“The Biden administration is betting that Covid infections for most people are now so mild that it’s safe for much of the country to go maskless, a strategy helping the White House avoid political backlash against stricter safety requirements.
But that strategy comes with the risk that millions of Americans, including the healthy and vaccinated, could suffer long-term health effects from Covid infections.
The policy could leave millions with a lifetime of little understood disease or medical complications. Those who get infected are at higher risk of brain shrinkage, blood clots, heart disease, strokes and diabetes, studies show. A separate post-viral syndrome called long Covid can cause a range of debilitating symptoms from cognitive dysfunction to extreme fatigue, according to federal estimates.”
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“This is why many public health experts say the Biden administration’s focus on preventing hospitalizations over infections is a poor strategy, one that ignores the potential of millions of newly sick or disabled Americans further straining the health care system and potentially worsening the labor shortage.”
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“Some public health experts agree with the administration’s approach, noting that for most people, vaccines provide strong protection against severe illness and death, and individuals should manage their own risk.
The country is averaging more than 37,000 infections per day, up about 45 percent over the last two weeks, according to the Centers for Disease Control and Prevention. Those figures are likely undercounted given the prevalence of rapid tests, which aren’t often reported to health departments.”
“The revised and expanded pain treatment guidelines that the Centers for Disease Control and Prevention (CDC) published today mention “patient abandonment” eight times. They also include two occurrences of this admonition, in bold and italics: “Clinicians should not abandon patients.”
That gives you a sense of the disastrous impact that the original version of the CDC’s advice, published in 2016, had on medical care. Something clearly has gone terribly wrong when clinicians have to be reminded that they are not supposed to abandon patients. At the same time, the CDC’s acknowledgment of the problem signals its willingness to address the needless suffering caused by the 2016 guidelines, which resulted in undertreatment, reckless “tapering” of pain medication, denial of care, and procrustean policies that prioritize reductions in opioid prescribing over the interests of patients.
The original guidelines, which were aimed at primary care physicians and focused on “prescribing opioids for chronic pain,” included grave warnings about the dangers of exceeding 90 morphine milligram equivalents (MMEs) a day. Many physicians, pharmacists, insurers, regulators, and legislators read that threshold as a hard cap, meaning that it should never be exceeded and that chronic pain patients who were already above it should be forced to comply with this arbitrary limit.
Although the 2016 guidelines focused on chronic pain, they also touched on acute pain, because “long-term opioid use often begins with treatment of acute pain.” For acute pain, the CDC said, a prescription for “three days or less will often be sufficient,” while “more than seven days will rarely be needed.” As a result, the CDC notes in the new guidelines, “more than half of all states have passed legislation that limits initial opioid prescriptions for acute pain to a seven day supply or less,” while “many insurers, pharmacy benefit managers, and pharmacies also have enacted similar policies.”
Ostensibly, the guidelines were purely advisory. But in practice, many patients found to their dismay, they were mandatory.”
“The root of the problem is the agency’s self-conception: It sees itself as the ultimate arbiter of what is true and what to do on all matters of infectious disease. In essence, the CDC believes there is no other authority besides the CDC, so it shuts out private labs from the testing process, insists that its faulty tests actually work pretty well long after problems arise, sticks with overly complicated plans that bog down processes, and resists calls to update its guidance, even when that guidance makes living ordinary life difficult or impossible. In a pandemic, where information is scarce and evolves rapidly—and when hundreds of millions of people have to make decisions right now—the agency’s preference for deliberative slowness and absolutist pronouncements would be a problem even if it were largely competent. And as it turns out, the agency isn’t that competent at all.”
“According to the CDC’s reading of the Public Health Service Act, the Court noted, it has “broad authority to take whatever measures it deems necessary to control the spread of COVID–19.” That includes the authority to override rental contracts and property rights across the country, since the CDC argues that evictions could promote the spread of COVID-19 by forcing people to live with friends or relatives, in homeless shelters, or in other “congregate or shared living setting[s].” But as the Court noted, “it is hard to see what measures this interpretation would place outside the CDC’s reach, and the Government has identified no limit…beyond the requirement that the CDC deem a measure ‘necessary.'”
The Court offers some illustrative hypotheticals: “Could the CDC, for example, mandate free grocery delivery to the homes of the sick or vulnerable? Require manufacturers to provide free computers to enable people to work from home? Order telecommunications companies to provide free high-speed Internet service to facilitate remote work?” But those examples only scratch the surface.
