Donald Trump: a political determinant of covid-19

Dear Editor

I do not previously remember seeing the author of a publication in a scientific journal giving political party affiliations which then lead to challenge from others to the content on those grounds.

There are interesting similarities and differences between the USA and the UK on the political handling of the pandemic and the role of partisan politics.

Both governments face similar challenges and criticisms - their timing of response, the adequacy of preparatory emergency planning, shortages of tests and care worker protective equipment, their epidemiological strategy, and the timing and details of the lockdown exit strategy. As in the USA, these issues have been taken up by British political parties and scientific and medical interests. But, so far at least, they have not been expressed with anything like the highly charged and hostile personal partisan rhetoric that characterizes many USA exchanges.

One reason is that in Britain the pandemic has been seen as a major national emergency of the kind last experienced in the Second World War. This has generated some feeling of a common national challenge and to a degree softened the language of public exchanges. More profound constitutional reasons are explored in a recent article of mine published in the USA (1).

There is a significant difference between the British and American governments' styles in regular presentations of progress with the pandemic. In Britain every day there is a televised presentation from Downing Sreet in which a Cabinet Minister is flanked by two very senior members of the career medical and scientific public services. This leads to a balanced mixture of government policy assertion with non-political professsional expertise. The Minister - most often the Health Secretary during the Prime Minister's COVID infection and convalescence - describes government policy in favourable terms without concealing the uncertainties and dilemmas. The professonals deal with scientific and medical questions and illustrate the course of the pandemic with statistical charts. Without dissenting from the political presentation they do sometimes more fully emphasise the complexities and uncertainties.

The occasions come across as clear and disciplined with no impassioned hostility or displays of temperament. No-one recommends speculative but un-researched cures for the virus. Interactions with the press are courteous on both sides but there is no lack of hard and persistent questions from journalists, sometimes directed straight at and answered by the professionals.

There are unresolved questions about reports that the British government's key internal scientific advisory committee has been politically infiltrated. But up to now its regular public presentations have been reasonably balanced.

(1) Luce, T. "Comparing British and American pandemic Politics". 25 April 2020, www.postalley.org/2020/04/25/comparing-british-and-american-pandemic-pol...

Dear Editor,

I agree that this administration could have handled some aspects of the pandemic differently, but in hindsight, everyone has 20/20 vision. Statements made in this editorial seem to stretch the truth and strongly lean towards partisan. They assign blame to a single individual when there were errors committed at several levels by more than one government. The reader would be wise to take this paper with a grain of salt, especially after reviewing the conflicts of interest on the footnote.

The authors make the following statements:

1. China's quarantine and lockdown measures bought the United States administration time to scale up its preparedness efforts.

Here, the authors do not mention that Dr Li Wenliang initially brought concerns in late December in Wuhan. He was reprimanded by local authorities for bringing up his concerns about a new pandemic (1). Also, the Chinese government took 6 days (from January 14 to January 20, 2020) to warn the public about the likely pandemic (2). It took the WHO another 3 days to warn all governments to get ready for transmission of a novel coronavirus in their countries. The authors also do not mention that even as late as March 2nd, 2020, New York officials were encouraging people to get out on the town despite coronavirus and celebrate lunar New Year parade (3). New York has been the epicenter of the pandemic in the US, currently accounting for 30% of cases and at one point more than 50%.

On the other hand, Mateo Chinazzi et al (4) estimate the effects of international travel restriction on spread of COVID-19. The measures implemented by the Federal government starting February 2nd, 2020 likely bought 2-3 weeks to further prepare for the pandemic, while the travel quarantine and lockdown around Wuhan only had a modest delay in the spread of the disease to other areas of mainland China. Despite the benefit of international travel restrictions, the WHO recommended against them (5).

2. The federal government did not expand hospital capacity to manage surge in demand.

The Army Corps of Engineers, along with other nongovernment entities, built several field hospitals across the country (6). The Navy also deployed the USNS Comfort to New York and the USNS Mercy to Los Angeles (7). The Global Health Security Index (8), along with the John Hopkins Center for Health Security, both rank the US as the best prepared country to handle a pandemic. Luckily, the initially estimated number of deaths and hospitalizations the CDC predicted have not materialized (9). The number of patients seen at these field hospitals and ships has been anemic. The field hospital in Century Link field in Seattle was dismantled before it even opened (10). From empiric evidence, it seems that hospitals are below their expected census.

3. The Federal Government failed to produce enough personal protective equipment (PPE) for all healthcare workers.

This is a source of stress and worry for all healthcare workers, including myself. Office days were decreased and elective procedures were deferred to save PPE for COVID-19 cases. However, the current administration is not the only one to blame. In 2009, we had a novel influenza A pandemic, H1N1. There was a nationwide shortage of masks and the national stockpile was tapped. The Obama administration never replaced PPE used during the 2009 pandemic (9). Most PPE is made in China. In January, the Chinese government began blocking exports of PPE. At the same time, it imported 2.46 billion pieces of PPE from the European Union, Brazil and Cambodia (11), essentially cornering the market. The current administration is considering legal action. These findings support the efforts of the current administration to decrease our dependence of critical products made overseas and increase national manufacturing.

In summary, the authors seem to blame President Trump and the current administration for mistakes made across continents and across the political board. They then scare the reader by mentioning US Citizens are "alone against the virus." In difficult times, optimists tend to win American elections. Instead of doom and gloom, President Trump continues to put his hope in healthcare workers and experimental treatments, including hydroxychloroquine/azithromycin, remdesivir, and, most recently, endotracheal UV light (12). At the end of the day, it seems that the American voter will be the one to decide if Donald Trump is a political determinant of COVID-19.

