Sunday, June 28, 2020

Do Cry for Those in Arizona: What Happens When Politicians Disregard Health Care and Public Health Professionals During a Pandemic

Introduction: Health Care Professionals Vilified After They Caution Against Premature Reopening During the Pandemic

As we discussed in April, 2020, after the curve of the coronavirus pandemic began to flatten in the first heavily affected areas in the northeast US, supposedly popular protests, broke out calling for the end of onerous social distancing measures, ostensibly to let the economy recover.  President Trump then jumped in, calling for the "liberation" of multiple states from these  measures.

Trump wrote: 'LIBERATE MINNESOTA' and then, 'LIBERATE MICHIGAN' and then, 'LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!'

As these protests multiplied, health care professionals responded by staging counter-protests to warn people about the danger of premature "reopening."  For their pains, they were often vilified.  In particular, we noted that one brave ICU nurse silently stood at the capitol of Arizona.

'She would spend the next few hours standing silent, her facial expressions partly hidden behind her medical mask. Her body standing rigid in surgical scrubs.'

For that, she was insulted, scorned and generally screamed at by flag-waving protesters, some of whom carried signs about an overblown crisis and a 'pretend-demic'.

The state Republican chairwoman even accused her of one of the "actors playing parts."

In that and a later post we noted how these "reopening" protests were egged on by right-wing politicians, including President Trump himself; infiltrated by extreme right-wing groups, including armed militias; accompanied by threats of death and violence to counter-protesters and anyone preaching restraint; and organized and funded by right-wing political organizations, often allied with Trump, and often funded by plutocrats.  It was unclear whether more than a small minority of the protesters were truly concerned about the economic costs of delaying reopening.  Rather, they seemed mainly about pushing a political agenda which had little to do with public health or health care.

Was this any way to make health care and public health policy?  Nonetheless, these protests, which were orders of magnitude smaller than those which later broke out after the death of George Floyd, and pressure from Trump et al seemed to induce Republican state leaders to reopen early and quickly.

Now the health care professionals' warning are shown to be valid.  Consider the case of Arizona.

Health Care Professionals Inundated as Coronavirus Surges

As documented by the Washington Post on June 25, 2020:

Arizona has emerged as an epicenter of the early summer coronavirus crisis as the outbreak has expanded, flaring across new parts of the country and, notably, infecting more young people.

Maricopa County, which includes Phoenix, is recording as many as 2,000 cases a day, 'eclipsing the New York City boroughs even on their worst days,' warned a Wednesday brief by disease trackers at Children’s Hospital of Philadelphia, which observed, 'Arizona has lost control of the epidemic.'

This came after Arizona became the poster child for early and quick reopening. "The state’s cases began rising dramatically about May 25, 10 days after Ducey allowed the state’s stay-at-home order to expire...." said a local public health expert.

The Republican Governor seemed to be reacting directly to Trump's push to "liberate" states:

Trump, who was urging governors to jump-start their economies, was coming to Arizona to tour a Honeywell plant and to convene a discussion about issues facing Native Americans.

The day before the president’s visit, Ducey announced plans to accelerate the reopening of his state’s economy, lifting restrictions on salons and barbershops and allowing restaurants to resume dine-in service. A chart displaying the number of new cases, which did not show the 14-day decline recommended by White House guidelines, 'really doesn’t tell you much,' Ducey said at his May 4 news conference.

In the Washington Post's summary:

At critical junctures, blunders by top officials undermined faith in the data purportedly driving decision-making, according to experts monitoring Arizona’s response. And when forbearance was most required, as the state began to reopen despite continued community transmission, an abrupt and uniform approach — without transparent benchmarks or latitude for stricken areas to hold back — led large parts of the public to believe the pandemic was over.

Stories coming out of Arizona are starting to resemble those that came out of New York at its peak of pandemic induced misery.  On June 24, 2020, the Arizona Republic published a vivid anecdote of yet another person who scoffed at the virus, and then became ill.

Jimmy Flores, 30, met up with his close friends at the bars in Scottsdale on a Saturday night in June.

'This bar was super packed. I was kind of concerned because I was like, man, everyone's tight, they have limited cups. Some people were sharing drinks, it was weird,' said Flores, who also shared drinks with his friends at a bar in north Scottsdale that night.

He ended up hospitalized for over a week. He "was discharged home Monday, but breathing is still a challenge and he is taking multiple medications."  He started posting about his case on Facebook, but his friends thought he was being "political."  Now he says, "I really care about people not going through this and that they have to take this seriously because it really hurts."

[Old Town, Scottsdale in happier times]

And the New York Times published an op-ed on June 26, 2020 from an emergency department physician sadly mirroring the tales of despair coming out of New York only a few months ago. 

