America's healthcare system will struggle to deal with Covid 'long-haulers'
The US already has sky-high rates of chronic illness. Now comes a wave of Covid patients who never seem to fully recover
Post-viral fatigue syndrome (PVFS) isn’t new, but that won’t stop Covid “long-haul” syndrome from toppling an already unsteady medical system. The symptoms faced by so-called long-haulers – Covid patients who don’t seem to fully recover, even months after infection – can be debilitating. Understanding the similarity of long-haul syndrome to previous outbreaks (as well as the differences) should advise an incoming administration on the need for massive healthcare reform.
Post-viral fatigue syndrome has followed many viral outbreaks, such as the Spanish Flu of 1918, the 2002 SARS-CoV, the 2009 influenza, and the Ebola outbreak of 2014 – to name a few. PVFS is also frequently linked to Epstein-Barr virus (EBV), which can cause infectious mononucleosis (mono, sometimes called the “kissing disease”). Similar to Covid-19, EBV may present with no symptoms – especially in children – but it has been linked to the triggering of autoimmune disorders.
The threat of long-haul syndrome isn’t its novelty, but rather its history. Post-viral fatigue is often categorized with (and sometimes becomes) chronic fatigue syndrome (CFS), an illness that effects women at four times the rate as men and still eludes effective treatment. Current reports estimate that at least 10% of people reportedly infected with Covid-19 have gone on to develop long-haulers syndrome. As of Thanksgiving, the United States will have surpassed 12m cases of Covid. At 10%, we can anticipate a heavy addition to the already staggering rate of chronic illness in the US; if our healthcare system doesn’t adapt, it will likely fail.
What exactly is long-haulers syndrome? It’s too early to know. As of now, the phrase is a catch-all diagnosis. It appears that long haulers can be divided into two main groups: those who experience physical damage to their organs, and those who exhibit symptoms without clear physical explanation. The latter is most similar to classic PVFS, and the former seems to be a consequence of Covid’s function as a vascular disease – novel for a respiratory virus.
As a vascular disease, the widespread inflammation caused by the immune response to Covid can inflame the inner lining of endothelial cells, which line our blood vessels. Simultaneously, when the virus enters the cells via the ACE2 receptors, it can cause exocytosis – basically, causing the cells’ guts to spill out, which further increases systematic inflammation. The vascular injury triggers wide-spread clotting, which may explain many of the seemingly weird and unrelated symptoms of acute Covid. This circular reaction may have long term consequences, such as tissue damage and scarring. Whether the injury is obvious, or not, both groups of long-haulers can suffer long-term damage to the lungs, heart, brain and immune system.
It’s not uncommon for a virus to trigger autoimmunity when there is a predisposition. An overactive immune response (such as that seen in Covid) can cause self-antigens to attack a person’s own body. Autoimmune conditions such as diabetes, systematic lupus, rheumatoid arthritis, celiac disease and multiple sclerosis have all been linked to a viral stimulus.
We are also seeing low-grade systematic inflammation in patients who recover from Covid-19. Systematic inflammation has been linked to chronic fatigue, autoimmunity, type 2 diabetes, metabolic syndrome, cardiovascular disease and obesity, among others.
The NIH estimates that 8% of the US population has an autoimmune disease. The national obesity rate is above 40%. Diabetes affects more than 10.5% of the population. In other words, the US already has a chronically ill population – and Covid-19 is only going to make that worse. Economically speaking, preventable chronic diseases account for nearly 75% of aggregate healthcare spending in the US, or an estimated $5,300 per person annually, according to the CDC. Six in 10 adults in the US have at least one chronic disease; four in 10 have two or more chronic diseases. We have long been an unwell nation, even before Covid-19. If anything, Covid long-haul syndrome shines a necessary spotlight on the United States’ chronic problem.
