Vol. 242 October 15, 2020 Dying From COVID-19 in a Leadership Vacuum

“Our leaders have taken the Coronavirus crisis and turned it into a tragedy. . . . The magnitude of the failure is astonishing.” 
-NEJM Oct 8, 2020, 383: 1479

The New England Journal of Medicine (the iconic, evidence-based, peer-reviewed, internationally-revered, general medical journal published by the Massachusetts Medical Society) just dropped this bombshell . . .”quote”

“The response of our national leaders has been consistently inadequate. 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.. . .  This election gives us the power to render judgement.”

“Not only have many democracies done better than the U.S., but they have done so by orders of magnitude.”

“Though we are increasing the number of tests performed, the more important number (the number of tests performed per infected persons) is lower in the U.S. than in Kazakhstan, Zimbabwe, and Ethiopia.”

“The federal government has largely abandoned disease control to the states. Even competent governors do not have the tools that Washington controls. The CDC has been eviscerated, The NIH is playing a key role in vaccine development, but has been excluded from much government decision-making. The FDA has been shamefully politicized, appearing to respond to pressure from the administration rather than scientific evidence. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.. . . our leaders have largely chosen to ignore and even denigrate experts.”

“Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the U.S. still suffers from disease rates that have prevented many businesses from reopening with a resultant loss of hundreds of billions of dollars and millions of jobs.”

“Reasonable people will certainly disagree about many political positions of candidates. But truth is neither liberal nor conservative. When it comes to the response of 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.”

Why is this editorial such a “blockbuster”? The NEJM has a decades-long reputation for staid, drily-written, scientific, medical articles with understated, apolitical language. Never in a thousand years would I have ever expected to read such words as “lackadaisical”, “astonishing”, “recklessly”, and “dangerously incompetent” to appear in one of its editorials, or even in one of the articles, when published by its 36 named masthead editors, 16 member Editorial Board , and the 18 member Massachusetts Medical Society Committee on Publications! Even so, true to its tradition of understatement, this two page editorial condemnation of the U.S. response to the pandemic never mentions Trump’s name.  

The New Yorker (the ionic, internationally respected literary magazine of liberal essays, investigative reporting, and humor) devoted its recent editorial pages to “the need for a Biden Presidency” for confronting 5 aspects of the American crisis: health care, climate change, the rule of law, civil rights, and foreign policy  (New Yorker, October 5, 2020)

Atul Gawande, MD writes in that issue on “rescuing the health care system” from the deficiencies exposed by President Trump’s “squandering of many opportunities” to control the pandemic: “Fixing economic and racial inequality isn’t possible without fixing health care. . . . Biden does not favor Medicare For All. Biden’s plan would build on Obamacare by lowering Medicare eligibility age to sixty, and providing a public option enabling people to obtain coverage from a government plan. . . . Repairing our systems of medical care and public health isn’t an elective procedure. The afflictions of our body politic threaten the well-being of us all.” 

Even the Journal of the American Medical Association (a well known, widely read and quoted, peer review journal of general medicine, medical economics, and conservative politics) has joined the evidence-based chorus of dismay about our current plight:

“The authors report that during the 5-month period of March to August 2020 there were 151,105 U.S. excess deaths (“those over expected”) related to COVID-19.”   Among the 15  countries with either moderate or high mortality rates from COVID-19 the US ranked third with 71.6 deaths/100 000 population. (Spain was #1 with 102.2 and UK second with 94.5.  Sweden  was at 50.8, Canada at 13.3, and the “winner” was Denmark at 5.1 COVID-19 deaths per 100,000 population) 

“This estimate suggests that for the entirety of 2020 more than 400,000 COVID-19 deaths in the U.S. will occur. These deaths reflect a true measure of the human cost of the Great Pandemic of 2020. These deaths far exceed the number of US deaths from some armed conflicts, such as the Korean War and the Vietnam War, deaths from the 2009 H1N1 (Swine flu) pandemic, and approach the number of deaths from World War II.”

“President Trump retweeted a post falsely claiming the CDC had quietly updated its guidance to indicate that only 6% of the coronavirus death toll was actually attributed to severe acute respiratory syndrome coronavirus 2. Twitter removed the erroneous post, and the chief of the mortality statistics branch of the NCHS hastened to make clear that 92% of all death certificates that mention COVID-19 indicate it as the underlying cause of death, that is, ‘the condition that began the chain of events that ultimately led to the person’s death.‘ “  

Another JAMA article in the same issue comments “on the unrelenting and seemingly intractable and embedded disparities that exist in the U.S. and within the US health care system”. Its authors call for “restorative justice”. “This issue is not new, but rather the COVID-19 pandemic has once again highlighted and further compounded the health, social, and economic disparities inherent in communities of color.”

In an accompanying JAMA editorial, Dr. Harvey Fineberg, past President of the Institute of Medicine, underscores that the data on excess deaths related to COVID-19 are “sufficiently mortifying and motivating”. . . .  and he calls for  “an intense, persistent, multi-pronged, and coherent response as the order of the day and an urgent priority for the nation.”

There you have it. Like or not, the NEJM, the New Yorker, and the AMA, each coming from widely disparate political/philosophical bases, are united in labeling the Trump’s administration anti-scientific, anti-expert, and inconsistent response to the greatest pandemic in our recent history as disastrous, dangerous, and avoidable.

Make your plan to vote, if you have not already done so.

One Response to Vol. 242 October 15, 2020 Dying From COVID-19 in a Leadership Vacuum

  1. Vivienne Gerard says:

    So powerful… thank you for sharing this in a fact-based format that allows it to be easily shared with all parties. Just posted on FB!

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