Patients are evaluated, stabilized and admitted to an inpatient medical team. But many admitted patients remain in the emergency department, 'boarding' while awaiting transfer to the hospital wards because there are no more intensive-care beds available in the hospital or there is insufficient staff to care for them in the beds that are available.

Because of that, far fewer emergency department beds are available for people with non-Covid-19 health conditions and medical emergencies. So sick people wait for an emergency department bed to become available. The surge in cases night after night shows no sign of slowing and it is terrifying.

The media has reported how few hospital beds are available in the state. But even if we had enough beds, it wouldn’t matter if our staff wasn’t physically and emotionally well enough to attend to the people occupying those beds. Many hospital systems have chosen to furlough staff and tighten belts even as health care teams were beginning to feel the psychological strain of the pandemic. Physicians are a small part of our clinical care teams. We are profoundly limited in what we can do without the support of nurses, paramedics, emergency and intensive-care technicians, respiratory therapists, radiology technicians, environmental services workers, social workers, case managers, unit coordinators, clinical pharmacists and others.

Health care workers are exhausted. Staffing shortages and increasing fatigue are the new normal for emergency departments, intensive-care units and Covid-19 units, and across hospital wards. Staffing levels are being set with an emphasis on 'productivity' as determined by financial calculations rather than clinical severity or the complex needs of our patients and the community we serve.


Emergency medical and critical-care team members are canaries in the coal mine. When we are understaffed and overworked, when there is no staff to triage patients, when more and more patients are piling up at the emergency department door, the system breaks down, then people break down. You can borrow ventilators (until you can’t) and make more personal protective equipment (we hope). You cannot magically produce more nurses, respiratory therapists, physicians or other professionals.

And things are getting worse every single day.  The Arizona Republic reported June 28, 2020:

Arizona cases of COVID-19, the disease caused by the new coronavirus, increased by more than 3,850 cases on Sunday — the highest number of cases in a single day, according to data released by the Arizona Department of Health Services.

Arizona's total identified cases rose to 73,908 on Sunday with 1,588 known deaths, according to the most recent state figures. That's an increase of 3,857 confirmed cases, or 5.5%, since Saturday.

Inpatients with suspected or confirmed COVID-19 and ventilator and ICU bed use again hit record highs Saturday, while emergency department visits dropped from Thursday's record of 1,249, according to the daily report from the Arizona Department of Health Services.

As of Saturday, 85% of current inpatient beds and 87% of ICU beds were in use for COVID-19 and other patients.

But it did not have to happen.  Had Arizona's political leadership paid attention to the message of one brave ICU nurse back in April, or numerous messages from other health care and public health professionals, had they resisted President Trump's constant exhortations that the economy comes first, and that coronavirus is not a big problem, the pandemic would likely have been better controlled in Arizona, and elsewhere, than is actually the case.

 So do cry for those in Arizona.


Traditionally, political leaders have trusted health policy experts, and health care and public health professionals to help them make health policy.  In the past, political leaders listened to such experts and professionals when planning for epidemics and pandemics, and addressing new health and public health emergencies.

However, in our new (ab)normal, many political leaders follow the lead of the current president, Donald Trump, and his party.  They seem unworried that the president has a record of peddling lies and disinformation (look here), and has a record of conflicts of interest and corruption goes far beyond any conceivable precedent (look here). They accept Trump's multiple assurances that the coronavirus pandemic is either a hoax, or "fake news," or inconsequential, or fading away (look here).  They shrug when Trump scoffs at public health measures meant to slow viral spread, such as face masks (look here).  They put extreme politics, ideology, and sectarianism (look here) ahead of science, logic, and the warnings of experts.

So, health care professionals trying to uphold their mission to put patients' and the public's health first have stumbled into a political conflict far beyond anything we have seen in our lifetimes.  Upholding the mission is proving to be difficult, unpleasant, and now dangerous.  The danger is not just from the virus, but from our fellow humans putting their politics and ideology ahead of all else.  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 even more 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?"

ADDENDUM (30 June, 2020) - This was re-posted by the Naked Capitalism blog here.

Thursday, June 11, 2020

Health Care Corporate Leaders Have Pledged Their Support for Racial Justice and Harmony: Will They Renounce Their Previous Support of a Very Racially Divisive Politician?

Leaders of big health care organizations frequently profess their social responsibility, and traditionally have avoided political partisanship.  However, their actions have not always been consistent with these sentiments.

Now, in response to the police killing of George Floyd and subsequent protests, many health care leaders pledged their support for racial peace and justice.  However, some of these leaders have previously supported  political leaders whose actions may have contributed to the current crisis.

Recently there were two cases showing vivid contrasts between health care leaders' pronouncements and their and their organizations' recent actions.