The current health care model doesn’t work. There needs to be more emphasis on lifestyle interventions with a broader understanding of integrative practice. The goal of these prevention strategies is to help Americans live longer, live healthier, and live cheaper. Simply put, preventative healthcare saves money and lives. For instance, researchers have recently discovered that type 2 diabetes can be reversed with early intervention. Headway has been made in treating multiple sclerosis and lupus with immune treatments, as well as with diet and exercise. Almost all chronic diseases are preventable by integrative practices and early intervention.
It must also be noted that chronic illness affects mental health, which manifests physically, increasing the risk for diabetes, sleep disorders, chronic pain, and heart disease, among others.
Simultaneously, health care must be made more accessible – including preventative healthcare, which can no longer be considered as an add-on to traditional care. We know that some communities of color experience chronic illness at overwhelmingly higher rates. We know that autoimmunity affects women at strikingly higher rates than men. We know that chronic illness disproportionately affects those in lower socioeconomic groups. Health must not be a privilege of wealth, whiteness, and gender. The cost is too great.
Currently, we are in the acute stage of a crippling pandemic caused by an invisible pathogen. Layered on top of that is a second pandemic, the mental health costs of this virus. Then there is a third layer: a hyper-partisan political climate, which exacerbates the first two. When a medical mask becomes a sign of political division, we are in grave danger.
No Co-Sponsor of 'Medicare for All' Has Lost Reelection in the Past Decade (Even in GOP-Leaning Districts)
Every single Congressional co-sponsor of these bills in the House and Senate who were up for reelection beat their Republican opponents in 2020. And in 2018. And in 2016.
It'scommon sense: Democratic politicians who support "radical" notions like Medicare for All, free college, or preserving a habitable planet via a Green New Deal guarantee their own defeat. A recent New York Times interview with Pennsylvania Congressman and corporate Democrat Conor Lamb states simply that Medicare for All is "unpopular in swing districts," an idea presumably so obvious that it requires no documentation. Lamb asserts that opposition to Medicare for All and other progressive policies "separates a winner from a loser in a [swing] district like mine."
The Democratic Party's army of political strategists has used this logic for decades, to explain both victories and defeats. Wunderkind party consultant David Shor, for example, assures us that "boring, moderate" Democrats systematically outperform the "ideological extremists."
"Of the 12 Medicare for All sponsors previously elected in swing districts, 9 were running for reelection in 2020. All 9 won. Four of these districts had even leaned Republican in the prior two presidential elections. By contrast, 30 percent (11 of 37) of the moderate Democrats from swing districts lost their reelection bids."
This mantra been internalized by much of the Democratic electorate. Millions of voters in the 2016 and 2020 primaries voted for the "moderate" choices largely because they thought Bernie Sanders and other progressives were not electable. "I might like Medicare for All," the thinking goes, "but most of the country is inalterably opposed, so someone like Sanders just can't win."
It may be common sense, but it's wrong. Every single Congressional co-sponsor of the "Medicare for All" bills in the House and Senate who were up for reelection beat their Republican opponents in 2020. And in 2018. And in 2016. And every Democrat who lost reelection to a Republican had campaigned on the "boring, moderate" platform that Shor contends is the formula for success.
In fact, you have to go back a full decade to find a single Democratic incumbent who co-sponsored a Medicare for All bill and lost their reelection bid. One lost in 2010, when 52 total House Democrats lost reelection in the Republican blowout. For the entire period from 2002 to 2020, there were two. During that time Medicare for All has had between 38 and 124 co-sponsors in the House.
In 2003, Rep. John Conyers (D-MI) first introduced his "Expanded and Improved Medicare for All" bill (H.R. 676). He reintroduced the bill in each session until 2019, when Rep. Pramila Jayapal (D-WA) introduced a successor (H.R. 1384), the "Medicare for All Act of 2019." (In the meantime, Bernie Sanders first introduced a Senate version in 2017.) Starting with the election of 2004, therefore, many voters could express their opinion about this prototypical progressive measure by voting for or against the co-sponsor of a Medicare for All bill. And, if Conor Lamb, David Shor, and the other Democratic establishment gurus are correct, the "ideological extremists" who sponsored those bills should have performed poorly in swing districts, which are only willing to send "boring, moderate" Democrats to Congress. The Medicare for All advocates could be elected and reelected only in overwhelmingly Democratic districts with a strongly progressive population, exemplified by Jayapal's 7th Washington district in Seattle.
