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Internal Emails Show How CDC Chaos Slowed Coronavirus Response

Reprinted with permission from ProPublica.

On Feb. 13, the U.S. Centers for Disease Control and Prevention sent out an email with what the author described as an “URGENT” call for help.

The agency was struggling with one of its most important duties: keeping track of Americans suspected of having the novel coronavirus. It had “an ongoing issue” with organizing — and sometimes flat-out losing — forms sent by local agencies about people thought to be infected. The email listed job postings for people who could track or retrieve this paperwork.

“Help needed urgently,” the CDC wrote.

This email is among hundreds of pages of correspondence between federal and state public health officials obtained by ProPublica through a records request in Nevada.

During the period in which the correspondence was written, from January to early March, health officials were trying to stay ahead of the coronavirus outbreak underway in China. By mid-February, when the CDC job postings email went out, the virus had a toehold in the United States, where there were already 15 confirmed cases. In another two weeks, the first case of community transmission would be reported in California, followed shortly by cases in Washington.

The documents — mostly emails — provide a behind-the-scenes peek into the messy early stages of the U.S. response to the coronavirus, revealing an antiquated public health system trying to adapt on the fly. What comes through clearly is confusion, as the CDC underestimated the threat from the virus and stumbled in communicating to local public health officials what should be done.

The same week the CDC sent out the email about the job openings, the agency sent Nevada officials alerts about 80 potential coronavirus patients to monitor, documents show. Four were not Nevada residents.

A state epidemiologist, in each instance, corrected the agency, informing the CDC that the person was from New York, not Nevada. (The CDC then redirected each report to New York, the documents show.)

The confusion sometimes went both ways. On March 4, a program manager in the Nevada Health Department reached out to the CDC to ask about congressional funding for COVID-19, the disease caused by the novel coronavirus.

“There seems to be a communications blackout on this end,” the program manager wrote, wondering if funds would be distributed based on the number of cases in each state or by population.

“Unfortunately, there is no clear answer to your questions,” responded a CDC staffer, apologizing for the lack of information. “We are hearing all of the rumor mills as well.”

“Thank you,” the Nevada program manager replied. “It’s good to be confused together.”

Chaotic Coordination

For much of February, the CDC kept a tight grip on who should be tested for the coronavirus, a strategy that has been criticized by epidemiologists for limiting the ability to track the spread of the disease.

In a Feb. 19 presentation to state health officials, the CDC described the definition of a person who ought to be tested: You had to have had close contact with someone confirmed to have COVID-19, or to have traveled from China and then had respiratory symptoms and a fever at the same time.

However, the CDC’s own guidance from a month prior, distributed to the states on Jan. 17, had a footnote that said that “fever may not be present in some patients,” such as people who had taken fever-lowering medications, according to one of the documents obtained by ProPublica. That caveat was not on the slides presented to the states in mid-February.

In a statement to ProPublica, the CDC said clinicians could always use their judgment to decide who received a test. “CDC never declined a request for testing that came from a state or local health department,” the agency said.

In mid to late February, the CDC was trying to move responsibility for coronavirus testing from itself to state health departments — a critical step, since the CDC does not have the capacity to be the nation’s testing lab. Slides from the Feb. 19 presentation describe the process for transitioning from “Phase 1,” in which the CDC determined who was a potential COVID-19 patient and conducted all the testing, to “Phase 2,” in which local health departments would do that work and report data back to the CDC.

Because of delays with test kits, Phase 2 had to be “redesigned,” the presentation said, so the CDC would continue to test specimens and return results. The CDC told ProPublica that all states have now transitioned to the original Phase 2 plan, where they can run their own tests.

The CDC presentation also directed the states to use a web platform called DCIPHER, which the agency was already using for food-related outbreaks, to report potential COVID-19 patients and confirmed cases.

But it wasn’t until the week of Feb. 24 — the same week that the U.S. would discover its first case of community-acquired COVID-19 — that the CDC scheduled a training for states on how to use the platform, according to the documents.

On March 1, the CDC emailed Nevada’s Health Department, requesting that it send a list of users and email addresses to connect to the DCIPHER system, to “ensure that we can onboard your jurisdiction.”

“We sent a spread sheet a couple weeks ago which I thought covered this,” a state epidemiologist responded.

Four days later, Nevada announced its first confirmed case of the coronavirus. It’s unclear when the state managed to successfully get on the DCIPHER system. Officials from Nevada declined to comment.

