Logical Fallacies in Support of Propaganda and Disinformation

Health Care Renewal's original goal was to open discussion of US health care dysfunction.  We originally focused on issues discussed in my 2003 article (Poses RM.   A cautionary tale: the dysfunction of American health care.  Eur J Int Med 2003; 14(2): 123-130. Link here). These included ill-informed, incompetent, self-interested, conflicted or even corrupt leadership; and attacks on the scientific basis of medicine.  We soon found out that bad health leadership and attacks on science were facilitated by deceptive marketing, public relations, propaganda, and disinformation.  Furthermore, we then realized that logical fallacies were important tools used by deceptive marketers, propagandists, and disinformationists.

Introduction: Logical Fallacies

To help understand logical fallacies, we used two main sources.  One was the Nizkor project, a Holocaust educational resource, which contained a guide to logical fallacies (available here and here).  The impetus for publishing this guide was to counter the use of logical fallacies to push the agenda of holocaust deniers. Another was Logically Fallacious, a book by Bo Bennett PhD, and its accompanying website. 

Logically Fallacious defines logical fallacies thus:

Criteria for Logical Fallacies: 

It must be an error in reasoning not a factual error.

It must be commonly applied to an argument either in the form of the argument or in the interpretation of the argument. 

It must be deceptive in that it often fools the average adult.

Therefore, we will define a logical fallacy as a concept within argumentation that commonly leads to an error in reasoning due to the deceptive nature of its presentation. Logical fallacies can comprise fallacious arguments that contain one or more non-factual errors in their form or deceptive arguments that often lead to fallacious reasoning in their evaluation.

Our first semi-formal discussion of logical fallacies appeared in 2008. Its focus was how logical fallacies were used to support public relations/ propaganda about health care policy in support of the interests of pharmaceutical corporations. I confess it was rather personal.  The blog and I had come under written attack by a blogger who worked for a non-profit that was funded by and associated with the pharmaceutical industry.  The attacks featured "creative use of multiple logical fallacies."  My post attempted to analyze some examples.

Logical Fallacies in Health Care and Public Health

Since 2008 we published multiple posts about logical fallacies often featuring vivid examples. Logical fallacies were: used to obfuscate the role of an academic medical center in giving apparently preferential treatment to members of Japanese organized crime (Yakuza) (look here);  justify conflicts of interest affecting clinical researchers (look here, ); justify huge compensation given to managers of non-profit hospital systems (look here); justify a federal prosecutor who pursued unethical practices by health care corporations exiting the revolving door to become a defense attorney for such corporations (look here); justify a renowned academic medical center going into the contract research business (look here);  and justify use of a poor clinical research practice, an active run-in period before a randomized controlled trial (look here).

Then things got much wilder during the Trump years.  Early on, Trump and his enablers became known for a steady stream of propaganda and disinformation, often employing logical fallacies, and sometimes to support his health care or health policy ideas.  For example, by 2019, the Washington Post documented Trump's voluminous uses of the appeal to common belief fallacy to justify, among other things, his attacks on the Democrats health care agenda as a "disaster," and his boasts about a reform of the US Veterans Administration, reforms that actually preceded his time in office.

Then we heard about an unusual viral disease in China that quickly morphed into the COVID-19 pandemic.  Logical fallacies became a powerful tool for generating the onslaught of propaganda and disinformation about the pandemic.  The propaganda and disinformation came so fast and the pandemic situation was so unstable that I had trouble keeping up with it, other than documenting it on my Twitter feed.  However, once again logical fallacies were used by the disinformationists, eg, to justify decreases in coronavirus testing (look here); and to justify attacks against pandemic mitigation measures, such as mask wearing (look here).  

