling prescriptions.  Nor would it be clear how to interpret many existing contracts that assumed ACA policy was in effect.  The agency would also need to determine how to interpret a 2018 law that made modifications to this ACA provision, which could generate additional litigation.
  • Health care systems that have invested in Accountable Care Organizations would face significant additional uncertainty.Accountable Care Organizations (ACOs) deliver care for about a quarter of Medicare beneficiaries, but all existing ACO payment models derive from the ACA. ACOs have made significant investments in redesigning care on the assumption that they could receive incentive payments if they met certain standards for the quality and efficiency of the care they delivered.  The federal government might attempt to resurrect some aspects of ACO models under non-ACA authorities, but its success is likely to be limited, and the scope of any new program will be quite uncertain as policy is developed, likely for years.  There would also be considerable uncertainty about how ACOs that had already signed contracts with CMS would be treated if the legal authority undergirding those agreements vanished.
  • Medicare’s authority for a variety of other demonstrations and quality improvement projects would be eliminated, disrupting all the payment streams impacted by those projects. As just one example, the Innovation Center’s Comprehensive Primary Care Initiative (one of about 50 active Innovation Center projects), has more than 3000 participating providersacross the country. As with ACO payment models, federal agencies might be able to resurrect portions of these initiatives using non-ACA authorities but doing so would be complex and time consuming. In the meantime, many of the payment changes bound up in these complex projects would need to be undone, impacting a wide variety of types of health care providers in uncertain ways.
  • The Medicare Hospital Insurance Trust Fund would face insolvency far sooner, and there would be significant uncertainty about when. Elimination of the ACA would eliminate taxes on high income household’s investment earnings that support the Medicare Hospital Insurance Trust Fund and require Medicare to pay more to insurance companies and providers, accelerating the insolvency of the trust fund, already projected for 2024. Some of these changes could also be retroactive, with insurance companies, providers, and high-income taxpayers seeking compensation (through the agencies, or through the courts) for past years. Therefore, the magnitude of the near-term impact on the Trust Fund is difficult to predict and might be affected by subsequent litigation.

And that is only the beginning of the problems that would be caused by tossing out a government health insurance plan that currently protects 20 million people. Read the whole essay.

The New York Times reports that the public schools of New York City have been conducting random drug tests, and the results reveal a surprisingly small number of COVID-19 infections. The city might be a “national model.”

For months, as New York City struggled to start part-time, in-person classes, fear grew that its 1,800 public schools would become vectors of coronavirus infection, a citywide archipelago of super-spreader sites.

But nearly three weeks into the in-person school year, early data from the city’s first effort at targeted testing has shown the opposite: a surprisingly small number of positive cases.

Out of 15,111 staff members and students tested randomly by the school system in the first week of its testing regimen, the city has gotten back results for 10,676. There were only 18 positives: 13 staff members and five students.

And when officials put mobile testing units at schools near Brooklyn and Queens neighborhoods that have had new outbreaks, only four positive cases turned up — out of more than 3,300 tests conducted since the last week of September.

New York City is facing fears of a second wave of the virus brought on by localized spikes in Brooklyn and Queens, which have required new shutdown restrictions that included the closure of more than 120 public schools as a precaution, even though few people in them have tested positive.

But for now, at least, the sprawling system of public schools, the nation’s largest, is an unexpected bright spot as the city tries to recover from a pandemic that has killed more than 20,000 people and severely weakened its economy.

If students can continue to return to class, and parents have more confidence that they can go back to work, that could provide a boost to New York City’s halting recovery.

The absence of early outbreaks, if it holds, suggests that the city’s efforts for its 1.1 million public school students could serve as an influential model for school districts across the nation.

In September, New York became the first big urban district to reopen schools for in-person learning.

Roughly half of the city’s students have opted for hybrid learning, where they are in the building some days, but not others. The approach has enabled the city to keep class sizes small and create more space between desks.

Since then, large school districts across Florida have opened for in-person learning, too. Some wealthier districts in the New York suburbs declined to take this step, worried that it was too risky and logistically challenging.

The city’s success so far could put much more pressure on other districts that have opted for only remote instruction to start considering plans to bring their children back as well.

“That data is encouraging,” said Paula White, executive director of Educators for Excellence, a teachers group. “It reinforces what we have heard about schools not being super spreaders.”

So far, it is also good news for Mayor Bill de Blasio, who has staked much of his second-term legacy on reopening schools for in-person learning during the pandemic.

While public health experts said the data was encouraging, they also cautioned that it was still early.

In general, maintaining low levels of infection at schools would depend on how well New York City does in holding off a broader spread in the population.

