Leadership Responses to COVID-19 Pandemic

On May 23, I posted an article, Who Should Be in Charge of the COVID-19 Response?  It concluded with, “The president, governors, county executives, and mayors clearly need to listen to the experts, both inside and outside of government but ultimately, the decisions will be made by elected officials.” 

As a follow-up, I will periodically provide my assessments of the pandemic responses of various political leaders. These assessments are mine and mine alone, based on 25 years of work in the field of pandemic preparedness and response, and have nothing to do with partisan politics, the upcoming election, or issues not associated with the pandemic response.

On June 28, Vice President Pence implored Americans to wear face masks. 

Assessment:  It’s about damn time!  Political leaders at all levels, and for that fact, media celebrities (yes, Laura Ingram I am talking about you) should be encouraging the use of masks, social distancing and hand washing. Every person in this country can play an important role in controlling this pandemic and getting America back to work. 

On June 26, Texas Governor Greg Abbott stated, “If I could go back and redo anything, it probably would have been to slow down the opening of bars.” In addition to re-closing bars, he also scaled back restaurant capacity to 50%, shut down rafting and tubing businesses, and banned outdoor gatherings of over 100 people unless approved by local officials.

Assessment:  Kudos to Governor Abbott. I fully supported his bold decision on May 1 for beginning the process of re-opening Texas (guidance included a recommendation for wearing masks in public). The data clearly demonstrated the state-wide lockdown and ban on elective medical procedures were causing a greater public health threat to Texans than COVID-19. Governor Abbott demonstrated political courage in beginning the re-opening process for Texas in early May, and great judgement last Friday in making adjustments to policies–when the facts clearly called for such actions.

On March 7, Travis County Judge Sarah Eckhardt and Austin Mayor Steve Adler demonstrated great political courage when they cancelled South by Southwest (SXSW), an international music, technology and film festival that annually brings 400,000 visitors and a third of a billion dollars to the local economy.

Assessment:  The bold action of Judge Eckhardt and Mayor Adler, at a time when there were fewer than a dozen COVID-19 cases in Texas, likely prevented Travis County and Austin from becoming a major pandemic hotspot. Their actions saved untold numbers of lives.

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Smallpox Eradication and the COVID-19 Response

Written by Leigh Henderson

On the 40th anniversary of the global eradication of smallpox, there are calls for attacking the COVID-19 pandemic as smallpox was attacked. One hallmark of smallpox eradication has been undertaken with enthusiasm—research. Scientists around the world are investigating COVID-19. Scientific journals are waiving their usual access fees to ensuring rapid and widespread communication of results.

Can smallpox eradication be a model for tackling the COVID-19 epidemic? Yes and no. Smallpox eradication could not have succeeded without its basic management, organization, and epidemiologic principles. These ‘lessons’ apply broadly and can influence the success or failure of global public health programs. 

However, the two diseases are very different. Smallpox had many characteristics that made it a viable candidate for eradication, and the strategies used took advantage of these. Confronting COVID-19 will require different strategies.

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Interview with Dr. Irwin Redlener

Dr. Irwin Redlener (IR) 
Randy Larsen (RL)
June 17, 2020

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Dr. Irwin Redlener is the founding director of the National Center for Disaster Preparedness, part of the Earth Institute at Columbia University where he holds professorships in public health and pediatrics. In a wide ranging interview, Dr. Redlener discusses key COVID-19 issues: underlying medical conditions, therapeutics, vaccines, the age issue, communicating with the public, alternative standards of care, lockdown and reopening, schools and daycare, and nursing homes.

Full Interview

Interview with Dr. Amesh Adalja

Dr. Amesh Adalja (AA) 
Randy Larsen (RL)
June 22, 2020

We are pleased to have with us a scientist and frontline physician, Dr. Amesh Adalja. He is a Senior Scholar at the Johns Hopkins University Center for Health Security, a Fellow of the Infectious Diseases Society of America, the American College of Physicians, and the American College of Emergency Physicians. He practices infectious disease, critical care, and emergency medicine in the Pittsburgh metropolitan area. 

Our interview with Dr. Adalja covered a wide-range of topics including: Lessons Learned During First Four Months of the COVID-19 Pandemic, Testing (virus and antibody), Reopening the Economy, Therapeutics, MMR and TB Vaccines, The Age Issue, Schools and Daycare, I Think I May Have Been Exposed–What to Do?, and more.

Full Interview

Easing The Burden—What We Missed

Written by Leigh Henderson

COVID-19 has dominated the headlines, quarantined much of the U.S. population, and devastated the U.S. economy. As of June 12, the United States reported 2 million confirmed and probable cases with 111,000 deaths.1 There were, an estimated 271,000 hospitalizations.2

When COVID-19 was first reported, most of the population was self-quarantined and non-essential businesses were closed. We were told that this would ‘flatten’ the epidemic curve. It would extend the duration of the epidemic but would ease the burden on overtaxed hospitals. The number of patients would be distributed over a longer period, but there would be fewer at any one time.

