Minor Thoughts from me to you

I've been as hesitant as anyone else to send children back to school. It seemed like a recipe for disaster—pulling together children from across the community, putting them together all day to spread sickness around, and then sending them back home to infect their families. But the research shows that school can be very safe. We should reopen schools and let every family send their children.

Kids and Covid: Schools can reopen safely now

Benjamin P. Linas, writing at Vox.

When Covid began to spread in the US last year, teachers were right to be worried about schools. We knew almost nothing about the virus’s spread. Operating schools under business-as-usual conditions very well could have led to more infections among teachers, students, and people in the community.

But since then, we have accumulated a massive amount of data about how to keep schools open safely.

First, last spring, we observed the experiences of other countries like Scotland, Singapore, and France, where schools reopened and masks and social distancing seemed to prevent large-scale transmission.

In the US, epidemiologists compared the timing of school closures to changes in Covid incidence. Some studies found that school closures might have reduced the spread of illness, but the findings are complicated because we were also making other major public health changes at the same time. And overall they failed to find a strong link.

Data and patterns also began to emerge about children’s Covid-19 test results and their exposures. Playdates with friends emerged as the common exposure among the infected; time in school did not.

Still, as reassuring as the data were, they were all indirect. The gold standard to learn if schools can open safely is fairly simple: Open schools, measure Covid incidence, and see what happens. Many US school districts have now done this, and we have the data.

First, researchers in North Carolina published results from 11 school districts and over 100,000 students and staff. Schools in those districts employed mandatory masking and six-foot distancing where feasible, but no major capital improvement to HVAC systems or buildings. In the first quarter of this school year, they found the rate of transmission of Covid in schools was dramatically lower (roughly 1/25) than the level of transmission in the community. Among all of the Covid-19 infections observed in school, the state health department’s tracers found 96 percent were acquired in the community, and there were no documented cases of the virus passing from child to adult in schools — zero.

Second, a similar study followed 17 schools in Wisconsin. Like North Carolina, those schools required masks indoors, three-foot distancing with effort to distance farther whenever feasible, and no major capital improvements. Between August 31 and November 29, with over 4,500 students and 650 staff, they found seven cases of Covid transmission to children and also found no cases of Covid transmission to educators in the buildings. Further, these schools eliminated Covid transmission at the same time that the surrounding community saw a rapid rise in Covid-19 cases.

A third important preprint study analyzes data from two schools in Atlanta. This study is small, but it is important because the schools were conducting routine asymptomatic screening of students, teachers, and staff. In Atlanta, 72 percent of the limited number of transmission events in one school were known to be the result of non-compliance with masking. And again here, there were no cases transmitted from students to teachers.

Sadly, at the same time that we are learning definitively that we can open schools safely and essentially prevent Covid transmission, data are emerging about the real damage being done to children by prolonged remote learning, including a rise in the use of pediatric emergency rooms for psychiatric illnesses, increasing anxiety and depression symptoms, losses in learning progress, and large racial disparities in both the availability of in-person instruction, and educational achievement.

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At the same time, teachers also need to recognize that full vaccination is not a prerequisite for safe schools, as some educator unions have called for. We did not have a vaccine in North Carolina or Wisconsin when they safely opened schools in August 2020.

We must also not let other demands, such as universal asymptomatic testing or large-scale capital improvements to buildings, stymie the return to in-person learning. Yes, we should be working to implement more screening in schools and improving air exchange, but we can do that in parallel with re-opening. We know now from good data that we can effectively stop Covid-19 at the school doors and get American education back on track without these things. Essentially, all we need to safely reopen schools are mask mandates, reasonable distancing of at least three feet, minor and affordable upgrades to existing HVAC systems, and teachers.

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A realistic plan for reopening schools is to immediately begin bringing the youngest learners back to full-time, in-person learning with strict guidance for masking indoors, three-foot minimal distancing with effort to maximize distance as much as possible. Districts can certainly conduct air-exchange surveys in classrooms as an extra precautionary measure and use simple and affordable mitigation strategies for suboptimal conditions, such as upgrading HVAC filters, opening windows, and deploying portable HEPA filters in problem spaces.

“Today, the best evidence suggests that about half of Covid-19 cases are caused by infected people who do not have symptoms when they pass on the virus.”

Asymptomatic infection blunder let Covid-19 spin out of control

Daniel P. Oran and Eric J. Topol writing for STAT.

At least one of three people infected with SARS-CoV-2, the virus that causes Covid-19, do not develop symptoms. That’s the conclusion of a review we just published in the Annals of Internal Medicine. It summarizes the results of 61 studies with more than 1.8 million people.

… But during much of the pandemic, fierce resistance — and even outright denialism — in acknowledging this not-so-typical disease pattern led to ineffective testing practices that allowed the pandemic to spin out of control.

In June, when we published a report of 16 cohorts with sizable proportions of asymptomatic infection and suggested that it might play a role in the progression of the pandemic, several researchers wrote letters to the editor demanding that our paper be retracted.

Today, the best evidence suggests that about half of Covid-19 cases are caused by infected people who do not have symptoms when they pass on the virus. These symptom-free spreaders are roughly divided between those who later develop symptoms, known as pre-symptomatic individuals, and those who never develop symptoms.