Also, some experts have called for much more frequent random testing in all schools — something that city officials are considering — in order to increase the odds of discovering an outbreak early.

So far, most coronavirus testing for school workers has taken place at city-run sites outside the purview of the education department.

Out of 37,000 tests of staff members at city sites, 180 were positive, a city official said.

According to separate data reported to the state by local school districts, 198 public school students in New York City have tested positive since Sept. 8. (Gov. Andrew M. Cuomo in early September ordered those conducting coronavirus tests to collect school information on children, but so far compliance has been spotty, state officials said.)

The city’s new schools testing regimen, which began Oct. 9, calls for 10 to 20 percent of the school population to be tested once a month, depending on the size of the school. The city is applying this testing to its 1,600 traditional public schools; the city’s 260 charter schools are not included.

Some researchers have questioned the efficacy of that approach, saying it could miss a large outbreak.

“It’s great that New York City is doing some level of random testing,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. “It’s not at the level that would be ideal.”

One study recommended testing half the students twice a month.

Michael Mulgrew, president of the teachers union, said the city is looking to increase testing to as much as three times a month citywide. Such frequency, he said, would be “much more valuable” in terms of keeping the virus in check…

A positive test of a student or teacher causes the city to spring into action. Under the rules, one case can cause the closure of a classroom. Two or more cases in separate parts of the same school can prompt a temporary schoolwide closure. At least 25 schools have temporarily closed since classes began. But only three were closed as of Friday…

A positive test of a student or teacher causes the city to spring into action. Under the rules, one case can cause the closure of a classroom. Two or more cases in separate parts of the same school can prompt a temporary schoolwide closure. At least 25 schools have temporarily closed since classes began. But only three were closed as of Friday.

Nancy Bailey checks in on Betsy DeVos and reports that she is still hating on the public schools that the overwhelming majority of American students attend. Moreover, she discovers that charter schools are taking advantage of the pandemic to market their class sizes. Wouldn’t every public school teacher like to have small class sizes? Of course. But it won’t happen without funding to make it possible.

She writes:

Meanwhile, in Baltimore, a public school teacher interviewed in a CNN reportmentions that she’s teaching 42 third-graders remotely.  She’s uncomplaining, smiling, and forging forward positively.

It’s wrong to showcase charter schools as innovative due to class size when public school teachers across the country are juggling huge numbers of students under serious conditions to help them learn.

Where’s DeVos? Of course, never having been a teacher, she cannot understand what it’s like to manage 42 students remotely or in-person. It’s not in the job description she has been permitted to design for herself.

Nor does she care. DeVos’s goal is to privatize. The pandemic gives her a chance to falsely make the public think that charters, private, and religious schools are on the frontline of the disease, and real public schools and their teacher unions don’t have what it takes.

But the pandemic doesn’t discriminate between schools, and the charter school report is problematic. Lowering class size is hardly an innovative experiment. It’s a choice. Those in charge make those choices.

A government agency that has long been trusted as nonpartisan relies on public trust for the information it releases. When that agency is the Centers for Disease Control, public trust is essential to persuading the public that its advisories represent the work of scientists, unaffected by political considerations. This article by ProPublica describes how the Trump administration persistently interfered in CDC guidelines in an attempt to convince the public that the pandemic was no big deal and that the administration was doing a fabulous job in handling it.

It begins:

At 7:47 a.m. on the Sunday of Memorial Day weekend, Dr. Jay Butler pounded out a grim email to colleagues at the Centers for Disease Control and Prevention in Atlanta.

Butler, then the head of the agency’s coronavirus response, and his team had been trying to craft guidance to help Americans return safely to worship amid worries that two of its greatest comforts — the chanting of prayers and singing of hymns — could launch a deadly virus into the air with each breath.

The week before, the CDC had published its investigation of an outbreak at an Arkansas church that had resulted in four deaths. The agency’s scientific journal recently had detailed a superspreader event in which 52 of the 61 singers at a 2½-hour choir practice developed COVID-19. Two died.

Butler, an infectious disease specialist with more than three decades of experience, seemed the ideal person to lead the effort. Trained as one of the CDC’s elite disease detectives, he’d helped the FBI investigate the anthrax attacks, and he’d led the distribution of vaccines during the H1N1 flu pandemic when demand far outstripped supply.

But days earlier, Butler and his team had suddenly found themselves on President Donald Trump’s front burner when the president began publicly agitating for churches to reopen. That Thursday, Trump had announced that the CDC would release safety guidelines for them “very soon.” He accused Democratic governors of disrespecting churches, and deemed houses of worship “essential services.”