Why did we not take the most obvious step to ‘ease the burden’? 

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The Coming Food Crisis

Written by John Hoffman

I am not sure that leaders at all levels fully appreciate the grave danger we face with our food supply, our economy and our nation. The food system in the United States represents one sixth of our economy. Historically, as the food system goes, so goes the economy. The national food infrastructure has always had a direct impact on confidence in government.

Many in our nation face growing food supply insecurity today. This is particularly true in the large cities. Today we have broad shortages that are in the range of 20% of key protein products.  Food prices are rising as a consequence of production cuts that have created these shortages and supply disruptions. This is all the result of the COVID-19 pandemic and the failure of the federal interagency team to take the necessary steps to assure full access to the things every family needs every day.  What we are seeing today need not have been the case. 

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Understanding the Limitations of Computer Modeling

Written by Dennis Haugh, Dave Morgan and Ron Scott

Everyone in the United States has now become painfully aware of how computer models can impact their lives. We can no longer ignore their existence. Every citizen needs to have a rudimentary understanding, not of modeling itself—but of when it can be trusted and when it cannot. 

There is a fundamental question of knowing the future. In 2007, The Black Swan explored the bounds of our knowledge in a world of uncertainty and introduced the “ludic fallacy”—using the past to predict the future.[1] This paper puts some of the concepts from that book into the context of computer modeling.

The response to the Covid-19 pandemic response has largely been based upon the published predictions from models like the ones constructed by the Imperial College[2] and the Institute for Health Metrics and Evaluation (IHME).[3] Had these models not produced the fear they did, the impact of the pandemic would have been reduced significantly.

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We Need Challenge Studies for COVID-19 Vaccines

Combined with standard testing protocols, challenge studies could accelerate development of a safe and effective vaccine.

Challenge studies involve giving a developmental vaccine to volunteers followed by infecting those volunteers with the SARS-CoV-2 virus. Challenge studies are rare but the National Institutes of Health has been doing them for a few years for a mild strain of influenza.

From 1954-1973, during The Cold War, the U. S. Army conducted a series of challenge studies on more than 2000 Seventh-day Adventist volunteers. Operation Whitecoat was created to protect against the threat of Soviet bioweapons. The studies were conducted at Ft Detrick MD and set the gold standard for the use of human volunteers in medical experiments. In 2018, I directed & produced a documentary film about these incredibly patriotic young men.

Looking forward, after a COVID-19 vaccine completes Phase I safety testing, volunteers for a challenge study would be vaccinated and later infected with the COV-SARS-2 virus. Initially, only young, healthy volunteers would be selected. They would be closely monitored in a medical facility.

Donna Shalala (D-FL), a former secretary of Health and Human Services, along with 33 other members of Congress from both parties, have expressed support for the use of human challenge trials. The World Health Organization and National Institutes of Health are currently examining the issue.

This is not a common procedure for vaccine development.

These are not common times.

Who Should Be in Charge of the COVID-19 Response?

During the past few months, how many times have you heard a pundit on TV say, “We must listen to the experts.”  Every time I hear this, I wonder if the pundit has ever sat around a conference table with a group of scientists—or for that fact, lawyers, economists, senior military leaders or other such “experts”. 

I have.  

During the past two decades I have spent many hours—in fact, entire days, listening to distinguished experts engage in exhausting, ferocious debates while failing to reach consensus on a wide variety of national security issues. This is in no way a criticism–it is the essence of policy debates. Such “real-time peer review” is even more pronounced when dealing with the COVID-19 pandemic. There is so much we don’t yet know about the virus, the disease and the social and economic consequences–and no one dealing with the current pandemic has ever faced such a challenging crisis–at least not in the “real world”.

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Reopening is a Critical Health Issue

When we began this blog, our lead article was written by A. J. Kay stating the ban on elective procedures (which includes things like heart valve replacements, bone marrow transplants, organ donations, and cancer screenings) could kill more Americans than COVID-19. Today’s op-ed in the Washington Post by the Secretary of Health and Human Services adds even more information to this argument.

Since the stay-at-home orders and ban on elective procedures began—which we fully supported at the time to prevent the potential overloading of the healthcare system—the unintended consequences have grown at an alarming rate.

  • mammograms down 87 %
  • colonoscopies down 90%
  • breast cancer surgeries reduced by 66%
  • vaccinations down 60%

These are all classed as elective procedures.

Additionally, many hospitals have experienced a 60% reduction in revenue due to the cancellation of elective procedures resulting in the furloughing of healthcare providers and creating a situation in which many rural hospitals are on the brink of bankruptcy and may be forced to close—permanently.

One has to wonder if the epidemic modelers add these and other unemployment heath risks (increases in suicides, opioid deaths and spousal abuse plus loss of healthcare benefits) to their equations?

There are not any “no-risk” solutions, but Secretary Azar makes it very clear—this is not an argument about health vs the economy. It is about health vs health.

We recommend you read Secretary Azar’s op-ed.