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The GOP makes excuses — weak excuses

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Judd Legum has a good column at Popular Information that destroys the GOP’s current excuses:

The federal government’s response to the COVID-19 epidemic in the United States has been a disaster. As of Tuesday, there were more than 170,000 confirmed infections, the most in the world. While the virus spread in China and elsewhere, the federal government conducted virtually no testing, allowing COVID-19 to spread within communities undetected. During these critical weeks, there was no effort to stockpile protective equipment for health care workers or ramp up production of critical medical devices like ventilators. Already, more than 3,400 people have died. And it’s projected to get much worse.

How did this happen?

Appearing on the radio with conservative media personality Hugh Hewitt, Senate Majority Leader Mitch McConnell said the federal government was distracted because the House of Representatives impeached Trump. “[I]t came up while we were tied down on the impeachment trial. And I think it diverted the attention of the government because everything every day was all about impeachment,” McConnell said.

If the federal government failed to respond to an imminent pandemic because it was too concerned about the political fate of Trump, it would be an outrage. But the reality is even worse.

Years before Trump was impeached, he decimated the government’s capacity to respond to a pandemic. Moreover, . . .

Continue reading.

Written by LeisureGuy

1 April 2020 at 8:11 pm

What Is “Public Health” and What Does It Mean for the Coronavirus and COVID-19?

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A comment from The Eldest pointed out that calling a medical anthropologist an expert in public health is incorrect. So I thought that this article by Omar Saeed would be of interest:

The coronavirus-related shutdown of schoolsworkplaces, community events, and mass gatherings can be summarized with one increasingly desperate plea: “Please take this seriously!” During a confusing time for young people across the country and the world, we can turn to the field of public health to understand why the COVID-19 pandemic merits such a drastic response.

The fact that no one in our generation has ever dealt with anything like this makes it difficult to wrap our heads around it. Many students who learned that their universities were moving online found themselves with ample time and took the situation as an excuse to party. The urge to celebrate the shutdown of live classes and partake in an extended spring break is a natural response from those who don’t understand the severity of the public health impact.

So what can the field of public health teach us about what’s going on? I’m a current medical student who’s also pursuing a masters of public health. To help explain how our officials are responding to COVID-19, let’s take a look at the history of my field of study and how it’s relevant right now.

What is public health?

At its core, public health is quite literally just about the health of the public; it’s about community-level care and — most importantly — prevention, especially of disease, injuries, infections, and other negative health outcomes. Public health is often promoted by the government through educational programs, like anti-smoking campaigns; public policies, like anti-pollution laws; services, like community health screenings; and research, like work that tracks the spread of disease.

To put it simply, think of it in terms of big pictures and close-ups: While medicine treats individuals within communities, public health focuses on communities as a whole.

COVID-19 has been labeled a pandemic by the World Health Organization (WHO), the organization rooted within the United Nations whose responsibility it is to direct international public health responses. So what does that mean? First, drawing on the basics of public health, we must understand the phases of disease spread. We can look to epidemiology, the subcategory within public health that studies disease, for guidance. An outbreak is when there is a sudden spike in disease transmission within a certain region. Outbreaks that occur over a widespread area (i.e., within a country) are considered epidemics, as explained by the United States Centers for Disease Control and Prevention (CDC). An epidemic [click that link — LG] that has spread around the world is technically considered and often labeled a pandemic.

Pandemics don’t occur often, but when they do, they are often deadly. One major example is the 1918 Spanish Flu, which has been referenced regularly as people discuss COVID-19. As noted by the CDC, it was “the most severe pandemic in recent history.” It’s been estimated that the 1918 influenza infected nearly one-third of the world’s population and caused at least 50 million deaths. Back then, there were no national public health agencies to mitigate the damage, but the flu gave rise to a revolution in public health so that, today, we can at least control part of that narrative.

What can public health teach us about COVID-19?

Public health has a lot to teach us about how to fight COVID-19, both medically and as community members.

