COVID-19 Day 56: There’s Someone Missing from the Covid Taskforce

C19_taskforcemia

After the My Pillow Guy and Trump’s Disinfectant Gaffe, I wouldn’t think anything else would surprise me about the White House COVID Taskforce until I happened to look into its members. I went through each bio trying to figure out which one was the epidemiologist? There isn’t one.

President Trump assembled the Taskforce on January 29, to monitor and brief him on the potential threat of COVID-19. This was about a week after the first case of COVID-19 was identified in the US in Washington state. Three days after their first briefing, President Trump announced a public health emergency and imposed travel restrictions on mainland China and later Europe.

The Taskforce was expanded in February with Vice President Mike Pence as Chairman, adding US Surgeon General Jerome Adams, Dr. Ben Carson head of HUD, Treasury Secretary Steven Mnuchin, and others. The current 22 taskforce members include 7 lawyers, 5 businessmen/economists, 2 civil administrators, 1 meteorologist, 1 journalist, 1 diplomat, and 5 medical doctors, including Dr. Robert R. Redfield, a virologist, and Dr. Deborah Birx and Dr. Anthony Fauci who are both immunologists.

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Original January taskforce members highlighted

While related to epidemiology, immunology and virology focus inward on how a virus infects the body and the body’s immune response. Epidemiology, on the other hand, looks outward; the big picture of how a disease starts, develops, spreads, and ends in a population.

Redfield, Brix, and Fauci are certainly experienced in epidemiology even though their academic degrees are in other sciences. And presumably they have epidemiologists working with them. Redfield is the head of the CDC, Brix directs Global HIV initiatives at the CDC, and Fauci has been involved with HIV/AIDS vaccine and treatment research since the 1980’s; as well as leading the NIH’s response to SARS, MERS, and H1N1.

All of the taskforce MD’s are first and foremost doctors. They took an oath to treat or cure their patients to the best of the ability. This patient-centric world-view may explain some of the decisions and guidelines the taskforce has made.

From the start back in January, the CDC and Surgeon General discouraged face-mask use by the general public. I presume their concern was the preservation of PPE (Personal Protective Equipment) supplies for health care workers. It took until April before they reversed their position, citing new data on the risk of infection from asymptomatic individuals. But this is a flimsy excuse as it was known since February from credible reports that an alarming number of COVID-19 patients were asymptomatic, so this was hardly ‘new data’ in April.

Filtration-Efficiency-and-Pressure-Drop-Across-Materials-Tested-with-Aerosols-of-Bacillus

Published scientific studies have shown that cloth masks are 25%-50% as effective as a surgical mask at filtering out viruses. An MD would see this data and conclude that cloth masks are useless, because up to 75% of viruses could get through and cause infection. On the other hand, an epidemiologist would see a 25% success rate as an improvement. Yes some people will get infected but a 25% reduction in the spread of an airborne pathogen is better than a 0% reduction.

This difference in point-of-view can also be seen in the priorities at the CDC and FDA at developing and approving COVID-19 tests. At the start of the National Emergency, the FDA stumbled in providing PCR tests, used to determine if an individual is infected with active coronavirus. Doctors need to know the results of this test to direct the course of care for a patient. Responding to criticism, the FDA relaxed its approval process and now PCR tests are being mass-produced and available.

The same can’t be said about serological test kits. These tests identify coronavirus antibodies (not any virus itself) in an individuals bloodstream, identifying who has previously been infected by SARS2 and recovered. Epidemiologists need widespread antibody tests to determine accurate statistics like case-death rate, rate of spread, and risk of death. But to an MD, these tests are useless because any individual who has recovered from an illness is by definition ‘well’ already. Today, serological tests are still in limited availability, and most are still undergoing FDA approval.

An epidemiologist would have put antibody tests at a higher priority than even a vaccine. An MD (and everybody frankly) wants a vaccine because it is the best way to prevent people from becoming infected. But an epidemiologist would argue that new vaccines take years to develop and by then the pandemic is likely over. In their view, antibody tests are needed now to determine how deeply a pandemic has spread, predict how it will grow, and determine how its risk, and effectively respond to it.

A PCR test can identify the tip of the iceberg. But an antibody test reveals how big the iceberg really is. Our first domestic ‘unknown-source’ case of COVID-19 was identified near San Francisco on February 27, but we had no serological tests give to his family and community, to track the source or determine how widespread COVID-19 was in California. This lack of information forced the government to assume a worst-case scenario. California’s governor ordered statewide business and school shutdowns, and shelter-at-home orders. At the taskforce’s urging, other states soon followed.

This is no criticism of Dr. Fauci or Dr. Redfield or any of the MD’s on the taskforce who have worked tirelessly to help this country and save lives. The motivations and biases I proposed are purely conjecture. And of course, hindsight is 20/20.

This all may be moot as President Trump suggests that he will be disbanding the taskforce for now. I suppose reforming it later. I know its a radical idea, but for the next pandemic, maybe we could forgo one less lawyer on the taskforce, to make room for an epidemiologist?

 


SOURCES

https://en.wikipedia.org/wiki/White_House_Coronavirus_Task_Force

https://www.nytimes.com/2020/02/29/health/Trump-coronavirus-taskforce.html

https://jamanetwork.com/journals/jama/fullarticle/2762028

https://www.fda.gov/news-events/fda-voices/insight-fdas-revised-policy-antibody-tests-prioritizing-access-and-accuracy?fbclid=IwAR1jqOKknp4RASSp5n-3GXXgDNmkZ4YI0YCwCNxdCBJovhIHXW9Rd_UMqDE

https://www.researchgate.net/figure/Filtration-Efficiency-and-Pressure-Drop-Across-Materials-Tested-with-Aerosols-of-Bacillus_tbl1_258525804

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