If the CDC’s understanding of its powers were correct, it would have the authority to make any of its frequently contentious COVID-19 recommendations, including its advice on mask wearing by K–12 students and the general public, mandatory. Rather than focus on people who move because they are evicted, it could simply decree that no one is allowed to change residences. It could require every American to be vaccinated against COVID-19. It could unilaterally impose nationwide shutdowns of businesses and order every American to stay home except for “essential” purposes. It could prescribe fines and jail sentences for people who defy those requirements, as it has with the eviction moratorium. And it could do any of these things not just in response to COVID-19 but also to control the spread of any communicable disease, including the seasonal flu and the common cold.
Where does the CDC think it gets this limitless discretion? The Public Health Service Act, which Congress approved in 1944, says “the Surgeon General, with the approval of the Secretary [of health and human services], is authorized to make and enforce such regulations as in his judgment are necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the States or possessions, or from one State or possession into any other State or possession.” It adds that “for purposes of carrying out and enforcing such regulations, the Surgeon General may provide for such inspection, fumigation, disinfection, sanitation, pest extermination, destruction of animals or articles found to be so infected or contaminated as to be sources of dangerous infection to human beings, and other measures, as in his judgment may be necessary.”
A regulation delegates that authority to the CDC, which has heretofore used it rarely and for narrow purposes such as banning the sale of small turtles that carry salmonella. But last fall, when it first imposed its eviction moratorium, the CDC claimed to discover previously unnoticed dictatorial powers. In the CDC’s view, “other measures” includes literally anything it claims will help reduce the spread of communicable diseases.
Two-thirds of the federal courts that have considered the issue, including the U.S. Court of Appeals for the 6th Circuit, have said the CDC does not have the power it claims. They generally have taken the view that “other measures” must be similar in kind to the specific examples listed in the statute.”
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“The Court adds that “even if the text were ambiguous, the sheer scope of the
CDC’s claimed authority…would counsel against the Government’s interpretation,” since “we expect Congress to speak clearly” when it means to authorize powers of “vast ‘economic and political significance.'””
“Substantially reducing the doses of pain medication prescribed for patients on long-term opioid therapy is associated with a threefold increase in suicide attempts and a 69 percent increase in overdoses, according to a study published this week in The Journal of the American Medical Association (JAMA). The study reinforces concerns that the “tapering” encouraged by federal guidelines as a response to the “opioid crisis” causes needless suffering among patients, leading to undertreatment of pain, withdrawal symptoms, and emotional distress.”
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“Although the CDC’s advice was not legally binding, and although the guidance said doses should be tapered only when medically appropriate, doctors, lawmakers, insurers, and pharmacies interpreted the agency’s warnings about daily doses exceeding 90 MMEs as a hard limit. “These and other widely disseminated recommendations have led to increased opioid tapering among patients prescribed long-term opioid therapy,” Agnoli et al. note.”
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“The CDC is mulling revisions to its advice. “A revised CDC Guideline that continues to focus only on opioid prescribing will perpetuate the fallacy that, by restricting access to opioid analgesics, the nation’s overdose and death epidemic will end,” Mukkamala warned in his letter to the CDC. “We saw the consequences of this mindset in the aftermath of the 2016 Guideline. Physicians have reduced opioid prescribing by more than 44 percent since 2012, but the drug overdose epidemic has gotten worse.””
“And, to be sure, the Trump administration did things that not only were well outside established norms but also undermined the CDC and the entire field of public health. For example, on April 3, 2020, while announcing the agency’s recommendation to wear masks, the president repeatedly emphasized that no one had to wear masks and explicitly said that he personally wasn’t going to wear one.
The administration also pushed for edits to the CDC’s Morbidity and Mortality Weekly Reports, long the primary means for communicating scientific data to other researchers and the broader medical community. These edits were political, designed to downplay the growing number of COVID-19 deaths and support decisions the administration had already made about issues like school reopenings. Emails revealed that members of the Trump administration were accusing the CDC of trying to make the administration look bad by releasing data disclosing the dire nature of the pandemic.
Those kinds of actions by a presidential administration were unprecedented. And they contributed to a loss of morale and a sense within the CDC that everyone just needed to keep their heads down and not make waves. But the political issues weren’t just about what the administration did — they were also about what it didn’t do.
By early March 2020, the CDC had all but disappeared from press briefings on the COVID-19 pandemic. No one in the Trump administration ever explicitly said that the agency wouldn’t be speaking to the public. But, quietly, that’s exactly what happened. By May 2020, the Union of Concerned Scientists could graph the disappearance of the CDC. And this was a completely different situation from what had happened in past pandemics, when presidents let the CDC take the lead.
At the same time, the Trump administration did not seem to facilitate communication between the CDC and outside experts — something the scientists I spoke to said had been the norm for past administrations faced with a public health crisis.”
