Results of Government Public Health Response to SARS-Cov2

Copyright 2020, John Moyer. I wrote this rant because the number of COVID-19 deaths in the USA makes me sad and angry. You may copy and share this so long as you attribute any changes you make to yourself and attribute the original to John Moyer.

https://www.rsok.com/~jrm/COVID-19.html send email to John Moyer Last updated January 21, 2021.

The numbers on this web page are from January 19, 2021 unless another date is included and are continuing to increase as this is written.

Public Health and Markets

The 398,981 COVID-19 deaths in the USA are the result of policies from our president and his republican enablers in the Senate and from governors like Stitt of Oklahoma. Up until January 19, 2021, Oklahoma has had 3,037 deaths from COVID-19 while Vietnam with about 20 times as many people as Oklahoma has had 35 deaths. To a libertarian who has faith that government is the problem and never the solution, public health is impossible. The libertarian worships the Invisible Hand of the Marketplace and says the private sector will do it. The invisible hand of the marketplace is a false god and should not be worshiped. Markets sometimes allocate resources very efficiently and other times fail. Externalities prevent markets from doing public health.

Public health cannot happen when left to the private sector. Public health cannot happen when left to "personal responsibility".

Numbers for comparison among countries

Some countries did better than the USA and some did worse. In the past, the USA has handled virus outbreaks much better and has led the world in fighting disease and saving lives.

These numbers are updated frequently. https://coronavirus.jhu.edu/data/mortality

country     deaths/100,000 population
United Kingdom 135.41
USA            121.95
Germany         56.99
Finland         11.20
Norway           9.80
Australia        3.64
South Korea      2.48
New Zealand      0.51
Vietnam          0.04
Taiwan           0.03

The example of Vietnam and the USA CDC

Vietnam cheated by having help from the USA CDC while the USA CDC was prevented from helping the USA by the Trump administration. https://www.cdc.gov/globalhealth/stories/vietnam-covid-response.html Quoting:

Vietnam Responds to COVID-19 with Technical Support from CDC

The U.S. Centers for Disease Control and Prevention (CDC) has partnered with Vietnam since 1998 to address HIV, tuberculosis, and influenza, as well as to strengthen laboratory networks, surveillance systems, and workforce development. CDC has also collaborated with the government of Vietnam since 2014 to build public health capacity to prevent, detect, and respond to infectious disease threats through the U.S. government’s commitment to the Global Health Security Agenda.

Today, through trusted, high-level relationships with the Ministry of Health, CDC Vietnam is supporting the country’s response to the COVID-19 pandemic. Specifically, CDC Vietnam supports the Ministry of Health to develop guidelines for COVID-19 surveillance, laboratory testing, and infection prevention and control (IPC). CDC also provides direct technical assistance for IPC, laboratory testing, field investigations, surveillance, and data analysis.

Since its first case was identified on January 23, 2020, Vietnam has excelled in controlling the spread of infections through strong leadership and coordination, rapid case detection and isolation, rigorous contact tracing, and strict quarantine measures. The government of Vietnam’s rapid and strong response to COVID-19 demonstrates the impact of CDC’s capacity-building efforts and close collaborations with Vietnam government partners, both before and during the pandemic. As of June 9, 2020, only 332 cases of COVID-19 had been confirmed in Vietnam, and 316 of the individuals had recovered and been discharged from the hospital. This is a vital achievement."

Vietnam: COVID-19 Response

https://www.cdc.gov/globalhealth/healthprotection/fetp-40th-anniversary/stories/vietnam-covid-response.html

On January 23, 2020, Vietnam reported its very first case of COVID-19. May 6th marked 100 days of COVID-19 in Vietnam, and 100 days of strong cooperation between Vietnam and the U.S. Centers for Disease Control and Prevention (CDC). Vietnam has excelled in controlling COVID-19 through strong leadership and coordination, rapid case detection and isolation, aggressive contact tracing, and strict quarantine measures.

Causing the CDC to fail

Propublica

https://www.propublica.org/article/inside-the-fall-of-the-cdc Inside the Fall of the CDC by James Bandler, Patricia Callahan, Sebastian Rotella and Kirsten Berg, ProPublica

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.

New York Times

https://www.nytimes.com/2020/12/16/us/politics/cdc-trump.html ‘Like a Hand Grasping’: Trump Appointees Describe the Crushing of the C.D.C. Kyle McGowan, a former chief of staff at the Centers for Disease Control and Prevention, and his deputy, Amanda Campbell, go public on the Trump administration’s manipulation of the agency. By Noah Weiland, Dec. 16, 2020

“Every time that the science clashed with the messaging, messaging won,” said Kyle McGowan, a former chief of staff of the Centers for Disease Control and Prevention.

