Institutional Failures - Covid-19
Faith in our institutions is shaken, not stirred. What I learned from reading Scott Gottlieb's "Uncontrolled Spread"
The strength and resilience of a well-functioning society, especially in the case of a republic such as ours, depends on its citizens faith in the institutions that they have consented to be governed by. In the case of America’s founding, we recognized the dangers and pitfalls of succumbing to a majority rule and instead transferred such representation to our centralized government and localized governments, where a series of checks and balances would ideally keep tyranny and government control at bay. Since our founding, we have ceded much of said balances, whether it be state governments checking the power of the federal government or one branch of the federal government checking the powers of another. Such a transfer of power balance requires a serious change of the citizenry’s mindset and attitudes toward government, and such arguments continue over whether we can continue to do so. The familiar tone of our politicians or those seeking political office is that we need to cut the size of government (just not their pet projects and programs). They fight for positions and special interests and their “constituents” and often resort to outright lies or misleading statements from all sides of the political aisle so much so that it becomes hard to discern the truth. I found myself and many that I know having trouble distinguishing what is exactly real anymore.
We are at critical juncture in our society where people and political parties have taken to their corners with an aversion and unwillingness to meet in the middle or seek out the humanity from which most of us tend to operate. These extremes are stoked by the seeming politicization of all of our institutions. The Supreme Court, for example, was never meant to be the political behemoth and controversial body that it is now. The growing power of the supreme court, highly diverged from it’s intended purpose enshrined by the founders in the constitution, has increasingly shouldered the burden for making laws vis-à-vis its rulings, which has allowed congress to abdicate it’s responsibilities to make laws, a power which it explicitly does not have. Our departures from the original intent of how our institutions were intended to function, aside from any benefits that may have arisen from such changes that can be argued, have no doubt contributed to the dysfunction that we see today. Our institutions do fail, and have failed, frequently I believe, because public policy requires the assumption that we can take all of the circumstances that individuals face, aggregate them, and then make the best decision on the whole to create the best outcomes. In my view, this is a false premise, simply because it is impossible to account for all relevant factors that would be processed at the individual level facing a particular circumstance or set of circumstances.
This leads me to discuss what I’ve learned from reading Scott Gottlieb’s “Uncontrolled Spread”. The book is about America’s COVID-19 response and it’s author is the former FDA commissioner who also currently serves on the Board of Pfizer, one of the makers of the breakthrough mRNA vaccine technology that has allowed us to slowly crawl out of the Pandemic and save lives. The book is largely an autopsy of America’s health institutions and why we failed to see this coming, how we’ve failed to see it coming in the past, and why we may continue to fail in the future. Gottlieb does propose solutions throughout the book, but government moves slowly, so I’d like to focus the attention on the root causes for the failures. I think a focus on the failures is key, as these failures appear to me to be a large contributor to vaccine hesitance as well as the distrust of the institutions and the media that covers them (well deserved distrust, might I add).
Much of the media blame at the beginning of the pandemic as well as from democratic politicians took aim at President Trump and claimed that he threw out the pandemic handbook and dismantled our ability to respond. As a disclaimer, this blog’s author is no fan of Trump nor his lackadaisical and asinine approach toward most things that require astute thinking and responsible behavior. It also does not appear that Scott Gottlieb has many positive feelings regarding Trump, although not explicit. It turns out, he did indeed veer off course from the playbook, but this same playbook that was created by Bush had been discarded by the Obama/Biden White House prior to the H1N1 scare where it was then reinstated before Trump scrapped it and as Gottlieb mentions throughout the book, this playbook would not have effected the outcome much since we lacked any capabilities to execute it and based the playbook on the flu virus, something the coronavirus was not. It would have been like bringing a football playbook to a Yankee Game and expecting to win. However Trump is not the topic of this blog post, so I digress.
