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Sunday, May 29, 2022
Australia’s solution
Sandy Hook to Uvalde
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The Anti-Vaccine Movement’s New Frontier
A wave of parents has been radicalized by Covid-era misinformation to reject ordinary childhood immunizations — with potentially lethal consequences.
https://www.nytimes.com/2022/05/25/magazine/anti-vaccine-movement.html?referringSource=articleShare
Anti-vax, an old story
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Sunday, May 15, 2022
How
Public Health Failed America
The U.S. clearly failed to heed expert advice,
but there’s plenty of blame to go around.
By Jay
Varma
MAY 15, 2022, 7
AM ET
https://www.theatlantic.com/ideas/archive/2022/05/how-public-health-failed-america/629869/
About the
author: Jay Varma, a professor
at Weill Cornell Medical School, is a physician and epidemiologist who worked
for the CDC in New York, Bangkok, Beijing, and Addis Ababa.
Even
though anthony Fauci, the White
House’s chief medical adviser, backed off his statement that the United States
is “out of the pandemic phase,” elected officials and much of the public seem
to think that he had it right the first time. But if the end of the COVID-19
emergency is at hand, the United States is reaching it with lower vaccination
and higher per capita death rates than other wealthy nations. The conventional
wisdom is that the American political system failed at public health—by
prioritizing individual rights over collective safety; sowing doubt about the
benefits of vaccines, masks, and other protective measures; and most important,
failing to implement universal health care, paid sick leave, and other
safety-net programs.
I agree with the conventional wisdom. But
there’s plenty of blame to go around. Public health also failed America. The
two most important federal public-health agencies, the CDC and the FDA, have been uniformly criticized for muddled
messaging and guidance to the public on masks, vaccines, rapid tests, and other
matters; those arguments need no rehashing here. Less well understood is that
other sectors of our public-health system—including local agencies and
prominent public-health academics—were unprepared for a nationwide
infectious-disease emergency, particularly in a divided country with tight
limits on government power.
As federal, state, and local health officials
struggled in spring 2020 to obtain the basic funding, staff, lab supplies, and
data systems to test, trace, and isolate cases, academics on Twitter and cable
news became the face of public health—and they zeroed in on the many ways in
which the U.S. response to COVID-19 fell short of a textbook approach to
pandemic control. Public-health agencies were ill-prepared for this crisis, and
academics were ill-prepared to speak on their behalf.
The U.S. has a highly decentralized
public-health system that relies on thousands of state and local health
agencies operating with a wide degree of independence. The origin of these
agencies lies in combatting malaria, yellow fever, smallpox, syphilis, and
other infectious diseases; their standard activities historically included
controlling mosquitoes, improving water quality and sanitation, isolating and
quarantining people during disease outbreaks, and the direct provision of
prevention and treatment services.
By the mid-20th century, though, heart disease,
lung disease, cancer, and other chronic conditions replaced infectious diseases
as the leading causes of death. Over several decades, public-health agencies
reduced their focus on environmental dangers, infectious disease, and clinical
services. In the 2000s, these agencies dedicated more and more personnel and
public communications to tobacco control, promoting physical activity and
healthy diets, and screening for diabetes, heart disease, and cancer. The
consensus of government and academic public-health experts was that the most
effective way for these agencies to serve the public was to reduce illness and
death from chronic disease. The key metric for judging the effectiveness of
public-health agencies was life expectancy in the community they served, and—at
least in the immediate pre-COVID era—promoting healthy lifestyles for all was
more likely to avert premature deaths than infectious-disease control was.
In theory, public-health agencies could add
chronic-disease control activities without sacrificing their infectious-disease
expertise. In reality, however, public-health departments have experienced
a progressive decline in real spending power,
particularly since the Great Recession, and as a result, have chosen to cut
infectious-disease programs. More than 75 percent of the nation’s larger health
departments reported eliminating clinical services from 1997 to 2008.