“Maybe Just Kidding”

A key part of the CDC’s strategy during the early days of the outbreak was identifying infected travelers returning from China. The process for screening passengers arriving at Los Angeles International Airport did not go smoothly, the correspondence obtained by ProPublica indicates.

On Feb. 16, a CDC staff member sent a message to colleagues about a buggy electronic traveler screening questionnaire that wouldn’t save correctly, among other issues. Also, the tool’s drop down field auto-populated with “United Kingdom” instead of “United States,” forcing users to type “United States of America.”

The CDC staffer also said the agency was struggling to interview non-English speakers in a timely manner and needed additional interpreters.

“Hello Team,” another CDC staff member responded, offering a solution: “The Google translate App has a real-time voice translation option.”

The screening protocol also wasn’t always clear. On Feb. 29, a CDC officer at LAX sent an email to her colleagues, saying: “In case this comes up again, we are not screening private flights. These would be flights that land at LAX but don’t arrive into the regular terminal … mainly for rich people.”

Just over two hours later, the officer emailed again. “And, maybe just kidding,” she wrote. Information from headquarters seemed to contradict what she had said about private flights, she said.

The CDC told ProPublica that it scaled up the screening almost overnight, so it focused on vetting the largest segment possible of high-risk passengers coming from places like Wuhan, China. The agency trained staff and dealt as best it could with limited staffing and translation services, it said.

“Protecting Americans Is What We Do”

The CDC’s initial response to COVID-19, particularly its failure to initiate swift, widespread testing, has drawn intense criticism.

Nonetheless, the correspondence ProPublica obtained shows that the CDC director, Dr. Robert Redfield, exuded confidence in communications with others at the agency.

On Jan. 28, when the CDC had confirmed five cases of the coronavirus, all in travelers who arrived from outside the country, he emailed colleagues to acknowledge it posed “a very serious public health threat,” but he assured them “the virus is not spreading in the U.S. at this time.”

That actually may not have been the case. The CDC confirmed the first case of COVID-19 in Washington on Jan 20. Trevor Bedford, a computational epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, has said he believes that the virus could have begun circulating in the state immediately after the traveler arrived in mid-January, based on his analysis of genetic data from the initial Washington cases.

The CDC said in its statement that Redfield’s comments were based on the data available at the time. “At no time, did he underestimate the potential for COVID-19 becoming a global pandemic,” the agency’s statement said. “He stated consistently that more cases, including person to person spread, were likely.”

On March 3, Redfield wrote to his staff again, stressing the agency’s readiness, despite the growing evidence that it wasn’t. “We anticipated and prepared for the possible spread of COVID-19 in communities across the United States,” he said in an email.

The CDC said in its statement that Redfield was telling staffers that the agency would continue to be engaged in a sustained response to COVID-19. Redfield’s email was not characterizing the state of the outbreak, the CDC said.

By that point, it was clear that the coronavirus was gaining ground within the country, even if the inability to test for it was obscuring the true numbers. Physicians and public health experts begged for more tests while warning that thousands of cases would soon emerge.

Still, Redfield’s March 3 email struck a reassuring note.

“Confronting global outbreaks and protecting Americans is what we do,” Redfield wrote in the message. “More and more, people are turning to us for guidance, and we respond consistently with evidence-based information and professionalism.”

Trump’s Shady CDC Director Forced To Resign In Disgrace Over Tobacco Stocks

Reprinted with permission from Shareblue.

Donald Trump and his administration have already had to face a number of embarrassing ethical issues in just one year, and now there’s one more humiliation to add to his list.

Dr. Brenda Fitzgerald, appointed just seven months ago to head the Centers for Disease Control and Prevention, has been exposed for trading stocks in Japan Tobacco, a multinational cigarette corporation, while simultaneously heading the CDC.

Less than 24 hours after the story broke, Fitzgerald submitted her resignation.

Even before this story broke, Fitzgerald was facing heavy scrutiny for her conflicts of interest that precluded her from fully performing her jobs. She was forced to recuse herself from a wide variety of public health issues, ranging from cancer to the opioid crisis, and had declined to testify to Congress.

This comes at a time when Trump has left hundreds of CDC positions vacantly and proposed billions of dollars in cuts to the agency, even as they struggle to cope with flu season.

Fitzgerald had been appointed to her role by Trump’s former Health and Human Services secretary, Tom Price, who was forced to resign last September amid allegations he had blown over $1 million in taxpayer money traveling on private jets.

