Friday, February 28, 2020

The Virus This Time: Ill-Informed, Incompetent Leadership Enabling Suppression of Free Speech, Intimidation of Whistleblowers, Propaganda and Disinformation

Unfortunately, the rapid progression of coronavirus is providing a demonstration of the dysfunction, and worse, that can be produced by bad leadership in health care and public health.

Ill-Informed Leadership

During the Trump regime we began to find striking examples of top government officials expressing ill-informed, if not outright ignorant opinions about medical, health care and public health topics.  We had not previously expected leaders of government to be personally knoweldgeable about health related topics, but traditionally they consulted with experts before making pronouncements.

For example, in September, 2017, we noted a series of examples showing some basic ignorance of health policy, including fundamental confusion about the nature of health insurance. In August, 2018, we noted that Trump had long been an apologist for asbestos, which is known to cause asbestosis, lung cancer, and mesothelioma, claiming that those opposing use of asbestos were associated with organized crime, while more recently Trump's EPA seemed willing to relax regulation of asbestos, at a time when Russia seemed ready to become the major US supplier of it.

Now the Trump administration's leadership on the coronavirus epidemic seems similarly ill-informed.

Trump's Unjustified Optimism

As the epidemic has progressed, Trump has repeatedly made extremely rosy predictions without providing any factual basis for them.

StatNews reported on January 22, 2020:

'It's one person coming in from China," Trump said in Davos, Switzerland, during an appearance on CNBC.  'We have it under control.  It's going to be just fine.'

Meanwhile, the count of cases and fatalities was growing.

Later, per USA Today on February 11, 2010, at a rally President Trump

told the crowd that 'in theory' once the weather warms up Coronavirus, which he referred to as 'the virus,' will 'miraculously' go away. Trump did not offer any scientific explanation to back up his claim.

He continued in the vein on his trip to India, as reported by CNN on February 25, 2020:

'I think that's a problem that's going to go away,' Trump said during a trip to India, expressing confidence that the epidemic will not seriously harm the global economy.

This at best appears to be wishful thinking. 

While the count of cases and fatalities was rising, and more nations were reporting cases, as reported by CNN on February 28, 2020, Trump was hoping for an intervention from on high:

'It's going to disappear. One day it's like a miracle, it will disappear,' Trump said at the White House Thursday

Was he claiming direct communication from on high?

Nevertheless, remember that Trump should be easily be able to access very expert opinion and the latest data from the Centers for Disease Control and Prevention (CDC), US Food and Drug Administration (FDA), National Institutes of Health (NIH), and Department of Health and Human Services (DHHS).  However, if he add used this access, the effects on his thinking are not apparent. 

The Acting Secretary of the Department of Homeland Security (DHS) is Confused

As reported by the Washington Post on February 25, 2020, Acting Secretary of the DHS demonstrated confusion about some basic issues regarding coronavirus, although his agency is being tasked with many responsibilities in order to control the disease.

Appearing in front of a Senate appropriations subcommittee, Wolf was on the receiving end of a brutal line of questioning from Sen. John Neely Kennedy (R-La.). Throughout the exchange, Wolf struggled to produce basic facts and projections about the disease. Perhaps most strikingly, the hearing came at a time of heightened fears about the disease, with the stock market plunging over new estimates about its spread into the United States. It’s a moment in which you’d expect such things to be top of mind for someone in Wolf’s position.

Wolf got started on the wrong foot almost immediately, when Kennedy asked him how many cases of the coronavirus there were in the United States. Wolf stated there were 14 but was uncertain about how many cases had been repatriated back to the United States from cruise ships, placing the number at '20- or 30-some-odd.'

Asked how many DHS was anticipating, Wolf didn’t have an answer and suggested this was the Department of Health and Human Services’ territory. 'We do anticipate the number will grow; I don’t have an exact figure for you, though,' Wolf said.

'You’re head of Homeland Security, and your job is to keep us safe,' Kennedy responded, asking him again what the estimates might be. Wolf talked around the question, which led Kennedy to say, 'Don’t you think you ought to check on that, as the head of Homeland Security?'

Wolf also seemed confused about what was known about human-to-human virus transmission, the mortality of the virus versus that of influenza, the availability of respirators, and the likely time course of vaccine development

The Acting Deputy Secretary of the DHS Asked on Twitter How to Find Coronavirus Information Online

Again, despite his theoretical ability to get expert opinion and data from the CDC, FDA, NIH, DHHS etc, in an op-ed in the Washington Post on February 26, 2020, Max Boot noted:

Meanwhile, the acting deputy secretary, arch-nativist Ken Cuccinelli, took to Twitter to ask for the public’s help in accessing an online map from Johns Hopkins University tracking the virus’s spread. Imagine if the head of U.S. Strategic Command asked the public for helping in learning about nuclear weapons, and you start to comprehend the scale of the problem.

