Im-Politic: When Public Health Professionals Lose It

Tags

African Americans, CCP Virus, coronavirus, COVID 19, George Floyd, Im-Politic, police brutality, protests, public health, racism, white supremacists, Wuhan virus

I didn’t believe it possible: One group of voices in the United States has just proven itself more flagrantly hypocritical and, frankly, deranged than woke religious leaders about the violence that has too often resulted from legitimate and needed protests about George Floyd’s killing and related racial injustice and police brutality issues. That group consists of the supposed public health experts who signed a letter claiming that the urgency of protesting outweighs the importance of maintaining the social distancing and other personal behavior curbs that they’d previous declared vital to fight the CCP Virus pandemic.

The letter, which was released last week, has rightly drawn widespread outrage, ridicule, and often both. (See, e.g., here.) For its message is clearly politically based rather than scientifically based. Unless you can think of another explanation for suddenly shifting from demanding sweeping curbs on personal and business behavior that have wreaked historic economic damage for the sake of preventing millions of virus-induced deaths, to claiming that the need to demonstrate is paramount even if the inevitable public crowding resulting from mass gatherings increases superspread risks?

And that description is no exaggeration. Here’s the core of the signatories’ message:

“To the extent possible, we support the application of these public health best practices during demonstrations that call attention to the pervasive lethal force of white supremacy. However, as public health advocates, we do not condemn these gatherings as risky for COVID-19 transmission. We support them as vital to the national public health and to the threatened health specifically of Black people in the United States. We can show that support by facilitating safest protesting practices without detracting from demonstrators’ ability to gather and demand change. This should not be confused with a permissive stance on all gatherings, particularly protests against stay-home orders.”

Two particular points stand out here:

First, the public health specialists are backing only “the application of…pubic health best practices” to “the extent possible.” In other words, if it’s not possible…lah de dah. Indeed, the signatories explicitly consign six-foot social distancing itself to the intrinsically lower priority “where possible” category. And the most astonishing (or most predictable?) example of politicizing public health? “Prepare for an increased number of infections in the days following a protest.”

Second, even all of these logical and ethical backflips get the heave-ho when it comes to “white protesters resisting stay-home orders.” Their demonstrations should remain entirely verboten. The reason? The “public health response to these demonstrations” must be “clear and consistent in prioritizing” their unacceptability because they’re intrisincially racist. Even granted the assumption that about racism and anti-curbs protests, you couldn’t provide a clearer definition of a double standard.

Something else bizarre about the letter: It’s anything but clear that all the signatories are even public health experts. Right off the bat, we’re told that some of the signers are “community stakeholders.” Judging from the actual list, descriptions like “activist” and “indigenous health advocate” and even “African American” and “human” justified inclusion. Many more signatories didn’t bother to present any descriptions or qualifications whatever. Still others, like “Andrew H” and “Christine D” and “Diana A” wouldn’t state their full names. And two were permitted to sign (is that even the right verb?) by identifying themselves as “Anonymous JD” and simply “anonymous.”

But what strikes me as most striking about this manifesto is the argument that protesting despite the public health risks is praiseworthy because it’s part of an effort to end racial inequities in U.S. health care delivery that have taken countless African American lives. There’s no doubt that the black community has suffered from many dangerous health challenges that haven’t been nearly so serious  for other Americans. (Here’s one representative study.) Nonetheless, the logic of this position is remarkably similar to that of claims (made by me and many others) that the lockdowns themselves have created serious public health threats, and that these need to be weighed against the sickness and deaths caused by the virus.

Which brings us back to the public health signatories’ unequivocal condemnation of those who have protested these lockdowns. If all of most or a significant percentage of these protesters really are white supremacists, they have a point. If not, it’s time they start looking into some mirrors.

Making News: New Daily Caller Piece On-Line on the CCP Virus and the Economy

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bankruptcies, CCP Virus, consumers, coronavirus, COVID 19, DailyCaller.com, deflation, economy, exports, Im-Politic, Jobs, manufacturing, public health, real estate, recession, recovery, rent, reopening, restart, restaurants, retail, small business, testing, travel, unemployment, vaccines, Wuhan virus

I’m pleased to announce that my latest freelance article has just been published on the popular DailyCaller.com news site.  The title pretty much says it all:  “Don’t Expect A V-Shaped Recovery From Coronavirus,” and you can read it at this link.