Previous pandemics like the 1918 Spanish Flu and the 2009 H1N1 Flu (aka the swine flu) have reinforced the notion that antiviral treatments (to treat the illness) and vaccines (to prevent infection) are two of the most important medical interventions for reducing illness during pandemics. But there hasn’t been a chance to develop these interventions when it comes to COVID-19 because it’s caused by a novel strain of coronavirus that was not discovered in humans until recently.

That means public health measures must be emphasized right now, including social distancingself-quarantining, and handwashing. Notably, long before the COVID-19 outbreak, way back in 2003, public health research estimated that 1 million deaths a year could be prevented if everyone just washed their hands.

We can look to the Substance Abuse and Mental Health Service Administration (SAMHSA) for definitions of these other key terms. Social distancing means  . . .

Continue reading. There’s more. And check out the links.

Written by LeisureGuy

1 April 2020 at 5:58 pm

How Bad Antitrust Enforcers Kill People

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Matt Stoller comments in BIG on a NY Times story I blogged recently:

How A Merger Killed the Ventilator Market

The New York Times had an important story about the ventilator market a few days ago, with Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg reporting why a government effort to stock up on the machines after the SARS epidemic failed.

In 2006, in attempt to learn from what might happen should a SARS-like disease hit here, civil servants in government decided to stockpile ventilators. They wanted both more ventilators and better ventilators than were on the market. So government officials found a small innovative corporation called Newport Medical, and contracted with the corporation to design a cheaper and better version.

Ventilators at the time typically went for about $10,000 each, and getting the price down to $3,000 would be tough. But Newport’s executives bet they would be able to make up for any losses by selling the ventilators around the world.

“It would be very prestigious to be recognized as a supplier to the federal government,” said Richard Crawford, who was Newport’s head of research and development at the time. “We thought the international market would be strong, and there is where Newport would have a good profit on the product.”

At first the project seemed on track. Newport built a working prototype, and the government was on track to order 40,000 ventilators to put into the national stockpile. Newport would then be able to sell additional units into the health care market, as well as abroad. But in 2012, Covidien, a large medical device manufacturer and distributor, bought up Newport Medical, canceled the Federal contract, and shut down Newport’s ventilator line of business.

The result, in 2020, is that we don’t have enough ventilators in a pandemic.

There are three failures of policy here. I’ll start with the simplest, which is that the merger should have been blocked.

Antitrust Failure

The merger by any standard was a clear-cut antitrust violation. There are two theories as to why Covidien sought to buy Newport. First, Covidien already had a ventilator product, and didn’t want to compete with a lower priced and better version. Covidien bought Newport to take its competitive product out. That’s called a ‘killer acquisition,’ meaning that the goal is to undermine a potentially innovative or lower prices product line.

The second is that roll-ups were part of a broader consolidation trend in the industry in general. “Manufacturers,” as the Times reported, “wanted to pitch themselves as one-stop shops for hospitals, which were getting bigger, and that meant offering a broader suite of products.”

Both theories are likely true. Covidien from 2008-2014 bought 17 other corporations. Covidien pitched itself not just as a device maker, but as a device distributor to hospitals. It even called itself a platform, saying in its press release bleating about the acquisition that the acquisition would strengthen its “ventilation platform” for patients around the world. In other words, Covidien was both trying to take out a potential competitor *and* strengthen its own bargaining posture against hospital purchasers, who were themselves getting bigger.

The merger should have and could have been blocked on many different grounds, the simplest being the killer acquisition theory. Yet the Federal Trade Commission, led by Jon Leibowitz, just waved the illegal merger through without even asking any questions. Now there are calls, by both FTC Commissioner Rebecca Kelly-Slaughter, and antitrust thinkers across the board, to reexamine this merger. In Congress, Antitrust Committee Chairman David Cicilline made this point on Twitter. . .

Continue reading. There’s much more, and it shows the degree to which the US is out of whack. Later in the column:

The roll-up of device makers that Covidien was pursuing was part of a longstanding consolidation in the medical industry that correlated to consolidation more broadly. Because our antitrust laws focus on low consumer prices, what has happened across the economy is the creation of ‘power buyers.’

