Wednesday, June 03, 2020

Coronavirus News (129)

Protests continue for eighth night





The C.D.C., long considered the world’s premier health agency, made early testing mistakes that contributed to a cascade of problems that persist today as the country tries to reopen. It failed to provide timely counts of infections and deaths, hindered by aging technology and a fractured public health reporting system. And it hesitated in absorbing the lessons of other countries, including the perils of silent carriers spreading the infection. ...........  In communicating to the public, its leadership was barely visible, its stream of guidance was often slow and its messages were sometimes confusing, sowing mistrust. ...............  “The C.D.C. is no longer the reliable go-to place,” said Dr. Ashish Jha, the director of the Harvard Global Health Institute. ......... Even as the virus tested the C.D.C.’s capacity to respond, the agency and its director, Dr. Robert R. Redfield, faced unprecedented challenges from President Trump, who repeatedly wished away the pandemic. His efforts to seize the spotlight from the public health agency reflected the broader patterns of his erratic presidency: public condemnations on Twitter, a tendency to dismiss findings from scientists, inconsistent policy or decision-making and a suspicion that the “deep state” inside the government is working to force him out of office. .............  Given its record and resources, the agency might have become the undisputed leader in the global fight against the virus. Instead, the C.D.C. made missteps that undermined America’s response. .........  “Here is an agency that has been waiting its entire existence for this moment,” said Dr. Peter Lurie, a former associate commissioner at the Food and Drug Administration who for years worked closely with the C.D.C. “And then they flub it. It is very sad. That is what they were set up to do.” ............  The agency’s allies say it is just one part of a vast network of state and local health departments, hospitals, government agencies and suppliers that were collectively unprepared for the speed, scope and ferocity of the pandemic. They also point out that lawmakers have long failed to adequately prioritize funding for the kind of crisis the country now faces. ..........  “They are learning at the same time the world is learning, by watching how this disease manifests.” ..........  “It’s important to remember that this is a global emergency — and it’s impacting the entire U.S.,” the agency said. “That means it requires an all-of-government response.”  ...........   Wearing a red “Keep America Great” cap, Mr. Trump falsely asserted that “anybody that wants a test can get a test,” claimed he had a “natural ability” for science and noted that he might hold campaign rallies even as the virus spread. ............   At one point that month, administration officials asked the agency to provide feedback on possible logos — including “Make America Healthy Again” — for cloth face masks they hoped to distribute to millions of Americans. The plan fell through, but not before C.D.C. leaders agreed to the request ...............  The C.D.C., established in the 1940s to control malaria in the South, has the feel of an academic institution. There, experts work “at the speed of science — you take time doing it” ..........   The C.D.C.’s most fabled experts are the disease detectives of its Epidemic Intelligence Service, rapid responders who investigate outbreaks. ............  the C.D.C. is risk-averse, perfectionist and ill-suited to improvising in a quickly evolving crisis — particularly one that shuts down the country and paralyzes the economy. .......... increasingly bureaucratic, weighed down by “indescribable, burdensome hierarchy.” ............ the C.D.C.’s most consequential failure in the crisis: its inability early on to provide state laboratories around the country with an effective diagnostic test. ..........  European travelers had brought the virus into New York as early as mid-February; it multiplied there and elsewhere in the country. In Seattle, a strain from China had struck nursing homes in late February. ...........  The C.D.C. could not produce accurate counts of how many people were being tested, compile complete demographic information on confirmed cases or even keep timely tallies of deaths. ..........   “We got crappy data,” said Fran Phillips, Maryland’s deputy health secretary. “We would call them up and people would say, ‘Well, I was in China, but that was three years ago.’” ............    Some staff members were mortified when a Seattle teenager managed to compile coronavirus data faster than the agency itself, creating a website that attracted millions of daily visitors. “If a high schooler can do it, someone at C.D.C. should be able to do it,” said one longtime employee. ...............  Data is one of the essential tools of public health; Mr. Trump, though, often appears to see it as a weapon against him. He has suggested that testing is “overrated” and that it makes the United States look bad by increasing the number of confirmed cases. He has seized on lower-end projections of the virus’s toll, only to see them eclipsed as the cases and deaths rose. ..........  “The scientists at the C.D.C. are still great,” Dr. Jha said. “It’s very puzzling to all of us why C.D.C. performance has been so poor.” ............   Veteran officials at the C.D.C. were not unfamiliar with the ways of Washington. But they had never dealt with a president like Mr. Trump or a White House like his. ..........  a second wave of the virus could be “even more difficult” than the first .........   In private, some senior administration officials began referring to agency scientists as members of the “deep state” ...........   In late February, Dr. Nancy Messonnier, who oversees the C.D.C.’s respiratory diseases center and had been leading the agency’s emergency response, was sidelined after she issued a stark public warning that the virus would disrupt American lives. The comments sent stocks tumbling and infuriated Mr. Trump, who had not been told in advance. Public health officials, inside and outside the agency, saw her forced retreat as an effort to silence the truth. ..................   To the president’s aides, one of the most frustrating moments came on May 1, when Dr. Schuchat published one of the agency’s regular reports on morbidity and mortality without giving the White House any notice .........  Written in dry, scientific language, the report offered a blunt assessment of the virus’s spread, showing how travel from Europe and mass gatherings had accelerated it. Dr. Schuchat went further when interviewed for an Associated Press article — “Health Official Says U.S. Missed Some Chances to Slow Virus” — saying that “taking action earlier could have delayed further amplification.” .............   the president — who the next day would explain, “In America, we need more prayer, not less” — made it clear the C.D.C. no longer had any choice. ..........  Doctors and nurses remain desperate for updates on how to protect themselves. School superintendents and college presidents need to decide how to hold classes in the fall. And employers want advice about whether to test all of their workers before returning to business as usual. ............   In a crisis, one of the C.D.C.’s main roles is to explain its guidance and reasoning, provide a rationale for when its thinking changes and acknowledge what it does not know. The agency’s routine in past emergencies was to hold press briefings almost daily ..............   it took until April 27 for the agency to expand its list of possible symptoms to include more than a dozen signs of illness that some medical specialty societies had reported weeks earlier. .........  Initially, the C.D.C. recommended that all doctors and nurses coming in contact with coronavirus patients wear N95 respirators, which filter out 95 percent of all airborne particles. But on March 10, with supplies dwindling, the C.D.C. announced that less protective surgical masks were “an acceptable alternative” except during procedures that might aerosolize the virus. Days later, the agency said health workers could even wear “homemade masks (e.g., bandanna, scarf) for care of patients with COVID-19 as a last resort.” ...........   N95 and other respirator masks are superior to surgical or cloth masks in protecting medical workers against the virus.  







What Will College Be Like in the Fall? Administrators, professors, a union representative and students consider the new realities of life on campus in the midst of a pandemic. ..........   With the threat of the coronavirus continuing into the fall and next year, colleges and universities across the country are struggling with whether to reopen their campuses — and if so, how. ...........  two-thirds said at the end of May that they were planning for an in-person semester in the fall ............   If students return, what changes to college life will be needed to contain and suppress the virus? .........  ensuring that schools have the capacity to test students upon arrival and at other intervals, as well as faculty and staff members who come to work on campus, and to conduct contact tracing; and providing guidance about masks, physical distancing and density for dorms, dining halls and classrooms. ...........  recommends giving schools that comply with the applicable state regulations immunity from lawsuits for infections that occur on campus. ...........  hospitals and essential businesses that have figured out how to continue their work without seeding an outbreak in their communities    


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