While the importance of asymptomatic infection in understanding Covid-19 has been surprising to some, infectious disease experts have long known that infection without symptoms is common in many illnesses. More than 90% of people infected with poliovirus have no symptoms. And about 75% of influenza infections have been estimated to be asymptomatic. Yet these important precedents have largely been ignored.

Asymptomatic coronavirus infection is not necessarily benign. Several studies have reported abnormal lung scans in those infected without symptoms, as well as myocarditis, a type of heart inflammation. The long-term health implications of asymptomatic infection aren’t known.

Even though knowledge about asymptomatic infection has greatly evolved, tactics for combating the pandemic have not. It is now obvious that testing only those with symptoms, as was common early in the pandemic, is a mistake because it ignores the invisible legions of infected people who have no symptoms.

“Vaccines don’t save people; vaccinations do”.

Opinion | Biden’s Covid-19 Plan Is Maddeningly Obvious — The New York Times

Ezra Klein, in an op-ed for the New York Times.

I wish I could tell you that the incoming Biden administration had a genius plan for combating Covid-19, thick with ideas no one else had thought of and strategies no one else had tried. But it doesn’t.

What it does have is the obvious plan for combating Covid-19, full of ideas many others have thought of and strategies it is appalling we haven’t yet tried. That it is possible for Joe Biden and his team to release a plan this straightforward is the most damning indictment of the Trump administration’s coronavirus response imaginable.

The Trump administration seemed to believe a vaccine would solve the coronavirus problem, freeing President Trump and his advisers of the pesky work of governance. But vaccines don’t save people; vaccinations do. And vaccinating more than 300 million people, at breakneck speed, is a challenge that only the federal government has the resources to meet. The Trump administration, in other words, had it backward. The development of the vaccines meant merely that the most logistically daunting phase of the crisis, in terms of the federal government’s role, could finally begin.

In the absence of a coordinated federal campaign, the job has fallen to overstretched, underresourced state and local governments, with predictably wan results. According to data from the Centers for Disease Control and Prevention, of the roughly 31 million doses that have been sent out, about 12 million have been used.

The incompetence of the Trump administration continually surprises me. They’re constantly finding new depths to break through. This is, apparently, what happens when major cabinet departments are left leaderless and the President is more interested in overturning an election than in doing the governing that he was originally elected to do. I thank God that it’s only 5 more days until we get a new President and a new leadership team.

There is no COVID vaccine reserve. Trump admin already shipped it | Ars Technica

The Trump administration announced Tuesday, January 12, that it would begin shipping reserved vaccine supplies, raising hopes that states may see their vaccine supply potentially double as they work to accelerate the sluggish immunization campaign. But according to a report by The Washington Post, that promised vaccine stockpile doesn’t actually exist—it was already shipped out—and the limited vaccine supply available to states will remain as it is for now.

The news has not only left state health officials angry and confused by the false promises, they’re also left scrambling to sort out distribution changes. In addition to claiming they would release the (non-existent) stockpile, Trump administration officials told states to expand access to vaccines—now allowing anyone over age 65 to get vaccinated and people under 65 who have a documented underlying health condition that makes them more vulnerable to COVID-19.

… Amid the chaos, the Trump administration isn’t offering clear answers on what happened or why officials misled states. According to the Post’s reporting, the Trump administration stopped reserving second doses of the Pfizer-BioNTech vaccine at the end of last year, and the last reserves of Moderna’s vaccine supply were shipped out over the past weekend.

There was no stockpile to release on Tuesday when the Health and Human Services secretary said at a press briefing that "because we now have a consistent pace of production, we can now ship all of the doses that had been held in physical reserve.”

Dave Ramsey, noted Christian financial guru, is an unkind, abusive employer. How else do you describe the fact that he freely admits that COVID cases are out of control at his company, but that employees are not allowed to work from home? The only choice he gives his employees is coming to an infected workplace or quitting their job. He’s also suing a hotel for trying to institute safety measures at one of his conferences.

Ramsey has the audacity to say that “fear is not a fruit of the spirit” and “I do not let my behaviors be — dictated by fear unless it involves getting out of the way of a car that is coming toward me.” His statement is profoundly silly. COVID can mess you up just as bad as a car. Or worse. So why are you “getting out of the way of a car that is coming toward [you]”, but not getting out of COVID’s way? After all, most drivers will swerve around you. And if God wants to “call you home”, who are you to interfere with God’s plan by leaping aside? Or by wearing a seatbelt while driving?

After suggesting that staff members quit their job if they were worried about COVID, Ramsey’s HR director said “It is harsh and hard for me to say this”. Surprisingly, he didn’t seem to question whether or not he should be saying harsh things. I would suggest that Christians should be thinking long and hard before criticizing people’s fear and saying “harsh and hard” things about where to work, especially during a global pandemic. I don’t know what kind of a business Ramsey is running, but it’s not one that Jesus would claim.

Here are some of the actual fruits of the spirit: “love, forbearance, kindness, goodness, gentleness”. Too bad no one ever told Dave Ramsey that those fruits of the spirit apply to running a business and interacting with one’s employees.

Dave Ramsey, Christian personal finance guru, defies COVID-19 to keep staff at desks

by Bob Smietana, for Religion News.