And keep checking in with RealityChek for news of upcoming media appearances and other developments.

Im-Politic: How Much Did the Lockdowns Really Help?

Tags

African Americans, CCP Virus, coronavirus, COVID 19, economy, Georgia, hospitalizations, Im-Politic, lockdowns, public health, reopening, shutdown, Virginia, Washington Post, Wuhan virus

Is it time to start putting the CCP Virus economy-reopening debate shoe on the other foot, at least when it comes to one key measure of progress or backsliding against the pandemic? More specifically, is it time to put less emphasis on finding out whether states that have reopened relatively quickly have seen their virus situations worsening, and more on whether states that closed early and/or have stayed largely closed have achieved progress that’s been any better?

This question occurred to me this morning upon reading in my Washington Post that when it comes to new infections and fatalities, Virginia has just seen record highs recently whether we’re talking about single day totals or the more informative seven-day averages. That’s striking because Virginia has been one of those states that shutdown substantially quite early, and has reopened very slowly.

So I began wondering how Virginia’s record compares with a state that reopened very early – Georgia. And the numbers clearly show that their performances over the most relevant timeframes have been…pretty comparable. Which represents new evidence that the economically devastating lockdowns have been under-performers for containing the virus’ spread.

Virginia and Georgia are particularly interesting to compare because of their similarities. The latter’s total population is estimated this year at 8.63 million while the latter’s is a not greatly bigger 10.74 million.

Both states also have relatively big populations of African-Americans – who have been among the virus’ biggest victims. Blacks represent 31.03 percent of all Georgians, and 18.81 percent of all Virginians.

That Washington Post Virginia article did mention one area of continuing improvement for the state: new hospitalizations. They’re especially important both because fears of hospitals getting overwhelmed by the pandemic were prime justifications for the original shutdown orders, and because they’re the best measures of whether the virus is being contained or not. After all, numbers or new cases seem to depend heavily on increases in testing (which naturally reveal more and more infections). And controversies over identifying genuine CCP Virus-induced deaths remain heated – in large part because methodologies vary so greatly state-by-state.

By contrast, there have been no debates over how many patients with virus symptoms have been admitted to healthcare facilities. The only uncertainties are those stemming from how promptly these facilities report their admissions to state health departments.

That kind of uncertainty is still clouding Virginia’s data. As of today, (see this link and scroll down till you see the option for hospitalization data) the state has only reported new hospitalizations through May 20, and these data are divided between confirmed cases and probably cases. (The former are the great majority, though.)

Even so, because of Virginia’s lockdown policy – which began in earnest at the end of March, began easing in phases for the state’s least populous areas in mid-May, but which largely continue for its most populous areas (those closest to the District of Columbia)– it should be among the gold standard states for virus progress if turning off most economic activity is considered crucial. (Here’s an unusually informative lockdown timeline for Virginia, Maryland, and the District.)

Its interactive hospitalization chart is a little hard to read, but it seems to show that on March 31, the seven-day moving average of new admissions stood at just under 59, and through early May (when the lockdown began to be lifted). moved up steadily to a little over 81. So they rose by just under 39 percent. By May 20, this average had decreased all the way to just under 45. In other words, daily hospitalizations dropped by a little less than 45 percent. And for the entire period, the seven-day moving average for new hospitalizations dipped by 2.34 percent.

Georgia’s lockdown began only a bit later than Maryland’s (on April 2) but serious easing began much earlier (on April 24). Indeed, Governor Brian Kemp was widely pilloried for the decision.

During its three weeks of lockdown, Georgia’s seven-day average daily hospitalization numbers went from about 80 to about 130. (The non-interactive chart below is even harder to read precisely than Virginia’s interactive graphic, but check it out for yourself below.)

This roughly 62.50 percent rise in daily hospitalizations was much higher than Virginia’s during its lockdown period Did this discrepancy mean that Georgia ended its lockdown too soon? Or was its somewhat heavier African-American population density the major difference? Search me.

Georgia’s reopening has been more aggressive than Virginia’s, and that could well explain why its seven-day average hospitalization figure remained just about flat from the start of this phase through May 22.