Butler’s team rushed to finalize the guidance for churches, synagogues and mosques that Trump’s aides had shelved in April after battling the CDC over the language. In reviewing a raft of last-minute edits from the White House, Butler’s team rejected those that conflicted with CDC research, including a worrisome suggestion to delete a line that urged congregations to “consider suspending or at least decreasing” the use of choirs.

On Friday, Trump’s aides called the CDC repeatedly about the guidance, according to emails. “Why is it not up?” they demanded until it was posted on the CDC website that afternoon.

The next day, a furious call came from the office of the vice president: The White House suggestions were not optional. The CDC’s failure to use them was insubordinate, according to emails at the time.

Fifteen minutes later, one of Butler’s deputies had the agency’s text replaced with the White House version, the emails show. The danger of singing wasn’t mentioned.

Early that Sunday morning, as Americans across the country prepared excitedly to return to houses of worship, Butler, a churchgoer himself, poured his anguish and anger into an email to a few colleagues.

“I am very troubled on this Sunday morning that there will be people who will get sick and perhaps die because of what we were forced to do,” he wrote.

When the next history of the CDC is written, 2020 will emerge as perhaps the darkest chapter in its 74 years, rivaled only by its involvement in the infamous Tuskegee experiment, in which federal doctors withheld medicine from poor Black men with syphilis, then tracked their descent into blindness, insanity and death.

With more than 216,000 people dead this year, most Americans know the low points of the current chapter already. A vaunted agency that was once the global gold standard of public health has, with breathtaking speed, become a target of anger, scorn and even pity.

How could an agency that eradicated smallpox globally and wiped out polio in the United States have fallen so far?

ProPublica obtained hundreds of emails and other internal government documents and interviewed more than 30 CDC employees, contractors and Trump administration officials who witnessed or were involved in key moments of the crisis. Although news organizations around the world have chronicled the CDC’s stumbles in real time, ProPublica’s reporting affords the most comprehensive inside look at the escalating tensions, paranoia and pained discussions that unfolded behind the walls of CDC’s Atlanta headquarters. And it sheds new light on the botched COVID-19 tests, the unprecedented political interference in public health policy, and the capitulations of some of the world’s top public health leaders.

Senior CDC staff describe waging battles that are as much about protecting science from the White House as protecting the public from COVID-19. It is a war that they have, more often than not, lost.

Please open the link and read it all.

The Wall Street Journal reports that more than 1,000 current and former officials at the Centers for Disease Control denounced the Trump administration’s response to COVID-19.

More than 1,000 current and former officers of an elite disease-fighting program at the U.S. Centers for Disease Control and Prevention have signed an open letter expressing dismay at the nation’s public-health response to the Covid-19 pandemic and calling for the federal agency to play a more central role.

“The absence of national leadership on Covid-19 is unprecedented and dangerous,” said the letter, signed by current and former officers of the CDC’s Epidemic Intelligence Service of outbreak investigators. “CDC should be at the forefront of a successful response to this global public health emergency.”

Signers included two former CDC directors: Jeffrey Koplan, who led the agency under Presidents Bill Clinton and George W. Bush, and Tom Frieden, who served under President Barack Obama.

All of the signatories were writing to “express our concern about the ominous politicization and silencing of the nation’s health protection agency” during the current pandemic, said their letter, which was published Friday in the Epidemiology Monitor, a newsletter for epidemiologists.

“CDC has today, as it has every day during its 74-year history, provided the best available information and recommendations to the American public,” the agency said in a response to the letter. “Since January, more than 5,200 CDC personnel have dedicated themselves to protecting the health of the American people.”

Long regarded as the world’s premier public health agency, the CDC normally plays a leading role globally in a response to epidemics.

The Trump administration has been deeply involved at times in the shaping of scientific recommendations at the CDC during the pandemic, raising objections to guidelines for reopening churches and schools and for wearing masks, The Wall Street Journal reported. An administration spokesman said that “the CDC occupies a critical seat on the (coronavirus) task force, which is made up of public health leaders with an array of valuable expertise.”

Donald Trump, as everyone knows, got the best of socialized medicine when he was hospitalized at Walter Reed. He received drugs not available to the general public. One, in particular, was effective, apparently, and he called it a “miracle cure.” It is not currently available to the public; it has not yet been approved by the FDA. But if it is approved, the problems of availability, affordability, and distribution are immense, https://www.wired.com/story/trumps-miracle-cure-for-covid-is-a-logistical-nightmare/as described in this article in Wired.

It’s likely that the Food and Drug Administration will authorize these therapies for emergency use any day now. Before that happens, though, three simple questions must be answered if we’re to avoid turmoil and confusion: Who will be eligible to receive these treatments and have access to them? Where will the therapies be administered? And how muchwill they cost?

No one, certainly not Trump, has figured out the answers to these questions.