Taking Lamb's challenge, we identified the 147 Congressional swing districts which flipped from Republican to Democrat in a House election in 2002 or later. We then looked at which of those Democrats won reelection the next time around, comparing the 12 Democrats from those districts who became co-sponsors of Medicare for All with the 135 "moderates" who did not support the bill.
All 12 Medicare for All sponsors won reelection, despite the fact that their seats had been held by Republicans just two years before. On the other hand, 30% (40 out of 135) of the moderates lost re-election in the next cycle.
This pattern was particularly striking in 2020, when Democrats were surprised by their loss of 10 seats in the House despite Joe Biden's victory at the presidential level. Of the 12 Medicare for All sponsors previously elected in swing districts, 9 were running for reelection in 2020. All 9 won. Four of these districts had even leaned Republican in the prior two presidential elections. By contrast, 30 percent (11 of 37) of the moderate Democrats from swing districts lost their reelection bids.
These results refute Conor Lamb's maxim that progressives can't win election or reelection "in a [swing] district like mine," as well as David Shor's proclamation that "boring, moderate" Democrats systematically outperform the "ideological extremists." The simple truth is that progressives have a better record of winning reelection, even in the swing districts.
"These results support the argument that the left has long been making: that there is a real appetite for progressive, anti-corporate policies among the U.S. public—even in swing states."
Is Medicare for All just an exception? That is, do other progressive policies still alienate the "moderate" voter, as Lamb and Shor argue? To test this possibility, we looked at what is likely the most polarizing of prominent issues in the 2020 election: the willingness of candidates to support systemic reform to curb racist violence by the police. We considered the electoral fate of the eight swing-district Democrats who co-sponsored H.R. 7120, the "George Floyd Justice in Policing Act of 2020." We found that all had won reelection, despite the unanimous common sense among establishment Democrats that supporting the demands of the Movement for Black Lives was electoral poison.
These results support the argument that the left has long been making: that there is a real appetite for progressive, anti-corporate policies among the U.S. public—even in swing states like Lamb's Pennsylvania, and even among the white voters who are so often dismissed and misunderstood by Democratic leaders and hotshot consultants. If those policies are framed clearly and honestly in terms that are intelligible to the average person (e.g., "Medicare for All"), they often garner wide support even in swing districts. And they gain more support than the idea of returning to the pre-Trump status quo and the hollow promises of establishment Democrats.
It's difficult to believe that Democratic Party gurus really misunderstand this reality. All the data we've presented above is easily available online. We collected and analyzed it in about 48 hours. They study this stuff full-time. If they don't see it by now, it's because they and their bosses—and their real bosses, the corporate overlords—are committed not to seeing it. As Upton Sinclair said, "It is difficult to get a man to understand something when his salary depends upon his not understanding it."
https://www.commondreams.org/views/2020/12/21/no-co-sponsor-medicare-all-has-lost-reelection-past-decade-even-gop-leaningHospital Workers Start to ‘Turn Against Each Other’ to Get Vaccine
“I am so disappointed and saddened that this happened,” a New York hospital executive wrote to his staff after workers who did not have priority cut the line for the vaccine.
by Joseph Goldstein - NYT - December 24, 2020
At NewYork-Presbyterian Morgan Stanley Children’s Hospital, one of the most highly regarded hospitals in New York City, a rumor spread last week that the line for the coronavirus vaccine on the ninth floor was unguarded and anyone could stealthily join and receive the shot.
