Just two weeks ago, Food and Drug Administration Commissioner Stephen Hahn got up in front of a podium with Secretary of Health and Human Services Alex Azar and President Donald Trump to announce an Emergency Use Authorization for convalescent plasma to treat Covid-19. Each crowed in succession about how this pooled blood product could reduce deaths by a third. Within seconds of the announcement, scientists and clinicians were pointing out that this was a rookie statistical error. The study in question actually showed a far more modest 35 percent relative risk reduction in hospitalized patients less than 80 years old not on ventilators and who received plasma with high levels of antibodies within three days of diagnosis, compared with those who received plasma with low levels of antibodies.
Of course, the FDA commissioner is not a rookie; he’s a trained oncologist from a major academic medical center. Furthermore, the study that was the basis for all these claims had serious methodological flaws that made even the statements about relative risk reductions in mortality suspect and unreliable. The NIH then and in a new statement this week has admitted as much. But this was the eve of the Republican National Convention, and you don’t drag the president to an announcement of something that isn’t a breakthrough, so juking the stats for the day was just what the doctor ordered. Since then, major newspapers have raked Hahn over the coals, and there have been calls for his resignation, even from his peers in academic medicine.
But if you thought that after Hahn dragged himself and his agency down into the mud things couldn’t get any worse, Centers for Disease Control and Prevention Director Robert Redfield has a message for you: Hold my beer. Last week, the CDC announced that it was no longer recommending testing for people without symptoms of Covid-19, that is, the asymptomatic individuals who may account for upwards of 40 percent of infections in the United States. The Infectious Disease Society of America, the American Medical Association, and the American Public Health Association all came out with statements within hours to slam the CDC’s new guidelines as politically motivated and without basis in fact—dangerous. Red and blue states around the country said they would not follow the new guidance.
Disease control and prevention for Covid-19 depends on us knowing who has the virus, where they are, and to what extent the disease has spread through our communities. Testing asymptomatics is central to the fight against Covid-19. Earlier this week, in The New York Times, Nobel Prize winner and former NIH director Harold Varmus and current head of the Rockefeller Foundation and former chief of the US Agency for International Development Rajiv Shah made this startling recommendation: Ignore the CDC. These men are institutionalists, not fire-breathing activists, and in the midst of a pandemic, they offered a rebuke to the agency that at any time would be momentous. To see this now from these two men tells us we’re in a hair-on-fire emergency in this country. We have lost our main public health agency to the whims of the White House.
It’s not a coincidence that these two agencies are part of HHS under Azar. If edicts from above are flowing down to these once-venerable institutions, he is the one with line responsibility—and the power—to make the FDA commissioner and CDC director a set of offers they can’t refuse. He also has a communications team, led by Trump loyalist Michael Caputo, chasing down reporters who might cover him or HHS unfavorably. There may be 185,000 dead, but Azar still will look fresh as a daisy. But what of the NIH, the other main agency under his purview? We know that earlier this year the White House wanted to cancel a grant to the EcoHealth Alliance on coronavirus research in China. Azar made that happen over the objections of NIH Director Francis Collins and National Institute of Allergy and Infectious Diseases Director Anthony Fauci. Again, there was criticism of this move, but, strangely, Azar has escaped the opprobrium that his underlings at the FDA and the CDC have faced.
But wait, there’s more. The Washington Post this week put out an explosive story on Scott Atlas—a little-known, newly appointed member of the White House’s task force on the pandemic, a Fox commentator who now talks with the president regularly. Atlas, a fellow at the Hoover Institution at Stanford, and once a practicing neuroradiologist, is a champion of all the things the president likes, and has a special talent for the one thing the president likes best: getting his worst instincts validated by someone with an advanced degree.
The Post story describes how Atlas is nudging the Trump administration to an implicit strategy of “herd immunity”—the idea that you can let everyone catch Covid-19, but just protect the elderly, who are at highest risk of developing severe complications of it. This concept was tried out in the real world in Sweden earlier this year and failed: Sweden’s death rate was higher than its neighbors’, and it didn’t escape the economic impact of the pandemic, which was the initial rationale for keeping the country open. Should we try this here in the United States, we are likely to see upwards of 2 million deaths. Since the Post story came out, Atlas has said it all was a lie and he doesn’t support herd immunity. But he is on the record advocating for almost all the components of such an approach: reopening schools and business, refraining from testing asymptomatic individuals, protecting the elderly while letting the virus take its course through the rest of the population—who he suggests are not at risk of serious complications of the disease.
To be fair to Atlas, the Trump administration’s policies have been consistent with a herd immunity strategy all along: We’ve never had any emphasis on scaling up widespread testing, contact tracing, and isolation—or the support to state and local governments that would be needed to do these things—nor the social and economic support needed by ordinary Americans to get through these tough times, allowing them to continue to socially distance and isolate if necessary. The administration, however, is interested in protecting the elderly at all costs—it just invoked the Defense Production Act to deliver millions of tests to nursing homes around the country. The rest of us, apparently, are expendable. Finally, just this week, FEMA suggested it would pull funding for face masks in US schools. Even kids are being thrown to the wolves, deprived of financial support for the most simple of protective equipment against the virus as the president and Secretary of Education Betsy DeVos are urging schools to reopen.
As we head toward the November election, the stakes couldn’t be higher—and I am afraid that, after all these months, there is now a method to the Trump crew’s madness on Covid-19. They do think that trying to sequester the elderly will stave off the worst of the pandemic—and thus have no interest in protecting the rest of us. No matter that plans to shield our seniors will be almost impossible to carry out, as most of the elderly are integrated into our communities and do not reside in skilled nursing facilities. No matter that with the rates of underlying medical conditions in this country, the vulnerable also include millions of people who are far from old.
Hydroxychloroquine? Convalescent plasma? An October surprise of a vaccine trotted out before we know if it works? It’s all been theater: to provide false hopes and to distract us from the gory path we are on for the foreseeable future. None of these drugs or vaccine miracles are going to save us. We’ve had the tools to stop the pandemic—or to at least slow its relentless march—in front of us all the time: the very basic public health measures that people from the left and right have been crying out for for months. But as we head toward the fall, with the prospect of a resurgence of the virus, we’ve had an utter and complete abdication of responsibility from the federal government. It turns out that has been the plan all along.