US House of Representatives Select Subcommittee on the Coronavirus Crisus

https://coronavirus.house.gov/news/press-releases/chairman-clyburn-releases-memo-new-evidence-political-interference-pandemic Chairman Clyburn Releases Memo With New Evidence Of Political Interference In Pandemic Response Dec 16, 2020 Press Release Trump Administration Official: “We Want” Americans “Infected”

Washington, D.C. (December 16, 2020) — Today, Rep. James E. Clyburn, Chairman of the Select Subcommittee on the Coronavirus Crisis, sent a memo to Members of the Select Subcommittee citing new documents obtained in the Subcommittee’s investigation of political interference by senior Trump Administration appointees in the work of career officials at the Centers for Disease Control and Prevention (CDC). The documents show that officials at the Department of Health and Human Services (HHS) repeatedly discussed pursuing a “herd immunity” strategy and were aware that Administration policies were causing an increase in virus cases—but tried to hide the true danger of the virus and blame career scientists for the Administration’s failures.

“I am deeply troubled that, instead of promoting the best available science needed to keep Americans safe, the Trump Administration has played politics with a pandemic that has claimed the lives of more than 300,000 of our fellow Americans,” the Chairman stated. “The documents obtained by the Select Subcommittee show a pernicious pattern of political interference by Administration officials. As the virus spread through the country, these officials callously wrote, ‘who cares’ and ‘we want them infected.’ They privately admitted they ‘always knew’ the President’s policies would cause a ‘rise’ in cases, and they plotted to blame the spread of the virus on career scientists.”

“The documents released today reinforce the need for HHS to end its obstruction of the Select Subcommittee’s investigation into the political meddling that has hindered the nation’s response to this deadly virus. HHS must produce the critical documents and witnesses it is withholding, and CDC Director Robert Redfield must appear for an interview regarding evidence that he ordered CDC staff to delete a key email. Unless the Administration abandons this flagrant obstruction, I will be forced to start issuing subpoenas,” added the Chair.

US House of Representatives Select Subcommittee on the Coronavirus Crisus

https://coronavirus.house.gov/news/press-releases/select-subcommittee-investigation-finds-evidence-career-cdc-officials-were

Dear Secretary Azar and Director Redfield:

I write today to express my serious concern about what may be deliberate efforts by the Trump Administration to conceal and destroy evidence that senior political appointees interfered with career officials’ response to the coronavirus crisis at the Centers for Disease Control and Prevention (CDC). This week, a career CDC official stated in a transcribed interview with Select Subcommittee staff that she was instructed to delete an email in which a Department of Health and Human Services (HHS) appointee demanded that CDC alter or rescind truthful scientific reports he believed were damaging to President Trump. She also stated that she understood the instruction to delete the email came from CDC Director Robert Redfield. After the career official provided this troubling testimony, HHS abruptly canceled four transcribed interviews the Select Subcommittee had scheduled with other CDC employees. These actions follow months of obstruction by HHS, during which the Department has failed to produce key documents your staff promised to provide more than a month ago.

I am deeply concerned that the Trump Administration’s political meddling with the nation’s coronavirus response has put American lives at greater risk, and that Administration officials may have taken steps to conceal and destroy evidence of this dangerous conduct. It is critical that the Department end its stonewalling, preserve or recover all responsive documents, and provide the documents and witnesses that the Select Subcommittee needs to investigate this conduct and help protect American lives during this deadly pandemic.

The example of the Bush administration in the USA

During the Bush administration, the USA CDC led the world in limiting the SARS coronavirus outbreak to 29 countries with less than 1,000 deaths worldwide and less than 30 cases in the USA. The world does better with America leads and worse with "america first" and America remains part of the world when there is a pandemic. https://www.cdc.gov/about/history/sars/timeline.htm

The example of South Korea

South Korea learned from the 2015 MERS coronavirus outbreak and did very well with the current outbreak. A conservative government in South Korea thought they could do without leadership from the USA in 2015 and learned from their mistake how they actually can do without leadership from the USA now that such leadership is absent. https://www.cdc.gov/coronavirus/mers/index.html

Countries able to do public health without leadership from the USA

Germany, Finland, Norway, Australia, Taiwan, New Zealand, and others have adapted to the lack of American leadership and have lower rates of death than the USA.

Nonpharmaceutical interventions

If you like statistics, then this is interesting reading. Their statistical model seems to me to be carefully constructed and the results are nicely reported. (If you do not like statistics, then skip to the "Discussion" section for the results.)

