The viral outbreak that exploded out of central China suddenly has captured the rapt attention of Wall Street, the White House, and Americans from coast to coast. The rising pitch and politicization of the important conversation about Covid-19 — a respiratory virus that already has posed a growing global health threat — can only be described as worrying.
For ordinary folks, the guidance emerging from all this: It may be time for smart preparation — definitely not panic.
The Trump Administration apparently has gotten the message that viral concerns are high, and the president and his men have conducted two news conferences in almost as many days, including announcing the first coronavirus death of an American in the continental U.S. and travel restrictions affecting Iran, Italy, and South Korea.
The patient who died of the virus lived in the Seattle area, officials said. They also expressed concern about spreading cases of the infection in a nursing home, also in suburban Seattle. That outbreak also has infected a health worker.
President Trump, vague on facts and insights, conducted a prime time news conference, and apparently also stabbed in the back one of the chief health officials in his administration, Alex Azar, the head of the sprawling federal Health and Human Services agency. After appearing to take the position as the obvious lead of the administration’s virus-fighting plans, Azar got dumped.
Trump, instead, declared that Vice President Pence would be the federal government’s top bug battler. Why Pence? Trump told some aides that he considered his veep underemployed. Pence took an immediate shellacking for his record on health care, including how, as Indiana governor, he allowed an HIV outbreak to grow. Pence, a religious conservative and career politician or radio talk show host, has long propounded views not based in scientific evidence, common sense, or facts, including that:
- smoking does not kill (heart and cancer groups disagree, bigly)
- condoms aren’t a good protection against sexually transmitted diseases (the federal Centers for Disease Control and Prevention disagrees)
- climate change is a myth and the world is not warmer but cooler than it was a half century ago, as well that the United States has the cleanest air and water on the planet (where to begin the rebuttal …)
The vice president, who launched into his major new role by jetting off to conservative political events, was hit from the outset with a giant gaffe by the administration with its plans to gag renowned medical experts like Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, and Dr. Anne Schuchat, the CDC’s principal deputy director. They were told they could not talk publicly about their expertise without clearing their remarks with the White House.
In their second news conference, officials walked back the significance of that White House order, with Fauci saying he and others would not be, and had not been, prevented from speaking freely. He said the administration just needed to work out procedures to coordinate the publicly disclosed information.
That controversy further stirred unease about the federal virus response, already under fire for extensive problems in testing for the illness. CDC-provided kits to screen for Covid-19 failed to work, and, initially, only three states reported they could test for the infection.
Even as the CDC said it had cleared up problems with its materials, a new furor erupted about agency guidelines for who could or should be tested. California officials blasted their federal counterparts for declining their repeated requests to let them test an ailing patient whom they suspected had Covid-19. She had not traveled overseas and didn’t meet CDC testing guidelines. When her condition worsened and she required mechanical breathing support, she was transferred to an academic medical center, where doctors pushed hard again for the test — finding the patient indeed had the bug.
Now, medical personnel at two facilities near the state capital are under watch because of their Covid-19 exposure.
A whistleblower also ripped the administration for how it handled Americans flown from Japan and a bungled quarantine on a cruise ship off Yokohama. The State Department and CDC officials battled in Japan over how the Americans should be returned, with diplomatic personnel winning. That meant that two flights with hundreds of people mixed passengers known to have Covid-19 with those who might not.
Further, when the hundreds of tired Americans hit the ground at an air base in northern California, the whistleblower claims, the officials who greeted them were unprepared — they had received neither training for quarantine nor protective gear. Officials who had contact with the returnees before they went into lockdown may have traveled in their own communities, potentially explaining how the seriously ill patient who had not gone outside the United States may have contracted her puzzling Covid-19 case.
That case and several others popping up on the West Coast raised concern about “community spread” of the illness, infections that cannot easily be traced to patients traveling overseas or having contact with known carriers of Covid-19.
Azar, in a grilling before Congress, deflected questions about the incident — not exactly inspiring lawmakers’ confidence about the administration’s anti-virus work.
The president himself, as well as a top official testifying to Congress and representing the federal Homeland Security department, also have upset experts by making counterfactual assertions on key issues, such as Covid-19’s mortality rate and the number of Americans infected. Trump emphasized in his new conference how few cases he asserted there were in the United States: 15. The day after, as the disputes over care erupted in California, Gov. Gavin Newsom told reporters the Golden State had dozens of infections and was monitoring thousands of individuals, particularly because of their international travel.