New Coronavirus Czar Mike Pence's Bizarre Beliefs About Science and Promotion of Sectarian-Based Health Care

President Trump named Vice President Mike Pence was named the "czar" of the effort to control coronavirus. Pence is a politician without background in medicine, biomedical research, health care, public health or epidemiology.  Worse than that, he has a record of professing bizarre beliefs about the relevant science.  As summarized by Newsweek on February 27, 2020,

'Time for a quick reality check,' Pence wrote in an op-ed back in 2000. 'Despite the hysteria from the political class and the media, smoking doesn't kill.'

He then went on to list smoking-related statistics: Two out of three smokers do not die from smoking-related illnesses. (False—it may be the opposite: two in three smokers die as a result.) Nine out of ten do not get lung cancer. (It makes it 15 to 30 times more likely you will.) But he did add 'smoking is not good for you' and suggested those 'reading this article through the blue haze of cigarette smoke' should quit.

The scientific consensus, as per the U.S. Centers for Disease Control (CDC): 'Smoking is the leading cause of preventable death.'

Pence also disputed the ability of condoms to protect against sexually transmitted disease, possibly because he espouses abstinence as a method of contraception, and refused to say whether he believes in evolution.

Furthermore, as we discussed here, Pence seems to be on a mission to align all of US health care with his extreme fundamentalist beliefs, regardless of the responsibility of government health care agencies to support the health of all Americans, regardless of their religious beliefs.  In particular, he allegedly engineered the appointment of people with similar sectarian beliefs to positions of responsibility in DHHS.

A person who is at best skeptical about some pretty well-established medical premises, and who espouses health care policies apparently mainly based on extreme religious beliefs for coronavirus "czar?" What could possibly go wrong?

Incompetent Leadership- President Trump's Word Salads about Coronavirus and Related Issues

Previously, we had discussed  ill-informed and incompetent leadership in terms of leaders who had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.

However, we began to note concerning examples suggesting that the top leader of the US executive branch, President Trump himself, could be cognitively impaired perhaps from a dementing, neurological or psychiatric disorder.

- In October, 2017, we first started cataloging pronouncements by President Trump on health care and related topics that started with a grossly cavlier attitude toward health policy (e.g., it is only about fixing somebody's back or their knee or something," and ended with word salad

As we were taught in medical school, word salads may be produced by patients with severe neurological or psychiatric disorders.

- In January, 2018, we discussed more examples of Trump's confused, incoherent comments on health care.

- In May, 2018, we noted attempts by Trump Organization functionaries to intimidate Trump's former personal physician, presumably to prevent him from revealing details of the president's medical history.

- In December, 2018, we cataloged Trump's counter-factual, and often severely incoherent pronouncements - basically more examples of word salad - about public health, health care and other topics, at times interspersed with claims of his high intelligence.

Now Trump has produced more word salad about coronavirus.  For example, as reported by Presswatchers on February 27, 2020:

This will end. This will end. You look at flu season. I said 26,000 people. I never heard of a number like that: 26,000 people, going up to 69,000 people, doctor, you told me before. 69,000 people die every year — from 20 to 69 — every year from the flu. Think of that. That’s incredible. So far, the results of all of this that everybody is reading about — and part of the thing is, you want to keep it the way it is, you don’t want to see panic, because there’s no reason to be panicked about it — but when I mentioned the flu, I asked the various doctors, “Is this just like flu?” Because people die from the flu. And this is very unusual. And it is a little bit different, but in some ways it’s easier and in some ways it’s a little bit tougher, but we have it so well under control, I mean, we really have done a very good job.

The video of this is below:

Another example from that press conference was reported by Esquire the same day.

Suppression of Free Speech by Scientists, Health Care Professionals, and the Media

While President Trump has been proclaiming the wonders of his handling of the coronavirus, his message has been contradicted by scientists and health care professionals working in his government.  So now he seems resolved to better "control the message," that is, to suppress the views of those who disagree with him, even if they are far more expert and better able to justify their views with facts.  As reported by the New York Times on February 28, 2020:

The White House moved on Thursday to tighten control of coronavirus messaging by government health officials and scientists, directing them to coordinate all statements and public appearances with the office of Vice President Mike Pence, according to several officials familiar with the new approach.