Several nonpharmaceutical interventions (NPIs) were compared across 41 countries. Not included were mask wearing, quarantine, and contact tracing.

https://science.sciencemag.org/content/early/2020/12/15/science.abd9338 
RESEARCH ARTICLE
Inferring the effectiveness of government interventions against COVID-19 
cience  15 Dec 2020:
eabd9338
DOI: 10.1126/science.abd9338

Business closures and gathering bans both seem to have been effective at reducing COVID-19 transmission. Closing most nonessential face-to-face businesses was only somewhat more effective than targeted closures, which only affected businesses with high infection risk, such as bars, restaurants, and nightclubs (see also Table 1). Therefore, targeted business closures can be a promising policy option in some circumstances. Limiting gatherings to 10 people or less was more effective than limits of up to 100 or 1000 people and had a more robust effect estimate. Note that our estimates are derived from data between January and May 2020, a period when most gatherings were likely indoors due to weather.

Whenever countries in our dataset introduced stay-at-home orders, they essentially always also implemented, or already had in place, all other NPIs in this study. We accounted for these other NPIs separately and isolated the effect of ordering the population to stay at home, in addition to the effect of all other NPIs. In accordance with other studies that took this approach (2, 6), we found that issuing a stay-at-home order had a small effect when a country had already closed educational institutions, closed nonessential businesses, and banned gatherings. In contrast, Flaxman et al. (1) and Hsiang et al. (3) included the effect of several NPIs in the effectiveness of their stay-at-home order (or “lockdown”) NPIs and accordingly found a large effect for this NPI. Our finding suggests that some countries may have been able to reduce Rt to below 1 without a stay-at-home order (Fig. 3) by issuing other NPIs.

... Our study has several limitations. First, NPI effectiveness may depend on the context of implementation, such as the presence of other NPIs, country demographics, and specific implementation details. Our results thus need to be interpreted as the effectiveness in the contexts in which the NPI was implemented in our data (10). For example, in a country with a comparatively old population, the effectiveness of closing schools and universities would likely have been on the lower end of our prediction interval. Expert judgement should thus be used to adjust our estimates to local circumstances. Second, Rt may have been reduced by unobserved NPIs or voluntary behavior changes such as mask-wearing. To investigate whether the effect of these potential confounders could be falsely attributed to the observed NPIs, we performed several additional analyses and found that our results are stable to a range of unobserved factors (fig. S9). However, this sensitivity check cannot provide certainty and investigating the role of unobserved factors is an important topic to explore further. Third, our results cannot be used without qualification to predict the effect of lifting NPIs. For example, closing schools and universities in conjunction seems to have greatly reduced transmission, but this does not mean that reopening them will necessarily cause infections to soar. Educational institutions can implement safety measures such as reduced class sizes as they reopen. However, the nearly 40,000 confirmed cases associated with universities in the UK since they reopened in September 2020 show that educational institutions may still play a large role in transmission, despite safety measures (30). Fourth, we do not have data on some promising interventions, such as testing, tracing, and case isolation. These interventions could become an important part of a cost-effective epidemic response (31), but we did not include them because it is difficult to obtain comprehensive data on their implementation. In addition, although the data are more readily available, it is difficult to estimate the effect of mask-wearing in public spaces because there was limited public life as a result of other NPIs. We discuss further limitations in the supplementary text, section E.

Although our work focused on estimating the impact of NPIs on the reproduction number Rt, the ultimate goal of governments may be to reduce the incidence, prevalence, and excess mortality of COVID-19. For this, controlling Rt is essential, but the contribution of NPIs toward these goals may also be mediated by other factors, such as their duration and timing (32), periodicity and adherence (33, 34), and successful containment (35). While each of these factors addresses transmission within individual countries, it can be crucial to additionally synchronize NPIs between countries, since cases can be imported (36).

January 21, 2021: Biden has a Plan

https://www.npr.org/sections/president-biden-takes-office/2021/01/21/959048903/on-day-2-biden-to-focus-on-covid-19-strategy-with-10-executive-actions

President Biden plans to sign a series of orders and directives on his second day in office to take charge of stopping the spread of the coronavirus, steps that his advisers say will start to boost testing, vaccinations, supplies and treatments.

Accelerating the sluggish federal response to COVID-19 is Biden's top priority, and he has promised 100 million vaccinations in his first 100 days. He is also pushing Congress for another $1.9 trillion in relief, a package that would include direct payments to Americans, support for small businesses and a huge boost in funding for vaccines and testing.

Biden will push to advance the strategy his team has developed, starting with 10 executive orders and directives, his COVID-19 response coordinator, Jeff Zients, told reporters.

"Last week you heard the president lay out his vaccine strategy," Zients said, adding that on Thursday, Biden will advance "the road map to guide America out of this public health crisis."