{"id":47097,"date":"2020-04-03T18:22:02","date_gmt":"2020-04-03T17:22:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47097"},"modified":"2020-04-14T11:11:00","modified_gmt":"2020-04-14T10:11:00","slug":"paul-d-thacker-americas-covid-19-problems-will-not-be-fixed-complaining-about-trump","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/03\/paul-d-thacker-americas-covid-19-problems-will-not-be-fixed-complaining-about-trump\/","title":{"rendered":"Paul D Thacker: America\u2019s covid-19 problems will not be fixed complaining about Trump"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Trump\u2019s incompetent handling of the covid-19 outbreak has set off a spate of criticism of him in the American press and on social media. But placing sole blame on Trump for the projected rise in American mortality disguises an ugly reality: no American president would be able to stem the flow of deaths, because America lacks a real healthcare system. A change in president would not magically fix that, unless our nation fundamentally reform our healthcare sector, which now puts profit before public.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">A couple weeks ago, the American media ran story after story about Trump\u2019s inability to ensure Americans were tested for covid-19. But at the same time, in other countries such as Spain, doctors were warning citizens to stop coming to hospitals for a test, as they were potentially exposing themselves to the virus, and distracting doctors from treating the sick. \u201c<\/span><span style=\"font-weight: 400\">Testing is not treatment,\u201d says <\/span><a href=\"https:\/\/www.jhsph.edu\/faculty\/directory\/profile\/1781\/joshua-m-sharfstein\"><span style=\"font-weight: 400\">Joshua Sharfstein<\/span><\/a><span style=\"font-weight: 400\">, the former Deputy FDA Commissioner, who is now Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins University. \u201c<\/span><span style=\"font-weight: 400\">It\u2019s one piece of the puzzle that is the response. It makes sense in a number of situations, but in others it can provide a false sense of security.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In a <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762951\"><span style=\"font-weight: 400\">JAMA Viewpoint<\/span><\/a><span style=\"font-weight: 400\"> published in early March, Sharfstein and colleagues detailed how bureaucratic snafus and bad luck led to a lack of tests in the States. They also noted that testing does not substitute for other steps to control the spread of the virus, such as handwashing, isolation, and social distancing. <\/span><a href=\"https:\/\/amp.theguardian.com\/commentisfree\/2020\/mar\/15\/america-public-health-system-coronavirus-trump?__twitter_impression=true\"><span style=\"font-weight: 400\">In the Guardian<\/span><\/a><span style=\"font-weight: 400\">, Robert Reich, the former US secretary of labor wrote that America\u2019s dirty little secret is that \u201cthere is no real public health system in the United States.\u201d More than 30 million Americans have no health insurance and lack a system to pay and administer the test, and likely have no paid sick leave so that they can stay home.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In a later op-ed <\/span><a href=\"https:\/\/www.usatoday.com\/story\/opinion\/2020\/03\/19\/pass-coronavirus-crisis-insurance-use-medicare-networks-billing-column\/2865457001\/\"><span style=\"font-weight: 400\">in USA Today<\/span><\/a><span style=\"font-weight: 400\">, Sharfstein expanded on this, writing that America\u2019s<\/span><span style=\"font-weight: 400\"> health insurance system is not designed to fund testing, treatment and recovery services. It was only on 18 March that the US Congress passed the <\/span><a href=\"https:\/\/www.congress.gov\/bill\/116th-congress\/house-bill\/6201\"><span style=\"font-weight: 400\">Families First Coronavirus Response Act<\/span><\/a><span style=\"font-weight: 400\"> which required public and private insurers to provide free testing for the SARS-CoV-2 infection\u2014but this still does not cover treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Even if a test was available, every state is using its own algorithm and protocol for who should be tested, when, and how. Because of this, an American <\/span><a href=\"https:\/\/themarkup.org\/2020\/03\/19\/who-gets-a-coronavirus-test\"><span style=\"font-weight: 400\">journalism outlet<\/span><\/a><span style=\"font-weight: 400\"> sent public records requests to all 50 states to gather and understand these protocols.<\/span><\/p>\n<p><span style=\"font-weight: 400\">And if someone tests positive, the US does not have clear policies telling them what to do next.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Andrew\u00a0<\/span><span style=\"font-weight: 400\">Noymer<\/span><span style=\"font-weight: 400\">, a population health scientist at the University of California Irvine, says that he has advised family members who have no symptoms to stay at home, and avoid being exposed to the virus while going for a test. In an email, he explains that scholars have written about isolating and avoiding people with disease since the Old Testament.<\/span><span style=\"font-weight: 400\"> Quarantining originates from the fourteenth-century plague pandemic, the Black Death.