So now seems like a good time to catalog some of the logical fallacies that have most frequently or vividly been used in a health care or public health context to support deceptive marketing, propaganda, and disinformation to sell products and services, justify management behavior or misbehavior, or further leaders' self-interest.  The catalog is organized by the usual names of the cognitive fallacy arranged alphabetically.  Examples from the archive of Health Care Renewal of each fallacy will be provided.  Some will be from our early days, when logical fallacies were often used to support aspects of pharmaceutical/ biotechnology/ device company marketing and public relations practices, and to support public relations practices by hospital management and related groups.  Some will be more recent, and reflect the new (ab)normal, their widespread usage to generate propaganda and disinformation about the COVID-19 pandemic

Ad Hominem

There are several sub-types of the ad hominem fallacy. In particular, the circumstantial version is defined:

Suggesting that the person who is making the argument is biased or predisposed to take a particular stance, and therefore, the argument is necessarily invalid.

Example: Richard Epstein, a prominent market fundamentalist law professor, attacked critics of conflicts of interest affecting pharmaceutical marketing as those who "often treat the phrase 'market forces' as though it embodies the worst things in life," that is, as anti-capitalists (look here). 

Example: A physician decrying proposed restrictions on conflicts of interest in medicine called for leaders to "resist the temptation to join the separation witch hunt."  The implication is that people calling for more restrictions are witch hunters, that is embarking on a totally unreasonable and dangerous ideological crusade (look here). 

[Witch from The Lost King of Oz, Ruth Plunky Thompson, 1925]

Note that a person may be biased towards a certain point of view, and that bias could affect that person's arguments, but not necessarily.

The ad hominem tu quoque fallacy is defined:

Claiming the argument is flawed by pointing out that the one making the argument is not acting consistently with the claims of the argument.

Example: Since I worked on a project for and thus was paid as a consultant by Merck in 1997-9, it was implied my criticism of a pharmaceutical company in 2008 was hypocritical and therefore invalid (look here). 

Note that one's actions in one case do not necessarily affect one's arguments in another. 

Appeal to Authority

The appeal to authority is defined:  

Insisting that a claim is true simply because a valid authority or expert on the issue said it was true, without any other supporting evidence offered.

Example: An author tried to dismiss concerns about conflicts of interest affecting medical societies because physicians are so virtuous and responsible that conflicts could not possibly affect them (look here)  

Note that an authority may be more likely to make a valid argument, but there is no guarantee that all arguments made by an authority are valid.

Appeal to Common Belief

The appeal to common belief is defined:

 When the claim that most or many people in general or of a particular group accept a belief as true is presented as evidence for the claim.

Example: President Trump claimed that everyone knew that the Democratic health care policies were a "disaster," and that his reforms of the VA were extremely significant (although they were actually enacted during the previous administration (see the Washington Post in 2019). 

Just because many people believe something does not make it true.

Appeal to Common Practice 

The appeal to common practice has the following structure:

X is a common action.

Therefore, X is correct/moral/justified/reasonable etc 

Example: An author tried to dismiss concerns about conflicts of interest affecting physicians, particularly research physicians by saying publication bias "has been reported for more than 2 decades," implying that because it is common, worry is uncalled for (look here). 

Example: The CEO of a renowned academic medical center, formerly a high paid biotechnology executive, defended its venture into the contract research business by saying ""universities need to recognize this is how things are," and "the old way of doing things doesn't really work anymore." (Look here)

Just because some people do something does not mean what they do is justified, or based on truth.

Appeal to Fear

There are many kinds of appeals to emotion, generally defined as.

the general category of many fallacies that use emotion in place of reason in order to attempt to win the argument.  It is a type of manipulation used in place of valid logic.

The appeal to fear is one sub-type.  It is defined:

 When fear, not based on evidence or reason, is being used as the primary motivator to get others to accept an idea, proposition, or conclusion.

Example: A physician decrying proposed restrictions on conflicts of interest in medicine warned that "Those institutions that choose such inquisitional approaches will be blighted and suffer competitive disadvantages." The use of the emotionally charged word "blighted," in the absence of a clear argument that the blight would necessarily occur, made this an appeal to emotion, particularly fear (look here). 

Just because something is feared does not make it more likely.

Appeal to False Authority 

This is related to the appeal to authority, above.  The appeal to false authority is defined:

Using an alleged authority as evidence in your argument when the authority is not really an authority on the facts relevant to the argument.

