March 11, 2020 Liz Borkowski, MPH 3Comment

The World Health Organization has formally declared COVID-19, the disease caused by the novel coronavirus, to be a pandemic, with more than 118,000 cases in 114 countries and 4,291 deaths. In the US, the case count has passed 1,000 in 39 states, and will likely climb quickly as tests become more widely available. As we face this global threat, the US is fortunate to have many skilled and dedicated healthcare, emergency response, scientific, and public health workers addressing it. However, our ability to respond appropriately is severely hampered by an administration that disregards science and scientists and appears to put political considerations above public health.

Most of us have grown accustomed to having a president who lies routinely, but we should remember that untrue statements can have immediately harmful repercussions during a pandemic. President Trump referred to the coronavirus outbreak as Democrats’ “new hoax” and incorrectly told a Fox News host that the World Health Organization’s reported case fatality rate was a “false number,” and now a new Reuters/Ipsos poll finds that Democrats are more likely than Republicans to report taking infection-controlling steps like more frequent handwashing or limiting travel. And Trump acknowledged that he wanted to passengers on a cruise ship off California where several COVID-19 cases had been confirmed—despite advice that evacuating them was the safest course—because he didn’t want the number of US cases to increase. Such refusal to accept bad news is dangerous.

In a public health crisis, will decisionmakers rely on science?

Last week, the Center for American Progress held a coronavirus panel discussion with a top academic expert—Jennifer Nuzzo of the Johns Hopkins Center for Health Security—and three former Obama administration officials: Ron Klain, who served as President Obama’s Ebola Response Coordinator; Lisa Monaco, former White House Homeland Security Advisor; and Zeke Emanuel, who was a Special Advisor for Health Policy at the White House Office of Management and Budget (prior to that, he worked for many years at NIH, and he’s now affiliated with both CAP and the University of Pennsylvania). Moderator Mara Rudman, CAP’s executive vice president for policy, asked the panelists an important question about science-based policy decisions during this outbreak.

Monaco explained during a crisis like coronavirus, policymakers have to make hard calls, but they should be asking subject-matter experts to provide data and help them understand threats and set priorities. “You have to send the tone from the top that you’ll be driven by data,” she emphasized.

That’s not what seems to be happening under the Trump administration. Klain noted that President Trump has sent clear signals that he doesn’t want to hear bad news that might disrupt the economy, and he wants to minimize the case count. “When the signal is that if you tell people the truth and it’s bad, you’re going to lose your job or get sidelined, that’s a signal … that’s not the way you get the bureaucracy and the professionals and the experts to respond,” Klain said. (New reporting by Politico’s Dan Diamond documents how this is operating.)

Emanuel also brought up the big picture in terms of what this kind of White House attitude means for the crucial project of recruiting and retaining scientific talent. Government has to respect epidemiologists, virologists, biostatisticians, and other scientists, he stressed. If the administration won’t pay attention when federal scientists have bad news, they have many other employment (or retirement) options.

Nuzzo reminded the audience of what’s at stake when decisionmakers sideline science during a pandemic: When politics gets in the way of an outbreak response, she warned, it can exacerbate the toll of the disease.

The Trump administration’s apparent disinterest in getting the best information from a strong and respected scientific workforce didn’t start with the coronavirus outbreak, of course; it’s a pattern that’s been evident since Donald Trump took office.

Weakening public health infrastructure

During the 2014 Ebola outbreak in West Africa, President Obama recognized that responding effectively to diseases with pandemic potential requires coordinating across multiple agencies. He appointed Klain as a kind of “epidemic czar” to play that coordinator role, and at Klain’s recommendation established a permanent directorate at the National Security Council to coordinate government-wide pandemic preparedness and response. This infrastructure is now gone, Laurie Garrett explains in Foreign Policy:

In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10. Meanwhile, throughout 2018, the U.S. Agency for International Development and its director, Mark Green, came repeatedly under fire from both the White House and Secretary of State Mike Pompeo. And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent, the disease-fighting cadres have steadily eroded as retiring officers go unreplaced.

