On May 6, the U.S. Senate Committee on Homeland Security and Governmental Affairs held a hearing on “COVID-19: How New Information Should Drive Policy” and heard testimony from six experts.
They didn’t all agree that it was necessary to conduct millions of tests and widespread contact tracing on everyone who tests positive. There was encouraging news about treatment for hospitalized COVID-19 patients. And there were hints of how the practical requirements of implementing a chosen policy can cause the rhetoric of politicians to become separated from the evolving facts.
The expert whose views most closely mirrored what we’re hearing from the governor and some local officials in California was Tom Inglesby, M.D. He’s Director of the Center for Health Security at the Bloomberg School of Public Health at Johns Hopkins University, where he is also a Professor of Public Health and of Medicine.
Inglesby’s colleagues worked with the American Enterprise Institute to produce a report titled “National Coronavirus Response: A Roadmap to Reopening.” It advised that four conditions were necessary “to reopen states with low risk.” These were a “sustained reduction in cases for 14 days,” hospitals “safely able to treat all patients requiring hospitalization,” the state is “able to test all people with COVID-19 symptoms, mild or severe,” and “the state is able to conduct active monitoring and quarantine of confirmed cases and their contacts.”
Inglesby told the committee that political and public health leaders should “strongly advise” six-foot distancing between people, “strongly encourage” the wearing of cloth masks, and “strongly discourage” gatherings.
In California, “strongly” encouraging or discouraging an entire population has meant daily directives with ever-more-specific and sometimes irrational restrictions and exceptions, accompanied by shaming, harassing and arresting, not to mention urging people to snitch to government officials whenever they see someone who’s not sticking with the program.
Inglesby inadvertently shed light on one reason that officials are so insistent on having millions of COVID-19 tests before the state may reopen. He said the manufacturers of diagnostic tests want “market security” before they invest to ramp up production of COVID-19 test kits to meet that kind of demand. You can’t blame the companies. They could go under trying to make millions of tests only to see the requirement called off, leaving them with debt and warehouses of unsold products.
Other experts did not agree that it’s necessary to conduct a million tests per day, or to stay locked down until that can happen.
Scott W. Atlas, MD, the David and Joan Traitel Senior Fellow at Stanford University’s Hoover Institution and the former Chief of Neuroradiology at Stanford University Medical Center, testified that “total isolation prevents broad population immunity and prolongs the problem.”
David L. Katz, MD, PhD, and president of the nonprofit True Health Initiative is an internist with 30 years of experience, and a board-certified specialist in Preventive Medicine and Public Health. He recommended testing a “representative random sample” of the U.S. population, requiring perhaps 50,000 tests per day. Katz advised “risk-based interdiction policies that shelter/protect those most vulnerable to severe infection and grave outcomes, while phasing back to relative normalcy those in lower risk groups.”
Katz said the risk of a bad outcome from COVID-19 for younger people is related to chronic health conditions that are “modifiable,” such as obesity, type 2 diabetes and heart disease. He said it’s a great time for the government to encourage a national “get healthy” campaign.
There was encouraging news about treatments for COVID-19 patients from Pierre Kory, MD, MPA, Medical Director, Trauma and Life Support Center and Critical Care Service Chief, as well as Associate Professor of Medicine, University of Wisconsin School of Medicine and Public Health.
Kory and other experienced critical care physicians around the country formed the Front-Line Critical Care Working Group and developed a protocol for treating COVID-19 that has been used to treat more than 100 hospitalized patients with great success. The protocol can be found at covid19criticalcare.com.
Kory’s group sharply disagrees with the “national and international health societies” that issued recommendations for a strategy of treating COVID-19 with “supportive care only” while recommending against the use of corticosteroids. Calling this a “tragic error,” Kory reported that in hospital settings, the use of steroids led to a “massive reduction in mortality,” allowing even severely ill patients to eventually “walk out of the hospital.”
Hydroxychloroquine and remdesivir, Kory said, could be appropriate for patients in an earlier stage of the disease, in “outpatient settings,” but are not the right treatment for hospitalized patients.
Timing, it turns out, is everything. The policy that makes sense at the beginning of a pandemic can be pointless or ruinous later on.
Avik S. A. Roy, president of the Foundation for Research on Equal Opportunity, testified about the harm that the lockdowns are causing to people with incomes or wealth below the U.S. median. His organization’s data and recommendations are online at FREOPP.org. “Work by hourly employees has collapsed,” he told the committee. “I am gravely concerned about the profound economic destruction that the COVID-19 lockdowns have caused.”
That concern was shared by Stanford’s John P.A. Ioannidis, MD, Professor of Medicine, of Epidemiology and Population Health, of Biomedical Data Science and of Statistics. “We need to consider both the benefits and harms of each of our policy interventions and to adjust our interventions according to continuous feedback with reliable data,” he testified, “real data, as opposed to just using models.”
Sweden provides a look at “what might have been” in the United States. Swedish officials bucked the trend and chose not to lock down the country, yet that nation has had roughly the same outcome from COVID-19 illnesses as countries that did lock down. Sweden banned large gatherings and recommended social distancing, but they did not close businesses, bars, nightclubs, restaurants or elementary schools. The U.S. experts told the Senate committee that Sweden could have done a better job of protecting its nursing homes, and that the U.S. knows how to do that. As an example, they recommend keeping staff “local” instead of having workers visit multiple facilities.
Overall, the report from the experts was good news. It is possible to reopen the nation while protecting vulnerable people.
And it’s time to do it.
Susan Shelley is an editorial writer and columnist for the Southern California News Group. Susan@SusanShelley.com. Twitter: @Susan_Shelley