The CDC….Another Trump Disgrace

The CDC has been neutered, shamed, and blamed amid the novel coronavirus pandemic and global crisis. From internal missteps that bungled the country’s rollout of diagnostic testing to blatant political interference and strong-arming on critical public health guidance, the CDC has gone from the world’s premier public health agency to a silenced, overridden, distrusted afterthought in the US response—an agency stripped of its ability to collect even basic health data from hospitals during a raging pandemic.”

Medicynical note: A beloved institution trashed by Trump and his misfits. Once the authoritative epidemiology in the world now the tool of an incompetent Presidency. It will take years to fix……if a competent government follows Trump.

COVID:What Went Wrong–EVERYTHING

In many states the response to the COVID outbreak mirrors that of Trump’s government, I.e. chaotic and incompetent

“As the government shifted its coronavirus reporting system, numbers have vanished from CDC Web pages. News organizations have had to sue for information about racial disparities in deaths. In many Florida counties, officials won’t tell parents whether there are coronavirus cases at their children’s schools.”

“Iowa is no exception. The state has refused to release its pandemic plan, which guides its response to the coronavirus, saying the document is “confidential.” The health department’s covid-19 dashboard doesn’t list hospitalizations among health care workers or outbreaks in congregate facilities such as homeless shelters and prisons.””

“In July, state auditor Rob Sand said Iowa’s system for reporting test results was rife with “illegal and unbusinesslike practices, inefficiencies, and apparently pointless risks.” He criticized Iowa’s use of medical privacy laws to justify its secrecy.”

Medicynical note : Delay and obfuscate seems to be Iowa’s policy. “

It wasn’t until May 5, more than seven weeks after the first Postville cases were diagnosed and 15 days after Agri Star requested help, that a state testing strike force finally came to the plant. Over 450 workers were tested for current and past infections.”

“Iowa did not make the results of that event public, and Guerrero said the state provided no interpretation when it sent the company its lab report.”

People are dying and some are playing politics.

Vaccines– game plans for now

We now have the official clinical trial designs for the three biggest and most advanced coronavirus vaccine trials: Moderna, Pfizer/BioNTech and Oxford/AstraZeneca. Now, as for you, J&J, Novavax, Merck, and all the others that are pushing into efficacy trials as fast as possible – don’t think for a moment that you won’t be expected to do the same. But this is a good start. So how do these trials differ?”

“Let’s start off with some background, starting with “vaccine efficacy” (VE), which is pretty much what it sounds like: the percentage difference of infection by the virus between the vaccinated group and the unvaccinated control group. The FDA has already said that they want to see 50% at least (i.e., the vaccine cuts the rate of coronavirus infection at least in half). All of these trials have different subgroups, especially broken out by age and/or pre-existing conditions, and there will be not only an overall VE for the trial but separate VEs determined for all of the predefined subgroups. As is standard, the trials will be using what’s called a Cox proportional hazard regression model to assess the differences between the various groups – I won’t go into the details here, but that’s how you get the eventual figures of “Group A is 2.1x less likely to get infected than Group B” and so on. The Cox model actually gives you the “hazard ratio” (HR) which is just the opposite of the VE, so a 60% HR would mean a 40% VE.”

Medicynical note: the companies’ plans sound fine if they stick to them. The Russians And Chinese are prematurely, IMHO, marketing their not fully tested vaccines around the world. Their reach may be making these companies nervous as does the ignorant political prodding from Trump.

Guns, Racism and Greed……the Downfall of America

And hovering above the violence in our country is the false prophet lure of so called “2nd amendment rights.” Unlimited weapons in a once civil culture has led to a degradation of order; of increased threats to minorities; to increased threats to police; and ultimately will lead to the end of that once civil society.

I don’t understand the sirens call of unlimited access to weapons of mass death in our culture. It leads nowhere good.

Our enemies around the world are delighted by our unique chaos–not seen in any other industrialized country. Gun manufacturers are delighted and shamelessly profit. Immature militant sycophants march around with assault weapons on all sides of the culture war and end up killing innocents and not so innocents to what end? Our police are fearful and as a result often over-react putting themselves and others in jeopardy.

In other cultures with stricter gun laws it is a rare once a year or every few years event that a police officer is killed in the line of duty or kills a suspect. Is there a lesson we can learn or have we permanently lost our collective minds.

Trump and The Russians

The Russian campaign for President…….of the United States……….becomes clear.

“Over all, the Senate report was a bipartisan endorsement of the finding that Russia tried to intervene in 2016 on behalf of Mr. Trump’s election and that the campaign welcomed the assistance. It also hinted that Mr. Manafort may have known about the Russian efforts to hack Democratic emails and dump them into the public sphere, as it did through WikiLeaks.”

Medicynical note: During these four years the U.S. has abdicated its leadership role in the Middle East, torn apart NATO, fatally bungled the public health response to a pandemic, created the largest peacetime federal budget deficit in history (before and after the pandemic started), created an immigration crisis that undermines America’s reputation as a nation of immigrants, and destroyed overseas markets for U.S. agriculture.