Most people look at monopolies who made commodities, say, steel, and believe a monopoly manifests by how much that company can raise the price of what it sells. But monopolies can operate on the buying side too. Walmart is a buying monopoly, able to use its market power to push prices down against suppliers and workers. I mean if you sell a large chunk of your product to Walmart, they can tell you what price to take. The price to consumers may be low, but that’s because Walmart is using market power against the supplier and not the consumer. But because our antitrust enforcers don’t see anything but consumer prices, corporations like Walmart became far more powerful from the 1980s to the 2000s.

As Olivia Webb noted, there was a Walmart-ization of the medical industry as well, as hospitals combined purchasing power in cartels called Group Purchasing Organizations. GPOs buy supplies for hospitals, and they are supposed to get better prices. But they often don’t. In 1986 Congress exempted them from anti-kickback laws, so there are huge conflicts of interest in how they operate. GPOs are also big. In 1996, the Clinton administration basically said GPOs wouldn’t be subject to antitrust prosecution. Today, for context, just four GPOs account for 90% of generic pharmaceutical purchasing. GPOs also handle medical devices.

Throughout the 2000s and 2010s, one of the results of these choices, as well as the refusal to enforce merger law or antitrust, was the concentration in these corporations that sell things to hospitals, everything from syringes to software. During the HIV epidemic, a corporation called Retractable Syringes developed a safer syringe that doctors and nurses wanted to prevent accidental needlesticks, but GPOs prevented them from selling their product to hospitals. None of this went unnoticed. Congress held hearings, to no avail, on all sorts of innovative medical devices that couldn’t make it into hospitals. Retractable won a private antitrust lawsuit, but more recently it lost one on appeal. Without legal redress, much of the medical device industry consolidated. Covidien itself was bought by Medtronic a few years ago.

Written by LeisureGuy

1 April 2020 at 5:36 pm

The psychiatrist at the centre of the opioid crisis

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Emiliano Rodríguez Mega writes in Nature:

On a cold Friday night in February 1995, addiction researcher Nora Volkow and her husband got into their car after a long day at Brookhaven National Laboratory in Upton, New York. Ice had covered the trees and the roads, making them sparkle. But as the couple drove down a slope, the tyres lost their grip. The vehicle spun out of control. Volkow curled up to shield herself as an oncoming car crashed into her door.

Metal bit into her flesh. The pain was unrelenting. Finally, the fire service arrived to break her free and an ambulance rushed her to the nearest emergency department, where a doctor gave her Demerol, a powerful and highly addictive opioid painkiller also known as pethidine, which is similar to morphine.

Volkow had spent countless hours talking to people with addiction and had read hundreds of papers on the mechanisms of drug abuse. Neither prepared her for what happened next.

“It was extraordinary, those impressive sensations,” she says. A moment of ecstasy, one she describes as comparable only to long-lasting sexual pleasure, eclipsed all other feelings. She stayed on the medication for another few days and was sent home with more. But she decided not to take it. She was afraid — she knew many of her patients could not stop once they started. She would get through the pain without the help of drugs.

That night, a discomfort she had never felt before overran her body. She felt restless, agitated, desperate. Volkow took a painkiller and, like an apparition, the feeling faded away. “It was then that I realized how fast dependence develops,” she says. “It also made me realize that I’m very afraid of opiates.”

Twenty-five years later, Volkow’s name has become widely known in the addiction field and beyond. As a neuroscientist who has directed the US National Institute on Drug Abuse (NIDA) in Rockville, Maryland, since 2003, she has championed the idea of addiction as a disease of the brain rather than a moral failing. Under her direction, NIDA has prioritized research on the biological basis of addiction, and fought against the mistreatment of drug abusers in both the medical and criminal-justice systems.

Her quest has taken on a new urgency as the United States finds itself contending with shifts in the legal status of cannabis, a growing market for electronic cigarettes, a sudden comeback of cocaine and methamphetamine, and a two-decade-old opioid epidemic that has devastated many parts of the country: opioid overdoses have killed nearly half a million people in the United States (see ‘Tackling the opioid epidemic’). In response, her agency has started projects to monitor drug use and has ploughed money into medications that can reduce the cravings and pleasurable effects of drugs. . .