The vice president’s move to control the messaging about coronavirus appeared to be aimed at preventing the kind of conflicting statements that have plagued the administration’s response. The latest instance occurred Thursday evening, when the president said that the virus could get worse or better in the days and weeks ahead, but that nobody knows, contradicting Dr. Anthony S. Fauci, one of the country’s leading experts on viruses and the director of the National Institute of Allergy and Infectious Disease. At the meeting with Mr. Pence on Thursday, Dr. Fauci described the seriousness of the public health threat facing Americans, saying that 'this virus has adapted extremely well to human species' and noting that it appeared to have a higher mortality rate than influenza.

'We are dealing with a serious virus,' Dr. Fauci said.

Dr. Fauci has told associates that the White House had instructed him not to say anything else without clearance.

IMHO, to best defend against an epidemic we need transparent communication about relevant facts and policies.  Suppressing expert opinion and data to make politicians look good could be disastrous for public health, and eventually disastrous for the politicians responsible.

The same is true about attempts to suppress reporting by the media.  Nonetheless, on February 26, 2020, CNN reported

the president has been blaming the media for this predicament, reverting to the same tactics that he has employed ever since taking office.

On Wednesday, in a widely-criticized tweet, he claimed that CNN and MSNBC 'are doing everything possible to make the Caronavirus look as bad as possible, including panicking markets, if possible.'

He misspelled coronavirus and the typo is still visible on his Twitter profile more than eight hours later.

CNN also explained why health care professionals are worried about Trump's repeated attempts to "control the message" about coronavirus

'When you learn you have a dangerous disease, you need to be able to trust your doctor. When entire populations face a dangerous public health crisis, they need to be able to trust their governments,' Dr. Leana S. Wen, a visiting professor at George Washington University's Milken Institute School of Public Health, wrote in a Washington Post op-ed last month.

That's a problem in this environment, where trust is in short supply. Multiple polls have shown that only one in three Americans believe he is honest and trustworthy.

The President's lies have given the public ample reason to distrust what he says -- and this has negatively affected perceptions of his administration as a whole.

'This president has lied about everything from trade deficits to Russian interference in US elections. He has disparaged experts at almost every opportunity,' said Daniel W. Drezner, professor of international politics at Tuft University's Fletcher School of Law and Diplomacy and author of the forthcoming book "The Toddler in Chief."

'At a time when people are looking to the federal government for reassurance,' Drezner said, 'he will be hard-pressed to provide any.'

Finally, on February 28, 2020, the New York Times reported that Trump surrogates on jumping on the media intimidation bandwagon:

Mick Mulvaney, the acting White House chief of staff, on Friday blamed the media for exaggerating the seriousness of coronavirus because 'they think this will bring down the president, that’s what this is all about.'

Intimidation of Whistleblowers

In the same vein, on February 28, 2020, the New York Times reported that a whistleblower charged DHHS with sending staff to meet quarantined Americans arriving from overseas without adequate preparation or equipment, and that the DHHS response was to attempt to intimidate the whistleblower:

In a narrative prepared for Congress, the whistle-blower painted a grim portrait of staff members who found themselves suddenly thrust into a federal effort to confront the coronavirus in the United States. The whistle-blower said their own health concerns were dismissed by senior administration officials as detrimental to staff 'morale.' They were 'admonished,' the complainant said, and 'accused of not being team players,” and had their “mental health and emotional stability questioned.'

After a phone call with health agency leaders to raise their fears about exposure to the virus, the staff members described a 'whitewashing' of the situation, characterizing the response as 'corrupt' and a 'cover-up,' according to the narrative, and telling the whistle-blower that senior officials had treated them as a 'nuisance' and did not want to hear their worries about health and safety.

Given Trump and cronies' attempts to control the message, how will we know when things are going wrong without whistleblowers?

Propagation of Propaganda and Disinformation

We just discussed how disinformation is distorting the conversation about and maybe the response to coronavirus.  Things are only getting worse.  the President and his allies continue to spread propaganda to make his administration look good and his perceived enemies look bad, regardless of the effect on the public's health.

On February 28, 2020, Politico reported:

President Donald Trump accused congressional Democrats early Friday morning of unfairly blaming the coronavirus’ threat to Americans on his administration, tying the global health epidemic even closer to domestic politics.

