Pernicious

What conclusions should we draw from this account of the story of testing for COVID-19 in the United States, published in the Houston Chronicole? I think it’s summed up pretty well in one quote, from an exasperated researcher:

“The most pernicious effect of the current regulatory environment is that it kneecaps our ability for preparedness should a true emergency emerge,” Greninger wrote to colleagues on Feb. 14.

or maybe the conclusion of the article:

On March 12, Fauci, who runs the National Institute of Allergy and Infectious Diseases, told lawmakers the problem was not simply the failure of the CDC test. The coronavirus testing debacle had exposed deep structural problems in the nation’s public health system, he said.

“Yeah, it is a failure, let’s admit it,” he said. “The idea of anybody getting it easily the way people in other countries are doing it, we’re not set up for that. Do I think we should be? Yes, but we’re not.”

Bureaucracts and political appointees may have succeeded in killing thousands of Americans.

14 comments… add one
  • TarsTarkas Link

    And Dr. Fauci is still at it. Hinting at shutdowns should continue until there are no new cases of Kung Flu, pooh-poohing HCQ until it has passed the FDA’s double-blind tests, etc. etc. All to cover his ass, because if he’s wrong, he was just erring on the side of caution, and if he’s right and POTUS didn’t follow his recommendation, he’s the heroic Cassandra and POTUS is the heartless monster who killed granny.

  • steve Link

    It is the job of leadership to cut through that bureaucracy.

    Fauci could be poo-pooing HCQ because he is talking to docs caring for patients. As i said we arent seeing a noticeable effect with our hospitalized patients. So either we are unlucky, it has a small effect hard to sort out, or it is mostly useful for milder cases.

    Several of the ICU docs we have working in our group trained at NYC hospitals and I hired another one working in NYC right now doing his fellowship in critical care. That is what they are seeing also. Certainly not seeing the kind of big obvious change we have seen with other drugs that have been effective with infectious diseases. Mostly, I suspect this is just the product of his being inexperienced doc. Miracle drugs rarely pan out and by history it seems like they do more harm than good.

    Steve

  • steve Link

    Oops, meant an experienced not inexperienced.

  • Andy Link

    Our government is sclerotic. It’s something only the Congress and Executive together can fix. Unfortunately, despite the glaringly obvious problems, neither party has any interest. 9/11 didn’t change it and it’s looking like Covid won’t either.

  • CuriousOnlooker Link

    The post reminded me of this interview with a South Korea medical expert who is treating patients and advising the government.

    https://www.youtube.com/watch?v=gAk7aX5hksU

    Its at the end — Dr Kim made a wry observation – “this is science, you have to be humble. The moment we become arrogant, we’ll lose.”

    I think that’s really it — until the President, the Congress, the bureaucracy, the States, citizenry have that attitude — on dealing with any risk or potential danger — things won’t change.

  • GreyShambler Link

    Then again, are shortages real? Or real because of fear on steroids.
    This link I copied from the comments section of new article in Quillette.

    https://theinfectiousmyth.com/CoronavirusRAQ.php

    Basically, is social media, the 24/7 news cycle, body counts without the context of normal death rates. Improper data on cause of death, magnifying fear of this virus, causing everyone to over-react, err on the side of caution. Are these things actually the cause of the shortages.
    I’m no doctor, but I can easily see that the toilet paper shortage is of this mold. Maybe it holds true for other supplies as well.

  • GreyShambler Link

    And again, as to a shortage of ventilators, being placed in isolation in ICU, with a breathing tube in your lungs, prevented from having loved ones visit, only to most certainly die after 2 or 3 weeks of hell is something we all might want to reconsider beforehand.
    https://www.npr.org/2020/04/01/825499422/ventilators-can-save-lives-of-some-covid-19-patients-but-theyre-no-panacea

  • TarsTarkas Link

    Steve: You’re on the ground floor of the pandemic, so your experience counts for a lot to me. Sorry to hear that you’re saying it is not all that effective with your patients. South Korea obviously seemed to think HCQ worked, the French and Germans do, and others here in the states. Certainly hoarding a la TP has begun for the drug and its relatives as a result.
    So far from my surfing of the web the bad outbreaks stressing the medical infrastructure are still pretty localized. NYC and burbs around it, New Orleans and southern Louisiana, a couple of other hotspots. LA and all of California seems to be thankfully quiet. There is some talk that California actually had an unrecognized wave of it pass through late last year. Won’t know until more tests, and probably won’t get those until they become more widely available when the worst is over. The testing mentioned in Scientific American (which I get but haven’t yet received) is interesting from an academic point of view, but IMO it’s more like checking an empty stable for the quantity of s**t left in the stalls by its former occupants.

    Stay healthy. Stay safe. Don’t get too stressed out by the political BS. You’re doing what you can do and that is all anybody can ask of you and everybody in your profession.

  • Guarneri Link

    Shorter: Government bureaucracies suck. Who knew? And you want them to run health care, welfare, education…….

  • bob sykes Link

    “the nation’s public health system”

    Of course, no such thing exists. What we have is a collection of local (not State) “systems,” and actually the local “systems” consist of competing providers and insurers.

    All of the talking heads I have seen on TV are unaware (or hate) that we have a federal system of government, and one, moreover, that favors local town and city control whenever possible.

    There are serious legal and constitutional limits on what the federal government can do, and that is by deliberate design. The President and Congress and CDC can do little more than advise and sway governors and mayors. Most of the recommendations would require the conversion of the US into a highly centralized system like the French have. Trump would appoint governors and mayors, and tell them what to do.

  • Jan Link

    Just some odds and ends:

    One NYC ICU physician is questioning what he sees might be an overuse of ventilators – people who are starved of oxygen but still have good musculature to ventilate for themselves. By forcing ventilators to push the oxygen, the lungs may actually be damaged more.

    The use of hydroxochloroquine has been noted to be the best available drug to use, in lieu of nothing else on the market, to stave off this new virus. It has been administered, globally, both preventively as well as a last ditch effort to save a life. I think, while there is nothing better on the market, it’s near-sighted of politicians who stand firm in rebuffing those who want to prescribe it to their patients. For those physicians who voice skepticism, because of the absence of their own eyes-on positive experiences, I would hope they could practice some benefit-of-the-doubt thinking, during times where clinical trials creating well-tested remedies are in short supply.

    Finally, going hand-in-hand with the inconsistencies of projected outcomes, there appears to be some hospitals, across the country, unduly suffering from a shortage of patients, creating hospital staffs to be laid off. Even the hospital ships, Mercy & Comfort, are overstaffed and underutilized, all the while tents are being erected for an anticipated overflow that so far is not materializing. Pictures, manifested in coverage by the news media, are not frequently matching a lot of pictures on the ground. ?????

  • CStanley Link

    I saw a video by the ICU doc Jan mentions and found a few more docs also questioning ventilator use. Saw one report that maybe Covid19 hypoxia isn’t (or isn’t always) an ARDS situation but instead either a perfusion mismatch or possibly the virus is attacking hemoglobin. In either of those cases the idea is that ventilators may not help and may do more harm than good. Don’t know if this is accurate or noise.

  • Probably noise but I’d be interested in theories as to why the pace of recovery is so slow.

  • Icepick Link

    So either we are unlucky, it has a small effect hard to sort out, or it is mostly useful for milder cases.

    I have heard that it is mostly useful on milder cases. This is a case for using it before ppl get to the ICU, is it not?

    There were also reports at times that by the time patients get to the ICU, their viral loads have already dropped considerably. If true, this would explain why a treatment meant to slow the virus would have little impart on ICU patients.

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