Continue reading.

Written by LeisureGuy

1 April 2020 at 12:51 pm

President Trump in his own words

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Dana Milbank collected President Trump’s actual statements for a virtual fireside chat:

The coronavirus is very much under control in the USA. We have it totally under control. I’m not concerned at all. It’s one person coming in from China. We pretty much shut it down. It will all work out well. We’re in great shape. Doesn’t spread widely at all in the United States because of the early actions that myself and my administration took. There’s a chance it won’t spread. It’s something that we have tremendous control over.

Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away. One day it’s like a miracle, it will disappear. Just stay calm. It will go away. The Democrats are politicizing the coronavirus. This is their new hoax.

Whatever happens, we’re totally prepared. Totally ready. We’re rated number one for being prepared. We are so prepared like we never have been prepared. Taking early intense action, we have seen dramatically fewer cases of the virus in the United States. We’re very much ahead of everything.

This is a flu. I didn’t know people died from the flu. Here, we’re talking about a much smaller range. It is very mild. Some people will have this at a very light level. Some of them go to work.

The mortality rate is much, much better. In my opinion it’s way, way down. I think it’s substantially below 1 percent. A fraction of 1 percent. I think the numbers are going to get progressively better as we go along. This is just my hunch.

We have very little problem in this country. We only have five people. We only have 11 cases. Out of billions of people, 15 people. They’re getting better, and soon they’re all going to be better, hopefully. We’re going very substantially down, not up.

The United States, because of what I did and what the administration did with China, we have 32 deaths at this point. To this point, and because we have had a very strong border policy, we have had 40 deaths. As of this moment, we have 50 deaths. I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be.

Frankly, the testing has been going very smooth. The tests are all perfect. Anybody that wants a test can get a test. The tests are beautiful. We have a tremendous testing setup.

I don’t believe you need 40,000 or 30,000 ventilators. We are very close to a vaccine. A matter of months. You take a solid flu vaccine, you don’t think that could have an impact? Hydroxychloroquine and azithromycin, taken together, have a real chance to be one of the biggest game changers in the history of medicine. Based on very strong evidence.

I would love to have the country opened up and just raring to go by EasterNo way I’m going to cancel the convention. Stock Market starting to look very good to me!

We’re the ones that gave the great response. I’d rate it a 10. We’ve done a fantastic job. I think they should be appreciative. Gallup just gave us the highest rating. The highest on record.

I like this stuff. I really get it. Maybe I have a natural ability. We think it’s going to have a very good ending. We’re going to win faster than people think. I hope.

This blindsided the world! Who could have ever predicted a thing like this? This was something that nobody has ever thought could happen to this country.

I’ve always known this is a real, this is a pandemic. I felt it was a pandemic long before it was called a pandemic. I always treated the Chinese Virus very seriously.

If you’re talking about the virus, no, that’s not under control for anyplace in the world. I was talking about what we’re doing is under control, but I’m not talking about the virus. I didn’t say Easter. It was just an aspiration. I am giving consideration to a QUARANTINE.

So you’re talking about 2.2 million deaths. If we could hold that down…between 100,000 and 200,000, and we all together have done a very good job. START MAKING VENTILATORS, NOW!!!!!! FORD, GET GOING ON VENTILATORS, FAST!!!!!! Invoke “P”. I want our life back again.

It was nobody’s fault. No, just things that happened. I don’t take responsibility at all.

Written by LeisureGuy

31 March 2020 at 7:31 pm

A Medical Anthropologist Tells Us Why She Was So Wrong About Coronavirus

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Matthew Gault writes in Vice’s Motherboard:

In the early days of the coronavirus pandemic, many public health experts were sure that the virus could be beaten before it had a disastrous impact: as long as testing was robust, and the systems in place functioned properly, America would pull through relatively unscathed.

They may have been right, but we’ll never know, because testing has not been robust, and the systems in place have all failed miserably.