I experienced this shift firsthand. When I began
overseeing infectious diseases at New York City’s health department in 2011, I
worked for one of the nation’s leading proponents of chronic-disease control:
Mayor Michael Bloomberg. Because of budget cuts, we had to shrink our infectious-diseases
programs; I had to close or reduce hours for our immunization,
sexually-transmitted disease, and tuberculosis clinics. I had to justify these
decisions to appropriately disgruntled community groups and
city council members by saying that the Affordable Care Act’s Medicaid
expansion would pay to ensure that these services could be provided by the
private sector—a claim that I based more on hope than evidence.
As local health agencies nationwide scaled back
their clinics, they also lost their presence in the community. Clinics are an
important way of building visibility and credibility, because most people do
not understand what a public-health agency is or does. Residents see the good
work you do, tell elected officials that your work matters, and then trust you
during emergencies. Running clinics also builds logistical expertise.
Unfortunately, when health agencies were called
on to run the largest, most rapid vaccination campaign in U.S. history, most
lacked personnel qualified to either run these clinics themselves or oversee
contractors effectively. This resulted in debacles like the one in Philadelphia, where the
health department let an untested start-up take on the job of running
mass-vaccination clinics in the city. Public-health agencies lost an
opportunity: One way to overcome vaccine hesitancy is to have trusted providers
deliver information and services. Without a strong public presence directly
administering vaccines before the pandemic, local health departments were
additionally unprepared to reach communities inherently distrustful of a
mass-vaccination campaign.
The U.S. is not as different from the rest of
the world as Americans frequently think. After the 2002–04 SARS epidemic and
the 2014–16 Ebola epidemic in West Africa, independent reviewers of the World Health
Organization concluded that the agency had become too
focused on providing high-level technical guidance and had failed to invest in
staff and systems to respond quickly during emergencies. During the COVID-19
crisis, the agency has been far more effective than during past crises in
mobilizing personnel and supplies in all regions of the world for border
screening, laboratory testing, and vaccination. The crucial lesson that WHO learned
from the earlier epidemics is that failure to rapidly and effectively solve
urgent problems, such as infectious-disease outbreaks, destroys your
credibility and prevents you from addressing the long-term problems and leading
causes of death. Imagine a fire department that was focused on reducing the
frequency of kitchen burns and not on putting out infernos in high-rise
buildings. That’s the situation that local public-health officials found
themselves in.
For
most americans, the face of public
health during COVID-19 was not, however, local health officials. The most
prominent voices—other than Anthony Fauci’s—were university professors
proffering guidance on television, in print, and through social media. People
who practice public health in government are expected to stick to the talking
points for their agency; the mayor or governor whom they serve constrains them
from freely explaining their recommendations and decisions. Even if afforded
freedom to talk more openly, they lacked the time to do so.
Into that void stepped university-based
physicians, epidemiologists, and virologists opining about what the government
should do without fully understanding or communicating what was feasible,
affordable, legal, and politically acceptable for public-health agencies. When
I was advising New York City Mayor Bill de Blasio on how to respond to COVID in
2020 and 2021, the city faced terrible choices. As we attempted to return the
country’s largest school district to in-person instruction in the fall of 2020
and then to keep classrooms open in the following months, I had to parse
uncertain science while balancing the demands of staff unions, parents, and
elected officials. Meanwhile, experts publicly faulted us for our limited ability to identify the source of infection for
any given COVID case and for our failure to test every COVID-exposed student every day.
Anyone who had actually implemented a large testing-and-contact-tracing program
understood the impossibility of such demands. But most of the people with
genuine technical expertise were busy practicing public health, not doing multiple
cable-news hits a day.
Consumers of that commentary could easily
conclude that the government was simply not trying hard enough to stop the
virus. And yet state and local health agencies generally cannot remove the
major legal, financial, and political constraints they face. For example, critics faulted the CDC and local health
agencies for not releasing enough data, but didn’t acknowledge the strict,
complex patchwork of regulations at the federal and state level that limit what
data public-health agencies can legally receive and report.
