Tuesday, May 26, 2020

More Attempts to Intimidate Health Care Professionals Who Try to Educate About Coronavirus


Physicians and other health care professionals are sworn to put patients' interests ahead of all else, and to uphold the integrity of education and science in health care.  This may put them in the uncomfortable position of speaking up when doing so offends vested interests.  Whistle-blowing is never easy for health care professionals.  Those who do so have been ostracized, lost jobs or been subject to lawsuits. 

So we were not surprised when cases appeared of health care professionals who spoke out about unsafe hospital practices during the coronavirus pandemic. Hospital management were not pleased at being made to look bad, so the whistle-blowers were warned, threatened, and sometimes fired.  We had seen a precursor case in which hospital professionals got in similar kinds of trouble for blowing the whistle on unsafe practices in caring for Ebola virus patients in 2014 (look here).

During the coronavirus pandemic, health care professionals have tried to educate patients and the public about the effects of the disease, and what it takes to mitigate a pandemic in the absence of effective prevention or treatment approaches.  That may have not seemed like whistle-blowing.  What powerful people could such education possibly offend?  Yet many of the professionals who did so have found themselves more directly threatened then were the whistle-blowers who protested actions by health care organizations in an earlier era.

We have previously discussed one set of illustrative examples. Health care professionals who sought to educate demonstrators who advocated quickly "reopening" the economy about the perils of doing so were subject to screams, insults, and charges they were "crisis actors" (look here).  Journalists discovered that the "reopening" protests attracted political extremists, and were funded  and organized by opaque right-wing groups, President Trump's supporters, and shady plutocrats. The protests seemed not to be about the economic damage pandemic mitigation measures had done to workers and small businesses.  It seemed that in our new political reality, powerful political interests are vested in pushing a rapid reopening not only in their economic self-interest, but in the interests of politicians who wanted to make the economy appear to thrive, no matter what the human cost. 

Continuing efforts by health care professionals to educate patients and the public about coronavirus have thus made them into targets of powerful political interests.

Trump Stirs Up His Supporters Against Health Care Professionals Who Might Question His Word

President Trump himself has berated qualified health care professionals who tried to speak the truth, even in the mildest terms, about the coronavirus pandemic.  We previously discussed his charges  that those who complained about lack of personal protective equipment (PPE) were only motivated by a desire for personal fame (look here).

On May 6, CNBC reported a newer example:

A nurse found out Wednesday what happens when you contradict President Donald Trump on how well coronavirus response efforts are going while standing near him in the Oval Office.

Trump clapped back at that nurse, Sophia Thomas, who said that access to sufficient supplies of personal protective equipment 'has been sporadic.' Her comments came during a National Nurses Day event at the White House meant to honor those first responders.

Trump upon hearing a less-than-glowing description of the front lines, quickly shot back, 'Sporadic for you, but not sporadic for a lot of other people.'

Note that Ms Thomas speaks from some authority.  She is President of the American Association of Nurse Practitioners.  As such, she seemingly tried to defuse the conflict, but Trump would have none of that:

After Trump’s testy response, Thomas said, 'Oh, no, I agree Mr. President.'

But Trump continued, folding his arms, 'Because I’ve heard the opposite.'

'I’ve heard that they are loaded up with gowns now.'

'And initially we had nothing, we had empty cupboards, we had empty shelves, we had nothing, because it wasn’t put there by the last administration,' he said, referring to former President Barack Obama.

Trump then noted that he had traveled to a Honeywell factory in Phoenix a day earlier, to tour a production line that is making 'millions of masks a month.'

'We have other factories being built now for masks, and for the most part I mean, that was fine,' Trump said, referring to the nurse.

'But I’ve heard that we have tremendous supply to almost all places,' he said.

'Tremendous supply.'

Never mind that the Trump administration has been in power for over three years, and thus had plenty of time to remedy any shortages that may have been left by the previous administration.  Never mind that Ms Thomas' view was supported by

a report by the inspector general for the federal Health and Human Services Department found that hundred of U.S. hospitals were experiencing serious shortages of PPE as well as equipment including thermometers and diagnostic testing kits.

Of course, Trump would have none of the IG's report either, either:

Trump, who disputed the report’s findings, last week moved to replace that inspector general, Christi Grimm.

It was in Trump's political interests to make it appear that his administration had made short work of the coronavirus pandemic.  Beyond that, his message seemed to be that the word of Trump overrides evidence and logic.  Like the Ingsoc movement in Orwell's 1984, he claims the power of making "2+2=5"  

Online Attacks On Health Care Professionals Who Tried to Educate about COVID-19

So it also should not be surprising that health care professionals who sought to educate the public and patients, online or in-person about coronavirus were subject to ad hominem invective, but also attacks on their facts and logic.    

On April 28, 2020, Buzzfeed News reported on what happens when health care professionals spoke  out online about coronavirus disinformation:

Eric Sartori arrived home on April 19 after working in the COVID-19 unit of a community hospital in Arizona. After reading social media posts claiming the virus was a hoax, the intensive care nurse opened Facebook and vented.

'While we're busy working to save people's lives we're also growing really concerned about the conspiracy theory BS that's seeming to become a bigger problem than #covid19,' he wrote.

What happened next?

Sartori’s Facebook post was shared more than 22,000 times. He’s received support from the post, but it has also attracted conspiracy theorists. 'I've had people asking me if I'm paid by Bill Gates. They think I'm a crisis actor. It shows me how easily people can be manipulated.'

Furthermore, he got this response from one man:

'He just kept pushing and pushing, and he was saying horrible things. He called me a faggot. He said I should die. A whole bunch of horrible, nasty things,' Sartori said. 'And then I found out that he actually works in health care. He works for some organizations that deliver things to my hospital.'

Then there was the case of the nurse who

blocked family members and friends on social media after they began spreading claims about the virus not being real and calling for stay-at-home orders to end. 'I have hidden so many people that my Facebook feed is essentially just ads at this point,' she said.

People who used to come to Swiers for health advice now view her work with suspicion.

On May 6, NBC reported the case of Dr Hadi Halazun,

At the end of another long shift treating coronavirus patients, Dr. Hadi Halazun opened his Facebook page to find a man insisting to him that 'no one's dying' and that the coronavirus is 'fake news' drummed up by the news media.

Hadi tried to engage and explain his firsthand experience with the virus. In reply, another user insinuated that he wasn't a real doctor, saying pictures from his profile showing him at concerts and music festivals proved it.

'I told them: 'I am a real doctor. There are 200 people in my hospital's ICU,' said Halazun, a cardiologist in New York. 'And they said, 'Give me your credentials.' I engaged with them, and they kicked me off their wall.'


'These anti-vaccination people were telling me I'm a sheep,' Halazun said. 'Dr. Fauci this, Bill Gates that. And I don't really care what you think about Bill Gates. It doesn't affect me. But it does affect me when they tell me what we're doing is not real and that the hospitals are really empty. It hurts.'


Halazun has since stopped engaging with the trolls on Facebook, some of whom claimed that 'the hospitals are empty' and that the virus was part of a plot to vaccinate or microchip U.S. citizens — just two of the many conspiracy theories that have swirled around the coronavirus.

Essentially these health care professionals attempts to educate the public about the science of pandemic, and the logical measures that could be used to manage them.  They were met not just with insults, but with claims their facts were a "hoax," and what they are doing "is not real."  These responses to health care professionals represents only some of the disinformation about the coronavirus pandemic now rampant on social media and the internet.