And while doing so Trump repeatedly kowtowed to Putin, his idol. All so that Trump can build a Trump hotel in Moscow.

Actions Have Consequences…….Iran

Trump-think………he doesn’t.

“The United States argues that even though it has left the nuclear deal, it retains the right as an original “JCPOA participant” to trigger the “snapback” of sanctions over any issue that violates the agreement, even though it no longer is a participant in it.”

Medicynical note: The U.S. abrogated, i.e. dropped out of the Iran nuclear treaty three years ago and in doing so unilaterally broke from the agreement with its actions . We now want to claim we have the authority to impose more restrictive sanctions to be implemented by all the signers of the treaty– all of whom have continued supporting the treaty.

In the U.N. Security Council vote only the Dominican Republic sided with the U.S. All others either opposed the U.S. action or abstained. Under Trump we went from a united front with Russia, China and our NATO allies to now being isolated with the D.R. Well done Donald.

1,000 Dying Daily…..And Trump? gone GOLFING

Medicynical note: That the Trump administration bungled the response to the pandemic from its actual onset in December and later spread to the U.S. is well documented. Trump thought it would go away like magic and to some extent still thinks that way. As leader of the world’s economic power he has stated that he “takes no responsibility at all.”

And despite multiple assertions from him that his response was perfect and that all is well, a thousand people died yesterday from COVID-19 infection. Think of it. We are six months into the pandemic in the United States and are approaching 170,000 Americans dead and the equivalent of three 747’s full of passengers perish daily from COVID and Trump is out there………golfing.

Vote

China– We (the U.S.) Have No Long Term Strategy

“Washington bears much of the responsibility for what has happened. In the years after the Tiananmen Square massacre in 1989, administrations of both parties touted the absurd theory that the best plan was to let China get rich and then watch as freedom and democracy evolved as byproducts of capitalist development.”

“But did capitalist competition, that ravenous machine that can chew up anything, change China? The regime’s politics did not change a whit. What did change was the US, whose business leaders now approached the Chinese dictatorship with obsequious smiles. Here, after all, was an exciting new business partner: master of a realm in which there were virtually no labour rights or health and safety regulations, no frustrating delays because of squabbles between political parties, no criticism from free media, and no danger of judgment by independent courts. For European and US companies doing manufacture for export, it was a dream come true.”

Medicynical note: The problem the U.S. faces is that China’s leadership is smarter at every level of government than ours. Trump is inexperienced, has no strategy and has only a very limited repertoire of responses.

Trump and The United States Are Failing

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me.”

And

“Compared with the average wealthy nation, America spends nearly twice as much of its national wealth on health care, about a quarter of which is wasted on inefficient care, unnecessary treatments, and administrative chicanery. The U.S. gets little bang for its exorbitant buck. It has the lowest life-expectancy rate of comparable countries, the highest rates of chronic disease, and the fewest doctors per person. This profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.”

Medicynical note: The Soviet Union failed because,in part, of U.S. economic and military policies in the 70s and 80s. The US is failing now because of money driven healthcare non-system and an incompetent administration elected (in part) because of Russian assistance in the last election. Trump has bungled the response to the pandemic.

The Bad Joke of American Healthcare

American healthcare in a nutshell.

“Mr. Aita, who lost his job at a record store at the start of the pandemic and is uninsured, received a document at the end of his visit estimating he would owe $1,157. If the hospital had tested him for coronavirus, the federal fund could have covered the visit entirely.”

“Last week, he received a medical bill for the visit that was only $350. He initially thought this was good news — that the hospital had dropped his charge. But when he looked into the issue, he learned this was an additional charge from the doctor who saw him.”

“I understood that if it was related to Covid, it would be taken care of,” Mr. Aita said. “It’s a pandemic, I’m unemployed, and now I’m dealing with the stress of this situation.”

Medicynical note: the design of the American non-healthcare system is elegant. From its lack of disclosure of prices to the multi tier pricing (whatever the market will bear), to the oh so clever linking of coverage to employment and finally to the cynical price gouging patients with the most serious illnesses.

To clarify, by linking health insurance to work insurers have a sure fire mechanism of cleansing their beneficiaries. Those that cost the insurer the most are automatically eased out of insurer’s liability by them having to stop working when they become ill.

In reality what our system does best is collect revenue. Healthcare? Patient outcomes? Not really the primary concerns.

Obamacare (the affordable Care Act) tried to correct some of these distortions but the REPUBLICANS AND TRUMP have diligently worked to undermine its’ benefits and maintain our grotesque triad of ineffectiveness — 1. millions uninsured, 2. the most expensive health care in the world–by far, and 3. mediocre quality care.

That’s America in the 21st century, a fading, mediocre world power with a government that really really really doesn’t want to be responsible……….for anything. VOTE.