Ramsey Solutions does not require masks at its offices — Dave Ramsey himself has been a vocal opponent of mask-wearing and other COVID restrictions. In a clip from his daily radio show, posted on YouTube in November, Ramsey railed against what he called “totalitarian” government restrictions and mask mandates, saying he wanted to “start a crusade” against them.

The Dave Ramsey Show is known for its host’s folksy financial advice balanced with a moralizing disdain for debt. One of the show’s highlights is a listener’s call featuring a “debt-free scream” to mark their liberation from consumer debt using Ramsey’s methods.

Since March, Ramsey Solutions has had about 100 cases of COVID-19 among its employees, according to a recording of a mid-November staff call obtained by Religion News Service.

Among that number were about 50 cases in mid-November, Ramsey Solutions Executive Director of Human Resources Armando Lopez told staff on the Nov. 13 call.

“There are 50 people that are somewhere in the neighborhood who are either positive or returning to work,” Lopez said.

Ramsey Solutions did not respond to multiple requests for comment from Lopez or other leaders.

During the November call, Lopez acknowledged the entire country — including suburban Williamson County, where Ramsey Solutions is located — was seeing spiking COVID-19 numbers. “Williamson County has seen a huge increase in COVID cases. And so have we. Ramsey Solutions has seen a huge spike,” said Lopez.

The human resources director also said he feared the numbers were higher, admitting the company lacked an accurate system for tracking COVID-19 cases.

Despite the number of positive cases, Lopez told staff in November there were no plans to allow remote working. The company allowed staff to work from home during the initial weeks of the pandemic but has required them to return to company headquarters since May.

Lopez said Ramsey Solutions leadership had decided it was not “a work from home employer.”

“Can we be a work from home employer for a short period of time?” he said on the Nov. 13 call. “We have proven for five weeks it works. Can we? Yes. Are we? No.”

That message was repeated in a company newsletter sent on Nov. 20, which reported 32 positive cases among staff and another 17 staff awaiting tests. The newsletter encouraged staff to report any COVID-19 test results to human resources but maintained that the company would continue operating out of headquarters.

“We know that many of you have felt pressure from family and friends, some of whom think you are ‘weird’ for still going in to work,” said the newsletter.

“Fortunately we work in a place that is used to being called weird,” the newsletter continued, then highlighted Ramsey Solutions’ “countercultural approach to business.”

“And now we are weird for following common sense and using logic in providing for our families and our customers,” according to the newsletter.

During the mid-November call with staff, Lopez said company leaders were not able to keep up with requests for exemptions to work from home, and employees were the best people to judge what is the right thing to do for their health. Some might decide they need to choose to quit their jobs, he said.

“We know we are going to lose some people through this,” he said. “It is harsh and hard for me to say this.”

The company has advised workers to social distance if possible and to stay home if they feel sick. In staff newsletters, the company has encouraged testing for COVID-19 but has also shared articles claiming the threat of COVID-19 has been exaggerated by the media.

“We are all adults here,” Luke Lefevre, a creative director at Ramsey, told employees in the Nov. 20 newsletter. “If you want to wear a mask, wear a mask. Give yourself healthy space from others. Use the stairs if you can. Don’t be careless.”

The company has also continued to hold large events during the pandemic, including its “EntreLeadership Summit” in July. That event was scheduled to be held at the Gaylord Palms Resort & Convention Center in Kissimmee, Florida, near Orlando, but Ramsey moved the event to its Franklin offices after the Gaylord informed the company of significant COVID-19 restrictions, including mask checks, according to a lawsuit filed by Ramsey Solutions.

The summit was one of a series of “high-end experiences” put on by Ramsey, attracting thousands of business owners and other attendees, “each of whom spends between $5,000 and $15,000 to attend, inclusive of hotel,” according to the amended complaint in the suit.

The COVID-19 restrictions at the hotel, which included no buffets or other self-service food along with limited use of the pool or other amenities, made having the conference there untenable, Ramsey Solutions stated in the complaint.

In court documents, Ramsey Solutions claimed the change of venue cost the company $10 million in lost revenue.

During a July staff meeting after the summit, Ramsey accused the hotel’s leadership of breaking their word to him and the company. The mask requirement in particular irked Ramsey. He ridiculed the idea that hotel staff would enforce a mask requirement on guests.

“As you guys are well aware we don’t require masks but if someone wants to wear a mask we don’t mind,” according to a recording of the meeting obtained by RNS. “Everybody gets to choose what you want to do. This is America — a voluntary thing, you choose what you want to do. But we’re not going to have someone pay $10,000 for a ticket to have some $8 an hour twerp at Marriott giving them a hard time about wearing a mask.”

At a staff meeting after Thanksgiving, Ramsey continued his criticism of those who are ruled by “fear” of COVID-19 and are “freaking out” due to the pandemic.

“They have got fear, they have trepidation on the COVID, they are scared to death about whether or not they are meeting all the social cues on fear and masks and temperature controls,” he said on a recording of the meeting obtained by RNS.

By contrast, he said, staff at Ramsey Solutions would spread Christmas cheer and joy during the holidays — as well as courage, which he said was contagious.

The company, Ramsey said, would not be ruled by fear.

“Fear is not a fruit of the spirit,” he told his employees in the meeting, while rallying them to step up their performance during the holiday season. “It is not on the list. And so, while sometimes I am afraid, I do not make decisions — and I do not let my behaviors be — dictated by fear unless it involves getting out of the way of a car that is coming toward me.”