The identity and the motivations of the people propagating this disinformation are unclear.  It is known, though, that coronavirus disinformation has been promoted by the Trump administration, its supporters, and President Trump himself (look here).  It has also been spread by ideologues, people selling quack cures, and various national governments, including that of Russia (look here).  

Patients Refusing to Wear Face Masks in Medical Facilities

The attacks on the evidence and logic used by health care professionals to educate the public and patients about the coronavirus pandemic are now shading into direct attacks on the professionals and their patients.   

As Vox reported on May 21, 2020:

A urologist in Florida, who requested anonymity because of fear of losing his job, tells Vox he had his first patient refuse to wear a mask on May 13. The doctor works at a private clinic, which recently instituted a policy requiring all patients to wear a mask while in the building to minimize transmission of the virus. The patient was given a mask at the front desk, but refused to put it on.

'The nurse asked him to put his mask on if he wanted to be seen,' the urologist said. 'He got verbally aggressive with her, saying he had a right not to wear a mask, and that we were denying his constitutional rights.' The clinic manager was summoned to speak with the patient, and explained that the mask was to protect both him and the medical staff. 'He continued to refuse, so the administration asked him to leave.'

At that point, the patient called 911 to complain he was being denied medical care. 'We’re a private property, not an emergency room,' the urologist said. 'We’re not required to treat him, and he was not having an acute emergency. I think he just had a very poor understanding of what his rights were.'

The dispatcher declined to send an officer to the scene, but the clinic then called the police. 'He ended up walking out of the building before the cops showed up.'

Note that the US Constitution is about the roles and limitations of the US government, not about how private organizations manage their affairs.

There have been other examples:

The patient was 'ranting and raving,' she says. 'He said he had been trying to get it and hadn’t caught it, so he didn’t think he needed to wear a mask. I wish I could be that confident and willing to take everyone in this building’s lives into my hands.'

Despite his refusal to don a mask, the patient was cared for, although staff wore gowns and masks as if he had Covid-19.

And this:

Ryan Shannon, an ER doctor in Florida, describes a patient refusing to wear a mask, even though she was in a room next to an immunocompromised person at high risk of severe Covid-19 illness and death. 'She refused, threw the mask on the floor, and proceeded to berate myself and my staff for being a part of the ‘conspiracy and hoax’ that is Covid-19,' he wrote in a May 11 Facebook post.

After the patient’s refusal to follow guidelines, her husband insisted on sitting in the part of the waiting room designated for patients with respiratory complaints like Covid-19, instead of in his car as he was instructed.

And this:

Sue Krohn-Taylor is an administrator at a 72-apartment low-income senior living facility in the large town of Grand Island, Nebraska, where a resident has tested positive for Covid-19. She says she’s been battling some residents who refuse to wear masks, and is exhausted.

'This week, the son of one of the residents told me I was taking away their liberties by making them wear a mask in the common areas,' she says. 'If they were only harming themselves, I would back off, but they are placing each and every resident here, and my staff, and our families in harm’s way.'

'I can fight the virus, but fighting the lies is what becomes overwhelming,' she says.

Now it is patients who call straightforward epidemiology a "hoax." Not only do some patients vilify health care professionals who profess evidence and logic about the coronavirus pandemic, but now they physically resist logical  measures to suppress the pandemic.  Who might be encouraging them who has a vested interest in ... people not wearing masks?

Once again, the question may have a political answer.  As we discussed here, President Trump has repeatedly refused to wear a mask in public, as have other members of his administration.  This behavior went against the recommendations of the Centers for Disease Control and Prevention (CDC). The reasons he has publicly subverted his own administration's experts' recommendations is not clear, but in the post above, we noted an AP news story on May 7, 2020 

Trump has told advisers that he believes wearing one [a mask] would 'send the wrong message,' according to one administration and two campaign officials not authorized to publicly discuss private conversations. The president said doing so would make it seem like he is preoccupied with health instead of focused on reopening the nation’s economy — which his aides believe is the key to his reelection chances.

Now others are imitating his behavior in a way that threatens health care professionals and other patients.  Once again, health care professionals seeking to protect their patients' and their own safety have fallen afoul of the vested political interests of those in control of the executive branch of the US government. 

Trump Campaign Tries to Line Up Physician Cadre to Parrot His Views

Not only has President Trump exhibited hostility to health care professionals who contradict his magical thinking about the coronavirus, his campaign is trying to develop a cadre of physicians willing to parrot his message, and discredit any messages from health care professionals seen as competing with his.  The campaign is looking for physicians willing to amplify the message that "2+2=5"

As reported by AP on May 20, 2020:

Republican political operatives are recruiting 'extremely pro-Trump' doctors to go on television to prescribe reviving the U.S. economy as quickly as possible, without waiting to meet safety benchmarks proposed by the federal Centers for Disease Control and Prevention to slow the spread of the new coronavirus.

The plan was discussed in a May 11 conference call with a senior staffer for the Trump reelection campaign organized by CNP Action, an affiliate of the GOP-aligned Council for National Policy. A leaked recording of the hourlong call was provided to The Associated Press by the Center for Media and Democracy, a progressive watchdog group.

CNP Action is part of the Save Our Country Coalition, an alliance of conservative think tanks and political committees formed in late April to end state lockdowns implemented in response to the pandemic. Other members of the coalition include the FreedomWorks Foundation, the American Legislative Exchange Council and Tea Party Patriots.

A resurgent economy is seen as critical to boosting President Donald Trump’s reelection hopes and has become a growing focus of the White House coronavirus task force led by Vice President Mike Pence.

Tim Murtaugh, the Trump campaign communications director, confirmed to AP that an effort to recruit doctors to publicly support the president is underway, but declined to say when the initiative would be rolled out.

The implied goal is to find physicians who will uncritically accept the word of Donald J Trump

Murtaugh said the campaign is not concerned about contradicting government experts.

'Our job at the campaign is to reflect President Trump’s point of view,' Murtaugh said. 'We are his campaign. There is no difference between us and him.'

So this an effort to use tame physicians to cloak in their white coats Trump's political agenda which contradicts CDC pandemic management recommendations.  It is apparently meant to undercut any arguments about the potential public health effects of premature "reopening" of the economy.  The AP interviewed Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University’s Mailman School of Public Health as saying:

having doctors relay contradictory information on behalf of the president is 'quite alarming.'

'I find it totally irresponsible to have physicians who are touting some information that’s not anchored in evidence and not anchored in science,' El-Sadr said. 'What often creates confusion is the many voices that are out there, and many of those voices do have a political interest, which is the hugely dangerous situation we are at now.'

The Trump campaign seems to want to specifically minimize the danger of COVID-19 infection.  AP talked to Matt Schlapp,"chairman of the American Conservative Union, which hosts the annual Conservative Political Action Conference attended by conservative luminaries," who participated in the call:

It’s important to get the message out there that most people recover from corona. Most people are not in mortal danger with corona and that we can safely open up the economy.

However, this contradicts well known data, for example

As of Tuesday, more than 1.5 million Americans had tested positive for COVID-19, with more than 91,000 deaths reported nationwide.

The effort to develop a cadre of physicians who uncritically accept the word of Trump already seems to be underway.  As The Hill Reported on May 21, 2020,

More than 600 physicians signed a letter organized in part by a conservative group that warns President Trump against a lengthy economic shutdown because of the coronavirus.

The doctors call such closures a "mass casualty" event.