Example: The CEO of a state hospital association justified the huge compensation given to local hospital system CEOs by quoting "management expert Peter Drucker" who asserted that hospital management is particularly difficult.  Note that she provided no evidence that Mr Drucker has any special expertise about health care (look here).  

Just because someone is said to be an expert in a particular field does not mean that person is an expert.  Just because a person is an expert does not make an argument based on that person's opinions right.

 Appeal to Ignorance

 This is also known as argument from ignorance.  Its definition is:

The assumption of a conclusion or fact based primarily on lack of evidence to the contrary.  Usually best described by, 'absence of evidence is not evidence of absence.'

Newer Example: President Trump called for a decrease in coronavirus testing apparently because he believes that diagnosing fewer cases would mean less actual disease: "Here's the bad part ... when you do testing to that extent, you're going to find more people; you're going to find more cases. So I said to my people, slow the testing down please." (look here and here). 

Newer Example: Governor Kristi Noem of South Dakota also claimed that there were more cases of coronavirus, and hence more hospitalizations for coronavirus in her state than other states because the state was testing at a higher rate (look here).  Thus she and the president seemed to equate diagnosis with disease, and were arguing that if there is less evidence of disease, there must be less actual disease.

Failure to see or detect something does not mean it does not exist.

Slippery Slope

The definition of the slippery slope is:

When a relatively insignificant first event is suggested to lead to a more significant event, which in turn leads to a more significant event, and so on, until some ultimate, significant event is reached, where the connection of each event is not only unwarranted but with each step it becomes more and more improbable.

Example: Richard Epstein, a prominent market fundamentalist law professor, attacked proposals of new restrictions on conflicts of interest affecting pharmaceutical marketing as leading to the prohibition of "the collaborative efforts that have long characterized standard practices [in research]." Yet none of the proposals he mentioned would have directly affected collaboration per se (look here).

Although things may appear to occur in sequence, a chain of causation may not be inevitable.

Special Pleading

The definition of special pleading is:

a fallacy in which a person applies standards, principles, rules, etc. to others while taking herself (or those she has a special interest in) to be exempt, without providing adequate justification for the exemption.

Example: An author attacked the credibility of a published critique of conflicts of interest affecting research sponsored by a particular drug company by saying that critique's authors had failed to completely disclose their alleged conflicts.  They were consultants to attorneys for plaintiffs who had sued the company.  Yet the author did not completely disclose his own conflicts in his article attacking the critiques, suggesting that he believed other people should have to fully disclose conflicts of interest, but he was exempt  (look here).

Straw Man

 [Scarecrow from Dorothy and the Wizard of Oz, L Frank Baum, 1908]

The definition of the straw man fallacy is:

when a person simply ignores a person's actual position and substitutes a distorted, exaggerated or misrepresented version of that position. 

Example: Because I had criticized manipulation and suppression of clinical research about particular drugs (SSRIs, Avandia, Vytorin), my critic implied "I suggested 'people should stop taking SSRIs, Avandia, and Vytorin.' He then added 'now I guess this should also apply to Zocor.'"  However, I had stated no such thing. (Look here)

Newer Example: A state Republican Chairman argued against pandemic mitigation members saying "We can’t live in a world where there’s never again a live, in-person concert or convention or gathering"  No one had credibly argued that pandemic mitigation meant that no such things would ever happen. (look here). 

Other Logical Fallacies Used to Support Propaganda or Disinformation

There are many other logical fallacies.  Some that have been used frequently lately by disinformationists in the political arena include:

- the abusive ad hominem fallacy: "Attacking the person making the argument, rather than the argument itself, when the attack on the person is completely irrelevant to the argument the person is making;" 

- cherry picking: "When only select evidence is presented in order to persuade the audience to accept a position, and evidence that would go against the position is withheld.

-the false dilemma: "When only two choices are presented yet more exist, or a spectrum of possible choices exists between two extremes.  False dilemmas are usually characterized by “either this or that” language"

- the red herring fallacy: "Attempting to redirect the argument to another issue to which the person doing the redirecting can better respond" 

Perusal of Logically Fallacious and the Nizkor project, as well as a number of other good sources, will reveal a catalog of fallacies and errors of reasoning, most of which are being used in contemporary political and sometimes specifically health care and public health related propaganda and disinformation.