But I’m not entirely persuaded that the lack of improvement during this period means that Georgia’s relatively fast reopening has flopped. Because for the first three weeks of this reopening, the state’s seven-day average new hospitalization figure fell by about half – faster than Virginia’s during its slower reopening. And as the Post has reported, despite Virginia’s caution, daily (although not yet seven-day averages) have been rising recently, too.

The fairest conclusion to me seems that the hospitalization data give an edge to Virginia’s more cautious lockdown-reopening strategy, but that the edge is on the modest side. And most important, it’s far from clear that this margin justifies both the economic and healthcare costs of relatively longer and/or more thorough lockdowns.

 

 

Following Up: Still More (Health-Related) Evidence for a Prompt Restart

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CCP Virus, coronavirus, COVID 19, Im-Politic, mortality, opioids, poverty, public health, restart, suicide, Tim Mullaney, World War II, Wuhan virus

If you haven’t seen today’s new CCP Virus figures for the United States, you really need to take a look. Not only do they show (continuing) stunning declines in new cases and deaths nation-wide, they strongly reenforce my Saturday post arguments that the death toll from keeping the economy mainly closed longer than necessary (whatever your favorite definition) is pretty comparable to the toll being taken by the virus. So from a public health standpoint alone, as I emphasized, there’s at least a respectable argument for the fastest possible (again, insert your favorite definition) re-opening.

To recap, that previous post challenged one argument claiming that the numbers of Americans being lost each day to the CCP Virus (at the point that argument appeared, 2,763), was dwarfing even the daily deaths recorded during America’s major wars. The author, Tim Mullaney, was right – but vastly under-counted fatalities from various forms of economic privation. As I noted, these kinds of deaths are much harder to count and even estimate than virus-related deaths (although the latter pose big methodology problems, too). But any reasonable person would conclude that both kinds of death are substantial, and that the economy versus public health framework dominating the national debate was dangerously simplistic and even stupid.

Of course, a few days have passed since the 2,763 death rate was recorded (on April 15, as it turns out – and in fact, that day’s figure has now been revised down to 2,751 according to this Washington Post count – the source of all the virus deaths data used in this post). And those few days have seen jaw-dropping progress in reducing deaths. Indeed, today, they’re all the way down to 521.

So therefore, if by some miracle, the CCP Virus was wiped out today, and all further deaths prevented, the 42,384 total national fatalities reported during the 53-day period since the first virus victim was recorded on February 29 would come to 800 per day. A horrendous number to be sure. But it’s reasonable to assume that this favorable trend will continue – at least until some unknowably strong second or third waves come. Moreover, the progress has been so impressive that it’s unlikely to be significantly affected by any of the under-counting problems identified by some health data specialists.

If these assumptions are true, then the current daily virus death toll is still way above that of daily military deaths suffered during World War II (240). It’s also way above the latest figures we have for daily American suicides (132). But it’s not that far above the most recent (and so far unchallenged) estimate for daily deaths from poverty (685). And when you combine those two figures, you get 817 daily deaths – above the current daily virus toll.

Still skeptical – largely because not all the suicide deaths are economic-induced? Then check out the best daily suicide attempts number available – 3,836. At least some meaningful share of these surely resulted from economic despair, and the only reasons they didn’t become actual fatalities were either incompetence or some timely intervention or simple luck. They speak volumes about the power and mental health effects of economic despair. And while we’re on the topic of despair, don’t forget opioid overdoses, either. Many of them have been closely linked with economic stress, and the latest numbers show them running at 128 per day.

Finally – and a big shout-out to Facebook friend Clare Goldsberry for pointing this development out: Reports keep coming in that many significant medical problems are going untreated because of the CCP Virus drain on the healthcare system. Here’s just one example.

Do major uncertainties still surround all these numbers? You bet. But they leave two overriding points completely certain: Any economy restart over any time frame is going to kill a substantial number of Americans, and no one has any basis for claiming that the one will save significantly more lives than the other. If you read or listen to anyone coming down emphatically on one side or the other, I’d strongly advise you to turn the page, change the channel, or walk away.