Under the rules, the most exposed health care employees were supposed to go first, but soon those from lower-risk departments, including a few who spent much of the pandemic working from home, were getting vaccinated.
The lapse, which occurred within 48 hours of the first doses arriving in the city, incited anger among staff members — and an apology from the hospital.
“I am so disappointed and saddened that this happened,” a top executive at NewYork-Presbyterian Morgan Stanley Children’s Hospital, Dr. Craig Albanese, wrote in an email to staff, which was obtained by The New York Times.
The arrival of thousands of vaccine doses in New York City hospitals last week was greeted with an outpouring of hope from doctors and nurses who had worked through the devastating first wave in March and April. But for now, the vaccine is in very short supply, and some hospitals seem to have stumbled through the rollout.
Most of the vaccinations in the New York region to date have involved hospitals giving shots to their own employees, a relatively easy process compared with what is to come as part of the largest vaccination initiative in the nation since the 1940s.
The dynamics playing out at hospitals in New York City may be emblematic of what may happen across the country in the near future, when all adults will be given a place in the vaccination line by either the government or their employers.
In interviews for this article, more than half a dozen doctors and nurses at New York area hospitals said they were upset at how the vaccine was being distributed at their institutions. They described what had happened to The New York Times but most asked that their names not be used because hospitals have shown a willingness to fire or punish employees for speaking to the news media during the pandemic.
At some major hospitals in Manhattan, doctors and nurses have recalled scrolling through social media and pausing to make a snap judgment each time they saw a selfie one of their colleagues had posted of getting vaccinated: Did that person deserve to be vaccinated before they were?
“We feel disrespected and underappreciated due to our second-tier priority for vaccination,” a group of anesthesiologists at Mount Sinai Hospital wrote to administrators over the weekend.
Health care workers said rumors were proliferating in WhatsApp groups and amid the banter of the operating room. Stories have begun to circulate of a plastic surgeon who managed to get vaccinated early, of doses being thrown out at one Manhattan hospital because of poor planning. On group chats, doctors debate how — and whether — to try to get vaccinated ahead of schedule.
At Mount Sinai Hospital, some doctors told others that you could talk your way into receiving a vaccine just by getting in line and repeating that you do “Covid-related procedures,” one Mount Sinai doctor, who requested anonymity for fear of retribution, recalled.
One doctor at the Morgan Stanley Children’s Hospital said, “Clearly, we’re ready to mow each other down for it.”
Coronavirus Briefing: An informed guide to the global outbreak, with the latest developments and expert advice.
Many of the rumors have not been true. Still, they illustrate a growing distrust and “every man for himself” attitude, another Mount Sinai doctor said.
Dr. Ramon Tallaj, who serves on a state task force advising the governor on the vaccine’s roll out, said that ill-will and resentment would fade as the vaccine became more widely available.
“People are going to fight over who goes first, or who doesn’t go first, but the important thing is that it’s happening,” Dr. Tallaj, the chairman of SOMOS Community Care, a network of clinics across New York City that treat many patients from Hispanic and Asian immigrant communities, said of the vaccinations.
Health care workers and nursing home residents and staff members form what is called Phase 1 of New York State’s vaccine distribution plan. About two million people are in this group, and the state’s initial allocation of the vaccine most likely means that Phase 2, which includes essential workers, won’t begin until late January. (Widespread distribution isn’t likely to begin until the summer, officials have said.)
But the state has left it mostly to each health care institution to devise a vaccination plan during the first phase. In the first week of vaccinations, many hospitals chose a wide variety of health care workers — nurses, doctors, housekeepers — from emergency rooms and intensive care units to be the first at their institutions to receive the vaccine. But in the days after the celebrations accompanying the first shots, the moods at hospitals have shifted.
Asked about workers cutting the vaccine line at Morgan Stanley Children’s Hospital, NewYork-Presbyterian said in a statement, “We are proud to have vaccinated thousands of patient-facing employees in just over a week, and we will continue to do so until everyone receives a vaccine. We are following all New York State Department of Health guidelines on vaccine priority, with our initial focus on I.C.U. and E.D. staff and equitable access for all.”
