{"id":9832,"date":"2020-10-12T10:53:37","date_gmt":"2020-10-12T14:53:37","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9832"},"modified":"2020-10-12T18:09:32","modified_gmt":"2020-10-12T22:09:32","slug":"dying-in-a-leadership-vacuum-defended","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/dying-in-a-leadership-vacuum-defended\/2020\/10\/12\/","title":{"rendered":"“Dying in a Leadership Vacuum” — Defended"},"content":{"rendered":"

\"\"<\/a>This past week, the Editors of the New England Journal of Medicine<\/em> published a piece entitled “Dying in a Leadership Vacuum.”<\/a><\/p>\n

It’s a scathing indictment of the United States government’s response to COVID-19, in particular our inability to have a science- and evidenced-driven approach to control a disease that has now killed more than 215,000 Americans.<\/p>\n

One might ask what purpose such an editorial serves. After all, those who agree with the sentiment (raises hand!) already know, less than a month before election day, how we’re going to vote.<\/p>\n

And those who disagree will dismiss its publication as politics as usual.<\/a><\/p>\n

Never mind that our government’s first comprehensive pandemic response program was started by a Republican president, George W. Bush.<\/a> The same president who launched the largest global HIV treatment program in history, the President’s Emergency Plan For AIDS Relief (PEPFAR)<\/a>.<\/p>\n

There’s hardly an ID specialist out there who didn’t strongly support these important initiatives. So no, this isn’t all about politics.<\/p>\n

Another criticism of the editorial, say some doubters, is that it could have the paradoxical effect of driving voters away — confirmation that doctors and scientists are elitist intellectuals with a liberal bias.<\/p>\n

In short, it does little more than “making the writers feel good.”<\/a><\/p>\n

There is perhaps some validity to this perspective — I was accused of the same when writing an imaginary “apology” issued by the president.<\/a> (Somehow we never heard from him — no surprise.). But it did make me feel better, so guilty as charged on that account.<\/p>\n

But still — are there other benefits to such an opinion piece?<\/p>\n

I’d say yes. An important counter view is that a pointed editorial from the usually apolitical New England Journal of Medicine<\/em> signals the severity of the problem we have. Saying nothing would arguably be a political stance as well.<\/p>\n

The piece also acts as a convenient way to catalogue some painful data, and highlight our more egregious mistakes. It’s well-written, and accurate, and already has been read over 2 million times.<\/a> But if you don’t have time to read the whole thing, here are some choice selections.<\/p>\n

First, some damming mortality statistics:<\/p>\n

The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000.<\/p><\/blockquote>\n

Next, our ongoing testing and PPE fiascos:<\/p>\n

When the disease first arrived, we were incapable of testing effectively and couldn\u2019t provide even the most basic personal protective equipment to health care workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.<\/p><\/blockquote>\n

Our inability to support coherent social policies:<\/p>\n

Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don\u2019t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures.<\/p><\/blockquote>\n

How about our usually capable and non-partisan government agencies?<\/p>\n

The Centers for Disease Control and Prevention, which was the world\u2019s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized, appearing to respond to pressure from the administration rather than scientific evidence.<\/p><\/blockquote>\n

And now, the big finish:<\/p>\n

But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to 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.<\/p><\/blockquote>\n

So there’s hope — and it comes on November 3.<\/p>\n

Until then, we have dogs, and The Beatles.<\/p>\n