(What’s Left of) Our Economy: The (Dangerously) False Choice Between the Virus and a Restart

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Angus Deaton, Ann Case, Big Business, CCP Virus, coronavirus, Deaths of Despair, growth, Jobs, lockdown, public health, shutdown, small business, stress, The New York Times, Thomas L. Friedman, Trump, unemployment, Wuhan virus, {What's Left of) Our Economy

And here I thought that Americans were starting to understand that defeating the CCP Virus and thus protecting public health on the one hand, and restarting economic activity as soon as possible on the other, are not sharply conflicting imperatives. They’re mutually reinforcing – including for public health reasons. Silly me.

One sign was this column by The New York Times‘ Thomas L. Friedman – not someone who’s career-defining predictions and analysis (like the always beneficial and inevitable expansion of economic globalization) have stood up real well. All the same, as one expert quoted by Friedman observed:

“Income is one of the stronger predictors of health outcomes — and of how long we live. Lost wages and job layoffs are leaving many workers without health insurance and forcing many families to forego health care and medications to pay for food, housing, and other basic needs. People of color and the poor, who have suffered for generations with higher death rates, will be hurt the most and probably helped the least. They are the housekeepers in the closed hotels and the families without options when public transit closes. Low-income workers who manage to save the money for groceries and reach the store may find empty shelves, left behind by panic shoppers with the resources for hoarding.’’

P.S. – This expert is a noted public health authority, not an economist callously focused on money and output.

If you still doubt how worsening economic fortunes can literally be a large-scale killer, check out the work of the husband-wife team of Angus Deaton and Ann Case. Yes, they’re economists. But since 2015, these Princeton University scholars have been documenting how deteriorating well-being has helped fuel an historic rise in mortality among middle aged, working class whites. This year, they’ve published the results of their research in a book (appropriately) titled Deaths of Despair. Serious health problems with economic roots have been identified among African Americans as well.

Nonetheless, President Trump’s statement yesterday setting a target date of Easter (April 12) for restarting economic activity was greeted by a howl of protests accusing him of ignoring public health experts’ pleas, and placing his reelection hopes (which, the argument goes, depend almost exclusively on his economic policy record) over the lives of [FILL IN YOUR FAVORITE NUMBER] of Americans. Could anything be eviller?

There’s a counter-argument of course, at least in theory: Cash payments to workers could keep their incomes up and address these economy-related health threats even as most of the economy remains closed. The problem, though, is that without support for business (especially smaller companies, which are big employers collectively but often lack big cash cushions or access to affordable credit even in the best of times), massive payments could (which would be needed as long as workers have regular bills to pay) last a lot longer than the current health emergency because many such companies are likely to close for good, and leave their workers in the lurch, if they don’t start regaining customers fast.

Moreover, these small business vulnerabilities don’t exist in isolation because so many make much of their money selling to big businesses. So when the latter run into trouble because of a weak economy, the little guys – and their workers – inevitably will suffer, too.

So unless you’re a diehard Never Trump-er, and/or know absolutely nothing about the economy or Americans’ health and are unwilling to learn, you’ll recognize that the supposed choice between reopening the economy before too long (if not necessarily by Easter) and saving American lives is a false one. American policy, in other words, will have to learn how to walk and chew gum at the same time. The good news is that, as The Times‘ Friedman and others have noted, any number of approaches are available to achieve the best of both worlds that the nation urgently needs.

Im-Politic: No U.S. Politicians Own China Virus Bragging Rights (& That’s Not a Scandal)

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Biden, budgets, CDC, Centers for Disease Control and Prevention, China, China virus, coronavirus, Democrats, election 2020, health security, Im-Politic, Joe Biden, public health, Trump

Since the coronavirus’ serious threat to Americans’ health and their economy became clear, a blizzard of charges has accused President Trump of being caught flat-footed by the pandemic. I agree that the President didn’t expect a dangerous plague to break out overseas and swiftly cross America’s borders. I’ve also written that Mr. Trump made a big mistake in cutting funding for the Centers for Disease Control and Prevention (CDC) – but mainly for political reasons. For the amounts of money involved are so small that they couldn’t possibly even move the needle in terms of reining in federal spending and cutting deficits.

In fact, given the tiny sums, the picture looks pretty good when it comes to the latest Trump budget request for the CDC programs that actually deal with coronavirus-type threats. Check out the line items for “Emerging Infectious Diseases” and “Global Disease Detection and Other Programs.” The former is down only marginally from actual spending levels previously agreed to by Congress (including of course its Democrats) and the latter is up significantly.