Summary- Propaganda, Disinformation, and Logical Fallacies

As we noted recently, the coronavirus pandemic has been accompanied by a pandemic of disinformation, sometimes called the "infodemic."  In the US, while it would have seemed unthinkable up to 5 years ago, the biggest source of disinformation has been President Donald Trump (look here). Although Trump is now out of office, the barrage of coronavirus disinformation has continued apparently unabated, propagated by Trump's supporters (look here), foreign powers, eg, Russia (look here), and various anonymous internet-based trolls, bots, etc. The infodemic has likely had a major role in amplifying the pandemic by discouraging peoples' cooperation with pandemic control measures, and now generating vaccine hesitancy.  The result has likely been considerable morbidity and death.
If we hope to reduce suffering and death from the pandemic, we will need to confront the propaganda and disinformation that is driving it.

 Propaganda and disinformation operate through multiple mechanisms, including various forms of deception including manipulation and suppression of evidence; generation of specious arguments, including via the use of logical fallacies; and appeals to emotion and manipulation of human psychology.  Better understanding of logical fallacies will help us better counter propaganda and disinformation. 

Will US Health Care Leadership Challenge President Donald Trump's Propagation of Coronavirus Disinformation, a Major Source of the "Infodemic"?

Introduction: The Plight of Health Care Professionals Who Challenge the "Infodemic"

The coronavirus pandemic has been accompanied by a disinformation pandemic, sometimes called the "infodemic."  We have discussed how individual health care professionals trying to counter disinformation by educating patients and the public have encountered resistance, opposition and worse.  Here we discussed how 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."  Here we discussed how health care professionals who tried to counter disinformation online were subject to online challenges, insults and threats, and worse, how President Trump's campaign was organizing a cadre of "extremely pro-Trump" professionals who would parrot his messages, no matter how disinformative.

The Worsening Infodemic

Since then the disinformation problem has gotten much worse.  A recent study by Islam and colleages(1)

identified 2,311 reports of rumors, stigma, and conspiracy theories in 25 languages from 87 countries. Claims were related to illness, transmission and mortality (24%), control measures (21%), treatment and cure (19%), cause of disease including the origin (15%), violence (1%), and miscellaneous (20%). Of the 2,276 reports for which text ratings were available, 1,856 claims were false (82%).

So the challenge to health care professionals from disinformation has gotten much worse. On August 18, 2020, the New York Times reported

Doctors on the front lines of the global pandemic say they are fighting not just the coronavirus, but also increasingly combating a never-ending scourge of misinformation about the disease that is hurting patients.

The Times article included multiple anecdotes suggesting that the infodemic is directly harming patients:

An internist in New York treated a vomiting patient in May who drank a bleach mixture as part of a fake virus cure found on YouTube.

And in June a paramedic in Britain aided a clearly sick man who had refused to go to a hospital after reading misleading warnings about poor coronavirus treatment on social media.

Also,

Dr. Ryan Stanton, an emergency room physician in Kentucky, said a number of sick patients had waited until it was nearly too late to visit a hospital because they were convinced by what they had read online that Covid-19 was fake or 'no big deal.'

Similarly, the article by Islam et al noted estimates of the numbers of people who may have had adverse effects because of actions they took in response to disinformation: 800 dead and 5876 hospitalized world-wide after "consuming methanol as a cure for coronavirus"; "rumors have been the reported cause of 30 deaths in Turkey;" etc.

According to the Times article, health professionals who tried to challenge disinformation did not find it easy:

An emergency room doctor in Illinois was accused in April of profiting from naming coronavirus as the cause of a patient’s death, a rumor spreading online.

Also,

Some doctors say they face abuse when they participate in online discussions to correct the record.

And,

Dr. Mell, the physician in Illinois, encounters regular abuse from Facebook users when he has pushed back on false information.