One expert I spoke with in late February was Theresa MacPhail, a medical anthropologist, Assistant Professor at Stevens Institute of Technology, and author of the book The Viral Network: A Pathology of the H1N1 Influenza Pandemic. MacPhail worked with the CDC in 2009 as a volunteer intern as part of its Global Disease & Detection unit, taking part in global conference calls on the H1N1 pandemic and seeing how the organization is structured. She was in Hong Kong during its H1N1 outbreak.

In late February, she spoke optimistically with me about America’s ability to handle the coming Covid-19 outbreak. In early March, she got sick with what she believes to be Covid-19. She reached out to me recently, insisting to go on the record again to say that she was wrong, and that she put too much faith in the CDC and America’s ability to manage the crisis.

How are you feeling?
I feel guilty. I feel like I should have known better.

What was it about our previous conversation that made you feel guilty?
I made a lot of assumptions and didn’t think twice about having made them. I know I’m not alone, I’m just one of the only people that is saying publicly, “Well, I got this completely wrong.”

I think it was overconfidence. I feel like what we’re seeing is a bit of hubris. We’re basically suffering, partially, because there was no plan for when the [Center for Disease Control] fucked up, because they don’t fuck up, or they haven’t in the past. They don’t have a protocol for when they can’t do an assay. And that’s exactly what happened. Their assays didn’t work. And there was no plan for that.

What do you mean by an assay?
I just assumed that the US system would be a little bit better, would be a little bit more robust and do more testing and containment than China was able to do, and I just couldn’t have been more wrong.

When we talked, I was still so confident that this response was gonna look like the 2009 [H1N1] pandemic response, which was a good response. Initially, it had some problems… but once they realized what was going on, they kicked into gear and everything went pretty well.

One thing that’s super different is that the CDC in 2009 provided central leadership. They were proactively reaching out to state, regional, and local Health officials saying, ‘Here’s what you need to be doing. Here’s what this should look like.’ And people did it.

I am scared and enraged because there’s no central authority here. I don’t understand what’s going on.The CDC isn’t giving press briefings. They’re just absent. And that could be because the administration is muzzling them. Or it could mean that there’s disarray inside the CDC. And I guess all of that will come out.

But I feel guilty because I knew them. So it’s a bit like not wanting to think your Uncle Bob did something wrong or was capable of doing something wrong. That’s why I feel bad, because I just assumed that this response would look like the old response. And it doesn’t at all, and I just feel so awful.

I wasn’t one of those people sounding the warning alarm. I really felt like we had a shot at containing [it]. But that meant that we had to have tests. I didn’t realize what 10 years of underfunding public health had done.

You got sick after we spoke last, right?
I was never tested, but if I had to lay bets I would say I have it. I’m still sick now. I’m on day 25. I got sick on March 1. It was the classic sore throat, feeling a little bit disgusting, and then at day five or six my fever started to spike. It got as high as 102.5 and never went below 100, despite taking massive amounts of fever reducer.

I started having tightness in my chest. I had a dry cough. I went to the ER on March 9. They put me in a separate room. Before all this went down, I had been contacted to go to Washington to the House of Representatives and give a public statement before Congress about what we’ve learned in pandemics past. Of course, that all got shot out of the water.

I asked the ER doctor, “Can you tell me in your professional opinion, are you prepared for this?” He said, “Absolutely not.” He had been doing this for 12 years. He was there for the 2009 pandemic. He said in 2009 they were overprepared. They had extra flu kits, they had extra supplies, they were ready. They had been prepared by the Department of Health. The communication had been clear. He said, “I hate to tell you this but we’re underprepared now. We don’t have extra supplies. We don’t have any tests.” That’s when I started to think, “This is serious.”

The only way we get out of this, the only way we return to a semblance of normal, is massive testing. And I’m starting to get worried because when are we doing that? It’s mind boggling.

You’ve mentioned a few times that past responses were better. What do you mean? . . .

Continue reading.

Written by LeisureGuy

31 March 2020 at 12:47 pm

Kushner Firm Built the Coronavirus Website Trump Promised

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Self-dealing is the norm with the Trump administration. Robinson Meyer writes in the Atlantic:

On March 13, President Donald Trump promised Americans they would soon be able to access a new website that would ask them about their symptoms and direct them to nearby coronavirus testing sites. He said Google was helping.