Much of the blame of course lies with China. According to some accounts, China knew the virus was circulating a couple of months prior to the notification to the WHO in December 2019. In fact this is not the first time that this happened. China acted similarly in delaying communication of SARS-COV 1 and other possible Coronaviruses that infected Chinese miners in prior years (they claimed it was a fungus). This is what prompted agreements on notification to the WHO after SARS-COV 1. However, such agreements were not enforceable and it appears that China resorted to its typical clandestine behaviors and waited to disclose while whistleblowers insider China were sounding the alarm on various forums. In fact, China deleted many sequences or at least suppressed from its now famous Wuhan Institute of Virology and still refuses to share any data with us to establish the origins of COVID-19. This subject is still a point of much debate.
However, blame does lie at the feet of our institutions as well. As Gottlieb points out, you cannot know the trajectory of a virus, or know the extent of it, without the ability to test for it. Our initial testing guidelines were very strict due to our very limited testing capabilities (i.e. one must have recently traveled back from Wuhan China to be eligible for a test and we did some blasé theater temperature scans at airports). The CDC claimed a monopoly on testing, although it was not built to be able to support the widespread testing that we needed. Therefore we had the virus circulating for potentially months while claiming there were only a handful of cases. This was before we acknowledged the high potential for asymptomatic spread - we were assuming that all cases must have had contact with a confirmed infection from a symptomatic individual. This turned out to not be the case. The CDC mailed out test kits that showed the kit would fail 33% of the time, according to Gottlieb, and other private testing manufacturers were unwilling to create tests for which they weren’t sure they’d be reimbursed. Very few of our public health labs were able to get the test to work, and many gave up, and they were handicapped from creating their own tests. This is simply because the CDC is not a manufacturer of test kits, but rather a research based organization who’s purpose is to drive policy. It attempted to take on the manufacturer role, ignoring commercial manufacturing, and cost time and therefore lives in trying to wrangle the virus and understand how deeps it’s hooks were into our nations citizens.
According to Gottlieb, another reason for the delays is that the CDC was worried about its intellectual property around test design. The question that arises is, why during a pandemic do we care about the intellectual property of a government agency, that we the taxpayers fund to supposedly protect us? Why did CDC money interests take precedent over widespread testing and distributions of tests to our major metropolitan areas such as NYC, that may have been able to put better mitigation measures in place at an earlier time. The CDC did not allow private labs to access any viral samples that would help them create tests without first getting permission from the CDC as required. Gottlieb points out that the CDC essentially cornered the entire market for researching and creating the test kits. We are in a pandemic state of emergency and bureaucracy stands in the way of itself. Not only that but the CDC lacked the capabilities to even create and distribute a test to the scale needed. Gottlieb attributes this hesitance to reach out to manufacturers to a combination of fidelity to past practices, parochialism, and institutional pride. Any private commercial lab would have to get a license for the CDC’s intellectual property to create the tests and would need to follow the CDC’s exact blueprint, ingenuity be damned!
The CDC even caused massive delays in such contracting to make tests as it fought for provisions in a lengthy manner to protect its testing kit invention. This cost us weeks of precious time. As Gottlieb notes, “We needed to anticipate the threat, and the officials at HHS needed to create a market where one didn’t yet exist. However, nobody predicted how quickly the epidemic would explode… and how much testing we would need. Even if these needs had been anticipated, there was no natural home for mounting such a testing response… the CDC didn’t have the policy orientation, operational experience, or industrial expertise to pull off an effort on this scale. As a consequence, we never had enough testing to keep up with the initial spread and we lost control of the pandemic”. Furthermore, due to the lack of accurate and widespread testing, areas were blanketly put through lockdowns and other serious mitigation measures before there was any real risk in the area, which led to later hesitations to comply when the virus actually did hit these areas harder and the mitigation measures were needed. Widespread testing at the onset would have contributed to targeted mitigation measures that could have granted the moral authority to earn the trust and compliance of Americans.
