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.'
Also,
'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.'
So,
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.
Also,
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".
Discussion
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
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