The letter was spearheaded by Simone Gold, a California emergency medical specialist. Jenny Beth Martin, the cofounder of Tea Party Patriots, helped organize the letter and get it to the White House.

It was released as the Trump campaign has been actively soliciting the support of pro-Trump physicians, according to The Associated Press.

Note that the Tea Party Patriots is one of the right-wing political organizations that has tried to line up a cadre of physicians who uncritically "reflect President Trump's point of view."  It has also been an organizer of the "reopen" protests, including those in which included the vilification of health care professionals who tried to counter-protest in support of social distancing and other pandemic control measures, and to warn of disease resurgence were reopening rushed (look here).

The Hill stated that the first author of the letter, Dr Gold

said in an interview with The Hill she doesn't want to be seen as political, and is merely concerned about the negative medical impacts of the shutdown. Gold described it as a 'grassroots' effort and rejected characterizations of it as a 'political movement.'

However, the AP article noted that Dr Gold

is listed as a member of the Save Our Country Coalition on the group’s website. She has recently appeared on conservative talk radio and podcast programs to advocate for the use of hydroxychloroquine, an anti-malaria drug that Trump says he is taking because he believes it can prevent COVID-19 even though his own administration has warned it can have deadly side effects. Gold said she has prescribed the drug to two of her patients with good results.

The Food and Drug Administration warned health professionals last month that the drug should not be used to treat COVID-19 outside of hospital or research settings due to sometimes fatal side effects.


Gold told AP on Tuesday she started speaking out against shelter-in-place and other infection control measures because there was 'no scientific basis that the average American should be concerned' about COVID-19. Like the president, she is advocating for a fast reopening, and argues that because the majority of deaths so far have been the elderly and people with preexisting conditions, younger people should be working.

One wonders why a physician who is not "political" would choose to do such interviews.  One also wonders why she has been advocating for for hydroxychloroquine in the absence of any clear evidence that it does more good than harm for patients with COVID-19? One further wonders where she found "scientific basis" to say the average person should not be "concerned" about the pandemic?

So  the Trump campaign, in league with a group that sponsored "reopen" protests, is cultivating a group of pet physicians who are happy to "reflect" the word of Donald J Trump, even when the word is the epidemiological equivalent of "2+2=5". 


 As we said before, many dooctors and other health care professionals traditionally have not been very interested in health policy, and often have avoided activism, much less any appearance of partisanship.  Pushed by the suffering of COVID-19 patients and their own vulnerability in the pandemic, many have tried to educate the public about the need to suppress the pandemic through social distancing and various physical measures.

This has given some an impetus to protest unsafe conditions in health care facilities (look here), and to try to educate "reopening" protesters about the medical and public health risks of premature efforts to decrease the economic effects of the pandemic (look here).  Yet that put them in uncomfortable positions.  Hospital managers did not appreciate their protesting when it put management in a bad light.  Some "reopening" protesters responded to their educational counter-protesting with anger and vilification.  Now extreme political interests, specifically including President Trump and his supporters have targeted health care professionals whose educational efforts might undercut Trump's message of triumph over the pandemic resulting in a "transition to greatness."  Thus, while health care professionals have sought to educate about the facts and logic of an epidemiological approach to pandemic management, the Trump administration has contradicted obvious truths, and proclaimed delusional solutions.

The health care professionals have been saying the equivalent of "2+2=4" when the country's leadership proclaims its power to say "2+2=5" Whether health care professionals like it or not, Trump and company have turned health care education, and science-based reasoning, into political acts.

So health care professionals trying just to uphold their mission to put patients' and the public's health first have stumbled into a conflict far beyond anything we have seen in our lifetimes.  Upholding the mission will be difficult, unpleasant, quite likely dangerous.  The danger is not just from the virus, but from our fellow humans.  That does not make the mission any less important.  Innocent lives are still hanging in the balance.

We could retreat in fear from the powerful opposition we have stirred up.  That would allow complete politicization of the management of the coronavirus pandemic, doubtless leading to increased disease and death (and ironically, even worse economic disruption).  Retreating would betray our patients and make a mockery of our mission.  Or we could persist.  What will it be? "And if not now, when?"

1931 Soviet propaganda poster by Yakov Guminer, via WikiMedia

Sunday, May 17, 2020

Extremists, Guns, Militias, Threats of Violence - Is This Any Way to Debate Public Health and Pandemic Management?

In April, the rising curve of COVID-19 cases in the US started to flatten in response to fairly strict social distancing and collective public action (look here for latest data).  Despite this success, supposedly popular protests, albeit very small, broke out calling for the end of these onerous measures, ostensibly to let the economy recover, as we noted here.  Protesters were egged on by President Trump, who called to "liberate" various states, and thus end social distancing and physicial prevention measures, despite the recommendations of the Centers for Disease Control and Prevention (CDC) and his own coronavirus task force.

At these "reopening" protests, there were signs of political extremism.  At some, health care professionals who counter-protested to support social distancing and other measures to curtail disease spread were vilified.  Since then, it has become glaringly obvious that these protests and the arguments about backing off from pandemic suppression efforts have become caught up in an increasingly ugly political reality.  We have noticed some specific trends.

Local Political Leaders Endorsed Extremism

Not only the "reopening" protesters, but their supporters among local political leaders have endorsed extremist symbolism and viewpoints.  Recent examples follow in chronological order per when they were reported.  

Ohio State Senator Compares State Health Director, Who is Jewish, to the Nazis and Anti-Christ

Per Raw Story on April, 22, 2020, after Ohio Health Director Amy Acton suggested letting people who are immune from COVID-19 get a certificate to that effect, State Sen. Andrew Brenner’s wife, Sara Marie Brenner tagged her husband with a Facebook post that included:

This is the mark of the beast type talk.


'This is worse than China, for heaven’s sake,' they added. 'This actually feels like Hitler’s Germany where you had to have blonde hair and blue eyes to be able to function anywhere, and you were damned otherwise. When are people going to say enough is enough?'

The lawmaker signaled his endorsement of his wife’s post by vowing 'we won’t let that happen in Ohio,' in a Facebook comment.

Kentucky State Representative Endorses White Supremacist Militia Member

During an early May "reopen" protest in Louisville, per the Courier-Journal on May 3, 2020:

State Rep. Savannah Maddox, a Republican from Dry Ridge who alleged Kentucky's government has made residents 'prisoners in your own homes' during the rally, was pictured standing next to a woman wearing military-style gear and carrying a gun while flashing a hand signal associated with white supremacist groups.


Tara Brandau, the woman in the photo making the hand gesture, posted the picture to her Facebook page with an endorsement of Maddox.

Brandau lists her hometown as Live Oak, Florida, on her Facebook page, which includes photos of her at several recent protests of coronavirus restrictions in other states. Brandau posted another picture to her Facebook page with a group of people at the Kentucky protest wearing military-style gear, several of whom are flashing the same 'OK' hand gesture, which has become a prominent symbol of white supremacist groups in recent years, according to the Anti-Defamation League.

According to the Southern Poverty Law Center, Brandau is an active member of the Florida Three Percenter Security Force, a far-right militia movement and paramilitary group. She also has ties to the League of the South, which the SPLC labels a secessionist neo-Confederate hate group.

Louisiana Representative Compares Stay at Home Orders to Nazi Dictatorship

As reported by Big Easy magazine on May 12, 2020, Representative Dodie Horton:

compared the stay-at-home restrictions to living under 'Nazi Germany.'

Ironically, Rep. Horton was primarily concerned with her inability to attend church on Sundays during the lockdown.