Still, The Times interviewed four health care workers at Morgan Stanley Children’s Hospital, all of whom expressed resentment at colleagues and dismay that hospital administrators had allowed the vaccine distribution system to devolve.
One nurse at Morgan Stanley Children’s Hospital said she had gone as far as to confront a social worker who she believed had jumped the line about why the social worker thought she deserved the vaccine ahead of others.
“She said, ‘We have to go to E.R. sometime,’ but that’s not true,” the nurse said of the social worker.
At some places, doctors and nurses who work in dedicated Covid-19 units were not included in the priority group.
Ivy Vega — an occupational therapist who has been treating Covid-19 patients at another NewYork-Presbyterian hospital, the Columbia University Irving Medical Center — said she grew frustrated waiting to be vaccinated while others received the shot. She received her first dose on Wednesday.
“There has been a sense of camaraderie — that’s what’s helped us carry on during the pandemic,” she said. “And now this thing we should be celebrating — the arrival of this much anticipated vaccine — it’s turning into a rivalry. There is competitiveness and skepticism and mistrust.”
At Morgan Stanley Children’s Hospital, some of these nurses said they had yet to be vaccinated a week after vaccinations began.
“I think the sad thing is people are starting to turn against each other,” one doctor who works at the hospital said. “Can you honestly say this clerk deserves it before I do? No, but nobody deserves it before anyone else.”
Another doctor working in an intensive care unit at the children’s hospital recalled the scene last week: A group of staff members were striding energetically toward the elevator banks, where a vaccination station awaited. One of them even explained in passing that they were on their way to get the vaccine.
“It was a free-for-all,” said the doctor, who requested anonymity for fear of retribution from the hospital.
Dr. Albanese, the chief operating officer of the children’s hospital, addressed the free-for-all in the email, placing some blame on the vaccination team for not limiting vaccinations to people on their list.
“We need to prioritize the highest risk teams,” he wrote.
At Mount Sinai Hospital in Manhattan, the vaccine rollout has unfolded in plain view, in the hospital’s atrium, which staff members crisscross throughout the work day or visit to grab a snack or coffee. Many doctors and nurses said they would glance over to see who was standing in line — and whether that person fit the government’s recommendations for those who should be prioritized.
“Despite our strict and stringent vaccination policies and procedures, we are aware of a handful of accusations of improprieties,” Mount Sinai said in a statement. “Due to confidentiality, we cannot speak to any specific individual issue, however, any allegations of any missteps will be appropriately and thoroughly investigated.”
This weekend, anesthesiologists — who have played a crucial role in treating the sickest patients during the outbreak in New York — complained as they say they have watched others get vaccinated before them.
That led to the anonymous letter sent to hospital administrators.
“A boiling point was reached when we witnessed vaccines being administered, seemingly at random, to employees who were not a part of the originally-planned cohort,” read the letter, which was sent anonymously in the name of “Concerned Faculty Members” of the department of anesthesiology, perioperative and pain medicine. The letter was first reported by Politico.
In interviews, several anesthesiologists at Mount Sinai noted that their colleagues at some other hospitals had already been vaccinated.
The anesthesiologists said they expected to play a major role in the second wave if hospitalizations kept rising, and in recent days some in the department have gotten vaccinated.
But just last week, an email from the head of the anesthesiology department, Dr. Andrew Leibowitz, asked for volunteers willing to work full time in a unit for critically ill Covid-19 patients if the outbreak worsened. Some in the department felt they were being told there might be an upside to volunteering.
“I am looking into the possibility of having persons volunteering to perform this duty possibly vaccinated earlier than they might otherwise be,” Dr. Leibowitz wrote.
Dr. Leibowitz did not immediately respond to requests for comment.