The virus has infected tens of thousands, killed thousands, and spread to dozens of nations. Japan, with the bungled cruise ship quarantine, has become a Covid-19 hotspot, forcing the nation to request all public schools to shut for a month to try to hold down new infections. Iran, Korea, and Italy all are struggling to deal with high numbers of coronavirus cases.
With the Dow plunging in a fashion not seen since the start of the 2008 Great Recession and Wall Street and corporate America sounding alarms about the global economy, the administration has taken a public health threat and made its focus economic and political. Trump and his staff assailed media reporting on the virus and accused journalists and political rivals of exaggeration intended to harm the president and his reelection efforts. In South Carolina, Trump likened the huge attention the disease is getting to other criticisms made of him and his administration called it Democrats’ “new hoax.”
In his second news conference on the subject, Trump criticized reporters for asking him about his political remarks, saying they had been misconstrued. He said he takes the viral threat seriously.
This all is unhelpful. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the benefits they can reap by staying healthy — and out of the U.S. health care system, which has major problems with medical error, preventable hospital acquired illnesses and deaths, and misdiagnoses. That system already is treating hundreds of thousands of patients infected with another virus — the seasonal flu, which has killed at least 18,000 Americans, including more than 100 children.
Smart, reasonable, and expert sources — like Fauci — have offered the public sound ways to do what they can to safeguard themselves against not only Covid-19, but also the seasonal flu and other contagions. Let’s repeat these and repeat these: Get the recommended vaccinations. Wash your hands, often and thoroughly. Cover up any sneezes or coughs. Try to stay away from crowds and the sick. Avoid touching your face and buggy spots. Stay home when ill, and, please, keep the kids at home if they are sick.
Those with more concerns may wish to talk with their doctors. They may want to get them to work with insurers to lift typical prescribing limits, so patients can have several weeks extra of medications they need. This also may be an important step as virus-related disruptions to the global economy, especially in China, may create drug shortages. Patients also may wish to talk with their doctors about other medical supplies they may need, and which may become short in supply in difficult circumstance.
Hoarding of important goods and medications should be discouraged. Suppliers and vendors already are facing challenges in providing needed protective gear (masks, gowns, even sanitizers), some of which won’t be of great use to non-medical personnel in guarding against the virus. It’s good for every household to have emergency plans and items, including first-aid kits, battery-powered radios and lights, and ample food and water to hold through disruptions. But, please, don’t re-open grandpa’s bomb shelter or lay in supplies as if aliens are landing from Mars.
Schuchat and Fauci, while emphasizing that risks remain low in this country and panic is inappropriate, urged families to ensure they also have investigated and made plans if Covid-19 outbreaks occur in select areas or communities in this country.
Employers may be advising staff about telecommuting or work-from-home options. Schools, public and private, may be contingency planning about how they can keep kids up with their educations if they must shut for uncertain amounts of time. Local governments and hospitals are preparing, too, just in case.
And who, not only will pay for workers’ childcare, but also help them with furloughs or work shutdowns? Benefits like these too often aren’t available to the poor and workers with lower-paying jobs with low skill levels — and that could be a problem for them and the economy. As Los Angeles residents discovered during recent wildfires, housekeepers, gardeners, cooks, and workers in restaurants and hotels show up for work, no matter the dire conditions around them. They can put themselves and their employers at risk, because they have no choice — they need money and they lack paid sick leave or employer-supported time off.
Critics have assailed the Trump Administration and congressional Republicans for their relentless efforts to kill the Affordable Care Act, potentially stripping tens of millions of poor, working-poor, and middle-class Americans of health insurance. The assaults, including a pending attack in the federal appellate courts, has fostered market uncertainty that has led to higher coverage costs, including bigger out-of-pocket expenses (deductibles) for too many across the country, critics say. This will be a glaring problem for those who might need their coverage as they cope with a Covid-19 infection, or even testing to determine if they might have the bug. Because it is still relatively early in the year, patients would shoulder a big burden to pay for medical services out-of-pocket and as required by their policies’ deductible limits. The average deductible now is $1,655 for a single-person covered at work with a general policy.
We’ve got a lot to learn still about Covid-19 and other contagions. But as we dig in for the significant amount of work that lies ahead, perhaps the disease also can offer us guidance about the importance of staying cool in difficult circumstances and working cooperatively with friends and neighbors, as well as needing and having smart, accurate, reliable, and steady information and credible officials to develop it and to lead us in tough times.