As the CAP panelists emphasized, we need a robust federal workforce as well as strong leadership. Yet the hollowing out of the federal workforce is a widespread problem under and administration that seems to view civil servants as the enemy and is deconstructing the government. Across agencies, political appointees have cut off collective bargaining or imposed contracts that unions did not agree to. Instances of scientists having their work distorted or ignored, and facing retaliation when they raise concerns, can’t be helping with recruitment and retention. A recent survey found that morale in the government workforce has declined over the past two years. And the Union of Concerned Scientists’ Anita Desikan notes that at the three-year mark,President Trump has left nearly half of scientific leadership positions unfilled, with 39 vacancies, compared to zero at the three-year mark for President Obama and three at that same time point for President George W. Bush.

In this case, the Trump administration isn’t the only guilty party; successive Congresses have also underfunded public health, leading to capacity reductions in the state and local health departments that play crucial roles in responding to public health threats. But it’s particularly hard to understand how President Trump, or whoever was advising him about this, could look at teams designed to addressing global diseases of pandemic potential and decide to scrap them entirely.

After a long-overdue recognition that the coronavirus requires cross-agency coordination at the White House level, President Trump tapped Vice President Mike Pence to lead a coronavirus task force. Given that Pence has disregarded evidence while mismanaging Indiana’s HIV outbreak, this move does not inspire confidence. Better news is that scientist and physician Deborah Birx, the State Department’s global AIDS director, will serve as the White House coronavirus response coordinator—though she will still be reporting to Pence.

Muzzling experts

As Klain notes in a recent piece for The Atlantic, we’re fortunate to have experienced leaders still in place at some agencies:

Some of the world’s leading infectious-disease experts continue to serve in the administration, led by the incomparable Tony Fauci at the National Institutes of Health, and the level-headed Anne Schuchat at the CDC. These two, along with other leaders at key science agencies (and scores of men and women working for them), have decades of experience serving under presidents of both parties, and are among the world’s best at what they do.

However, one of Pence’s first moves as head of the administration response was to direct that all government health officials and scientists coordinate all statements and public appearances with his office. This moves harms both speed at trust. Given how quickly the situation is evolving, and how quickly the global scientific community is generating new findings, it’s essential that we be able to hear quickly from trustworthy experts. But Pence’s new policy introduces delays and also concerns about whether the messages we get are the same ones these experts would have given us if they didn’t have to first get clearance from the Vice President. The Union of Concerned Scientists’ Michael Halpern reminds us that this White House is known to pressure experts whose words contradict the picture it’s trying to paint:

We already know that this White House prioritizes the president’s ego over giving the public the information it needs. Remember Sharpiegate? The president erroneously claimed that Hurricane Dorian would hit Alabama. The professional civil service staff at the National Weather Service clarified that the state was not in the path of the storm. That’s their job.

Rather than admit a mistake, White House chief of staff Mick Mulvaney ordered the acting NOAA administrator to repudiate the experts and prevent other scientists from talking about the path of the storm. During the hurricane. Under termination threats, NOAA political appointees buckled, telling professional staff that the even when public safety is concerned, the president is always right.

We know that the president will fire anyone who crosses him, even leaders within the intelligence services, with nary a whimper from his allies in Congress who claim to care about the Constitution. The emperor will be sure that nobody will tell him when he has no clothes.

What will happen now that the White House has a compelling self-interest in downplaying the extent of the coronavirus outbreak in light of the plummeting stock market?

Anthony Fauci was reportedly scheduled to appear on all five major Sunday talk shows on March 1 to discuss coronavirus, but his appearances were canceled. The impact of Pence’s policy might not be just reduced speed and trust, but that we simply hear less from experts at a time when we need their insights.

Whistleblower complaint

Federal employees and contractors don’t just need to be able to speak openly and honestly about evolving knowledge on the coronavirus’s characteristics and spread; they also need to feel confident that pointing to shortcomings in the government response will lead to improvements rather than retaliation.