One anesthesiologist said he recognized it was reasonable to vaccinate the volunteers first.
But also, he said, it “felt that they were using the vaccine as a bargaining chip.”
https://www.nytimes.com/2020/12/24/nyregion/nyc-hospital-workers-covid-19-vaccine.html?
Remember the Great Toilet Paper Hunt? That May Happen to Vaccines
There are already signs that the rollout will be messy, confusing and chaotic.
by Elizabeth Rosenthal - NYT - December 23, 2020
WASHINGTON — Even before there was a vaccine, some seasoned doctors and public health experts warned, Cassandra-like, that its distribution would be “a logistical nightmare.”
After Week 1 of the rollout, “nightmare” sounds like an apt description.
Dozens of states say they didn’t receive nearly the number of promised doses. Pfizer says millions of doses sat in its store rooms, because no one from President Trump’s Operation Warp Speed told them where to ship them. A number of states have few sites that can handle the ultracold storage required for the Pfizer product, so, for example, front line workers in Georgia have had to travel 40 minutes to get a shot. At some hospitals, residents treating Covid patients protested that they had not received the vaccine while administrators did, even though they work from home and don’t treat patients.
The potential for more chaos is high. Dr. Vivek Murthy, named as the next surgeon general under President-elect Joe Biden, said this week that the Trump administration’s prediction — that the general population would get the vaccine in April — was realistic only if everything went smoothly. He instead predicted the summer or fall.
The Trump administration had expressed confidence that the rollout would be smooth, because it was being overseen by a four-star general, Gustave Perna, an expert in logistics. But it turns out that getting fuel, tanks and tents into war-torn mountainous Afghanistan is in many ways simpler than passing out a vaccine in our privatized, profit-focused and highly fragmented medical system. General Perna apologized this week, saying he wanted to “take personal responsibility.” It’s really mostly not his fault.
Throughout the Covid pandemic, the U.S. health care system has shown that it is not built for a coordinated pandemic response (among many other things). States took wildly different Covid prevention measures; individual hospitals varied in their ability to face this kind of national disaster; and there were huge regional disparities in test availability — with a slow ramp up in availability due, at least in some part, because no payment or billing mechanism was established.
Why should vaccine distribution be any different?
In World War II, toy makers were conscripted to make needed military hardware airplane parts, and commercial shipyards to make military transport vessels. The Trump administration has been averse to invoking the Defense Production Act, which could help speed and coordinate the process of vaccine manufacture and distribution. On Tuesday, it indicated it might do so, but just to help Pfizer obtain raw materials that are in short supply, so that the drug maker could produce — and sell — more vaccines in the United States.
Coronavirus Briefing: An informed guide to the global outbreak, with the latest developments and expert advice.
Instead of a central health-directed strategy, we have multiple companies competing to capture their financial piece of the pandemic health care pie, each with its patent-protected product as well as its own supply chain and shipping methods.
Add to this bedlam the current decision-tree governing distribution: The Centers for Disease Control and Prevention has made official recommendations about who should get the vaccine first — but throughout the pandemic, many states have felt free to ignore the agency’s suggestions.
Instead, Operation Warp Speed allocated initial doses to the states, depending on population. From there, an inscrutable mix of state officials, public health agencies and lobbyists seem to be determining where the vaccine should go. In some states, counties requested an allotment from the state, and then they tried to accommodate requests from hospitals, which made their individual algorithms for how to dole out the precious cargo. Once it became clear there wasn’t enough vaccine to ago around, each entity made its own adjustments.
Some doses are being shipped by FedEx or UPS. But Pfizer — which did not fully participate in Operation Warp Speed — is shipping much of the vaccine itself. In nursing homes, some vaccines will be delivered and administered by employees of CVS and Walgreens, though issues of staffing and consent remain there.