President Trump’s cavalier attitude to COVID-19 has put the lives of everyone in and around the White House at risk. This includes the White House staff, who make the beds, clean the house, prepare the food, etc. Donald Trump is a not a good man. A good man would treat those around him better, valuing their lives and health as highly as his own. I cannot fathom voting for a man with this little regard for those who serve him daily.

Risks rise in West Wing

Mike Allen, for Axios AM

White House aides have advised President Trump to avoid the Oval Office while he's still infected. But they’re making arrangements for him to work out of the Diplomatic Reception Room, and use it as a backdrop for future televised remarks, two White House officials tell Axios' Alayna Treene.

• Why it matters: The preparations show that far from bunkering down in the residence until he's well, Trump is considering remaining active while he recovers from COVID.
• Any Trump movement in the West Wing would create a series of risks for his staff.

A taste of Trump's attitude about the virus played out on live TV last evening as he returned by Marine One at sunset after three nights at Walter Reed: He walked up to a White House balcony, took off his mask for the cameras, put it in his jacket pocket, adjusted his suit, straightened his tie and lingered to give purposeful thumbs-ups and salutes.

• "Don’t be afraid of Covid," he tweeted — the exact opposite of what any medical or public-health professional will tell you. "Don’t let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!"
• "Will be back on the Campaign Trail soon!!!" he added.

Reflecting widespread dismay among administration officials, a White House source told Axios' Alexi McCammond:

• "It's insane that he would return to the White House and jeopardize his staff's health when we are still learning of new cases among senior staff. This place is a cesspool."
• "He was so concerned with preventing embarrassing stories that he exposed thousands of his own staff and supporters to a deadly virus. He has kept us in the dark, and now our spouses and kids have to pay the price. It's just selfish."

The big picture: The White House — despite its infinite access to the best resources available — continues to respond to its own coronavirus outbreak about as recklessly as possible, Axios' Caitlin Owens writes.

• The White House is doing only minimal contact tracing, and hasn't sought help from the CDC, the N.Y. Times reports (subscription)._ _The White House has decided not to trace the contacts of attendees at last weekend’s Rose Garden event celebrating the nomination of Judge Amy Coney Barrett to the Supreme Court.
• Mayor Muriel Bowser said D.C. officials have been unsuccessful in trying to connect with the White House to assist with contact tracing: "We have reached out to the White House on a couple of different levels, a political level and a public health level."

Among those endangered by Trump's approach:

• "The White House residence staff members are largely Black and Latino, and often elderly, according to Kate Anderson Brower, who compiled a trove of interviews with former staffers for her book ''The Residence,'" the WashPost reports. There are about 90 full-time ushers, butlers, housekeepers, valets, florists, engineers and cooks.
• "For the Secret Service, a New Question: Who Will Protect Them From Trump?" says a N.Y. Times headline.
• White House reporters are increasingly anxious and angry, Axios' Sara Fischer reports. N.Y. Times White House correspondent Michael Shear, who tested positive, tells Axios: "My wife has now tested positive for COVID. The collateral damage is going to be pretty significant, I think."

This article hardly needs an introduction. When the NEJM, America’s foremost medical research publication, breaks with 200 years of precedent to say that you’ve completely botched a medical crisis, there’s really no defense. Donald Trump’s handling of COVID-19 is a national disgrace and is responsible for the death of people who wouldn’t have otherwise died. His disregard for the lives and health of Americans disqualifies him from being a pro-life candidate.

In a First, New England Journal of Medicine Joins Never-Trumpers

by Gina Kolata, for the New York Times

Throughout its 208-year history, The New England Journal of Medicine has remained staunchly nonpartisan. The world’s most prestigious medical journal has never supported or condemned a political candidate.

Until now.

In an editorial signed by 34 editors who are United States citizens (one editor is not) and published on Wednesday, the journal said the Trump administration had responded so poorly to the coronavirus pandemic that they “have taken a crisis and turned it into a tragedy.”

The journal did not explicitly endorse Joseph R. Biden Jr., the Democratic nominee, but that was the only possible inference, other scientists noted.

The editor in chief, Dr. Eric Rubin, said the scathing editorial was one of only four in the journal’s history that were signed by all of the editors. The N.E.J.M.’s editors join those of another influential publication, Scientific American, who last month endorsed Mr. Biden, the former vice president.

The political leadership has failed Americans in many ways that contrast vividly with responses from leaders in other countries, the N.E.J.M. said.

In the United States, the journal said, there was too little testing for the virus, especially early on. There was too little protective equipment, and a lack of national leadership on important measures like mask wearing, social distancing, quarantine and isolation.

There were attempts to politicize and undermine the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, the journal noted.

As a result, the United States has had tens of thousands of “excess” deaths — those caused both directly and indirectly by the pandemic — as well as immense economic pain and an increase in social inequality as the virus hit disadvantaged communities hardest.

The editorial castigated the Trump administration’s rejection of science, writing, “Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.”

Donald Trump believes that any and all bad news makes him look bad. So he denies everything bad, ignores everything bad, and carries on as normal while the world burns around him. This is not a President that surrounds himself with good people, who help him to make good decisions. Because if there are good people around him, they are being ignored daily. If Nero fiddled while Rome burned, Trump writes self-congratulatory tweets while America burns.