Shortly after news broke about Pence’s restrictive communications policy, we learned that an Administration for Children and Families employee had filed a coronavirus-related whistleblower complaint against the Department of Health and Human Services, of which ACF is a part. The complaint states that the employee raised concerns about inadequate preparations and equipment for ACF employees sent to meet returning passengers from the Diamond Princess cruise ship (where COVID-19 spread during a quarantine), and soon after was reassigned to a position “in a subject matter where she has no expertise.” Government Accountability Project CEP and executive director Louis Clark said in response:

We not only need an army of dedicated civil servants and contractors to respond to this potential pandemic, but we need an army of employees willing to exercise their rights to raise the alarm about gross mismanagement and dangers to public health so we have the information to contain the crisis. The truth matters. Facts matter. Science and research matter. Now more than ever. Gag orders that attempt to chill employees from blowing the whistle and swift retaliation against those who dare to speak up will only exacerbate, rather than mitigate, the potential danger to public health and the economy. Let’s be crystal clear on this: when it comes to Coronavirus this administration’s aggressive war on whistleblowers, and those who seek to speak the truth, could have grave consequences for public health.

What we need now

As evidence mounts regarding the spread of coronavirus within the US, it’s essential that experts at CDC and other agencies be able to do their work independently and without fear of reprisal should their findings not be what President Trump wants to hear. The public must be able to trust government officials’ advice about what to do in the face of increasing community transmission and potential individual symptoms. Actions that erode scientific independence and public trust can have deadly consequences.

 

3 thoughts on “Facing coronavirus with an anti-science administration

  1. The problem with narcissists is that they believe something is correct just because they say it. Anything to the contrary must be incorrect. I hope the American people see the president for what he truly is. I don’t want to see people suffer and die, but that will be the outcome unless someone stands up to him and doesn’t let him lie his way out of this. I hope the voters remember this come November.

  2. Well then, what exactly is the science?

    About 98% of the literature it seems, says something like “Doctors believe the virus is spread by coughing and sneezing.” And now talking too. Most people divert their sneezes and coughs, and we mostly do keep social distancing. Yet the virus continues to mysteriously spread somehow. This is NOT science!

    Are there any documented cases of direct spread in the outdoors because people passed each other? What about aerosols, a problem or not? What about droplet spread on surfaces via sneezing, coughing or breathing- is there enough concentration to infect others indirectly? Maybe clustering indoors is the real problem? Maybe there’s more clustering from shelter-in-place orders and this is backfiring?

    What about the spread of oral saliva via fomites- a problem or not? Never anywhere in the literature (scientific or not) is there any mention of whether or not the oral saliva from infected person that is transferred to any surface, can infect another person indirectly. Yet in today’s news, a woman has been arrest for purposely spreading her oral saliva to surfaces in public.

    Now this is serious? What is the science behind this, a problem or not? If so, then why hasn’t anyone, anywhere addressed the fact that millions of people inadvertently spread their own saliva to surfaces daily? They do this when flipping pages in a book, opening produce bags in a grocery store, and very commonly when cooking, eating or dining, especially with finger foods. Millions of people on a daily basis insert their fingers to or into their mouths in lieu of napkins to clean or taste excess food that gets on their fingers.

    Their saliva that is now on their fingers is then transferred to all the surfaces they touch, which will of course be high use areas like door knobs, rails, countertops, etc. And a perfect concentration of virus (if there is any in the saliva), a moist environment to start, and assuredly attached to commonly touched areas. A commercial on tv right now for instance shows a man cooking something, and as he turns to the camera to advertise medical insurance, his finger is stuck squarely inside his mouth. Or a cook at a diner I noticed a few years ago is on break, and as she sits to eat a sandwich, between bites, she cleans every single one of her ten fingers by inserting them into her mouth. I am sure she washed her hands thoroughly before work, but if she is infected and contagious, everyone of her ten fingers has the potential to spread her virus to every single customer who subsequently enter that diner. (Maybe by this habit she could be a “super spreader”.) Others will touch those fomites, take up that saliva to their own fingers that will eventually end up to their own “T” zones, ie eyes, nose, mouth. And get sick too.

    If that is a problem? But apparently not since there is absolutely no “science” whatsoever that I could find that ever addresses this phenomenon. Where is the science? Maybe if we knew what was going on (with science as applied to actual human behavior) we can prevent future recurrences.

  3. This is weird regarding the woman recently arrested for licking items in public. At least from the few comments I read, NOBODY is getting it! The problem is mainly not whether someone might ingest the food and get sick, but the fact that her saliva is transferred to commonly touched surfaces. Which in turn will be touched by others, who then may touch their own faces and become infected. Nobody is getting this!

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