Every public-health practitioner I know
understands that the U.S. can reduce its vulnerability to epidemics by
improving data collection. Likewise, most of my colleagues believe that
strengthening the social safety net—particularly through universal health care,
paid sick leave, housing, and child care—will improve Americans’ ability to
fend off COVID-19 and other threats. But enacting those measures is beyond the
power of public-health officials, whose job it is to mitigate harm under
real-world conditions. Those conditions include the underlying laws and systems
that elected officials created.
Universities and government agencies are subject
to different prerogatives. The economic model of public-health schools rewards
professors who bring in research grants; tenure committees and research funders
do not necessarily demand that professors have experience inside government
public-health agencies. In reporting the comments of academic experts, news
outlets routinely include their university affiliation. But other credentials
are more crucial: Have you ever run a large government health program?
Have you ever led an official outbreak investigation? Academic experts
can offer the public an idealized version of what public health could be, but
during this pandemic they have also played a role in setting unrealistic
expectations—for instance, that emergency measures could go on indefinitely,
until society’s underlying failures are addressed.
I don’t mean to be too critical of my academic
colleagues. (Full disclosure: I now teach at a university too.) The greatest
threats to public health right now come from elected officials who would gut
public-health agencies’ budgets and legal authority on the grounds that they
threaten individual liberties.
One way to avoid that fate is for health leaders
to recognize that their daily work is largely invisible to the general
public—and that the public expects health agencies to focus on threats that
they do not believe they can protect themselves from. Public-health experts,
both in academia and in government, rightly point out that the holes in
social-welfare policies are the primary determinants of ill health. These
experts also believe that, for instance, promoting healthy diets and
encouraging people to wear masks are worthy goals of government policy. But most
Americans, for better or worse, still prioritize individual choice more and
community protection less than those of us drawn to the public-health field do.
To rally voters’ support, agencies need to make
themselves more visible in public life through direct clinical services and
ensure that they are dedicating sufficient resources, even within constrained
budgets, to public-health-emergency response. Meanwhile, the interested voter
should press elected officials on their plans for restoring infectious-disease
and emergency-response services. Ultimately, the highest aspirations of the
public-health profession must coexist with the reality of law and where power
actually resides in a democracy: with voters and their elected representatives.
Jay Varma, a professor
at Weill Cornell Medical School, is a physician and epidemiologist who worked
for the CDC in New York, Bangkok, Beijing, and Addis Ababa.
Saturday, May 14, 2022
How America Reached One Million Covid Deaths
THE MAGNITUDE OF THE country's loss is nearly impossible to grasp.
More Americans have died of Covid-19 than in two decades of car crashes or on battlefields in all of the country's wars combined.
Experts say deaths were all but inevitable from a new virus of such severity and transmissibility. Yet, one million dead is a stunning toll, even for a country the size of the United States, and the true number is almost certainly higher because of undercounting.
It is the result of many factors, including elected officials who played down the threat posed by the coronavirus and resisted safety measures; a decentralized, overburdened health care system that struggled with testing, tracing and treatment; and lower vaccination and booster rates than other rich countries, partly the result of widespread mistrust and resistance fanned by right-wing media and politicians.
The virus did not claim lives evenly, or randomly. The New York Times analyzed 25 months of data on deaths during the pandemic and found that some demographic groups, occupations and communities were far more vulnerable than others. A significant proportion of the nation's oldest residents died, making up about three-quarters of the total deaths. And among younger adults across the nation, Black and Hispanic people died at much higher rates than white people.
Understanding the toll — who makes up the one million and how the country failed them — is essential as the pandemic continues. More than 300 people are still dying of Covid every day.
"We are a country with the best doctors in the world, we got a vaccine in an astoundingly short period of time, and yet we've had so many deaths," said Mary T. Bassett, the health commissioner for New York State.
"It really should be a moment for us all to reflect on what sort of society we want to have..."
https://www.nytimes.com/interactive/2022/05/13/us/covid-deaths-us-one-million.html
More Americans have died of Covid-19 than in two decades of car crashes or on battlefields in all of the country's wars combined.