The Moderna vaccine, rolling out this week, will be packaged by the “pharmaceutical services provider” Catalent in Bloomington, Ind., and then sent to McKesson, a large pharmaceutical logistics and distribution outfit. It has offices in places like Memphis and Louisville, which are near air hubs for FedEx and UPS, which will ship them out.
Is your head spinning yet?
Looking forward, basic questions remain for 2021: How will essential workers at some risk (transit workers, teachers, grocery store employees) know when it’s their turn? (And it will matter which city you work in.) What about people with chronic illness — and then everyone else? And who administers the vaccine — doctors or the local drugstore?
In Belgium, where many hospitals and doctors are private but work within a significant central organization, residents will get an invitation letter “when it’s their turn.” In Britain, the National Joint Committee on Vaccination has settled on a priority list for vaccinations — those over 80, those who live or work in nursing homes, and health care workers at high risk. The National Health Service will let everyone else “know when it’s your turn to get the vaccine ” from the government-run health system.
In the United States, I dread a mad scramble — as in, “Did you hear the CVS on P Street got a shipment?” But this time, it’s not toilet paper.
Combine this vision of disorder with the nation’s high death toll, and it’s not surprising that there is intense jockeying and lobbying — by schools, unions, even people with different types of pre-existing diseases — over who should get the vaccine first, second and third. It’s hard to “wait your turn” in a country where there are 200,000 new cases and as many as 2,000 new daily Covid deaths — a tragic per capita order of magnitude higher than in many other developed countries.
So kudos and thanks to the science and the scientists who made the vaccine in record time. I’ll eagerly hold out my arm — so I can see the family and friends and colleagues I’ve missed all these months. If only I can figure out when I’m eligible, and where to go to get it.
https://www.nytimes.com/2020/12/23/opinion/vaccine-distribution.html?
Probe: Trump officials attacked CDC virus reports
WASHINGTON (AP) — Trump administration political appointees tried to block or change more than a dozen government reports that detailed scientific findings about the spread of the coronavirus, a House panel investigating the alleged interference said Monday.
Rep. James Clyburn, D-S.C., said his coronavirus subcommittee investigators have found evidence of a “political pressure campaign” to “bully” professionals at the Centers for Disease Control and Prevention in what may have been an attempt to “cripple the nation’s coronavirus response in a misguided effort to achieve herd immunity.”
Herd immunity is shorthand for a theory — rejected by most public health experts — that society can be best protected by allowing younger people to get infected and develop natural immunity until vaccines are widely available.
Accusing Health and Human Services Secretary Alex Azar and CDC Director Dr. Robert Redfield of stonewalling his investigation, Clyburn issued subpoenas to compel them to turn over reams of documents and emails by Dec. 30.
In a statement, HHS responded that there was no political interference, adding: “While the administration is focused on vaccination shots, the subcommittee is focused on cheap shots to create headlines and mislead the American people.”
The committee’s topline findings were detailed in a 20-page letter to Azar and Redfield that centered on the actions of two political appointees earlier this year at HHS. New York political operative and Trump loyalist Michael Caputo was installed as the department’s top spokesman during a period of high tension between White House officials and Azar. Caputo brought health researcher Paul Alexander with him as an adviser. Both men have since left the agency.
But for months, the letter alleges, they waged a campaign to block or change articles on the COVID-19 pandemic in a CDC publication called the Morbidity and Mortality Weekly Report, or MMWR, which is closely followed by the public health community.
With Alexander firing off internal emails, investigators said the campaign:
— Sought to block or change more than a dozen MMWR articles, sometimes succeeding in getting changes to draft language and at other times delaying publication as internal arguments raged.
— Intensely challenged articles that detailed scientific findings on the spread of COVID-19 among children. This came during a time when President Donald Trump was adamantly urging a return to in-person schooling in the fall. Those included reports about outbreaks in summer camps, data on hospitalization rates among children, and findings about a dangerous condition called “multi-inflammatory syndrome,” which afflicts some children who get sick from the coronavirus.