For Trump, a Pattern of Denial, From the Virus to Russia to Climate Change

by David Sanger, for the New York Times

his presidency has in many ways been defined by his dismissal of many of the biggest threats facing the United States. His preoccupation with demonstrating strength or rearranging facts to reinforce his worldview has led him, time and again, to downplay, ignore or mock everything from climate change to Russian interference in the American political process.

Mr. Trump’s own Pentagon declared in a report last year that a warming climate was a major “national security issue” that could spur future instability around the globe, but to Mr. Trump it remains a theory, something to be stricken from government reports and explained away when the West erupted in wildfires.

His intelligence agencies have assessed that North Korea’s nuclear stockpile has expanded significantly on Mr. Trump’s watch. But to the president, that arsenal — which he said in 2017 might force him to take military action leading to “fire and fury like the world has never seen” — is hardly worth mention today. Asked about it, he invariably turns the conversation to his relationship with Kim Jong-un, the North Korean leader.

The unremitting stream of cyberattacks by Russia, many aimed at the heart of the American political process, has preoccupied intelligence and military officials determined to keep Vladimir V. Putin from interfering in another election. But not Mr. Trump, who has said he has no reason to disbelieve the Russian leader’s denials that Moscow was involved.

On virtually every front, said Richard Haass, the president of the Council on Foreign Relations, Mr. Trump has embraced “denialism,” as if wishing problems away was a substitute for policy and action.

“The denialism is a pattern,” said Mr. Haass, who served several Republican presidents at the National Security Council and the State Department. “It is pervasive. And the fear among friends and allies is that all this is not limited to Trump but reflects how this country has not just changed, but changed for the worse.”

“They have put their security in our hands,” said Mr. Haass, the author of “The World: A Brief Introduction,” “and they are questioning that wisdom, at the same moment that our adversaries see us as divided and distracted.”

It is a distinctive pattern that began in the Trump administration’s first hours, when the new president bristled at photographs released by the National Park Service that suggested the crowds at his inauguration paled when compared with the turnouts for the swearing-in of some past presidents, including Barack Obama. Then came his search for three million fraudulent votes — all in the service of denying that he had lost the popular vote, even while winning the Electoral College.

Some of the moments were laughable, like the Sharpie used to alter National Weather Service maps of the course of Hurricane Dorian last year, all to justify Mr. Trump’s erroneous declaration that the storm was headed to Alabama.

It was great fodder for late-night comedians. Then, in March, as the virus emptied out offices and began to strike American cities, denialism went from deadly serious to simply deadly.

Mr. Trump’s own Department of Health and Human Services, with the help of the White House staff, had prepared for an influenza pandemic that many experts had viewed as inevitable. They had even run a monthslong exercise, code-named “Crimson Contagion,” that mapped out how the government needed to respond if a virus — somewhat different from the coronavirus — that originated in China came to American shores aboard direct flights, borne by tourists, students, business executives and returning Americans.

But the tabletop exercise missed one key element: a president who made it clear he didn’t want to hear news that imperiled economic expansion, especially in an election year.

“Nobody ever thought of numbers like this,” Mr. Trump said in mid-March, as his early story that the virus was under control began to collapse around him.

In fact, they had — it was simply that Mr. Trump did not want to acknowledge those numbers. He kept downplaying the casualties, saying he was sure that deaths would top out below 60,000 and creating a White House culture where mask-wearing was equated with weakness, rather than the pandemic equivalent of strapping on seatbelts.

Mr. Trump has also seemed incapable, or at least unwilling, to acknowledge the cost of denying reality. He continues to insist the economy will have a “V shaped” recovery, even though the Federal Reserve chairman he appointed, Jerome Powell, said on Tuesday that Americans should brace for a “longer-than-expected slog back to full recovery.”

Donald Trump wants to use his own medical expertise to certify when a coronavirus vaccine is ready. He wants to play the hero before election day, regardless of how many lives are put at risk by an unproven, poorly tested vaccine.

White House Blocks New Coronavirus Vaccine Guidelines

by Sharon LaFraniere and Noah Weiland, for the New York Times

Top White House officials are blocking strict new federal guidelines for the emergency release of a coronavirus vaccine, objecting to a provision that would almost certainly guarantee that no vaccine could be authorized before the election on Nov. 3, according to people familiar with the approval process.

… The struggle over the guidelines is part of a monthslong tug of war between the White House and federal agencies on the front lines of the pandemic response. White House officials have repeatedly intervened to shape decisions and public announcements in ways that paint the administration’s response to the pandemic in a positive light.

That pattern has dismayed a growing number of career officials and political appointees involved in the administration’s fight against a virus that has claimed more than 209,000 lives in the United States.

The vaccine guidelines carry special significance: By refusing to allow the Food and Drug Administration to release them, the White House is undercutting the government’s effort to reassure the public that any vaccine will be safe and effective, health experts fear.

“The public must have full faith in the scientific process and the rigor of F.D.A.’s regulatory oversight if we are to end the pandemic,” the biotech industry’s trade association pleaded on Thursday, in a letter to President Trump’s health secretary, Alex M. Azar II, asking for release of the guidelines.

