Public Health Alert -- Foreign Policy: Trump Has Sabotaged America’s Coronavirus Response by Laurie Garrett, January 31, 2020

If you don't know Laurie Garrett and her works regarding disease transmission, epidemic and public health policy, you should. Her expertise in these areas is renown and she knows more about these areas than nearly every practicing physician. I venture to guess that if you look in the library of many physicians, you'll probably see at least one or more of her books. If you have any interest in public health, particularly when it comes to the spread of disease, then I suggest that you read one or more of her books. 

Here is the link to Laurie Garrett's article in Foreign Policy: https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

 Trump Has Sabotaged America’s Coronavirus Response

Under President Obama, the US infrastructure and ability to respond to pandemics was unparalleled. It took years to create the organizational and management structures and put the systems put in place to manage a pandemic and protect Americans as well as others throughout the world. Trump on the other hand destroyed everything that President Obama had created for addressing pandemics, but has gone further to downgrade the capabilities of our public health systems including the Centers for Disease Control (CDC). 

Here are a few quotes from her article:

• In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure.
• In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.
• In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10.

Comparing the CoronaVirus to Something Similar that We Know and Have Experienced

As a means of comparison, the death rate from those infected by common and yearly influenza virus strains is about 1 in 1000. (.1%) In a recent interview, Laurie Garrett stated that the death rate for the Coronavirus is at 2 in 100 (2% or crude rate of 2000 in 100,000) and in some places in China, some have reported a death rate at closer to 6 in 100 (6%). The death rate in the influenza pandemic of 1918 was something on the order of 2 to 3 in 100 (2 to 3%). And if you have don't any sense of just how bad that pandemic was, there are many books and articles (printed and online) that discuss it and several documentaries that are available. One of the complicating factors that assisted the spread of the virus. This outbreak occurred during World War I and as part of US policy, the Federal Government did little or nothing to respond to stem the spread of the virus. The rationale was that the lack of a strong public health response was to continue to maintain the US's war fighting capability. It was feared that public health measures result in the reduction in war materials production and in the recruitment and training of troops. Also, there was concern that a public health response could create panic, thus also affecting the ability to prosecute the war. In fact the Federal Government actively suppressed information about the epidemic and the measures to take to prevent its spread.

There's a great deal of controversy regarding whether the actions or lack of action taken by the Federal Government was this was a good idea. The lack of a public health response created a situation where replacement troops from the US infected troops already in the field, thus reducing unit combat effectiveness and leading to field hospitals being overloaded and caregivers over taxed. Also, the lack of information and direction from the Federal Government created fear and panic. Providing the information and direction on ways to suppress the spread of the virus would have actually helped the war effort.

Finally, if you look at the responses by the Federal Government to the possibility of a Coronavirus epidemic hitting the US, the responses are uncoordinated, scattered and filled with both good and misinformation. The "head in the sand" approach taken by the White House and the President ("everything is fine, nothing to worry about here, the virus will disappear by April ...") is at odds with the statements from the CDC and the World Health Organization about the likely spread of the Coronavirus to the US.

What the US does to deal with this epidemic will be important. In 1918, the actions the US took actually aided the spread of the virus around the world. What the US did with other organizations such as Doctors without Borders (I should note that I make a monthly donation to Médecins Sans Frontières, Doctors without Borders) in 2014 to stem and contain the spread of the Ebola virus was important. What the US does in response to stem the spread of the Coronavirus will be important ... for better or for worse. 

Updated: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing: What appears to be causing this?

Here's the reference to the article I that has prompted my analysis into the data that they have collected and a brief summary of their results:

https://jamanetwork.com/journals/jama/fullarticle/2756187?guestaccesskey=c1202c42-e6b9-4c99-a936-0976a270551f&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=112619

Here's a summary of their conclusions: 

US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER.

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In my previous two articles that reference this study, I examined data from other countries and in my most recent article, I examined US mortality rates in comparison to US peer countries. If you read that article you'll know that my findings showed that the US is at the bottom of the group. The US life expectancy is even lower than for Puerto Rico. 

The JAMA article referenced above examined US mortality data only, but performed a careful analysis to examine why people died. I think that we can agree that US life expectancy in comparison to other peer countries is lower than it should be. And the fact that it appears to have begun to drop is unacceptable. My question is why? Why is US life expectancy dropping instead of rising? What appears to be the major driver or drivers for this phenomena?