Experts say deaths were all but inevitable from a new virus of such severity and transmissibility. Yet, one million dead is a stunning toll, even for a country the size of the United States, and the true number is almost certainly higher because of undercounting.
It is the result of many factors, including elected officials who played down the threat posed by the coronavirus and resisted safety measures; a decentralized, overburdened health care system that struggled with testing, tracing and treatment; and lower vaccination and booster rates than other rich countries, partly the result of widespread mistrust and resistance fanned by right-wing media and politicians.
The virus did not claim lives evenly, or randomly. The New York Times analyzed 25 months of data on deaths during the pandemic and found that some demographic groups, occupations and communities were far more vulnerable than others. A significant proportion of the nation's oldest residents died, making up about three-quarters of the total deaths. And among younger adults across the nation, Black and Hispanic people died at much higher rates than white people.
Understanding the toll — who makes up the one million and how the country failed them — is essential as the pandemic continues. More than 300 people are still dying of Covid every day.
"We are a country with the best doctors in the world, we got a vaccine in an astoundingly short period of time, and yet we've had so many deaths," said Mary T. Bassett, the health commissioner for New York State.
"It really should be a moment for us all to reflect on what sort of society we want to have..."
https://www.nytimes.com/interactive/2022/05/13/us/covid-deaths-us-one-million.html
Wednesday, May 11, 2022
Can Anyone Out-Plan a Pandemic?
Bill Gates has a strategy to save the world from the next infectious threat. He’s not the first.
...To believe that you need only a plan rests on an assumption that humans are rational creatures who have roughly the same values and priorities as you do, and—even more improbable—that humans are inclined to follow plans of any kind. After all, when Gates laid out a strategy for solving climate change last year, he was boldly going where world leaders had gone many, many times before without success. The United Nations has held no fewer than 26 annual climate-change conferences. The world committed to the Kyoto Protocol in 1997, but failed to meet its goals. The Paris Agreement is seven years old, and the UN itself says we’re falling short. But Gates told me that the plan he offered in How to Avoid a Climate Disaster has already done some good for the planet...
https://www.theatlantic.com/science/archive/2022/05/bill-gatess-plan-save-world-next-pandemic/629826/?utm_source=email&utm_medium=social&utm_campaign=share
Friday, May 6, 2022
Our Obsession with Ancestry Has Some Twisted Roots
...Today’s addictive Web sites and sleekly packaged DNA kits rest on deep, if not always acknowledged, assumptions about the fixity of status, race, ethnicity, and nationality... NYer
Wednesday, May 4, 2022
Something in the Way We Move
We may each have a movement "signature" that, like our face or fingerprints, is unique to us.
Each of us appears to have a unique way of moving, a physical "signature" that is ours alone, like our face or fingerprints, according to a remarkable new study of people and their muscles. The study, which used machine learning to find one-of-a-kind patterns in people's muscular contractions, could have implications for our understanding of health, physical performance, personalized medicine and whether and why people can respond so differently to the same exercise.
Intuitively, most of us probably know there is something in the way we move, and that that something defines us. In studies and daily life, most people can pick out their friends and loved ones, based solely on how they walk. At least one surveillance company also claims to be able to identify and track people using their gaits... nyt
Each of us appears to have a unique way of moving, a physical "signature" that is ours alone, like our face or fingerprints, according to a remarkable new study of people and their muscles. The study, which used machine learning to find one-of-a-kind patterns in people's muscular contractions, could have implications for our understanding of health, physical performance, personalized medicine and whether and why people can respond so differently to the same exercise.
Intuitively, most of us probably know there is something in the way we move, and that that something defines us. In studies and daily life, most people can pick out their friends and loved ones, based solely on how they walk. At least one surveillance company also claims to be able to identify and track people using their gaits... nyt
Monday, May 2, 2022
Sunday, May 1, 2022
Racial disparities in US healthcare
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