… A main sticking point has been the recommendation that volunteers who have participated in vaccine clinical trials be followed for a median of two months after the final dose before any authorization is granted, according to a senior administration official and others familiar with the situation, who spoke on the condition of anonymity. Given where the clinical trials stand, that two-month follow-up period would all but preclude any emergency clearance before Election Day.

As a super spreader of false information about COVID-19, how many deaths is Donald Trump responsible for? It’s undeniable that he is responsible for American deaths. His ridicule of protective face masks alone is responsible for many people refusing to wear them, resulting in the infection and deaths of both themselves and others.

Study Finds ‘Single Largest Driver’ of Coronavirus Misinformation: Trump

Sheryl Gay Stolberg and Noah Weiland, for the New York Times

Of the flood of misinformation, conspiracy theories and falsehoods seeding the internet on the coronavirus, one common thread stands out: President Trump.

That is the conclusion of researchers at Cornell University who analyzed 38 million articles about the pandemic in English-language media around the world. Mentions of Mr. Trump made up nearly 38 percent of the overall “misinformation conversation,” making the president the largest driver of the “infodemic” — falsehoods involving the pandemic.

The study, to be released Thursday, is the first comprehensive examination of coronavirus misinformation in traditional and online media.

“The biggest surprise was that the president of the United States was the single largest driver of misinformation around Covid,” said Sarah Evanega, the director of the Cornell Alliance for Science and the study’s lead author. “That’s concerning in that there are real-world dire health implications.”

[…] To those who have been watching Mr. Trump’s statements, the idea that he is responsible for spreading or amplifying misinformation might not come as a huge shock. The president has also been feeding disinformation campaigns around the presidential election and mail-in voting that Russian actors have amplified — and his own government has tried to stop.

But in interviews, the Cornell researchers said they expected to find more mentions of conspiracy theories, and not so many articles involving Mr. Trump.

Public health experts know that clear, concise and accurate information is the foundation of an effective response to an outbreak of infectious disease. Misinformation around the pandemic is “one of the major reasons” the United States is not doing as well as other countries in fighting the pandemic, said Dr. Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health and a former principal deputy commissioner at the Food and Drug Administration.

“There is a science of rumors. It’s when there is uncertainty and fear,” said Dr. Sharfstein, who teaches on public health crisis communications. In the absence of treatments or vaccines, he said, honest and consistent messaging is essential.

“This is what we need to save lives,” he said. “If it’s not done well, you get far more infections and deaths.”

Tom Ridge was the Secretary of the Department of Homeland Security during President Bush’s administration. Before that, he was the Republican governor of Pennsylvania. He knows something about national leadership during times of crisis. And he’s seen enough of Donald Trump. He took the to the Philadelphia Inquirer to explain himself.

Former Pa. Gov. Tom Ridge: I'm voting for Joe Biden

Many of us remember when President George W. Bush, with megaphone in hand, stood on the rubble in lower Manhattan and told his fellow citizens and the world that those responsible for the brutal carnage of 9/11 would be held accountable. His remarks unified the country and his appearance on the mound at Yankee Stadium days later put an exclamation point on the message that America was resilient and would overcome.

Compare and contrast that with the crisis of today. Imagine the impact of President Trump traveling to the Centers for Disease Control and Prevention back in February, and talking plainly about the challenge Mother Nature intended to throw at us, and how this country, working together, public and private sector, would confront it with all the fortitude and resources we could bring to bear. Then imagine him meeting with journalists the next day, appearing with a face mask, and calmly walking through the steps that his fellow citizens could and should take to do their part to combat this new challenge. Imagine the difference in attitude and outcomes. Perhaps I have more trust in Americans being able to handle the truth than the president.

Donald Trump has proven over these last four years he is incapable of such leadership. It is not within him. He lacks the empathy, integrity, intellect and maturity to lead. He sows division along political, racial and religious lines. And he routinely dismisses the opinions of experts who know far more about the subject at hand than he does – intelligence, military, and public health. Our country has paid dearly in lives lost, social unrest, economic hardship and our standing in the world.

With just about one month until Election Day, President Trump continues to claim the only way he can possibly be defeated is a rigged election. Can you imagine the hubris? Can you imagine any other president in our lifetime — or ever — saying something so dangerous and un-American? We are in the midst of a health crisis, when we should be doing all we can to help citizens vote safely, yet he continues to cast doubt on the sanctity of the vote. He’s done so multiple times here in Pennsylvania. It’s deplorable, yet utterly consistent with past reprehensible behavior.

The United States is still struggling to control COVID-19, because we don’t have the tools that we need to see where it’s been, where it is, and where it’s going. Mr. Lipsitch and Mr. Grad—experts in epidemiology—wrote an op-ed for The Washington Post describing what we need. It’s time to start planning how we can meet those needs, so that we can save lives, and jobs, the next time that a new virus invades.

How to fix public health weaknesses before the next pandemic hits

Surveillance systems — counting and tracking infected people, monitoring the course of the epidemic and projecting resource needs as the epidemic unfolds — are inflexible and outdated. The systems have been undermined by the long neglect of local and state public health. Fundamentally, there is no common system for collecting and reporting the key numbers, confounding efforts to control disease spread.

Eight months into the pandemic, states and counties around the country are struggling to track the spread of the virus through routine, reliable testing of representative members of their communities. Efforts to help hospitals and public health systems by modeling the covid-19-related demand for intensive care have been stymied by this fact: There is insufficient information available about the duration of stays in intensive care units in the United States. And few jurisdictions provide specific data on where their epidemiologists determine transmission is occurring, making it difficult to identify areas that can reopen safely or health-care facilities that need to bolster their prevention measures.