'What happened to separation of church and state?' she first queried, neglecting to mention that the public health order did not specifically target any religious practices.

'Can the fire marshal still be able to go in and close a business down [under HCR 58]? Can the Department of Health still close down restaurants? Our tax dollars – are they paying for that?'

'I mean, are we in Nazi Germany?'

The magazine got a response from Aaron Ahlquist, Regional Director of the Anti-Defamation League’s South Central Region.

To make a comparison of the Governor’s order to protect the health and welfare of the residents of Louisiana to a brutal regime that intentionally tried to exterminate the Jewish people and other vulnerable communities, is not only inaccurate, but cheapens the horror of Nazi Germany and the losses experienced by the victims

So anyone who would openly oppose the "reopen" movement by supporting public health measures against coronavirus, including measures advocated by the US government and the President's coronavirus task force could expect to be vilified as a "Nazi," (even if you are Jewish), or the Devil.

Guns and Militias

"Reopening" protests increasingly included people dressed in pseudo-combat gear, sometimes carrying military style weapons.  Many of these were apparently members of militia groups.  The most vivid examples are from protests in Michigan, although armed protesters have also appeared at "reopen" rallies in Pennsylvania (look here) and Virginia (look here).

Armed Protesters Invade Michigan State Capitol

The most obvious example occurred in late April. Per the Independent, April 30, 2020:

Michigan politicians have decided to don bulletproof vests when going to work as armed protesters defy lockdown orders.

State Senator Dayna Polehanki, a Democrat, revealed the protective decision some of her colleagues were making when sharing a picture of protesters on Twitter on Thursday.

In the picture, multiple men in the Michigan State Capitol building were armed with guns.

She wrote: 'Directly above me, men with rifles yelling at us. Some of my colleagues who own bulletproof vests are wearing them. I have never appreciated our Sergeants-at-Arms more than today.'

When contacted by The Independent, the senator shared a picture of her colleague Senator Sylvia Santana, a Democrat, wearing a bulletproof vest and face mask while working.

The Guardian's coverage on the same day noted:

One protest sign outside the statehouse on Thursday read: 'Tyrants get the rope.'

But protesters also included

militia group members carrying firearms and people with pro-Trump signs

In particular,

Members of the Michigan Liberty Militia were at the protest, armed with guns, and one member said that the group was there as a 'security detail' for the event organizers, MLive.com reported. The Southern Poverty Law Center, which monitors American extremist organizations, includes a 'Michigan Liberty Militia' among its list of extreme antigovernment groups.

Note that the AP reported in retrospect on May 13, 2020, that the armed protesters may have also been members of the "boogaloo" movement (see below).
Another anti-lockdown rally is planned for Thursday at the state Capitol in Lansing, Michigan, site of an angry protest last month that included armed members of the Michigan Liberty Militia. Michigan Gov. Gretchen Whitmer, a Democrat, has been the target of violent threats on Facebook forums, including a private one called 'The Rhett E. Boogie Group.'

Later, via NBC News, May 2, 2020, an article written by Michigan State Senator Mallory McMorrow noted that the protests also numbered:

protestors with a swastika, Confederate flags or a massive Trump 'bridge' float.

Given all that symbolism, it should not be surprising that Trump as quick to endorse his apparent supporters, per  the Guardian on May 1, 2020:

A day after armed protesters against Michigan’s stay-at-home order entered the statehouse in Lansing, Donald Trump once again expressed support for the rightwing movement.

Michigan’s Democratic governor, Gretchen Whitmer, should he said 'make a deal' with the demonstrators.

'The governor of Michigan should give a little, and put out the fire,' the president wrote in a tweet on Friday morning. 'These are very good people, but they are angry. They want their lives back again, safely! See them, talk to them, make a deal.'

So at this one "reopen" protest, protesters carried signs with Nazi and Confederate symbolism.    Armed militia members appeared, and pushed into the capitol building.  Yet, protesters also carried signs in support of President Trump, who later endorsed them as "very good people."

Later Protests at Michigan Capitol

Protests at the Michigan state capital have continued, although the armed protesters seemed deterred from their most recent protest by a bit of rain. Per the Guardian, May 14, 2020:

dozens of conservative protesters descended on the state capitol on Thursday morning.

Some arrived armed with assault rifles while others held up signs portraying the governor with a Hitler moustache and one speaker taunted police and called for Whitmer to be pulled outside and arrested for breaking the law with her emergency orders.

But the fears of serious violence that had preceded the event proved unfounded. Instead, a steady downpour and lightning pushed most of the protesters to their vehicles after about 90 minutes.

So anyone who would openly oppose the "reopen" movement by supporting public health measures against coronavirus, including measures advocated by the US government and the President's coronavirus task force could expect attempts at intimidation, even by members of armed militias. 

Threats of Violence Against "Reopening" Opponents

Beyond the vilification of health care professionals acting as counter-protesters (see our post here), some "reopening" supporters made apparent threats of violence against their perceived opponents. 

Death Threat Against Governor of Kentucky

In the context of protests of Governor Beshear's lock-down of businesses, per The Hill on April 22, 2020: an attorney, John Troutman, was on Facebook

reportedly having an exchange about protests planned in opposition to Beshear’s stay-at-home order amid the coronavirus pandemic

when  he stated

with any luck the Gov will be the one at whom the shooting will be directed

Just for emphasis, he also referred to the story of

William Goebel. For those of you who don't know the history...it's a good read...

The Hill explained:

Goebel, Kentucky’s 34th governor, was shot in 1900 the day before being sworn in after a divisive election and died four days later. He remains the only state governor in United States history who was assassinated during a contested election.

Boogaloo Militia Fans Threaten Various Violence

The background came from the New York Times, May 3, 2020:

Last month, the Department of Homeland Security warned law enforcement officials throughout the United States of the mobilization of violent extremists in response to stay-at-home measures, according to a senior law enforcement official and a congressional staff member, who were not authorized to discuss the warning publicly.

A department memo dated April 23 noted the recent arrests of individuals who had threatened government officials imposing coronavirus-related regulations. The memo was distributed to law enforcement “fusion centers” that counter terrorism nationwide and to congressional committees, the officials said.

In particular, there is a loosely set of people who could be called the "boogaloo" movement:

Some label their expected second civil war 'the boogaloo,' and experts have tracked a spike in interest in the term on social media, plus a proliferation of advice on how to prepare.

The name is a pop culture reference derived from a 1984 movie flop that became a cult classic called “Breakin’ 2: Electric Boogaloo.” It went through various mutations and emerged sometimes as the “Big Igloo” or the “Big Luau.” That is why adherents sometimes wear Hawaiian shirts, say those who track them. Many such shirts were in evidence when armed protesters stormed the state capital in Lansing, Mich., Thursday and they have appeared in rallies across the country.

Specific threats came from people tied to this movement:

Timothy R. Wilson, 36, an extremist suspected of planning an attack on a Missouri hospital, was killed in a shootout with F.B.I. agents in late March. An F.B.I. statement said he was 'motivated by racial, religious, and anti-government animus.'

The federal government sought to harness the pandemic as an 'excuse to destroy our people,' Mr. Wilson wrote on an online channel for violent neo-Nazi groups, Dr. Squire said, while also describing it as a Jewish 'power grab.'

An Arkansas man, Aaron Swenson, 36, had used an alias to 'like' more than a dozen 'boogaloo' Facebook pages, said the Tech Transparency Project report. He then went on Facebook Live on April 12 to announce that he was hunting for a law enforcement officer to ambush and execute in Texarkana, Texas, where the police arrested him, according to a police statement.