CEOs Condemn Racism

CVS CEO Larry Merlo

Early out of the gate was Larry Merlo, CEO of CVS, who released a statement to his employees on June 1, 2020:

The turmoil we are witnessing grows out of a long and deep history in our country, and as a nation we must focus on the injustices and discrimination that continue to divide us. I remain hopeful that we can find a way to move forward in unity to solve the nation’s most pressing issues.

In our workforce and in our communities, CVS Health’s commitment to inclusion and belonging is unwavering. It is critical to those we serve and grounded in our company values. We are a diverse community here at CVS Health – all 300,000 of us – and that diversity is one of our key strengths. It shows up in how we care for one another – walking in each other’s shoes, joining forces for the greater good and respecting one another no matter what our race or ethnicity. We will continue to uphold the commitment of mutual respect in everything we do. Discrimination and intolerance have no place in our business and will not be permitted in any form.

Johnson and Johnson CEO Alex Gorsky

On June 3, 2020, CNBC reported:

Johnson and Johnson CEO Alex Gorsky said Wednesday that white men need to 'do more listening' in the wake of George Floyd’s death at the hands of Minneapolis police.

'I realize that can be difficult,' Gorsky said during an interview with CNBC’s 'Squawk Box.' 'I think there’s no way you can just move through a checklist without I think demonstrating empathy and an understanding of some of the deep-seated nature and experiences the [black] community has had and is currently experiencing.'

Gorsky announced Tuesday that J&J is committing $10 million over the next three years 'to fighting racism and injustice in America' as people across the United States and other parts of the world protest against police killings of blacks.

'As the CEO of the world’s largest health-care company, I must state unequivocally that racism in any form is unacceptable, and that black lives matter,' he said in a LinkedIn post. 'And as a white man, I also need to acknowledge the limits of my own life experience and listen to those who have faced systemic injustice since the day they were born.'

CEOs' Friendliness with and Support for President Donald Trump

President Trump's recent actions have fanned the flames of racial discord. Here are just a few examples of news about what is still an evolving story: He called for a tough, militarized response to peaceful protests after the killing of George Floyd.  He tweeted "when the looting starts, the shooting starts," and  called protesters "thugs" (see Washington Post, May 29, 2020.)  He told governors to "dominate" the streets (see Washington Post, June 1, 2020.)  His Attorney General arranged the clearance of peaceful protesters out of Lafayette Square near the White House using teargas and flash bang grenades so Trump could have a photo opportunity at a nearby church (see New York Times, June 3, 2020.)  He pushed to call out 10,000 active duty US troops to quell a protest in Washington DC that was largely peaceful (see Reuters, June 7, 2020).

That seems like the opposite of "focusing on injustice and discrimination," or "fighting racism."  However, in contrast with their current proclamations about racial harmony and inclusion, and against racism, these two CEOs have shown their friendliness to and support for President Donald Trump.

CVS CEO Larry Merlo

Merlo's stance on racial inclusivity and harmony, and against racism does not seem to fit with the CVS track record of quietly supporting a dark money non-profit organization whose main mission seemed to be providing political support for Trump, and was once led by people with very different views on race, as we posted in 2018.

CVS was revealed to have been contributing to a "dark money" organization called America First Policies (AFP), ostensibly a "social welfare" charity, but actually an organization devoted to promoting the Trump agenda.  While CVS said its support for AFP was related to the organization's tax reform agenda, it also promoted various policies that seemed to contradict the CVS ethics and social responsibility policies.  In addition, the relationship between CVS and AFP only came to light after some AFP leaders were found to have made racist and pro-Nazi proclamations.  When the unsavory nature of the AFP leaders' utterances came to light, a CVS spokesperson announced the company would sever ties with AFP.  However, to my knowledge, CVS never clearly explained why it was giving money to the group in the first place, and how doing so was consistent with its stated policies and goals.

CVS past support for an organization led by professed racists seems inconsistent with Mr Merlo's recent commitment to inclusion and belonging.  One wonders if he will renounce his company's previous actions.

In 2018, we also noted that CVS was making substantial contributions to the US Chamber of Commerce, which despite its bland name, some asserted had become a major source of "dark money" support for politically right-wing and pro-Trump causes.  In 2019, we noted that CEO Merlo, like many of his fellow health care corporate CEOs at the time, had become very partisan in his personal political giving.  All the money he gave around the time of the 2018 election to organizations identified with either major political party went to the Republican party.

Now that he has proclaimed his anti-racist credentials, one wonders if Mr Merlo will renounce his previous direct and indirect support of Mr Trump and his associates?

