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Medisina at Politika by Dr. Rey Pagtakhan  

Epicentre USA:

Anatomy of failure and three great hopes

by Dr. Rey D. Pagtakhan

October 12, 2020: On Thanksgiving Day I asked myself, “What three cheers could we convey in the midst of COVID-19 pandemic?”

First, raise a collective cheer of gratitude for all individuals and institutions for discharging their duty of care and sharing their humanity during this critical period in the life of our nation. Together, we have followed public health directives and advisories. Canada succeeded in “flattening” the pandemic curve last spring. May we remain steadfast and continue in our commitment as we face the alarming surges of new cases. This is our first hope.

Second, hope that at least one effective and safe vaccine will soon be deployed. Third, let us hope the United States of America will have its political leadership unite, not collide, with science and medicine and, together with the WHO, manage the contagion better within its borders and work in global solidarity with the nations of the world. The greatest global health crisis of our time needs a global solution.

These are the three great hopes I reflected on when I celebrated Thanksgiving Day.

Are we seeing the second wave?

The influenza pandemic of 1918-1919, also known as the Spanish flu, came in three waves. Its highly fatal second save accounted for most of the American deaths attributed to it. This is the reference being made when we speak of COVID’s second wave and its dreaded severity. But the Spanish flu’s greater severity was due to a mutation of the virus into a more virulent strain. The COVID-19 virus has not shown a mutation.

Based on this reference, we had to have seen the end of the first wave, that is, the fall of cases to very low numbers, followed by a significant number of new ones. Since the first wave in the US never ended in most states, the country is still within its extended first wave. This indicates that the virus is 1. simply spreading into new populations, or 2. resurging in locations that let down their guard too soon.

In Canada, where we had flattened the first wave to a significantly low number of cases, the ongoing rise in new cases and hospitalizations in Quebec, Ontario, Manitoba, Alberta and British Columbia indicate the second wave is underway in the non-Atlantic provinces.

Prime Minister Justin Trudeau has expressed frustration but exuded confidence: “We flattened the curve before, we can do it again.”

Chief Public Health Officer Dr. Theresa Tam warned, “COVID-19 will keep spreading if behaviours don’t change.”

Adding her call for collective support, Health Minister Patty Hajdu eloquently said, “Living through a global pandemic has not been easy on anybody, and our lives have all been disrupted and upset. We’ve all had to change and adapt so much. Families have been strained, people have lost jobs, we’ve had to let go of celebrations, change our plans and forego seeing our loved ones. And of course, far too many lives have been lost to COVID-19.”

The resurgence could be due to a “number of bad apples,” as Premier Doug Ford of Ontario had alluded to. The Toronto Star’s editorial, “COVID restrictions – A few bad apples = thousands of lost jobs,” concluded with the message: “Pay attention to Public Health.”

Now into its ninth month since the first patient outside China was diagnosed in Thailand on January 13, COVID-19 has continued to cast its shadows of illness and death. But its gravity is reflected not only in the enormous human toll – physical and psychological illness and death – but also in the countless loss of livelihoods, interruption of schooling, shutdown of many social activities, and the free fall of the economy. Worse, we see no end in sight.

Update from September 28 to October 12, 2020

Worldwide 33,173,176  ⇒ 37,722,044  998,696 ⇒ 1,078,411 
Canada 155,428  ⇒  185,378  9,318  ⇒  9,680 
Philippines 307,288  ⇒  342,816   5,381  ⇒  6,332 
USA 7,118,523  ⇒  7,802,281 204,790  ⇒ 214,045 

(Data from Johns Hopkins University)

The world’s total deaths have surpassed the one million mark. For Canada, the two-week changes come to over 2,100 cases and 25 deaths daily. The USA has remained the epicentre – both in caseload and deaths, averaging nearly 49,000 cases and 660 deaths daily.

Epicentre USA – A failure of political leadership

The USA has remained for a long time now the epicentre, with over 7.8 million Americans sickened and over 216 thousand of them dying in the nine months since the disease left China on January 13, 2020.

How deeply disturbing, indeed, it has been to observe that a tiny virus could humiliate a country with the most military might, the best scientific minds, healthcare expertise, and biomedical manufacturing capacity. Yet the nation failed to provide health care workers and the American public the protective equipment in their time of greatest need! It could only be ascribed to a failure of political leadership.

A litany leadership failures

Below is a summation of the reasons (A to C) why the USA has become the epicentre:

A. The presidency

  1. had ample warning in late January 2020, but deliberately withheld the information from the American public;
  2. had advocated unproven treatments;
  3. has displayed negative role models in words and deeds;
  4. has been skeptical about wearing face masks;
  5. has politicized the vaccine development process;
  6. had disobeyed guidelines from the Centers for Disease Control and Prevention (CDC);
  7. has ignored government institutions and experts and even denigrated them, that is:
    1. has eviscerated the CDC’s effectiveness resulting in testing and policy failures;
    2. has excluded the National Institutes of Health (NIH) from much crucial government decision making for vaccine development; and
    3. has shamefully politicized the Food and Drug Administration (FDA), which appears to respond to pressure from the administration rather than scientific evidence in providing emergency use of certain unproven drugs.

B. The administration was, when the disease first arrived

  1. was slow in responding to the emerging crisis;
  2. was incapable of testing effectively; and
  3. could not provide even the most basic personal protective equipment to health care workers and the general public;

C. The administration has

  1. continued to be behind the curve in testing;
  2. struggled to expand testing capacity;
  3. often delayed the return of test results, rendering them useless for disease control;
  4. instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, and after the disease had spread substantially in many communities;
  5. had provided inadequate rules on social distancing, and loosened restrictions long before adequate disease control had been achieved;
  6. turned to uninformed “opinion leaders” and charlatans who obscure the truth and promulgate outright lies; and
  7. largely abandoned disease control to the states, which do not have the tools and, moreover, has undermined them.