Mr. Swenson, who remains in jail on $85,000 bail, was charged with making terroristic threats, evading capture and carrying a weapon illegally. 


In March, a Missouri man with ties to neo-Nazis was shot and killed when FBI agents tried to arrest him. Timothy Wilson, 36, was planning to bomb a hospital in the Kansas City area on the day that a COVID-19 stay-at-home order was scheduled to take effect, authorities said. Wilson told an undercover FBI agent that his goal was 'to kick start a revolution' and referred to his plans as 'operation boogaloo,' according to an agent’s affidavit.

Militia Member Planning to Attend Colorado "Reopen" Rally Arrested for Possession of Pipe Bombs

Per Vice News, May 4, 2020:

A Colorado man was arrested Friday when federal agents found pipe bombs at his home, hours before the anti-lockdown rally that he reportedly planned to attend at the state Capitol.

Bradley Bunn, 53, allegedly told agents that he planned to use the bombs against law enforcement if they attempted a forced entry, according to an arrest affidavit.

Federal agents with the FBI and ATF reportedly became aware of Bunn after a series of aggressive social media posts, according to an anonymous official who spoke to ABC News after being briefed on the case.

The Denver Post also reported that Bunn, who’s allegedly a member of an anti-government militia, boasted online that he’d bring high-powered weapons to the state’s Capitol for the protest.

Threats Against People who Complained about Violations of Washington's Stay at Home Order

Per the Seattle Times, May 9, 2020:

Two Facebook pages during the past week posted names, emails and phone numbers of state residents who had complained to the state about businesses allegedly violating Gov. Jay Inslee’s stay-at-home order. Some of the complainants say the Facebook posts have generated threats of violence and harassment against them.

One group publicizing the names, the Washington Three Percenters, has promoted the stay-at-home protests, and one of its leaders spoke at Saturday’s demonstration.

On its Facebook page, the far-right group of self-described 'God fearing Patriots,' had this message: 'Want to snitch on your neighbor? Don’t expect to hide behind you (sic) computer screen.' With the message, the group provided a link to a spreadsheet containing the names and contact information of people who made reports to the state.

In one case,

A woman on the list shared by the Washington Three Percenters said she quickly got threatening emails and phone messages. The woman, who lives in King County and asked not to be identified because of threats to her safety, had reported a business she said she believed was operating improperly despite Inslee’s stay-home order.

She sent The Seattle Times a voice message that she said was left on her phone. A man says, 'You got 48 hours to get the [expletive] out of Washington, or I am coming for you, and your loved ones.'

Note that the Three Percent group is also related to the "Boogaloo" militia.  Further note that a Kentucky state legislator seemed to endorse another member of the Three Percenters who appeared a "reopen" protest in that state (see above).  

Michigan Governor Threatened on Facebook Before "Reopen" Rally

Per the Detroit Metro Times, May 11, 2020:

Dozens of angry Michiganders, fueled by conspiracy theories and disinformation about the coronavirus, are promoting violence and mobilizing armed rallies against Gov. Gretchen Whitmer on Facebook, in violation of the social media company’s policies.

On Sunday, after being contacted by Metro Times, Facebook removed one of the groups, Michigan United for Liberty, and deleted posts on others for violating the company’s policy against inciting violence. Facebook announced last month that it will remove groups and events that encourage people to defy social-distancing measures. Facebook also is investigating the other groups.

'We removed one group for violating our policies and will remove any other violations as we continue our review,' a Facebook spokesperson tells Metro Times.

Assassinating Whitmer is a common theme among members of the groups. Dozens of people have called for her to be hanged.

'We need a good old fashioned lynch mob to storm the Capitol, drag her tyrannical ass out onto the street and string her up as our forefathers would have,' John Campbell Sr. wrote in a group called 'People of Michigan vs. Gov. Gretchen Whitmer,' which had nearly 9,000 members as of Monday morning.

Steve Doxsie had the same idea: 'Drag that tyrant governor out to the front lawn. Fit her for a noose.'

'Either President Trump sends in the troops or there is going to be a midnight lynching in Lansing soon,' Michael Smith chimed in.

There were many more. Note that some of the threats came from a "Boogaloo" related group as discussed above.

 So anyone who would openly oppose the "reopen" movement by supporting public health measures against coronavirus, including measures advocated by the US government and the President's coronavirus task force could expect not merely attempts at intimidation, but threats of violence and even death.  There have been instances in which people have made concrete preparations to carry out such threats.


Many dooctors and other health care professionals traditionally have not been very interested in health policy, and often have avoided activism, much less any appearance of partisanship.  Pushed by the suffering of COVID-19 patients and their own vulnerability in the pandemic, many have tried to educate the public about the need to suppress the pandemic through social distancing and various physical measures.

This has given some an impetus to protest unsafe conditions in health care facilities (look here), and to try to educate "reopening" protesters about the medical and public health risks of premature efforts to decrease the economic effects of the pandemic (look here).  Yet that put them in uncomfortable positions.  Hospital managers did not appreciate their protesting when it put management in a bad light.  Some "reopening" protesters responded to their educational counter-protesting with anger and vilification.

Health care professionals must open their eyes about whom and what they are up against.  The "reopen" protests seem to be more about a particularly ugly version of politics rather than economic concerns.  Political supporters of "reopen" protests are no more afraid of vilifying those who disagree with them than are the protesters themselves.   Protesters include armed militia members trying to intimidate their opponents.  "Reopen" campaigns often generate threats of violence against perceived political enemies.

Further, as we documented here, the "reopen" protests are supported by powerful, often opaque right-wing political groups, backed quietly by some of the country's richest plutocrats.

Even more intimidating, "reopen" protesters often pledge allegiance not to obscure cult leaders, but to the President of the United States, Donald J Trump.  Trump, after all, helped to fan the flames of the protests by calling for the "liberation" of some states led by Governors of the opposing political party, as noted here.  Finally, as discussed above, Trump clearly has signaled his support even for protesters who dress to intimidate in pseudo-military garb and carry guns into state capitol buildings, apparently threatening armed insurrection.

So health care professionals trying just to uphold their mission to put patients' and the public's health first have stumbled into a conflict far beyond anything we have seen in our lifetimes.  Upholding the mission will be difficult, unpleasant, quite likely dangerous.  The danger is not just from the virus, but from our fellow humans.  That does not make the mission any less important.  Innocent lives are still hanging in the balance.

"And if not now, when?" 


Sunday, May 10, 2020

Will Reality Intrude on Trump's Ability to "Laugh in the Face of This Disease?"

Introduction: The Coronavirus Pandemic versus Trumpian Denial of Reality

In the absence of a safe and effective vaccine or curative treatments for COVID-19, control of the pandemic rests on collective public action.  Public health authorities have been promoting a variety of physical measures that everyone should try to undertake to decrease the spread of the virus.

For example, the US Centers for Disease Control and Prevention (CDC) recommends that everyone should "Wash your hands often.... Avoid close contact ... Stay at least 6 feet (about 2 arms’ length) from other people. Do not gather in groups. Stay out of crowded places and avoid mass gatherings.... Cover your mouth and nose with a cloth face cover when around others." These measures are meant both to protect the people employing them, and those exposed to them.

Many have complied, "flattening of the curve" in some areas, but causing large economic dislocations.  Until vaccines or treatments are available, however, it might only be safe to relax the stringency of  physical prevention measures if it were possible to quickly diagnose and isolate new cases, and find and isolate their contacts.  However, that is not yet possible in most of the US. 