But more important, the allegations seem to assume that the American political system has been chock full of leaders who can boast the foresight the President lacked, and that the nation’s response would have been much more effective had one of them occupied the Oval Office. Is there any actual evidence for this proposition?

One crucial test is whether well before the virus became front-page news any of the leading recent and current Democratic candidates for President rolled out plans for beefing up American capabilities to respond to pandemics before the virus’ breakout in China. And do you know how many did? None – with the possible exception of former New York City Mayor and media magnate Michael Bloomberg.

That’s based on checking the polcy sections of the websites of former Vice President Joe Biden, Vermont Senator Bernie Sanders, and drop-out Massachusetts Senator Elizabeth Warren. Drop-outs Minnesota Senator Amy Klobuchar and South Bend, Indiana Mayor Pete Buttigieg have taken all the content down from their sites.  But a wide-ranging media survey of their positions reveals no attention paid to pandemics, either.

I describe drop-out Bloomberg as a possible exception because his site did Mr. Trump’s “erratic leadership, go-it-alone approach, and distrust of science” for putting the country “in a vulnerable position should a major public health emergency, such as the novel coronavirus…materialize.” And he outlined what can fairly be called a plan.

Yet it’s not clear when these Bloomberg proposals were unveiled, and there’s no evidence that he was thinking about such matters before COVID 19’s appearance.

The same goes for Warren and Klobuchar, whose plans only dated from late January. Biden published an op-ed detailing his own ideas at about the same time. (See this post for links.)

I don’t believe that any of these politicians (including those with long years of public service) deserve any blame for failing to anticipate the virus threat on a timely basis – and for the same fundamental reason I don’t believe Mr. Trump should be pilloried. Because this kind of pandemic (coming from a country with extensive ties with the U.S. and global economies, like China, as opposed to regions like Central and West Africa, with almost no such ties) really couldn’t be anticipated adequately.

And incidentally, this point is also relevant to the charge made by Biden and others that the President not only cut the budget for the CDC, but for the country’s foreign aid agency, and also dismantled the White House global health security team created during the Obama years.

But anyone honestly believing that a little office somewhere in the Executive Office of the President would have made a meaningful difference in preventing or fighting the virus is guilty of drinking the policy wonk kool-aid claiming that augmenting bureaucratic flow-charts in any way amounts to solving problems – even those that emerge suddenly. As for the foreign aid cuts, the U.S. Agency for International Development (USAID) has been working on helping prevent the spread of infectious diseases like the coronavirus, but Beijing made clear early on that American government help wasn’t wanted. (Nor was World Health Organization help.)

In other words, life is full of unpleasant surprises and shocks, and from time to time they’re big. Human beings don’t come with perfectly functioning crystal balls in their heads, and learning curves are rarely as steep as we’d like because lessons from experience and history tend to be excruciatingly difficult to draw. Hindsight can be superb, but says nothing about clairvoyance. Governments, moreover, although indispensable in such situations, are often not the most efficient actors, and in crises, they’re often forced to scramble.

That’s not to say that the President may not pay a political price for his coronavirus record, or that Americans don’t have a right to be frustrated with his actions to date, much less that he deserves reelection on any grounds. Indeed,  here’s a great suggestion for the kind of speech Mr. Trump should have made by now, and still should make – which urges him to use the virus crisis as an opportunity both to stimulate the economy and prepare better for future pandemics with major spending and other measures to bolster national health security.

But it is is to warn that none of President Trump’s critics or challengers can legitimately claim to have done better, let alone that they’ll act more effectively when the next black swan – biological or not -flies into our lives.

Im-Politic: Why the Haters are Wrong About Trump and the Coronavirus

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CDC, Centers for Disease Control and Prevention, coronavirus, Council on Foreign Relations, Im-Politic, impeachment, pandemic, public health, Senate, The New York Times, Think Global Health, Trump, WHO, World Health Organization

President Trump sure is getting slammed for his response to the coronavirus outbreak, both by the Mainstream Media, many Democratic Party politicians, and even some public health specialists. (See here and here.) Their main indictments: He’s been hopelessly behind the curve. Or has it been that he’s been too alarmist? Both charges have been made, making clear that the substance doesn’t matter much to the critics.