Fitzgerald’s departure isn’t the end of the conflicts of interest at Health and Human Services. The new secretary, Alex Azar, who is overseeing Trump’s supposed effort to reform prescription drug prices, is a former pharmaceutical executive who gouged diabetics for insulin and tested erectile dysfunction pills on children just to block competitors from developing a generic version.

The people Trump and his team have tapped to manage the health and well-being of the American people have been an absolute disaster. We deserve leaders who approach their job seriously and ethically.

Matthew Chapman is a video game designer and science fiction author from Texas. Can be found on Twitter @fawfulfan.


Thanks To The NRA And Their Lackeys In Congress, It Is Illegal to Study Gun Violence

Published with permission from Alternet.

As Black Lives Matter protests continue across the nation, a new study is complicating the debate around police violence.

The study, which comes out of Harvard, took data from a number of police departments across the country and looked at how different groups of people are treated by law enforcement.

As expected, the study found that police officers are more likely to use force when dealing with black people than they are when dealing with white people.

For example, police are 18 percent more likely to push black people against a wall, 16 percent more likely to put them in handcuffs, 19 percent more likely to draw their weapons, and so on.

These statistics are depressing for sure, but not really all that surprising given the reality of systemic racism in this country.

But what is surprising is what this study found about police officers use of lethal force, i.e. when they kill people. Contrary to what you’d expect, it found that police are just as likely to kill white people as they are black people.

Predictably, the right-wing media has jumped on this as proof—proof—that the Black Lives Matter movement is lying. For example, the Drudge Report linked to a New York Times story about the Harvard study with a headline that read, “STUDY: NO RACIAL BIAS in police shootings…”

But is this study really all that definitive?

No, it’s not.

The problem with the Harvard study is that it relies on data from just a handful of different police departments, most of which are located in big cities like Houston, Dallas and Los Angeles. This isn’t a bad idea on its own. After all, the bigger a city is, the more representative it is of the population as a whole. But in the context of studying police violence, relying on data from just a few big cities isn’t the best idea.

If there’s one thing we’ve learned over the past few years, it’s that some of the worst police violence occurs in smaller cities like Ferguson, Missouri or Baton Rouge, Louisiana. A truly accurate analysis of police use of force should therefore include data from these smaller cities, not just the big cities that are almost always better trained and better equipped than their local counterparts.

And that raises the question—why didn’t the author of the Harvard study use better data? Well, it’s probably not because he was trying to make it seem like there’s no racial bias in police violence. It’s because there’s not really any good police violence data out there.

Even after the reforms the FBI announced back in December, reporting of police violence to the federal government is still completely voluntary. Until reporting by police departments of their officers’ use of force is compulsory and countrywide, we’re never going to get an accurate picture of what’s going on.

But even if reporting police violence data were compulsory, there’d still be big obstacles to using that data in any sensible way. That’s because thanks to Republicans and the National Rifle Association, it’s been illegal for more than 20 years for the Centers for Disease Control and Prevention to conduct any research on gun violence.

That’s right—illegal!

This ban began back in the 1990s after the CDC published some good, solid research into gun violence. One of the first studies they did found a clear relationship between increases in gun ownership and increased homicide rates.

The NRA didn’t like where this was going for obvious reasons, so it started pushing its bought-and-paid-for shills in Congress to do something about those pesky scientists at the CDC. The NRA got its wish in 1996 when Republican Congressman Jay Dickey introduced what’s now known as the Dickey Amendment.

It was a policy rider attached to a spending bill and it stated that, “None of the funds available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

Because it’s so broadly worded, the Dickey Amendment has had a chilling effect on gun research at the federal level.

No one wants to go to jail for doing their job, and CDC researchers live in fear that they’ll become the next Lois Lerner, dragged in front of a congressional kangaroo court and forced to testify for hours on end.

Tragically, we really need the information from good studies about police violence—but the Dickey Amendment has prevented them from being done.

Therefore, we don’t know what kind of connections there are between gun ownership and police violence, connections we should have known about years ago but haven’t because of the gun industry’s stranglehold over public policy.

The NRA, of course, couldn’t be happier with this situation. But this is just absurd. Even Jay Dickey thinks so. He’s now come out against his own amendment and thinks it should be repealed.

He’s right.

Thom Hartmann is an author and nationally syndicated daily talk show host. His newest book is “The Crash of 2016: The Plot to Destroy America — and What We Can Do to Stop It.