Thus it has been disconcerting to see top government leaders publicly spurning the currently recommended physical measures.  We recently discussed how the US Vice President excused his failure to wear a mask at a public event by his recent negative test for coronavirus, obtained via his  access to a frequent testing regimen at the White House that is far more extensive than anything available to the population.  We wondered at the time whether this extraordinary access to testing at the White House may shield the top of the US executive branch from the realities of the epidemic, perhaps partially explaining their less than vigorous response to it.

We also speculated that this extraordinary access was being used by President Trump and associates to promote his propaganda that the pandemic is under control, and use this deception to justify prematurely "reopening" the economy.  However, by relaxing prevention measures, this would risk amplifying a still uncontrolled pandemic.

Now media reports suggest that the push to "reopen" is central to the administration's political plans.  At the same time, the administration may find that reality can only be denied for so long.

The Maskless Visit to A Mask Manufacturing Facility

As reported by the New York Times on May 5, 2020:

In his latest show of support for returning to normal life even as the coronavirus continues to spread, Mr. Trump took a day trip to Phoenix to visit a Honeywell International plant that manufactures N95 masks


In heavily political remarks to Honeywell employees after a tour of the factory, the president said that 'our country is now in the next stage of the battle' against the virus and that 'now we are reopening our country.'

Yet at this mask factory,

Mr. Trump wore safety goggles as he toured the 500-employee plant, which previously manufactured aerospace equipment. But he did not wear a mask, despite signage near the factory floor announcing safety guidelines that included an admonition: 'Please wear your mask at all times.' Other members of Mr. Trump’s entourage, including the White House chief of staff, Mark Meadows, and the national security adviser, Robert C. O’Brien, also did not cover their faces.

The CDC strongly advises every American to wear a mask.  The President visits a mask factory, makes political remarks, but he and his entourage fail to wear masks.

Avoiding Masks as a Propaganda Ploy

A column in the Washington Post on May 6, 2020, suggested that this was quite deliberate:

At the Honeywell plant that Trump toured, many employees of the company wore masks. Trump’s video showed those employees wearing masks — in fairness, his team didn’t try to hide this — but he and the executives did not wear them, as the video also shows.

It appears this may have been in violation of company policy. CNN’s Jim Acosta tweeted that a sign in the facility said face masks were required.

Furthermore, the article suggested that Trump used his extraordinary access to COVID-19 testing to try to enhance his personal protection to enable this deliberate action.  Starting with a statement from Honeywell:

Following White House recommended protocol, a small number of individuals directly interfacing with the President on Tuesday were tested for COVID-19 immediately prior to the event, received negative test results, and were permitted to not wear masks during portions of the visit based on that medical screening. All others present were wearing masks and social distancing in accordance with Honeywell’s site policy.

That strongly suggests the White House initiated this outcome: Honeywell executives, following the White House’s lead, got tested and cleared before interacting with Trump, which they did without masks. Trump aides traveling with him also didn’t wear masks.

Many of the others (such as those in the audience) wore masks, in accordance with Honeywell policy.

That means Honeywell executives might have violated their own company policy, in keeping with what Trump and the White House wanted, obviously for staging purposes.

The article went on to explain the deception involved:

Trump is almost certainly not wearing a mask at such events to send a message to the country that we’re approaching normalcy. That’s likely why Trump and Vice President Pence have been lately holding other events without masks and proper social distancing.

Another reason this matters: As David Nakamura reports, Trump and Pence are able to do this because they have special access to a rapid testing mechanism. Indeed, the White House has defended these mask-free events on precisely that basis.

It’s not surprising that Trump and his entourage have such special testing access, given that he’s president. But this still raises the question of whether Trump is exploiting this access to mislead the country into believing things are normal when the rest of the country lacks this access to testing and thus doesn’t enjoy the safety or quasi-normalcy Trump does.

The article suggests that Trump is using optics to contradict his own administration's policy without saying it in so many words:

'Particularly to his supporters, the behavioral choices he makes carry far more weight than virtually anything else,' Jeremy Konyndyk, a senior fellow at the Center for Global Development, told me. Konyndyk added that even if Trump and those around him benefit from special testing, 'what’s seen by Americans is, 'don’t wear a mask.'

An AP news story on May 7, 2020 also asserted that the goal is to portray a falsely rosy picture of pandemic control:

Trump has told advisers that he believes wearing one would 'send the wrong message,' according to one administration and two campaign officials not authorized to publicly discuss private conversations. The president said doing so would make it seem like he is preoccupied with health instead of focused on reopening the nation’s economy — which his aides believe is the key to his reelection chances.

The AP story also suggested that going maskless is not only meant to visually convey the message is not only that the pandemic is under better control than it actually is, but to appeal to "the Trump base's" ideology and emotions:

While not yet as loaded as a 'Make America Great Again' hat, the mask is increasingly a visual shorthand for the debate pitting those willing to follow health officials’ guidance and cover their faces against those who feel it violates their freedom or buys into a threat they think is overblown.

That resistance is fueled by some of the same people who object to other virus restrictions. The push back has been stoked by President Donald Trump — he didn’t wear a mask during an appearance at a facility making them — and some other Republicans, who have flouted rules and questioned the value of masks. It’s a development that has worried experts as Americans are increasingly returning to public spaces.

'There’s such a strong culture of individualism that, even if it’s going to help protect them, people don’t want the government telling them what to do,' said Linsey Marr, a Virginia Tech engineering professor with experience in airborne transmission of viruses.

At any rate, Trump's push back against the masks the CDC is recommending is propagating among the faithful:

White House aides say the president hasn’t told them not to wear them, but few do. Some Republican allies have asked Trump’s campaign how it would be viewed by the White House if they were spotted wearing a mask.

It appears that President Trump's extraordinary access to health care has not only enabled his lax approach to a lethal pandemic, but has enabled a denial of reality that is influencing people to abandoned social distancing and other such physical prevention measures.

Early in the Trump administration, we noted how the denial of reality had become part of its program:

In 2003 I published an article entitled 'A Cautionary Tale: the Dysfunction of American Health Care,' which summarized the views of health care professionals about the causes of health care dysfunction.  One of the major findings was the importance of 'attacks on the scientific basis of medicine.'  In turn, I hypothesized that some of these attacks stemmed from the rise of post-modernism, then a fashionable intellectual affectation on university campuses, mainly of the avant garde left-wing.  I wrote then:

Postmodernism is 'an attempt to question the fundamental philosophical and political premises of the West.   It argues that many of the concepts we take for granted—including truth, morality, and objectivity—are culturally ‘constructed’'  To postmodernists, truth is just what the powerful say is true.

Now it seems that post-modernist 'thought' has escaped the confines of left-wing humanities departments, and infiltrated political discourse, and for some unfathomable reason, seems to particularly affect some of those who profess to be conservative. After all, in January, KellyAnne Conway, a senior White House adviser, defended the administration's arguments as 'alternative facts.' (Look here.)

Now the reality of extraordinary access to health care has given Trump a tool to make "alternative facts" seem so real that his followers act on them. 

Denying Reality May Not Prevent its Intrusion

Of course, in the real world, reduction in physical prevention measures in the continuing absence of safe and effective vaccines or treatments likely will cause an amplification of the pandemic, and hence more disease, more death, and more health care facilities at risk of collapse.  Those who are influenced by Trump's propaganda would not be immune to these dangers.  Neither would the people with whom they have contact, including their friends and family.