1. Buckley, C & Myers SL (2020, February 1) As New Coronavirus Spread, China's Old Habits Delayed Fight: At critical turning points, Chinese authorities put secrecy and order ahead of openly confronting the growing crisis and risking public alarm or political embarrassment. The New York Times.
https://www.nytimes.com/2020/02/01/world/asia/china-coronavirus.html
2. (2020, April 14)
China didn't warn public of likely pandemic for 6 days. The Associated Press.
https://apnews.com/68a9e1b91de4ffc166acd6012d82c2f9
3. Vespa, M (2020, March 25)
Are 'Woke' Politicians Partially to Blame for the Wuhan Coronavirus Outbreak in New York City? Townhall.
https://townhall.com/tipsheet/mattvespa/2020/03/25/are-woke-politicians-...
4. Chinazzi, M., Davis, JT., Ajelli, M., Gioannini, C., Litvinova, M., Merler, S., ... Vespignani, A. (2020, April 24).
The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak.
Science Vol. 368, Issue 6489, pp. 395-400
5. Nebehay, S. (2020, February 3)
Who chief says widespread travel bans not needed to beat China virus. Reuters.
https://www.reuters.com/article/us-china-health-who-idUSKBN1ZX1H3
6. Loehrke, J., Petras, G. (2020, April 17)
Coronavirus hospitals in the field: How the Army Corps of Engineers fights COVID-19 with tents. USA Today.
https://www.usatoday.com/in-depth/news/2020/04/16/coronavirus-covid-19-f...
7. Paris, C. (2020, March 29)
Two Navy Ships Steam to New York and Los Angeles to Help With Pandemic: The USNS Comfort and Mercy are massive floating hospitals now deployed for the first time to deal with a pandemic. Wall Street Journal.
https://www.wsj.com/articles/two-navy-ships-steam-to-new-york-and-los-an...
8. Global Health Security Index
https://www.ghsindex.org
9. Fink, S. (2020, March 13)
Worst-Case Estimates for U.S. Coronavirus Deaths: Projections based on C.D.C. scenarios show a potentially vast toll. But those numbers don't account for interventions now underway. The New York Times.
https://www.nytimes.com/2020/03/13/us/coronavirus-deaths-estimate.html
10. Li, DK. (2020, April 8)
Emergency hospital at Seattle Seahawks stadium shut down, to be sent to state with more need. NBC News.
https://www.nbcnews.com/health/health-news/live-blog/2020-04-08-coronavi...
10. Brown, M. (2020, April 3)
Fact Check: Did Obama Administration Deplete n95 Mask Stockpile. USA Today.
https://www.usatoday.com/story/news/factcheck/2020/04/03/fact-check-did-...
11. Bowden, E. & Golding, B. (2020, April 5)
Trump administration weighs legal action over alleged Chinese hoarding of PPE. New York Post.
https://nypost.com/2020/04/05/trump-admin-weighs-legal-action-over-alleg...
12. (2020, April 20)
Aytu BioScience Signs Explusive Global License with Cedars-Sinai for Potential Coronavirus Treatment. The Associated Press.
https://apnews.com/b44f4531071e6204023f7b8e16f59d4b

Dear Editor,

While Yamey and Gonsalves' (1) editorial would not be out of place in the New York Times opinion section, not least for the authors' admission that they are both registered Democrats aligned with Elizabeth Warren in the Primary race, it does not belong in the pages of a serious scientific journal. The essential quality that separates scientific argument from political rhetoric is an objective analysis of all the available evidence. Rather than review all of the details they provide, which no doubt establish that serious mistakes have been made in the US response to the current pandemic, the scientific value of the editorial can be judged on a single fact: Yamey and Gonsalves make absolutely no attempt to look for any evidence to test their assertion, that President Trump is directly responsible for the deaths of countless US citizens.

It is instructive to compare the intellectual rigour of this editorial to those in the New York Times, Trump's chief protagonist amongst major US news organisations. The usual editorial approach to the coronavirus response at the NYT is to acknowledge that an early travel ban preventing foreign nationals who had recently travelled in China from entering the US was at least theoretically likely to reduce the spread of the virus, before dismissing it as irrelevant due to ineffective implementation https://www.nytimes.com/2020/04/04/us/coronavirus-china-travel-restricti....

In a column titled "The Coronavirus is Coming for Trump's Presidency" https://www.nytimes.com/2020/03/07/opinion/coronavirus-trump.html, Ross Douthat argues that the travel ban was wasted because the administration did not implement prevention measures with the perfection of hindsight. Douthat makes the startling (to NYT readers) admission that "Obviously the White House isn’t to blame for everything that’s gone wrong with the coronavirus response."

Clearly, the title of Douthat's piece betrays the quite conscious motivation shared and repeatedly stated by the NYT editorial team which should warn readers of the strong bias behind his writing. The fact that Yamey and Gonsalves (1) cannot rise to the level of acknowledging a single positive act by the Trump administration suggests that their bias is less conscious. Certainly it reveals their editorial as partisan political rhetoric with no scientific value.

Regards,
Dr Andrew Amos
F.RANZCP

1. Yamey G, Gonsalves G. Donald Trump: a political determinant of covid-19. BMJ 2020;369:m1643