Presumably efforts to combat disinformation should be informed by understanding of its sources.  The Times article briefly discussed physicians opinions of them. 

Before the pandemic, medical professionals had grown accustomed to dealing with patients misled by online information, a phenomenon they called Dr. Google. But in interviews, more than a dozen doctors and misinformation researchers in the United States and Europe said the volume related to the virus was like nothing they had seen before. They blamed leaders like President Trump for amplifying fringe theories, the social media platforms for not doing enough to stamp out false information and individuals for being too quick to believe what they see online.

A Major Source of the Infodemic: the US President and His Cronies

It would have been unthinkable a few years ago, but some physicians now are willing to state that a major source of dangerous health care disinformation is the current US president.

[Trump Chicago Hotel]


 In fact, the media has been replete with accounts of such disinformation propagated by President Trump.  Multiple  articles have cataloged examples of such disinformation.  The most recently updated were in published  in August, 2020, in the Washington Post, and the Atlantic.

Here is a summary of instances of disinformation that Mr Trump has peddled related to the coronavirus pandemic.  Sources are the two articles above or as noted.

Epidemiology, Diagnosis, Prognosis

The coronavirus is the same as influenza: "This is a flu.  This is like a flu." (from the Washington Post, March, 2020.)  However, coronavirus differs from the flu in its structure, epidemiology and clinical manifestations.

The coronavirus pandemic would spontaneously diminish or vanish, e.g., "disappear," "fade away," or "go away."  There is no rationale for this, and no trend in this direction in the US.

The pandemic is already going away, e.g., “Coronavirus numbers are looking MUCH better, going down almost everywhere,” and cases are “coming way down.”  The national case rate did decrease for a time, but then greatly increased, and now is considerably higher than it was a few months ago.

COVID-19 is not a severe disease, especially for children, e.g., children are "virtually immune," "99% of COVID-19 cases are 'totally harmless'" There is no evidence children are immune.  Cases in children are now rising.  The rate of significant morbidity or death is much higher than 1%.

Tests for coronavirus in the US are extremely accessible, e.g., "anybody that needs a test gets a test," "we're going up proportionally very rapidly," the US has done more testing "than all other countries combined."  There have been multiple reports of shortfalls in and inaccessibility of testing.

The US case rate is high because the US testing rate is so high: "There is a rise in Coronavirus cases because our testing is so massive and so good, far bigger and better than any other country." (from the Independent, July, 2020.)  By many measures, the US testing rate is lower than that of many other developed countries.

If testing stopped, then there would be no more cases, e.g. "If we stop testing right now, we'd have very few cases, if any." (from the Independent, June, 2020.)  This appears to be an instance of the logical fallacy of the appeal to ignorance, often characterized as "absence of evidence does not imply evidence of evidence" (see this from Logically Fallacious). 


Prevention, Management, Treatment

Hydroxychloroquine is safe and effective as a treatment or preventative drug, e.g., "I happen to be a believer in hydroxy.  I used it.  I had not problem,"  There is no good evidence that hydroxychloroquine is an effective treatment or preventative measure.  There is evidence that it has important and not rare adverse effects.

Bleaches or disinfectants could be administered internally for prevention or treatment  (from the New York Times, April, 2020.)  Doing so actually would be extremely dangerous, and possibly fatal. Note that there is reason to suspect that Trump's disinformation on this topic has harmed people. After he publicly discussed using bleach or disinfectant internally as a treatment for coronavirus, calls to poison control centers seemed to rise (from Vox, April, 2020.)  The article by Islam et al noted instances of patients harmed by ingesting disinfectant.

No Organized Challenges to Trump's Disinformation from Health Care Professionals

Donald Trump has extensively promoted disinformation about the coronavirus.  As US President, he commands a substantial "bully pulpit."  Essentially everything he says publicly is reported by US and foreign media.  He holds forth on Twitter daily, reaching millions of followers.  Thus his information is influential, and apparently dangerous.