One allegation seems justified to me: The President’s latest (fiscal 2021) budget request included a 16 percent cut in outlays for the Centers for Disease Control, the branch of the Cabinet-level federal Department of Health and Human Services in charge of the nation’s health security. The budget document was made public eleven days after the World Health Organization declared the outbreak to be an international public health emergency, and six days after Mr. Trump promised in his State of the Union address to take “all necessary steps” to protect Americans from the disease.

But the main problem with the CDC decision, as I see it, is political. Clearly, the timing was terrible, and was bound to be jumped on by reasonable and unreasonable critics alike. Indeed, all of the President’s budget requests have sought such cuts – which also deserves criticism even though Mr. Trump eventually accepted higher funding in the final budget deals each time.

Substantively, however, it’s inconceivable that had any of the sought cuts been actually made, they would have made a discernible difference in the nation’s early-stage anti-coronavirus efforts at least. After all, how could even more money have enabled the agency to predict or identify the virus once it broke out, since it cught China itself by surprise; and since Beijing still refusedsto let U.S. officials as such into the country to aid its own efforts?

It’s true that last year, the Trump administration ended a program in the U.S. government’s foreign aid agency aimed precisely at improving the detection of corona-type viruses “with pandemic potential.” According to ABC News, the program (called PREDICT) “is credited with identifying nearly a thousand” of these maladies since its creation in 2009. Which sounds great. Except the coronavirus clearly wasn’t one of them.

But as for being slow on the coronavirus uptake (a line of attack that’s – understandably – shown more staying power than the “overreaction” claims), timelines showing milestones in the virus’ identification and spread, and principal Trump administration responses demonstrate nothing of the kind. (My main sources are the Think Global Health initiative of the Council on Foreign Relations, a leading U.S. think tank; and The New York Times.)

They remind us that the first recorded onset of symptoms, in Wuhan, China, came on December 1, that Chinese authorities first told the World Health Organization (WHO) that something was rotten in that city on December, 31, and that Beijing took its own first anti-virus action the following day – closing a seafood market thought to have been the the origin point.

On January 21, the United States confirmed finding the first domestic American case of the virus – in a man who had traveled to Wuhan. By this time, China had reported six virus-related deaths, and several hundred cases.

A day later, WHO convened its first coronavirus meeting, and ultimately decided against declaring the outbreak to be a Public Health Emergency of International Concern. On January 23 came the first Chinese travel restrictions and quarantines.

Between January 24 and 26, Washington identified four more American cases, and on the 27^th, by which time 3,000 victims around the world had contracted the disease and 60 had died, announced screening programs at domestic airports that handled 90 percent of passengers coming from China along with CDC initiatives “to identify potential cases.” In addition, a high level State Department travel advisory had been announced for Wuhan, and President Trump had spoken with Chinese leader Xi Jinping and offered assistance.

On January 28 and 29, the United States began evacuating its nationals from Wuhan – dates which are significant because it wasn’t until the following day that WHO finally decided to declare the virus an official public health emergency. On the 31^st, as The New York Times reported, the administration announced that it “would bar entry by most foreign nationals who had recently visited China and put some American travelers under a quarantine as it declared a rare public health emergency.” At the time, worldwide deaths totaled 213 and cases approached 9,800 (eleven in the United States). Also significant – these actions came a day before the first coronavirus death outside China was reported (in the Philippines).

Official U.S. actions by no means stopped then. On February 5, all Peace Corps volunteers were evacuated from China and the CDC starting sending diagnostic kits to more than one hundred laboratories in the United States. (The Food & Drug Administration authorized the tests to be conducted by the kits the day before.) Two days later, on the seventh, the administration pledged $100 million to the global coronavirus fight.

The last week of January, incidentally, was kind of interesting for another reason: President Trump was being tried in the Senate on two articles of impeachment – which themselves represented the culmination of what I’m sure we’ll all agree was a great deal of work by Democrats in the House and Senate, as well as voluminous reporting by the national media. The journalism of course, included the publication of scoops of any number of supposed bombshell revelations about the President’s misdeeds, and even though acquittal seemed certain to most, they clearly sent the President and his top aides scrambling on an ongoing basis and surely occupied a great deal of their time.

Moreover, the trial didn’t end (with the acquittal vote) until February 5 – the date that the Peace Corps volunteers were being evacuated and the CDC diagnostic kits were being issued.