Photo: Flickr user DonkeyHotey

EXCLUSIVE: When Republicans Sabotage Zika Funding, Local Health Departments Suffer

As Congress continues to stall on funding Zika research, local health departments are bearing the brunt of their inaction.

Earlier this month, the Centers for Disease Control shifted $44 million of its federal funding towards research on the mosquito-borne disease after Congress failed to allocate any funds itself.

But since this money is normally funneled down to local health departments for emergency preparedness, city and statewide offices have lost critical funds they need in order to prevent the spread of Zika at the local level.

New York City, home to a confirmed 310 cases of the infectious disease, lost $1 million in emergency funds from the CDC — a number that deputy commissioner of emergency preparedness Marisa Raphael predicts could impact the city’s capacity to conduct lab testing as well as surveillance activities like tracking and interviewing Zika patients.

“It’s very painstaking, time-intensive work, but so critical for the ultimate goal of spreading disease,” she said in an interview. “You need people with that technical expertise to investigate outbreaks on any given day.”

Raphael added that the “highly problematic” cut could affect the department’s ability to sustain its existing Zika monitoring networks while also addressing the competing demands of other potential outbreaks.

House Republicans have repeatedly stalled a bipartisan Senate bill that sought to allocate $1.1 billion towards research on the virus. When the House passed another $1.1 billion plan in June, Senate Democrats objected to “poison pill” provisions that would have prohibited allocating funds to Planned Parenthood for fighting the virus, weakened pesticide restrictions, and, curiously, ended the ban on displaying Confederate flags in national cemeteries.

Louisiana, meanwhile, experienced a $700,000 slash in its CDC allocation — known officially as Public Health Emergency Preparedness, or PHEP. In past months, about a quarter of the state’s PHEP money has been used towards fighting the virus, through measures like a “Tip and Toss” campaign meant to keep mosquitoes out of residential areas.

Dr. Frank Welch, Louisiana’s medical director for community preparedness, said the reduction in funding means that the state’s already cash-strapped health department is struggling to fill empty positions.

“Before Zika, we were already really strapped with our ability to respond ourselves with boots on the ground,” Welch said. “When you’re already down to just a few and you can’t fill those positions you had before — when you’re down to nine instead of 11 — that’s really just a critical amount.”

While the private sector has taken up some work in treating cases, Welch explained that these medical providers tend to focus only on treating patients. Louisiana’s plan, on the other hand, looks to educate travelers returning from Zika-stricken countries and keep mosquitoes at bay in the state’s swampy terrain.

And when it comes to testing pregnant women twice for the virus—a federal recommendation—Welch said it would impossible for the Louisiana health department to carry out this measure on its own.

Dr. Oscar Alleyne, a senior adviser at the National Association of City & County Health Officials, conducted a survey in May that found the CDC reallocation would cause a majority of departments to lose between 5 and 10 percent of their funding. Survey respondents said that preparation measures, supplies, and staffing would be most adversely affected by the cuts.

“We’re still dealing with the fact that there hasn’t been any movement from the congressional side on providing necessary resources,” Alleyne said. “So that still maintains a degree of concerns.”

True to the survey, the Florida Health Department — which serves over half of the nine U.S. cities estimated to be at highest risk of an outbreak — lost over $2.3 million as a result of congressional inaction. It’s now unable to implement enhancements to its preparedness measures, a spokesperson said.

South Carolina, meanwhile, lost about seven percent of the budget for its Office of Public Health Preparedness, which is tasked with preparing for and responding to emerging infectious diseases like Zika, according to a spokesperson.

“You have infrastructure cuts and then you have to modify infrastructure to deal with the pending threat — which we are sure is not a matter of ‘when,’” Alleyne said. Mosquito season is now in full peak.

Some local health departments have received money to fight Zika from alternative sources: New York’s mayor, for instance, announced a three-year, multi-million dollar plan to address the virus. But Alleyne said that these amounts are “a drop in the bucket” compared to the $44 million that they have lost — not to mention the $1.1 billion in federal research funding.

For his part, Louisiana’s Welch said that the congressional stall shows that public health emergencies like Zika cannot wait for politicians to observe a threat and then fund it.

“Things like this will continue to happen,” he said. “We might be better served if we had a more global view, realized the importance beforehand, and funded it in a way where we were prepared.”


Photo: Aedes aegypti mosquitoes are seen inside Oxitec laboratory in Campinas, Brazil, February 2, 2016. REUTERS/Paulo Whitaker/File Photo