Health care professionals have seen patients whose beliefs about the coronavirus pandemic are now apparently inspired by disinformation, including specific points pushed by Mr Trump.  These beliefs have led to dangerous actions, and at times adverse effects.  Professionals sworn to put their patients' welfare ahead of all other concerns are thus in a bind, needing to challenge the leader of the richest country in the world to persuade their patients to avoid dangerous choices.

While physicians on the front lines are now struggling with how to best deal with the disinformation influencing their patients coming from the highest office in the US, they have gotten little support from their leaders.  I found only a few instances of physicians in positions of leadership and influence willing to challenge President Trump.

The most direct challenge was found in an editorial in the British Medical Journal by two American authors, both academics at respected institutions, one a full professor in a global health institute.  The authors had the courage to entitle their article "Donald Trump: a political determinant of covid-19." (2)  They asserted that

After the US confirmed its first case of covid-19 on 22 January 2020, Trump responded with false reassurances, delayed federal action, and the denigration of science.

In particular, they were willing to state:

Trump’s anti-scientific pronouncements during covid-19 have been particularly perilous. On 28 February, he said that the coronavirus would soon disappear on its own 'like a miracle.' On 21 March, he promoted the anti-malarial drug hydroxychloroquine for 'use immediately' as a treatment, despite the lack of evidence for its effectiveness. His promotion triggered 'panic-buying, skyrocketing prices, and overdoses in malaria-prone regions in Africa and South Asia,' and led to shortages of the drug for those who need it to treat other conditions such as lupus, for which it has proved benefit. Rick Bright, the director of the US agency that oversees covid-19 vaccine development, says he was removed from his post because he questioned Trump’s promotion of hydroxychloroquine. On the day that the CDC advised the public to wear face masks, Trump said he would not wear one himself. On 23 April, Trump suggested that injecting disinfectant or bringing 'light inside the body' could cure covid-19, prompting experts to urgently warn the public against inhaling or ingesting bleach.

Beyond this moral clarity, I could find only one other instance of a senior academic physician directly challenging Trump, and that was only indirectly about Trump's enthusiasm for disinformation.  From the Independent, July, 2020:

A leading professor of medicine has called president Donald Trump 'unteachable' on the subject of masks and said that it indicates he is not competent to manage the response to the coronavirus pandemic.

In an appearance on CNN, Dr Jonathan Reiner, professor at the George Washington School of Medicine & Health Sciences, responded to the president’s latest remarks regarding the wearing of masks.

'He is unteachable and I can’t understand it. His failure to understand this simple public health measure, his reluctance to accept the advice of all of his public health experts, makes me wonder whether he is qualified now to manage this.'

I have so far found no other instances of leading academics, like professors, chairpersons, deans, chancellors, vice-presidents for health affairs, university presidents; or of journal editors, hospital executives, leaders of professional societies, executives of health care corporations, etc, etc who were willing to publicly challenge Trump's disinformation.  I have found no official statements from any of these institutions or organizations that challenge Trump's disinformation. 

At best, medical societies have put out statements reiterating the need to base policy about the pandemic on the best evidence.  For example, the American College of Physicians put out a statement that supported "the use of scientific expertise, based on the best available evidence, in the fight against COVID-19." However, these statements do not explain the context, that is, how the current president has denigrated scientific expertise and evidence as informative in efforts to manage the pandemic.

Fighting a deadly pandemic is hard enough.  It is gut wrenching that the fight is being subverted by political leaders spreading disinformation.  It is sad that front line clinicians are hardly supported by those who claim to lead them.  Where is the courage?  Where is the outrage?

"If not now, when?"


References

1.  Islam MS, Sarkar T, Khan et al. COVID-19-related infodemic and its impact on public health: a global social media analysis. Am J Trop Med Hyg 2020. Link here

2. Yamey G, Gonsalves G. Donald Trump: a political determinant of covid-19. Brit Med J 2020; ; 369 doi: https://doi.org/10.1136/bmj.m1643. Link here.

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.

Finally,

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.

Summary


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.

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

Introduction

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

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

Then

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.

Nonetheless,

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.

Furthermore,

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.

Furthermore,

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.

Conclusion

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.