I fully accept that Presidents need to be able to walk and chew gum at the same time, and that indeed, the ability to manage crises successfully, and during the worst of circumstances, is the most important qualification for the job. It’s also possible that the administration has already lost crucial time in the anti-coronavirus fight, and that consequently it will never catch up.

But the above timelines reveal to me, anyway, that the American record so far measures up well versus that of any other national government, and especially well versus that of WHO, which is supposed to be the tip of the spear here. Moreover, the Trump administration response seems all the more alert upon remembering that, as the virus was breaking out, the President was, if not literally fighting for his own life, relentlessly besieged by adversaries both inside and outside his government.  I suspect that posterity, as a result, will need to struggle to judge his initial coronavirus policy decisions as failures.

(What’s Left of) Our Economy: What Washington Doesn’t Know About U.S. China Drug Dependence Can Literally Kill Us

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active pharmaceutical ingredients, antibiotics, chemicals, China, China virus, coronavirus, COVID 19, FDA, Food and Drug Administration, generic drugs, globalization, Hastings Center, Katherine Eban, medicines, pharmaceuticals, public health, Rosemary Gibson, supply chain, U.S-China Economic and Security Review Commission, {What's Left of) Our Economy

It’s bad enough, as widely reported, that as the coronavirus has begun spreading rapidly beyond China, the United States finds itself reliant on the People’s Republic for a wide variety of medicines and, just as important, for the chemical building blocks of those medicines. It’s at least as bad, and much less widely reported, that the U.S. government still doesn’t know the exact extent of this dependence, and still uses an inspection system for checking the safety of these Chinese inputs that looks as leaky as the proverbial sieve.

Even worse, as I see it, these shortcomings have been way out in the open since at least last July, when the official U.S.-China Economic and Security Review Commission held a hearing on the matter.

Anyone with any doubts about how dangerous this dependency on China has become should check out the testimony of Rosemary Gibson of The Hastings Center, one of the world’s leading research institutes focusing on healthcare and healthcare and broader scientific ethics issues. Gibson has been investigating this situation for years, months before the corona virus outbreak, made the following claims at the Commission session to justify her conclusion that “The nation’s health security is in jeopardy”:

>”The U.S. can no longer make penicillin. The last U.S. penicillin fermentation plant closed in 2004. Industry data reveal that Chinese companies formed a cartel, colluded to sell product on the global market at below market price, and drove all U.S. European, and Indian producers out of business. Once they gained dominant global market share, prices increased.”

>”The U.S. can no longer make generic antibiotics. Because the U.S. has allowed the industrial base to wither, the U.S. cannot produce generic antibiotics for children’s ear infections, strep throat, pneumonia, urinary tract infections, sexually-transmitted diseases, Lyme disease, superbugs and other infections that are threats to human life. We cannot make the generic antibiotics for anthrax exposure. After the anthrax attacks on Capitol Hill and elsewhere in 2001, the U.S. government turned to a European company to buy 20 million doses of the recommended treatment for anthrax exposure, doxycycline. That company had to buy the chemical starting material from China. What if China were the anthrax attacker?”

>”Beyond antibiotics, the U.S. industrial base for generic drug manufacturing is on the brink of collapse. Generic drugs are 90 percent of the medicines Americans take. Examples of generic drugs made in China by domestic companies and sold in the United States include: antibiotics, anti-depressants, birth control pills, chemotherapy for cancer treatment for children and adults, medicine for Alzheimer’s, HIV/AIDS, diabetes, Parkinson’s, and epilepsy, to name a few. If past performance is indicative of future performance, China’s generic drug companies will engage in cartel formation and predatory pricing, and drive out U.S. and other western generic companies.”

>[T]he pharmaceutical and chemical industry’s successful requests to the U.S. Trade Representative not to impose tariffs on medicinal products made in China corroborate that much of the US industrial base, and our self-sufficiency in manufacturing products essential for life, has collapsed.”

And Gibson categorically stated that “The FDA [U.S. Food and Drug Administration] cannot fix the underlying cause of the proliferation of contaminated and potentially lethal medicines in the legal supply of America’s medicines.”