“Over the past three decades, the Centers for Disease Control (CDC) has seen its taxpayer-funded budget doubled. Then doubled again. Then doubled again. And then nearly doubled once more.
But spending nearly 14 times as much as we did in 1987 on the agency whose mission statement says it “saves lives and protects people from health threats” did not, apparently, help the CDC combat the emergence of the biggest disease threat America has faced in a century. In fact, a new report argues, inflating the CDC’s budget may have weakened the agency’s ability to handle its core responsibility by giving rise to mission creep and bureaucratic malaise.”
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“In addition to combating dangerous infectious diseases like HIV and malaria, the CDC now also studies alcohol and tobacco use, athletic injuries, traffic accidents, and gun violence. While those things can indeed be important factors to public health, Minton notes, they don’t seem to fall within the agency’s original mission.”
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“when the coronavirus did hit, the CDC only confirmed that it should not be trusted to make important decisions by forbidding private labs from developing tests for COVID-19. The federal agency’s monopoly on testing supplies produced inaccurate tests that had to be discarded en masse.
The initial testing delay has certainly cost lives. It is also at least partially to blame for the severe quarantine policies that have tipped the American economy into a deep recession—without adequate testing, there was little else for policymakers to do except close the country in the hopes of slowing the disease’s spread.”
“The single most important failure of the U.S. response to COVID-19, the disease caused by the novel coronavirus, has been the slow rollout of testing. This was an abject failure of bureaucracy. But it was also a failure of presidential leadership.
The countries that have had the most success in containing the outbreak, such as South Korea and Singapore, have done so through early, rapid, and widespread testing and contact tracing, followed by targeted quarantines. South Korea and the United States discovered initial cases of the coronavirus on the same day in January. Since then, some 290,000 people in South Korea have been tested and new daily cases have fallen from 909 to just 93. Despite a much larger population, the United States, tested just 60,000 people in the same period of time.”
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“Much of the failure to make mass testing available lies with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). As a Wall Street Journal report makes clear, the CDC, which managed the development of the initial test kits, botched the job in just about every possible way: The CDC not only produced a faulty test that had to be retracted but adopted narrow testing criteria that meant many people with symptoms simply couldn’t be tested.
Perhaps most disastrously, as The Washington Post reports, federal health agencies initially declined to certify tests produced by private companies that were better suited for rapid mass testing anyway. This is despite the fact that experts, including the former head of the FDA, were publicly recommending that they do so as early as February 2.
The CDC was following its usual protocols, developing initial diagnostic tests on its own in order to maintain quality control, as it usually does. But that’s exactly the problem.”
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“But this was also a failure of political leadership, most notably from President Donald Trump. For weeks, Trump and senior White House officials actively downplayed the threat of the virus.
As late as February 25, National Economic Council adviser Larry Kudlow was offering assurances that the coronavirus was “contained” and that it was “pretty close to airtight.” Trump treated the virus with similar breeziness, suggesting that the virus was “going to disappear” and that while it might get worse, “nobody really knows.””
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“The problem here is obvious: Trump, who as the head of the executive branch oversees federal agencies such as the FDA, did not view the virus as a serious problem—and did not want others to view it that way either. That, in turn, translated into a downstream lack of urgency, which meant that critical aspects of the response were not prioritized. According to The Wall Street Journal, health officials who have examined the testing calamity have concluded that it was a result of both bureaucratic bumbling and a “broader failure of imagination,” in which Trump and other administration officials “appeared unable or unwilling to envision a crisis of the scale that has now emerged.”
The job of a president is to make decisions, set priorities, and convey clear information to both the public and the staff of the executive branch. This is especially important in a moment of crisis, when the executive is in charge of acting both quickly and with sound judgment. In this outbreak, Trump has failed on every count. Not only did he fail to see the threat even when it was apparent to experts, but he actively undermined preparedness by downplaying its significance far long after the problem was apparent, and by providing false and misleading information as the mitigation effort proceeded.”
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“The federal health bureaucracy deserves much of the blame for America’s faltering response to the coronavirus outbreak. But the president has made the fiasco worse.
The bureaucracy reports up to an executive, who is tasked with setting priorities and ensuring performance—and for taking responsibility when there are failures. Instead, Trump has inaccurately blamed the Obama administration for failures that occurred on Trump’s watch. (Indeed, under Barack Obama, diagnostic tests for swine flu were designed and approved in less than two weeks.) Asked whether any of this is his fault, the president rejected the idea, saying, “I don’t take responsibility at all.” Trump’s refusal to admit failures makes it more likely that he will repeat them, and that more Americans will pay the price.”