\u00a0 The word comes from Italian, for forty days, the length of time ships had to stay at anchor before coming ashore in Venice to verify they were clean.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But six hundred years after the Middle Ages, America\u2019s healthcare system lacks a coherent system, and does not have a policy for ensuring people stick to quarantine. Earlier this month<\/span><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/www.propublica.org\/getinvolved\/are-you-in-coronavirus-quarantine-tell-us-what-authorities-told-you-so-we-can-make-sure-its-right\"><span style=\"font-weight: 400\">ProPublica reported that<\/span><\/a><span style=\"font-weight: 400\">, after exposure to coronavirus, Americans were given quarantine information that was faulty or that conflicted with the policy of the Centers for Disease Control and Prevention. Exposed reporters were told they could still go outside by one state health agency while maintaining social distancing; a different state agency advised isolating in a room at home, and no contact even with family.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Even when federal or state agencies have a clear written policy on quarantine, ProPublica found that they fail to carry out these policies, and can give conflicting advice.<\/span><span style=\"font-weight: 400\"> Because agencies are giving Americans\u00a0<\/span><a href=\"https:\/\/www.propublica.org\/article\/should-i-quarantine-because-of-coronavirus-it-depends-who-you-ask\"><span style=\"font-weight: 400\">mixed messages<\/span><\/a><span style=\"font-weight: 400\">,\u00a0<\/span><a href=\"https:\/\/propublica.forms.fm\/are-you-in-coronavirus-quarantine-tell-us-what-authorities-told-you-so-we-can-make-sure-it-s-right\"><span style=\"font-weight: 400\">ProPublica is collecting<\/span><\/a><span style=\"font-weight: 400\"> and fact-checking the instructions Americans get from state and local health departments<\/span><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In another example, it seems obvious that America should have had a firm and widely disseminated policy on face masks, long ago. There has been much debate and misinformation shared about the effectiveness of wearing masks. Much of this was discussed\u00a0<\/span><a href=\"https:\/\/www.nytimes.com\/2020\/03\/17\/opinion\/coronavirus-face-masks.html?fbclid=IwAR1ZayWIbrPSZ_8b7ZTJF9YaJ9e27ybf_OD6k0DZM2NU8CnZ3tTJLenuB_E\"><span style=\"font-weight: 400\">in a New York Times op-ed<\/span><\/a><span style=\"font-weight: 400\"> which explained how advising against masks made health officials seem untrustworthy. Masks are not perfect, but in recent days <\/span><a href=\"https:\/\/www.washingtonpost.com\/health\/2020\/03\/31\/coronavirus-masks-cdc\/\"><span style=\"font-weight: 400\">the CDC sent memos<\/span><\/a><span style=\"font-weight: 400\"> to the Department of Health and Human Services and the White House coronavirus task force to revise policy, advising that people wear masks to slow the spread of the pandemic.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Catching Donald Trump in another lie or tweeting another story about something dumb he said at a press conference will not eradicate the real plague endemic to the United States\u2014 the complete lack of a coherent healthcare system. Having a public healthcare system is more important during a pandemic than any particular leader\u2014brilliant or incompetent. Americans can soothe themselves by complaining about Trump, or start coming to grips with this reality, and begin an honest discussion about our country\u2019s fundamental problems.<\/span><\/p>\n<p><em><strong>Paul D Thacker<\/strong> is a freelance journalist. <strong>Twitter<\/strong>: <a href=\"https:\/\/twitter.com\/thackerpd\">@thackerpd<\/a><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and note that I am paid to write for various media outlets, consult part time for a nonprofit research institute that studies brain disorders, and have had universities provide expenses for talks on corruption in science and medicine.\u00a0<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Trump\u2019s incompetent handling of the covid-19 outbreak has set off a spate of criticism of him in the American press and on social media. But placing sole blame on Trump [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/03\/paul-d-thacker-americas-covid-19-problems-will-not-be-fixed-complaining-about-trump\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":41174,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-47097","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Paul D Thacker: America\u2019s covid-19 problems will not be fixed complaining about Trump - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/03\/paul-d-thacker-americas-covid-19-problems-will-not-be-fixed-complaining-about-trump\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Paul D Thacker: America\u2019s covid-19 problems will not be fixed complaining about Trump - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Trump\u2019s incompetent handling of the covid-19 outbreak has set off a spate of criticism of him in the American press and on social media. 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