One reason for the FDA’s ineffectiveness is clearly a lack of good data. Not that the challenge of conducting adequate inspections is easy. Jennifer Bouey of the RAND Corporation, another leading think tank, told that Commission that on top of China’s foreign affiliated plants, “Researchers estimate there are 5,300 to 7,000 local manufacturers, each with a small share of the Chinese domestic market.”

Mark Abdoo of the FDA itself acknowledged to the Commission that because of “remaining gaps” in its data, the agency lacks “visibility of all Chinese manufacturers that produce drugs or active pharmaceutical ingredients of drugs that are ultimately shipped to the United States.”

Abdoo added that on top of drug building blocks (called “active pharmaceutical ingredients,” or APIs) that the FDA knows come into the U.S. market from China, such China-produced ingredients “also come to the U.S. as part of finished drug products manufactured in other countries, for example, India. Therefore, the percentage of APIs produced by China for the United States marketplace is likely underrepresented by our numbers as China is a major supplier of APIs for other countries.”

It’s worth mentioning at this point that relying on the main federal government system for slicing and dicing the U.S. economy – the North American Industry Classification System (NAICS) – can produce a highly misleading picture of American imports of drugs and their chemical ingredients from China.

For example, according to the NAICS data, although American purchases of finished drugs and their ingredients are up astronomically in absolute terms over the last 20 years, they still account for only 1.34 percent of such imports from the world as a whole. Similar trends have unfolded in “non-diagnostic biological products,” which are defined as “vaccines, toxoids, blood fractions, and culture media of plant or animal origin.” Despite soaring literally 80-fold from 1999 to 2019, imports of these goods equal only 0.34 percent of all U.S. imports.

But separate testimony to the Commission by journalist Katherine Eban, drawing on her recent probe of the foreign factories that supply so much of the U.S. drug market, identified numerous flaws in inspection procedures and broader policies that are much more easily corrected – and indeed, should have never been allowed to emerge in the first place. For example:

>”Most of the FDA’s investigators who are sent to China do not speak the language. They can’t read the manufacturing records. The FDA does not always provide independent translators. Instead, the companies provide translators who, more often than not, are company salesmen. Sometimes, FDA investigators simply give plants a pass, deeming them to be No Action Indicated because they have no way to tell otherwise. The investigators also can’t read street signs, which make them vulnerable to wild manipulations. Companies steer them to phony ‘show’ plants, where everything looks compliant, but the companies aren’t manufacturing there. Sometimes a group of companies pool their resources and invest in the same “show” factory, so that different FDA inspectors return to the same plant at different times, each one thinking they are inspecting a different facility.”

>”In the United States, in order to inspect drug plants, FDA investigators simply show up unannounced and stay as long as is needed. But for overseas inspections—due to the complex logistics of getting visas and ensuring access to the plant – the FDA has chosen to announce its inspections in advance. Overseas drug plants typically ‘invite’ the FDA to inspect and the agency accepts. Plant officials serve as hosts to the visiting FDA investigators, who become their guests. It is not unusual for manufacturing plants to arrange local travel for FDA investigators. This system has allowed manufacturing plants to ‘stage’ inspections, as one FDA investigator put it, and conceal evidence of data fabrication.”

>”According to the FDA’s own data, which I obtained, from 2013 to 2018, out of 864 inspections in China that FDA investigators recommended as Official Action Indicated, FDA officials downgraded 78 of those [that is recommended a milder response from Washington]. By contrast, in the same time period, out of 11,642 inspections that FDA investigators conducted in the U.S. and recommended as Official Action Indicated, only one inspection was downgraded in that time. This reflects the FDA’s willingness to give foreign plants, particularly in China, an opportunity to reform without sanctions.”

>The agency appears to discourage talented staff to deploy in China and elsewhere abroad because of “a lack of clear career progression and promotion opportunities. Right now, those who serve overseas often return to the FDA’s U.S. headquarters without a guaranteed job, and sometimes have to accept demotions.”

Alert readers will note that although most of the problems mentioned here are rooted in pre-Trump policies and practices, they’ve continued into the Trump era. All Americans should demand that the coronavirus outbreak be regarded by Washington as the most urgent possible wake-up call.

Incidentally, Rosemary Gibson’s latest findings are contained in her recent book, China Rx.  Katherine Eban’s are available in her recent book, Bottle of Lies.