Beyond our failure to create a test and scale it in a timely manner, we also had guidance that appeared to be contradictory or flip-flopping. One thinks immediately to Anthony Fauci and others suggesting that masks were unnecessary and would not protect anyone from COVID-19, all while some were already wearing masks in the White House, though ridiculed by some in the White House for appearing alarmist. (This makes one hearken back to Trump pulling off his mask while likely still symptomatic before re-entering the White House, likely to show strength, but also fueling some of the idiocy we continue to see today). This is because our entire pandemic scenario was based on assumptions of a flu-like pandemic. Our response was based on our expectations of a flu-like virus circulating, therefore SARS-COV-2 was treated like a flu virus. The CDC initially believed that COVID 19 behaved and circulated like flu and so we explained cases that could not be linked to those flying in from Wuhan with potential transmission via a contaminated surface. That’s why initial guidance focused on cleaning surfaces, not touching your face, and disinfecting your groceries before bringing them into the house. All of this turned out to be unnecessary as COVID-19 is spread through the air and not on surfaces.
Treating COVID-19 like the flu would also mean that asymptomatic cases were rare and not super spreading carriers. This also turned out to be false as cases spread like wildfire through asymptomatic carriers while we were unable to test and did not have a policy to test such people at the outset. Even the “6 feet apart rule” focused mitigation measures on the wrong thing and left people open to risk as more focus was placed on distancing than proper air filtering indoors. The six feet rule turned out to be completely arbitrary and also based more on a flu pandemic than anything else. I remember seeing the plastic barriers, a form of my favorite phrase “Hygiene Theater” and thinking that COVID particles lamented the fact that they hadn’t stretched to be able to leap over the plastic and infect the person dining on the Filet Mignon at the next table over. In fact, those barriers may have made it worse. But my skepticism, or any skepticism that questioned these dictates with accusations of COVID denial. One need only have common sense and be aware of how air works to understand that such protections would not be afforded by a flimsy piece of plastic. However, logic and common sense often do not rule in times of panic and hygiene theater gives people comfort. If you say anything that might breach such comfort blankets, people tend to feel threatened, a reason why we see such unattenuated hatred and death wishes for those that are skeptical of vaccination or masking. (Sometimes it seems that people have outsourced too much of their brains to the CDC while they watch the Bachelorette for dating advice or The Real Housewives to learn about humility and experience intellectually stimulating discussion.)
The CDC had simply not prepared for any other sort of pandemic other than Flu although we’ve faced potential pandemics in recent history such as Ebola, SARS-1, and MERS. What we had were imprecise recommendations based on limited evidence. The CDC was grasping for straws to do it’s best to help people protect themselves, but these recommendations that turned out to not be as helpful as initially thought, sowed the seeds of mistrust in the institution to lead us out of the pandemic. In retrospect, it would have been more beneficial for the CDC to level with the American people and tell them that they did not know for sure and more research was needed, but the CDC tended to act as all-knowing, and pompous, as I personally experienced it, and naturally skepticism followed. Gottlieb agrees with the part about transparency, and it is my own opinion regarding the tone of those in the scientific community to speak down to those outside of it.
We now are living through a time where a significant portion of the population does not believe COVID is real, as deadly as they say it is, that masks work to reduce community spread or that vaccines are effective. In fact, many still believe that other treatments work and are being suppressed for money and that masks are a form of muzzling to prepare us for an authoritarianism in America that has not ever been seen. Without commenting on whether these claims are based on reality, which from the evidence I’ve seen, they are not, these sentiments are the result of the erosion of public trust and lack of complete transparency from a government to the people that elected it.
I would like to end with a quote from Scott Gottlieb. In his conclusions, Gottlieb writes “In many respects, our lack of preparedness for a threat like COVID is not a lack of technology to deal with these threats, it’s the absence of policy coordination and an integrated approach between the different components that had relevant capabilities and expertise to inform and advance our response.”
We are at over 700 thousand American deaths due to COVID and blame needs to be put squarely on the shoulders of our institutions, shoulders that were too weak to set aside self-interests and do what was right for the American people, which was to execute their mission and save lives.