The list could go on. The common denominator is an antiquated and unstandardized system of linking data from clinical records and public health monitoring in ways that provide evidence on how to control the virus while minimizing the disruption to the economy and society. Electronic medical records — envisioned as a boon for public-health surveillance, providing data that could be readily analyzed — turn out to be much better for billing than for the exchange of data.

The next phase of pandemic response that might be placed at risk by these spotty data systems is vaccination. Accurate records of who has been vaccinated, when and with which vaccine will be essential. They will encourage trust in the safety and effectiveness of vaccines, ensure prioritization of the groups that should first receive the vaccine, and aid in monitoring vaccine impact on the pandemic. A patchwork of local systems, already strained, is not well-suited to this task.

Solving this problem will require significant investment to link public health agencies at the local level to state and national databases, and to ensure that the information coming into these systems is of adequate quality.

Nontraditional sources of data — tracking mobility through cellphones to see how people respond to lockdowns, measuring viral RNA in sewage and predicting epidemic trends through analysis of Internet searches — potentially provide information faster and with higher resolution than traditional epidemiologic data. But efforts to make use of them remain bespoke collaborations between companies or academic groups and individual health departments. Large-scale serological surveillance, a potentially game-changing idea pioneered by several of our colleagues, remains just that, an idea. Calls for a national pandemic forecasting center have so far gone unfunded.

All this will require new investment in these good ideas, IT infrastructure, highly skilled personnel and equipment to run large numbers of diagnostic tests. The improvements would aid in fighting the current pandemic, and they will be essential weapons against future pandemics and other major health threats, such as antimicrobial resistance, that will still loom when the world emerges from covid-19.

While we’re in the middle of the worst pandemic in 100 years, Donald Trump is busy demoralizing our top disease experts, because they’ve dared to contradict his view of the world. We’ll all be worse off if he succeeds in driving away Drs. Redfield and Birx. We need better leadership. It’d really help if we had a President that was willing to see the world as it is, rather than raging at everyone who doesn’t see it his way.

Trump has lost patience with CDC head after series of mixed messages - CNNPolitics

By Jeremy Diamond, Nick Valencia and Sara Murray, for CNN.

President Donald Trump has lost patience with the head of the US Centers for Disease Control and Prevention, Dr. Robert Redfield, as well as with the other public health experts on his coronavirus team because their sober messaging on the future of the pandemic clashes with his rosy assessments.

Trump believes that breakthroughs are not coming swiftly enough, according to people familiar with the President's thinking. Trump's frustrations have caused some to question whether Redfield is on the chopping block, but a Trump adviser said they did not expect the President to make major staffing changes before the election.

The ever-looming threat, Trump's public undermining of the CDC chief and Redfield's tendency to fold to the White House are taking a toll on CDC staff, from top to bottom, employees say. Some have questioned whether their work is making a difference and others have even considered resigning -- and whether the sagging spirits may be hampering pandemic response.

Eight current and former public health officials described for CNN a crushing environment at the agencies charged with the coronavirus response brought on by a President intent on contradicting critical public health messaging and downplaying the threat of the virus, politically motivated pressure from the White House and baseless allegations from political appointees that government scientists are part of a disloyal "deep state."

"The morale is as low as I've ever seen it and we have no confidence in our leadership," a CDC official said. "People are miserable and it's a shame because this pandemic is still flying away and we still need a robust public health response."

Inside the White House, Drs. Deborah Birx and Anthony Fauci have struggled to compete with the growing influence of Trump's new favorite coronavirus adviser, Dr. Scott Atlas, a neuroradiologist with no public health or infectious disease expertise whose views are wildly out of step with leading public health experts. Birx has told people around her she is "distressed" with the direction of the task force and is uncertain how much longer she can continue to serve as the coronavirus task force coordinator.

Donald Trump keeps promising that a COVID-19 vaccine will be available before the election. When the medical community promises to take the time to ensure that the vaccine is safe, he claims that he is being attacked and sabotaged. The more Mr. Trump promises to rush the vaccine, the more he scares everyone else. Now, nearly half of Americans say that they won’t take the vaccine, because they don’t believe that it will be safe.

We need better leadership.

How Trump is undermining his own vaccine race - POLITICO

by Adam Cancryn

FDA Commissioner Stephen Hahn spent weeks preparing a proposal to set more stringent standards for emergency authorization of a coronavirus vaccine, hoping to boost public trust in the government’s biggest public health decision in decades.

“Science will guide our decisions,” he pledged to a Senate panel on Wednesday. “FDA will not permit any pressure from anyone to change that.”

Hours later, President Donald Trump sought to do just that. Incensed over the prospect the new guidelines could slow the process, Trump blew up the FDA’s carefully laid plans – vowing to have final say over his administration’s procedures for authorizing a long-sought Covid-19 vaccine. The White House has since demanded that Hahn submit a fuller justification of his bid to set stricter standards, two administration officials said, a directive that could halt the proposal indefinitely.