It is unfortunate, indeed, since it is universally acknowledged that the USA had the following enormous advantages coming into this crisis, namely:

  1. an enviable biomedical research system and huge manufacturing capacity;
  2. enormous expertise and ability in public health, health policy, and basic biology to transform them into new therapies and preventive measures; and
  3. much of that national expertise resides in government institutions such as:
    1. The CDC – the world’s leading disease response organization;
    2. The NIH – for its a key role in vaccine development; and
    3. The FDA – for its robust watch of the drug and vaccine approval process.

All these reasons and misuse of known institutional strengths must have had a harmful impact on how America has dealt with the pandemic, so much so that the handling of the pandemic has become the single dominant issue in the minds of the American electorate as they head to the polls within days.

US presidential election – litmus test of leadership

Come Tuesday November 3rd, the eyes of the world will focus on the US presidential election. The major question is: Will the electoral results usher in a new political leadership that would, in the words of CNN analyst Stephen Collison, “navigate America through a moment of national peril” and adopt a coordinated plan based on science for control of the pandemic in the USA and in our interconnected world?

Response of individual Americans and institutions

Charles Lewis, a former editor at the National Post, had this to say in a recent issue of the Globe and Mail: “I just did something I have never done before in a U.S. presidential race: vote for a Democrat. I had no choice.” Alluding to COVID-19 specifically, he continued: “We now know, thanks to journalist Bob Woodward, that in early 2020 Mr. Trump understood how deadly the virus was but refused to relay that to Americans… He is even willing to expose his supporters to grave illness. During the worst of the pandemic, he held an indoor rally in Tulsa, Oklahoma – no masks required. Attendee Herman Cain, a former (Republican) presidential candidate, died of the virus. And now COVID-19 is wreaking havoc in the White House, with Mr. Trump himself contracting the virus. He is still playing it down…ignoring the devastating fact that more than 211,000 Americans have died.” He concluded: “But if Mr. Trump is re-elected, I fear the …United States will be in danger of losing its soul.” A serious non-partisan indictment, indeed, from a well-informed and concerned American citizen.

The USA’s top pandemic expert, Dr. Anthony Fauci, said in a recent interview that he, “hopes the latest data on a rising number of COVID-19 cases and projections of possibly many more deaths ‘jolt’ the American public into reality.” Earlier, he had called a White House social ceremony a “super spreader event.”

David Gergen, a White House adviser to four presidents and professor at the Harvard Kennedy School, where he founded the Center for Public Leadership, recently observed: “The Trump White House is falling apart at an astonishing pace.”

They are not alone. Two publications – Scientific American (SA) and the New England Journal of Medicine (NEJM), representing the collective voice of science and medicine, and traditionally apolitical – have felt compelled to add their assessment of the man at the top of their government and provide their urgent civic prescription.

The editors of SA, which has never endorsed a presidential candidate in its 175-year history, endorsed Joe Biden in its article, “From Fear to Hope,” in the October 2020 issue of the magazine: “The evidence and the science show that Donald Trump has badly damaged the U.S. and its people – because he rejects evidence and science. The most devastating example is his dishonest and inept response to the COVID-19 pandemic…He was warned many times in January and February about the onrushing disease, yet he did not develop a national strategy to provide protective equipment, coronavirus testing or clear health guidelines. Testing people for the virus, and tracing those they may have infected, is how countries in Europe and Asia have gained control over their outbreaks, saved lives, and successfully reopened businesses and schools…. It wasn’t just a testing problem…Trump has proposed billion-dollar cuts to the National Institutes of Health, the National Science Foundation, and the Centers for Disease Control and Prevention, agencies that increase our scientific knowledge and strengthen us for future challenges. …Biden plans to ramp up a national testing board, …to establish a Public Health Job Corps of 100,000 people, many of whom have been laid off during the pandemic crisis, to serve as contact tracers and in other health jobs. …direct the Occupational Health and Safety Administration … to avoid the kind of deadly outbreaks that have occurred at meat-processing plants and nursing homes…. (and) to spend $34 billion to help schools conduct safe in-person instruction as well as remote learning.” It concluded its endorsement: “It’s time to move Trump out and elect Biden, who has a record of following the data and being guided by science.”

Alluding to the President without using his name and his handling of the pandemic, the NEJM in its October editorial, “Dying in a Leadership Vacuum,” wrote: “Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment…. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs. There is no question that his slow response to the crisis, his administration’s struggle to expand testing capacity, his advocacy of unproven treatments and his skepticism about mask-wearing have had a decidedly negative impact on how Americans have dealt with the pandemic…COVID-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.”

America faces an epic choice on November 3rd, and the result will have global repercussions, including Canada. I echo the above-noted sentiments.

Rey D. Pagtakhan, a retired lung specialist and professor of pediatrics and former cabinet minister and Parliamentary Secretary to the Prime Minister, graduated from the University of the Philippines and the University of Manitoba (UM) Faculty of Graduate Studies and Research. He trained at the Children’s Hospital of Washington University School of Medicine in St. Louis and the Children’s Hospital of UM Faculty of Medicine in Winnipeg. As Canada’s former Secretary of State for Science and Research, he presented on “The Global Threat of Infectious Diseases” at the G-8 Science Ministers/Advisors Meeting held in Berlin in June 2003.

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