I pulled two figures from the study that appear to show why US life expectancy appears to be dropping over the last three years and why in earlier years the increases in US life expectancy had not kept up with its peer countries. 

Figures 4 and 6 from the JAMA article

Figure 4 clearly shows that the major increasing cause of death in all age categories is drug related -- Drug poisoning. All the other curves remain reasonably flat with one exception, hypertensive diseases for those 55 to 64 years old. One might expect that diabetes would be a contributor given that more and more people in the US are obese, but this is not the case. In each age group, diabetic related deaths are either flat or dropping. (The increase in hypertensive deaths are likely related to the overall increase in obesity.)

Figure 6 breaks down the drug poisoning deaths by Race/Ethnicity from 1999 to 2017. White Americans and American Indians & Alaska Natives show a steady increase in death from a drug overdose. African-American drug overdose deaths appear to have been relatively flat until 2014 when they showed a dramatic and unsettling rise. Both US Hispanics and Asian/Pacific-Islanders show an increase in drug related deaths, but nothing like the others. 

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Looks like we have more evidence of the level of significance of the impact of the opioid crisis. 

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I've seen references to one of the reasons for the decrease in life expectancy for the from 2015 to 2017 is the increasing rate of suicide. While suicides have been increasing, they've been increasing at a reasonably steady rate from 1999 -- which is the earliest date found from the CDC Wonder database. Suicides have not shown the dramatic and curvilinear rise that drug related deaths have shown. So yes, an increase in suicides is clearly a contributor to the reduction in the US life expectancy, but not a major contributor. 

US life expectancy has not kept pace with that of other wealthy countries and is now decreasing

I've analyzed US suicide and drug-related death data. And the results have been striking and concerning. In fact with respect to drug related deaths, I performed a worst case analysis to predict the deaths for 2017. As it turned out, my worst case analysis wasn't nearly bad enough. That was a shocking and saddening realization.

However this is one of the saddest and most concerning studies I have seen regarding indicators regarding life in the US. 

When it comes to life expectancy, the US does better than the world average. But, US life expectancy rate is falling when life expectancy around the world is in virtually every case, increasing. Furthermore, when you look at life expectancy of other countries, the US ranks with Poland and the Czech Republic, not with Japan, Switzerland, the UK, Canada, Spain, Norway, France and others in the EU. Puerto Ricans have a higher life expectancy than those in the US.

Here's the link to the recently published study from the Journal of the American Medical Association (JAMA) that discusses the recent findings.


https://jamanetwork.com/journals/jama/fullarticle/2756187?guestaccesskey=c1202c42-e6b9-4c99-a936-0976a270551f&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=112619

Here's a summary of their conclusions: 

US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

I wanted to get this out as soon as a saw it. I'll have more to say about this article in a later blog article. I'll add specific comparisons to data from other countries. 

If you're a US health care professional, it's worth your time just to scan the article. 

Public Health Crisis: Suicides

This is a public health related piece. I produced a video about suicides. The data that I analyzed was from the Centers for Disease Control.

Suicide has been on the public radar recently because of the scrutiny it has received in the press. And the concerns expressed in the press about the rising numbers and rate of suicide.

When I was in college, I was taught that suicide was a largely based on the victim's emotional state. That the answers of how to address it were to be found in psychology and psychiatry. That may have been true then, but the data that I analyzed, that you will see in this movie, says that suicide may now be more of a socio-economic problem.

Here is the link to the video:

Let us know what you think.

New York Times Magazine Article: Losing Earth - CO2 concentration in the atmosphere and it's relationship to global average temperature

This is related to public health not just for now but in the future as well. Here's the link to the article: https://www.nytimes.com/interactive/2018/08/01/magazine/climate-change-losing-earth.html This article is definitely worth your time.

I use this as a lead in to something that I posted on my other blog, Professional Predictive Models. I did this analysis on the connection between CO2 concentration in the atmosphere and it's relationship to the global average temperature. The strength of the relationship of these two measurement actually startled me. Here's the link to the blog post: https://professionalpredictivemodels.blogspot.com/2018/08/relationship-between-carbon-dioxide.html