Almost since the start of the coronavirus crisis, Trump has promised a vaccine is just around the corner, repeatedly contradicting his own experts on the timeline and the standards necessary for approval. The goal, he’s made clear, is a viable vaccine just before Election Day – the centerpiece of his own claims that the administration deserves an “A-plus” for its response to Covid-19.

But that single-minded pursuit has left a string of damaging episodes in its wake and hopelessly intertwined the delicate drug development process with Trump’s political aims, according to interviews with a dozen public health experts both inside and outside the administration.

“We shouldn’t even be having this discussion,” a former senior HHS official said of the struggle for control over the vaccine process. “There are experienced career scientists at FDA who make these judgments every day for public health. This shouldn’t even be a White House issue.”

The broader public’s faith in any eventual coronavirus vaccine, meanwhile, is in tatters. Just over half of Americans now say they would take a vaccine if it were available today, polling shows, a 21-point drop from earlier this year. That’s alarming from a public health point of view, since having fewer people take the vaccine dilutes its effectiveness.

Now, even as Trump’s top health advisers scramble to erect new safeguards, those involved in the process say they fear the damage is already done: Trump’s constant drumbeat for a vaccine by Nov. 3 has drowned out months of careful scientific work, reducing perhaps the most ambitious vaccine hunt in history to yet another presidential litmus test.

“It would help if Donald Trump stopped talking,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a member of the outside panel FDA has pledged to consult before authorizing a vaccine. “Every time he opens his mouth, most reasonable people feel they’re being sold something.”

COVID-19 has completely disrupted life. We can't get back to normal until we actually do the long-term planning now to make life better 2 months from now. As a nation, we keep refusing to do that planning. And life continues to be awful. We need better leadership.

Why Zoom School Is So Awful for Parents and Kids

Dan Sinker, for Esquire:

The lesson we refuse to learn with COVID-19 is that decisions we make today have no bearing on right now, but have a huge effect in a few months. That’s why locking down in March reduced the number of deaths in May. Why opening bars in May brought deaths right back up in July. Why parties on Memorial Day left us with COVID numbers nearly twice as high on Labor Day, and why reopening in-person school in September will likely do exactly what you’d expect come November. The delay between action and reaction means we keep half assing our way through a pandemic that kicks our asses in return.

Making school work in September required vision, action, funding, and resolve on the part of people far above your teacher or school board member in the spring when everything shut down. None of it came. The entire point of the shutdowns was to buy time, to make plans, to lay a foundation for a return that would work. All that time got flushed away by a president more obsessed with hyping miracle cures than doing the hard, thankless work of grinding out a workable plan with scientists and educators and then funding it at a level that could make it actually feasible. That’s what happened in pretty much every other country on the planet. None of them are foolproof, but they've done better than just the state of Florida alone, which had more than 10,000 kids under 18 test positive since their aggressive push for schools to reopen last month.

This must be some of that endless winning and good dealmaking that Donald Trump promised us. Agreeing to buy ventilators for 4x the list price—a ventilator design that the U.S. government funded a decade ago as a low-cost option.

The Trump Administration Is Backing Out of a $647 Million Ventilator Deal After ProPublica Investigated The Price

The federal government is backing out of a controversial $646.7 million deal to buy ventilators from Royal Philips N.V., acting before the company had delivered a third of the order.

…

This week, the House Committee on Oversight and Reform’s Subcommittee on Economic and Consumer Policy announced it is expanding its probe to look at other coronavirus-related deals negotiated by Peter Navarro, the president’s trade adviser, who served as the point man on the Philips deal.

In addition, the U.S. Department of Health and Human Services, which oversaw the Philips contract, confirmed that the deal is the subject of an internal investigation and legal review.

…

The congressional investigation determined that the deal would have resulted in the U.S. overpaying for the ventilators by as much as $500 million, thanks to “inept contract management and incompetent negotiating by the Trump Administration.”

ProPublica first wrote about the U.S. government’s relationship with Philips in March, detailing how a decade ago government planners had paid Philips millions of dollars to develop a low-cost ventilator that could be stockpiled and deployed if ever there were a pandemic. The U.S. ordered 10,000 once the company received clearance from the Food and Drug Administration.

But when COVID-19 cases overwhelmed hospitals in New York in the spring, Philips hadn’t delivered any. Instead, ProPublica found, Philips was selling a commercial version of that ventilator — manufactured at its Pennsylvania factory — overseas at far higher prices.

Rather than force production of low-cost ventilators, a White House team led by Navarro cut a new deal for more ventilators, agreeing to pay more than four times the price.

ProPublica in April revealed that this new deal boosted the price of what appeared to be similar ventilators from $3,280 each under the Obama administration deal to $15,000 under the Trump administration. Neither Philips nor HHS would explain how the two models were different.

In its investigation of the deal, the House subcommittee asked Philips to turn over a trove of records and discovered that the more expensive ventilators were “functionally identical” to the cheaper ones.

Navarro and his team “appeared gullible” and there was no evidence that they even tried to negotiate a lower price, the House investigators found.

The U.S. government paid the highest price for the ventilators among American buyers, the investigators found. The company’s records show that Philips had sold more than 5,000 of that model at far lower prices before May 27.

…

As coronavirus sweeps the globe, there is not a single Trilogy Evo Universal ventilator — developed with government funds — in the U.S. stockpile. Meanwhile, Royal Philips N.V. has sold higher-priced versions to clients around the world.