Reality often strikes back at those who deny.  In this case, reality may be striking back quickly.  The same day after the AP story above was published, and immediately after I wrote most of the post above,  CNN reported that coronavirus had invaded the White House:

A member of the US Navy who serves as one of President Donald Trump's personal valets has tested positive for coronavirus, CNN learned Thursday, raising concerns about the President's possible exposure to the virus.

The valets are members of an elite military unit dedicated to the White House and often work very close to the President and first family.

That night (May 7, 2020), the Washington Post had an expanded report suggesting that Trump was likely exposed to coronavirus:

The infected staffer is one of Trump’s personal valets, the military staff members who sometimes serve meals and look after personal needs of the president. That would mean the president, Secret Service personnel and senior members of the White House staff could have had close or prolonged contact with the aide before the illness was diagnosed.

The report also clarified that there was little observance of physical prevention measures in the White House.

the president likes to meet with many people and is itching to travel more, these aides said.


wider use of masks among staffers close to Trump is expected but will remain optional.

Relatively few staffers who interact frequently with the president wear masks. One who did, deputy national security adviser Matthew Pottinger, drew snickers from his colleagues, according to aides.

Trump has never worn a face mask in public during the pandemic and has said that to do so while performing his official duties would be unseemly.


Junior staffers often wear masks, but senior-level officials who meet with Trump have generally not worn them, three White House officials said.

Several former White House personnel said they have asked previous colleagues still working at the White House why staff members on the grounds, and especially those in proximity to Trump, were not automatically following a protocol of wearing masks and being regularly tested before this point.

'The president sees it as a sign of weakness to wear masks and so people just haven’t been doing it,' one current employee responded, according to a person familiar with that conversation.

One day later (May 8, 2020), reports of a second White House staffer with coronavirus appeared.  This time, the staffer was political, not a member of the military assigned to the White House, and one particularly likely to have been in close contact with the top levels of political leadership.  Per NPR,

The White House on Friday confirmed a second case of coronavirus this week, now in Vice President Pence's office, as both the president and his No. 2 have recently begun traveling again.

Pence spokeswoman Katie Miller tested positive for the virus on Friday, after having tested negative Thursday.

Note that

Miller is married to Trump senior adviser Stephen Miller, whose fiery anti-immigration stance and public loyalty to the president has made him one of Trump's closest allies.

Per the Washington Post:

Miller is married to Stephen Miller, a senior adviser to Trump who has interacted with him this week, though it remained unclear late Friday whether the couple would both be quarantined at home. The White House said Pence tested negative for the virus as did the aides removed from his plane.

Yet Katie Miller’s positive test raised questions over who else she might have been in contact with. She has attended nearly all of the White House coronavirus task force meetings, led by Pence, in the Situation Room, aides said.So

Here is the double-bind produced by post-modernist reality denial.  Now Trump et al either must accept the reality of the pandemic, or assume a real personal risk of being infected, possibly getting very sick, and possibly dying.  As the Washington Post, May 8, put it:

'This is a show of bravado. This is a show of ‘I got this. I’m in control,’ ' said one former security official familiar with White House security planning during past administrations.

'He’s tried to minimize this threat from day one. It’s the only way he can laugh in the face of this disease,' said this person, who like others spoke on the condition of anonymity to frankly address sensitive security matters. “If he backtracks now, and starts wearing a mask, it will contradict the red meat he’s feeding to his base constantly. This is the first health crisis that has been politicized.'

In the bad old days when post-modernism was rampant on university campuses, I suspected that the post-modernists denied reality only as part of a cynical academic pose. I went to a talk by a post-modernist academic who denied the existence of a single external reality.  Later I heard her take part in an intensely practical conversation about travel options at the post-talk social hour. I sidled into the conversation and asked if there is no reality, why don't you fall through the apparent but unreal floor into the depths of the earth?  She smiled nervously and found someone else to talk to.  I suspect no academic post-modernist had sufficient belief in their intellectual position that they would walk in front of an oncoming bus because it was not part of external reality.

So if Trump et al are like the old academic post-modernists, they would quickly start social distancing and physical measures to mitigate the pandemic at the White House.  However, maybe they would have to stop laughing at the coronavirus and pay some heed to the need to competently manage the pandemic. 

However, at the time I am writing this, I am not sure Trump et al will not step in front of the bus.  From the Washington Post, May 8:

President Trump on Friday continued to eschew key public health guidelines from his own administration — meeting with Republican lawmakers and World War II veterans without a face mask — while expressing confidence that he is protected from the coronavirus despite a second White House staffer testing positive this week.


On Thursday, the president met with close advisers, including son-in-law Jared Kushner, Republican National Committee Chairwoman Ronna McDaniel and campaign manager Brad Parscale, who brought with him five prototype masks featuring the Trump-Pence reelection logo.

Trump was delighted with the campaign swag and approved its distribution for public sale, officials said, and Parscale posted a photo on Twitter of himself wearing the mask.

But that was the only time anyone involved in the meeting had worn any sort of face covering, the officials said.

Three visitors to the White House on Thursday said that few officials inside the complex were wearing masks, and Trump and senior aides did not bring up the positive tests or express safety concerns.

As Trump often says, "we will see what happens."

At least if the Trump does figuratively walk in front of the bus, he and his associates may not be around to laugh at the coronavirus much longer, and there would be a chance the rest of us could leap out of the bus' way on our own before its too late.


As we wrote in 2017:

Facts ... are stubborn things.  Evidence is evidence, no matter what politician it might offend.  Basing legislation [or action] on the sorts of alternative thinking displayed in the cases above could lead to real life, or life and death consequences for the sick, injured and vulnerable.  True health care reform requires clear thinking and the input of people who actually know something about health care.

You  heard it here first.

Sunday, May 03, 2020

"No Skin in the Game" - Does Trump's Personal Insulation from the Coronavirus Pandemic Enable His Failure to Protect the Country From It?

Introduction: Very Important Patients

Most codes of ethics for health care professionals stress that taking the best possible care of each individual patient should come before all other concerns.  Yet access to health care has been a problem for many patients in the dysfunctional US health care system.

A particularly egregious aspect of this problem has been the preferential treatment of "very important patients." In 2007 we first posted about a prestigious academic medical center that maintained an "A-list" of VIP patients, apparently contradicting it stated mission to improve care for the entire community, state, and nation.  Other examples of preferential care given by hospitals to VIPs are here, and here.  Similarly, in 2012 we posted how big corporate executives have access to "executive health insurance" which provides benefits beyond what any normal person can obtain, even from seemingly the best employer paid policy.

In 2011 we wrote

If the rich and powerful can insulate themselves from the dysfunction of the current health care system, do not expect their sympathy or support in reforming this system

During the coronavirus pandemic, access problems became more salient.  A particular problem has been access to coronavirus diagnostic testing, both for individual patient care, and to suppress the pandemic.  Identifying all infected people allows quarantining them and isolating their contacts thus suppressing future disease transmission.  Back on March 6, 2020, President Trump infamously promised “Anybody that wants a test [for the coronavirus] can get a test.” That claim was rated a "pants on fire" lie by Kaiser Health Network and Politifact.  Coronavirus testing rates continue to lag what many public health experts consider the rate necessary for good patient care and successful pandemic suppression (look here).

So maybe it should be no surprise that access to coronavirus tests and preventive measures is different for VIPs, especially for the biggest VIP of all in the US, the country's President.  This may be one reason why the US response to the pandemic has been so poor.