That wasn’t true. But in the following days, Oscar Health—a health-insurance company closely connected to Trump’s son-in-law, Jared Kushner—developed a government website with the features the president had described. A team of Oscar engineers, project managers, and executives spent about five days building a stand-alone website at the government’s request, an Oscar spokesperson told The Atlantic. The company even dispatched two employees from New York to meet in person with federal officials in Washington, D.C., the spokesperson said. Then the website was suddenly and mysteriously scrapped.

The site would not have helped many Americans even if it had launched. Today, more than two weeks after the president promised a national network of drive-through test sites, only a handful of such sites have opened, and fewer than 1 million Americans have been tested.

The full extent of Oscar’s work on the project has not been previously reported. The partnership between the administration and the firm suggests that Kushner may have mingled his family’s business interests with his political interests and his role in the administration’s coronavirus response. Kushner’s younger brother Joshua is a co-founder and major investor in Oscar, and Jared Kushner partially owned or controlled Oscar before he joined the White House. The company’s work on the coronavirus website could violate federal ethics laws, several experts said.

For the past several weeks, Kushner has led a “shadow task force” on the coronavirus, separate from Vice President Mike Pence’s official committee, according to The Washington Post. Kushner’s team, composed of federal officials allied with Kushner and outside corporate executives, has met in the headquarters of the Department of Health and Human Services. A senior official at that agency called Oscar to ask for its help on March 13, the day of Trump’s press conference, the Oscar spokesperson said.

Kushner’s group has focused on expanding and publicizing coronavirus testing, especially at drive-through locations. Oscar’s website would have asked users if they were experiencing symptoms of COVID-19, the illness caused by the virus, and surveyed them about other risk factors, including their age and preexisting conditions. It also would have listed a limited number of testing locations nationwide, including some of the drive-through sites that Trump promised. It was designed to look like a government-developed product, provided freely by the Department of Health and Human Services to the American public. Oscar posted the source code for the site to Github, where The Atlantic reviewed it.

The site resembled a version of a tool Oscar had already built for its customers in response to the crisis, but it was “adjusted to meet the specifications and requirements set by the federal government,” Jackie Kahn, the Oscar spokesperson, said in an emailed statement. That Oscar had already been working on a coronavirus-testing website when HHS called to ask for help was a coincidence that had nothing to do with Kushner, Kahn suggested. She declined to say whether Oscar had discussed that site with Joshua Kushner or any board members or investors before Trump’s March 13 press conference.

Oscar donated its work freely and never expected to be paid for the project, Kahn said. The company is “not, nor has ever been,” a contractor or subcontractor for the government, she said, which would make it harder for the government to pay Oscar for its work. The work was “all at the direction of HHS,” she said. “The website never saw the light of day,” she added in an interview today.

That may not matter from an ethics perspective. The ad hoc nature of Kushner’s task force has already collided with federal laws. Oscar’s involvement deepens Kushner’s ethics and conflict-of-interest problems.

“It’s not typical. It’s usually not allowed,” Jessica Tillipman, an assistant dean at the George Washington University School of Law and an expert on anti-corruption law, told me.

Oscar’s relationship with the Trump administration could breach federal law in two ways, Tillipman and other experts told me. First, companies are generally not supposed to work for the federal government for free, though some exceptions can be made in a national emergency. “The concern, when you have some free services, is that it makes the government beholden to the company,” Tillipman said.

More important, she said, any Kushner involvement may have violated the “impartiality rule,” which requires federal employees to refrain from making decisions when they even appear to involve a conflict of interest. The rule also prohibits federal employees from making a decision in which close relatives may have a financial stake. Such a situation would seem to apply to Kushner and Oscar. In 2013, Jared and Joshua were the “ultimate controlling persons in Oscar’s holding company,” according to a New York State report that Mother Jones dug up earlier this month. . .

Continue reading.

Written by LeisureGuy

31 March 2020 at 12:17 pm

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