'So, the Coronavirus, which started in China and spread to various countries throughout the world, but very slowly in the U.S. because President Trump closed our border, and ended flights, VERY EARLY, is now being blamed, by the Do Nothing Democrats, to be the fault of ‘Trump,’' the president wrote on Twitter just after midnight.

In another message roughly half an hour later, Trump suggested Democratic lawmakers had been 'wasting time' on other legislative priorities and efforts to denigrate Republicans as the coronavirus outbreak proliferated.

'The Do Nothing Democrats were busy wasting time on the Immigration Hoax, & anything else they could do to make the Republican Party look bad, while I was busy calling early BORDER & FLIGHT closings, putting us way ahead in our battle with Coronavirus. Dems called it VERY wrong!' Trump wrote.

That post mirrored a similar tweet the president issued Thursday evening but later deleted, in which he charged that Democrats were “wasting their time on the Impeachment Hoax” as he sought to implement preventative measures to combat the coronavirus.

Neglecting a dangerous disease to fight perceived political enemies could ultimately leave all the humans involved worse off.

While the misinformation provided by Trump and his administration may be a product of their lack of knowledge and competence, it can directly hurt public health.  In StatNews on February 26, 2020, an opinion piece summarized some of the major misconceptions and lies promoted by the administration and explained their possible adverse effects.

'It’s really important for the U.S. government to be speaking with one common voice about these issues right now,' said Tom Inglesby, an infectious diseases physician and director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.

Without that, experts caution, the public will be left confused about their risks and what they can do to help curb the spread of the virus, such as staying home when sick.

Inglesby noted that health officials are working hard to prepare and plan for the spread of the virus within the U.S. But that work needs to be regularly and clearly communicated to the public — without conflicting statements from other officials.

'It will erode confidence in the effort if one part of the government says something in the beginning of the day, and another part of the government says something contradictory at the end of the day,' he said.

The specific examples of misinformation and lies the article used were:

Containment is ‘pretty close to airtight’ — Larry Kudlow, director of the National Economic Council, in an interview with CNBC Tuesday

The fatality rate is ‘similar to seasonal flu’ —Chad Wolf, acting secretary of the Department of Homeland Security, in testimony before Congress Tuesday

‘There’s a big difference between Ebola and coronavirus’ —Trump, in remarks in India Tuesday, when asked about decision to evacuate ill Americans from the Diamond Princess cruise ship, given his past criticism of the evacuation of an American health worker infected with Ebola

‘We’re very close to a vaccine’ —Trump, also in remarks in India

The virus might go ‘away in April, with the heat’ —Trump, speaking at a governor’s meeting earlier this month

Finally, just to ice this particular cake, Trump supporter and Trump's Medal of Freedom awardee is spreading some rank disinformation in support of his fearless leader.  On February 25, 2020, the Guardian reported,

The coronavirus outbreak is being 'weaponised' by the media to bring down Donald Trump when in fact it is simply a version of the 'common cold', the conservative radio host and presidential medal of freedom recipient Rush Limbaugh claimed on Monday.

His actual words were:

'It looks like the coronavirus is being weaponised as yet another element to bring down Donald Trump,' Limbaugh said on his Monday show. 'Now, I want to tell you the truth about the coronavirus. I’m dead right on this. The coronavirus is the common cold, folks.'

'The drive-by media hype of this thing as a pandemic, as the Andromeda strain, as, ‘Oh, my God, if you get it, you’re dead’ … I think the survival rate is 98%. Ninety-eight per cent of people get the coronavirus survive. It’s a respiratory system virus.'

That was complete nonsense, so

His comments were widely condemned: more than 80,000 people are known to have contracted the virus worldwide and 2,700 are known to have died. Authorities are struggling to cope in China, Iran, Italy and Tenerife.

That did not stop various pundits who regularly cheer for Trump on Fox News.  The Washington Post reported on February 28, 2020, that Sean Hannity, Tucker Carlson, Laura Ingraham, and Stuart Varney all joined the fray.


The Trump administration's response to the coronavirus seems more about their political fortunes, ideologies, and sectarian beliefs than about the health of the public.  If they do not change their ways, or the US does not change its leadership, it could be the death of at least some of us. Those in the US who uncritically support Trump should realize that viruses do not care about peoples' politics, so the Trump fans are just as much at risk as are the anti- and never-Trumpers.

1 comment:

Cetona said...

Superb exegesis of the current predicament. Hats off to Dr. Poses. Indeed, the misinformation itself, when you think about it, is in itself a form of virus. As is the case with the biological virus, with this social virus we're still learning about the "true" fatality rate and the long range consequences.