The White House is More Equal than Others

Coronavirus Testing Access, Frequency, and Availability of Results

The first hint of the issue appeared in articles about the visit of Vice President Pence to the Mayo Clinic.  For example, Politico reported on April 28, 2020:

Vice President Mike Pence refused to wear a mask on Tuesday as he toured the Mayo Clinic and met with hospital staff and a patient, rejecting the famed hospital’s policy that all visitors cover their faces to reduce Covid-19 risks.

His explanation was:

Pence told reporters after the visit that he believed that he was following guidance from the Centers for Disease Control and Prevention, and he asserted that he was not infected by Covid-19.

'As vice president of the United States, I'm tested for the coronavirus on a regular basis, and everyone who is around me is tested for the coronavirus,' Pence said, according to a pool report.

While many Americans cannot get a coronavirus test even when they are symptomatic, Pence suggested that he gets tested "on a regular basis," and "everyone" around him is tested, all presumably in the absence of symptoms.

It turns out that coronavirus testing at the White House is far more prevalent even than that at another co-equal branch of the US government.  As the New York Times reported on May 1, 2020:

Dr. Brian P. Monahan, the tight-lipped doctor who attends to Congress, sent up on Thursday what some have construed as a warning: His office, he told senior Republican officials on a private conference call, cannot screen all 100 senators for the coronavirus when they return to work on Monday.

The article made explicit the comparison with what happens at the White House

Two miles down Pennsylvania Avenue at the White House, the story is very different. President Trump and Vice President Mike Pence are tested frequently, aides who come into close contact with them are tested weekly and the list of people who need to be tested daily keeps expanding, according to officials familiar with the process.

The stark contrast between the testing haves at the White House and the have-nots on Capitol Hill, first reported in Politico, makes clear that Mr. Trump’s pronouncement that 'anybody that wants a test can get a test,' as he said on March 6 at the Centers for Disease Control and Prevention in Atlanta, is far from true. Although the rich and powerful are clearly favored, not even all the powerful have equal access.

Furthermore, there is a marked inequality not just in the access to and frequency of testing, but the timing of the information available from the testing.

At the White House, the medical unit is using a rapid-testing kit developed by Abbott, which yields results in about five minutes. But Dr. Monahan told the Republican aides on Thursday that he lacked such equipment, and that it would take at least two days to get test results.
So President Trump and his White House staff get far more tests with more rapidly available results than anyone else, even US Sentators.

Face Masks

Actually, this was not the first example the the very special access to health care given to the White House.  As described by the Washington Post, April 15, 2020, the Trump administration strongly discouraged the general public from wearing face masks: 

From January until April 3, the White House task force, the CDC and the U.S. surgeon general were all telling the American public that healthy people should not use masks or face coverings to protect themselves from the coronavirus.

Surgeon General Jerome Adams stressed that most Americans faced low risk of infection, but warned that mask wearers could heighten their risk because they were more likely to touch their faces as they adjusted their masks. He urged the public to save the supply for medical workers on the front lines.

'Seriously people- STOP BUYING MASKS!' Adams tweeted on Feb. 29, as stores across the country sold out. 'They are NOT effective in preventing general public from catching #Coronavirus.'

Yet by mid-March,

The National Security Council, in a 'race behind the scenes,' secured a supply of masks from Taiwan for White House staff.

The resulting arrangement he struck with Taipei made thousands of masks available for White House staff use two weeks before the administration reversed policy and advised that citizens should broadly begin wearing cloth face coverings in public.

This also happened at a time when President Trump was contradicting

top White House officials [who] were pushing for a wider embrace of masks early on to help slow the infection’s spread.

President Trump resisted endorsing such guidance, the subject of sharp debate between his advisers and government health experts, and even after doing so, declared that he would not wear one himself.

Since Trump would not wear a mask, the person most likely to benefit from his staff wearing them would be Trump himself.

Furthermore, importing the masks from Taiwan also apparently violated that country's stated public policy:

The deal was sensitive in Taiwan, which had banned commercial exports of masks to protect supply for its citizens.

So also in this example, not only did Trump, and perhaps his White House staff receive extraordinarily preferential access to health care, e.g., face masks at a time of huge national shortage, but this access was secretly afforded at a time when Trump and his cronies were denying that face masks conferred any benefits, and were discouraging their use.

Given the importance of the office of the President, I cannot deny the need for the President to get good, if not exemplary health care.  However, in these two examples, the President got extraordinary health care, beyond even what was available to the top stratum of one of the other co-equal branches of government.  At the same time he got such access, he denied the very obvious limitations in public access to one aspect of care (testing), and the benefits of another (masks).


There have been multiple summaries of the manifest failures of the US response to the coronavirus pandemic.  See just some of the many examples: in the Washington Post, Vox, and Raw Story.   Americans are daily paying the price: in lives lost, suffering from disease, and economic disaster.  If we survive, the reasons behind this historic failure will be analyzed for years.

Let me propose, however, one additional reason: the lack of "skin in the game" from the top of the US executive branch.

Back in 2011 we postulated

that the US has a secretive parallel health care system for the very rich.  The most important implication is that such a system could protect the very rich from the access problems and bureaucratic annoyances that plague ordinary patients in larger dysfunctional health care system.  By thus having "no skin in the game," those among the very rich who are not themselves directly involved with health care would have little reason to care or want to do anything about the problems besetting the larger health care system.  Since the very rich have become increasingly politically powerful, the absence of such interest or motivation for change among them would make true health care reform much more difficult.

Now when one very rich person is also the leader to whom all US health agencies report, the dangers to health and health care for all Americans of his lack of any "skin in the game" are obvious.

In this case, the dangers of Trump's lack of skin in the game go beyond that.  On May 1, 2020, the Washington Post reported that Trump may be using his special access to health care to prop up his propaganda extolling his response to the coronavirus pandemic, and promoting the notion that the country can soon end the lock-down that has punished its economy.

At the White House this week, President Trump sat less than six feet from New Jersey Gov. Phil Murphy (D) in the Oval Office. He invited small-business owners to crowd behind the Resolute Desk for a photo shoot. His vice president toured a medical research center without a face mask in defiance of its policy.

The daily images projected a sense of confidence that life, at least for the nation’s most prominent resident, is returning to a semblance of normalcy during the coronavirus pandemic — a visual cue to the public that conditions are improving as Trump pushes to restart sectors of the economy.

Yet even as Trump aides have signaled that he could soon begin regular travel, the reality is that the White House has created a picture of security that is propped up by special access to the kind of wide-scale testing for covid-19, the disease caused by the novel coronavirus, that most of the nation remains without.

The article also suggested that the special access to testing for White House staff was being used to promote Trump's magical powers, his ability to nullify the realities of epidemiology amidst a pandemic:

J. Stephen Morrison, a global health policy expert at the Center for Strategic and International Studies [said] 'In that sense, what Pence did at the Mayo Clinic was very deliberate as a sign of defiance against the authoritiesthumbing his nose at the medical authorities who run that institution and signaling to others watching you don’t have to buy into this.'

Prematurely "opening" the economy while the virus is still actively infecting new patients, without adequate testing and contact tracing to suppress it, could lead to many more infections, more illness, and more deaths.  So such propaganda could be actively dangerous to those living in the US.

These dangers will only get worse unless Trump quickly acquires skin in the game, and thus is made to realize that there will be severe negative consequences to him for his continuing failure to protect public health in the US.