Johnson and Johnson CEO Alex Gorsky

Again, Johnson and Johnson CEO Gorsky's stance on racial inclusivity and harmony, and against racism does not seem to fit well with the company's and Gorsky's track record of coziness with Trump.

In 2017, after a rally by white nationalists in Charlotte, Virginia lead to conflicts between them and counter-protesters. Many of the latter were injured, and one was killed, Trump initially refused to take any stand against the rally, and suggested that both sides were equally responsible.  After that, some corporate leaders broke with Trump, but  at first not Gorsky.  As the outrage about Charlottesville grew, Gorsky dropped his membership in Trump's Manufacturing Council, but one year later, but then returned to Trump's in-group, as reported by CNBC:

The manufacturing council was also disbanded in August of 2017, following a wave of public resignations from its CEO members in the wake of Charlottesville.

One of these came from Alex Gorsky, who leads Johnson and Johnson. Gorsky called Trump’s response to the rally 'unacceptable,' and said in a statement that it 'has changed our decision to participate in the White House Manufacturing Advisory Council.' Nonetheless, Gorsky is on the guest list Tuesday for dinner at [Trump's] Bedminster [golf club]. A spokesman for the company did not respond to a request for comment.

In February, 2020, Vanity Fair reported that the meeting that included Trump and Gorsky at Bedminster resulted in some very suspicious activity.  Trump seemed to assume the role of salesman for a drug Johnson and Johnson just put on the market:

On March 5 [2018], Trump signed a little-noticed order to create “a national roadmap to empower 'veterans and end suicide.' That was the same day, it turned out, that the Food and Drug Administration approved the sale of Spravato, an antidepression drug manufactured by Janssen Pharmaceuticals, a J and J subsidiary.


Trump continued to be a booster of Spravato, which analysts have estimated could earn some $600 million for J and J by 2022. At a June 12 White House meeting convened to discuss the opioid crisis in America, Trump urged Robert Wilkie, who replaced Shulkin as the secretary of veterans affairs, to essentially back the truck up for Spravato at the V.A. because, Trump said, it would result in an “incredible” drop in suicide among veterans. He even offered to negotiate the price of the drug with J&J. 'I think they’ll be very generous with you,' Trump told Wilkie. 'And if you like, I’ll help you to negotiate.'

The next year,

But Trump, being Trump, was not done trumpeting the drug. In August 2019, at an AMVETS conference in Louisville, Kentucky, he repeated his view that Spravato was 'incredible' and said he’d ordered the Department of Veterans Affairs to 'get as much of it as you can from Johnson and Johnson.'

The Trump promotion of the Johnson and Johnson drug is now under investigation. 'the House Committee on Veterans’ Affairs has demanded documents and information from the V.A.

Finally, the Vanity Fair included a reminder that Trump has not only been cozy with Gorsky, but a member of the family that founded Johnson and Johnson who also may be one of the company's bigger investors:

Trump’s ambassador to the U.K., Woody Johnson, is the great-grandson of one of the founders of J and J and, reportedly, continues to own more than 1.5 million shares in the company, worth around $217 million. His net worth is said to be around $4 billion. He donated $1 million to Trump’s inaugural committee.

So it appeared that the CEO of Johnson and Johnson, and a big shareholder in the company who is descended from its founder went out of their way to cozy up to Trump, who appears to have reciprocated by doing some marketing for its drug, and possibly improperly using his executive powers to increase its use.

Furthermore, in 2018 we noted that Johnson and Johnson, like CVS, was making substantial contributions to the US Chamber of Commerce, which despite its bland name, some asserted had become a major source of "dark money" support for politically right-wing and pro-Trump causes.

Now that Gorsky is so devoted to "fighting racism and injustice," given all that Trump has done to fan the flames of racial conflict after the death of George Floyd, one wonders if Gorsky will denounce his previous coziness with Trump?


After the killing of George Floyd, the CEOs of two large health care corporations publicly espoused  racial harmony and inclusion and condemned racism.  Both these CEOs had become very friendly with President Trump, and appeared very comfortable with his policies, despite the history of non-partisanship among leadership of the health care field.

Trump, however has sought to amplify racial conflict since protests began in response to the death of Mr Floyd.  Will these CEOs now renounce their previous coziness with and support of President Trump? 

There are bigger questions. Will there now be more attention to how health care corporations have preached social responsibility, and lately racial harmony while they were quietly pushing their own agendas, which often undermined these worthy goals?  Will health care organizations disclose their ties to political leaders, including contributions to "dark money" groups? Will there be new calls for accountability for those who lead the most powerful organizations in health care?  Will there be investigations into this or other forms of regulatory capture? Will there be penalties for resulting conflicts of interest?  Or will the leaders once again manage to make even discussions of their failings taboo?