__ Attacked a draft MMWR article showing a jump in prescriptions for hydroxychloroquine, an anti-malaria drug that Trump embraced early on as a “game changer” only to ultimately learn it could do more harm than good. HHS even went so far as to draft an op-ed rebutting the CDC article, although it was never published. The op-ed accused the MMWR authors of trying to grab headlines, calling them a “disgrace to public service.”
While some HHS career officials apparently tried to defuse Alexander’s criticism by making changes in wording or headlines of MMWR articles, at least one confronted the pressure tactics.
Bill Hall, a senior career spokesman, wrote to Caputo and Alexander to explain that the CDC’s publication was akin to a peer-reviewed scientific journal and that HHS historically had respected its independence. The HHS public affairs office that Caputo once headed “is not a science or medical program office,” wrote Hall. “As a matter of longstanding policy, we do not engage in clearing scientific articles, as that arena needs to remain an independent process.”
The HHS statement said Alexander’s emails “absolutely did not shape department policy or strategy.”
Clyburn explained he took the step of issuing subpoenas in part because his investigation has turned up evidence suggesting attempts to destroy records. A congressional demand for materials raises the legal stakes for anyone attempting to destroy or conceal materials.
Dr. Charlotte Kent, CDC’s chief of scientific publications, previously told committee investigators she was ordered to delete an email from Alexander attacking an MMWR article on coronavirus transmission among children. Kent said she believed the order had come from Redfield. It was transmitted to her through another official.
Redfield responded at the time that he had told CDC staffers to ignore Alexander’s email, and that he is fully committed to maintaining the independence of the MMWR health reports.
HHS said Monday that Kent’s email “was never deleted – it was archived.”
Senate Approves Repeal of Health Insurers' Antitrust Exemption
by Allison Bell - Think Advisor - December 22, 2020
Members of the U.S. Senate approved H.R. 1418, a bill that would repeal a partial antitrust exemption for health insurers, and for dental insurers, by a voice vote Tuesday.
The House approved an identical version of the “Competitive Health Insurance Reform Act of 2020″ bill by a voice vote Sept. 21.
Congress is now sending the bill to the desk of President Donald Trump. The president could sign the bill or veto it. If he decides to veto the bill, Congress could try to overturn the veto, or it could suspend work on the bill.
H.R. 1418 would change part of the McCarran-Ferguson Act of 1945, a law that establishes the framework for how the federal government shares oversight of insurance with state insurance regulators. One section exempts insurers from federal antitrust oversight under the Sherman Act.
H.R. 1418 would add a section that states that, “Nothing contained in this act shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the business of health insurance (including the business of dental insurance and limited-scope dental benefits).”
The bill contains exemptions for insurer efforts to collect and analyze experience data: to perform actuarial services, “if such contract, combination, or conspiracy does not involve a restraint of trade,” and efforts to develop standard insurance policy forms.
Sen. Patrick Leahy, D-Vt., introduced the bill in the Senate together with Sen. Matt Daines, R-Mont.
Reps. Peter DeFazio, D-Ore., and Paul Gosar, R-Ariz., introduced the bill in the House.
Health insurers, the National Association of Insurance Commissioners and the National Council of Insurance Legislators have been defending health insurers’ exemption from federal antitrust regulation for decades.
Matt Eyles, president of America’s Health Insurance Plans (AHIP), said in a statement about passage of H.R. 1418 that implementation of the bill would add layers of bureaucracy to health insurers and destabilize markets.
“Removal of this exemption adds tremendous administrative costs while delivering absolutely no value for patients and consumers,” Eyles said.
Consumer Reports put out a commentary welcoming passage of H.R. 1418.
“The antitrust exemption has essentially allowed health insurers to act as a monopoly, making demands in lockstep on the terms they will offer consumers and health care providers,” the advocacy organization said in a comment on bill passage. “The resulting squeeze puts pressure on providers to cut corners on service in order to increase the profits the health insurers can extract.”
