(07-27-2020 10:50 AM)Hambone10 Wrote:  

(07-27-2020 09:47 AM)RiceLad15 Wrote:  I'm focusing on the federal issue because I believe that the federal resources are best equipped to provide technical insight, guidance, direction, AND resources.

First, do we really think all 50 states have sufficiently staffed health departments, in both resources and technical capabilities, to operate without significant federal support and guidance?

Second, calling out a clear failure of the federal government does not mean that individual states, and their decisions are without blame. See Cuomo's decision to send sick back to elderly care centers. See Abbott's continual flip-flopping on his own guidelines.

Third, on a federal level, how did we respond to Ebola? Did the federal government push decisions down to the state level or did they drive the boat? Same for swine flu?

Fourth, I'm not sure how a data management decision (bolded) is exactly relevant to a discussion about the need to expand contract tasting or speed up testing turnaround.

Long story short - don't mistake a criticism of the federal response for a complete alleviation of the states' responses. But it seems pretty clear to me that this pandemic required a far more concerted and focused effort on a national scale. And I've been beating that drum for a while.

Lad... You're ignoring the separation of Powers.

I'm going out of order here because you're missing the forest for the trees

4th.... Data management is in a paragraph where I discuss the powers of the state health departments, not the need to speed up testing etc... If the Federal Government had the power to do so, don't you think the CDC would require everyone to report their data the same way so that they had 'clean' data? In the simplest example, don't you think they'd want to know how many of today's reported positives were viral testing (active) and how many were antibody (legacy)? That's specifically what they're trying to report, and they have to do it noting that they can't make the states give them that data.

The best evidence of my contention that they don't have the powers that you think they should have is that in such obvious examples where it would be so easy... hey, states... give us the information in 'this' format... Viral positive tests, antibody positive tests and total positive tests... and some states simply say... nah... that they don't have, and never did have, and nobody thought this was a problem that needed to be addressed until 2020, the powers that you want them to have?

The President/Federal government has the ability to keep you from traveling between states... or to enter the country... Barring Federal Martial law, which you are essentially complaining about in Portland... He/they do not have the ability to keep you from going to a bar within your state.... They don't have the power to tell state health departments or governors what to do.

So to your first... This question could be asked of almost any issue. We have some states that can't count paper ballots so why don't we have a single, national standard for voting? How about the death penalty? This IS our chosen form of government. In a nation this large, I think having 50 state health departments looking for solutions and trying different things is better than having one, Federal health department doing so. MOST diseases end up impacting some regions more than others. What might have been better for Covid might have been vastly worse for West Nile, Zika, HIV etc etc

Second, I have no problem calling out federal failures... I just don't see 'failing to violate the Constitution' or to come up with 'answers' to new diseases faster than anyone else without any mis-steps as a Federal failure.

Third... How did we react to Ebola and Swine? Very much the same way. The difference was, Ebola has been around for some time... is easily tested for, comes from only a few nations and requires VERY close contact (not generally from surfaces or coughs) and people who get it become incapacitated and die pretty quickly, so the 'traceback' is short. With Swine, we did next to nothing about it Federally... though I would note that unlike NOVEL COVID-19, H1N1 had ALSO been around for 100 years. We DID have some existing Federal resources for that, just as we do for other diseaseases and as we will for COVID-19 next year than could be made available to the states. We didn't have that, which is why it was referred to as NOVEL, meaning NOT previously identified.

So I get that you think they should have done something, but most of what you seem to want them to do would be against the law. Just what do you think the CDC does and was doing at the time?

The President may decide whether or not to include someone like Fauci on his daily report to the public, but State Health Departments don't get their advice from those press conferences. They get them from policy updates and briefings sent directly to them by the CDC. Fauci and others within the CDC have not been mistake free... I strongly support states rights to reach different conclusions in such unknown times.

If you want to revamp the CDC pandemic response... fine... as has been common and consistent through all of my posts across a broad range of issues, I feel this is a lot of Monday Morning QB'ing by non-professionals.... and to think that the CDC doesn't already do this is silly.... and they of course know more about this than any of us... See all of the references to 'lessons learned' from the Ebola and Swine outbreaks in the CDC budgets between 2010 and 2020. These were the 'best practices' agreed to through multiple administrations... and enacted by mostly non-political people (scientists and policy makers within the CDC).

I'm neither ignoring the separation of powers or missing the forest through the trees. And maybe it's because I'm not explaining myself clearly.

Your entire responses hinges on the idea that the federal government runs the entire show - and that's not what I'm promoting. Notice how I continue to use words like "provide," "guide," etc.?

I don't doubt that this is Monday morning quarterbacking, but we have seen governors talk about the lack of federal support, and how that it making their lives harder. We've mainly had a federal government response that was slow, or weak, and it hasn't ever increased to a point where governors have said, "No thanks, we can handle this now." Let the states say no, we don't want this, we'll do it our own way. The federal government barely gave them the opportunities to do that - the rope that states were given to hang themselves with was nearly non-existent.

The federal government is currently being led by an executive branch that has continually downplayed the severity of the virus and whose only goal was to try and minimize the potential responsibility they could receive. And we know that the current executive is a big fan of having significant influence over the agencies it oversees.

Do you think there was nothing more or different the federal government could have done to improve the response? If the answer is no, then what was the biggest factor in why it didn't respond? My money is not on a lack of knowledge, resources, etc, but a clear lack of direction/leadership. A clear feature of government agencies is to only jump when they're told to jump - and the person at the top was basically yelling not to jump.

Let me give an example of what I consider to be misleading statistics:

Given the headlines, we are to believe that Texas, CA and Fl are 'the new NY' for Covid... we are shown that CA now has 452k cases which is more than NY... FL at 423k cases has surpassed NY... and TX is right behind at 394k. FTR, NJ is 5th at only 179k cases. All of this is true.

What we don't talk about is the fact that 'deaths per 100,000' for NY and NJ are 168 and 178, while for the other states, they are fewer than 30.
We also don't talk about 'deaths per case' (because we're being told that higher cases leads to higher deaths) for CA, FL and TX are all below 2%, while for NY it's almost 8% and NJ, almost 9.

Those are HUGE differences... and we're being told that it is mostly because of 'poor local responses/rush to reopen' etc.

Some possibilities that come to my mind... and of course it could be 'a combination' and other possibilities
1) the older tests didn't catch minor infections and the newer ones do
2) the original strain was much deadlier than the newer ones
3) NY/NJ hit their peak early as we began to shut down... so most of the people being tested were highly symptomatic. Fl, Ca and Tx are peaking as we're beginning to open up, as more people are being tested to go back to work... and we're catching vastly more asymptomatic/low infection people as a result. NY and NJ now would likely see vastly more antibodies, but we aren't testing as many for that.
4) Summer MAY be weakening the disease greatly.... just not eradicating it. Maybe the original, deadly strain is gone, but the one that is surviving the heat is much less deadly.

The number varies, but the reported number of deaths from flu per case of flu is in that same 1-2% range that southern states are seeing for covid.

And more importantly, I think it says that NY/NJ didn't really flatten their curve as much as 'the virus' simply did what viruses do.

Of course the rate for southern states could still rise, but its got a long way to go before we're seeing 180 deaths per 100,000 people and 8-9% death rates per positive test.

(07-27-2020 11:17 AM)Hambone10 Wrote:  Let me give an example of what I consider to be misleading statistics:
Given the headlines, we are to believe that Texas, CA and Fl are 'the new NY' for Covid... we are shown that CA now has 452k cases which is more than NY... FL at 423k cases has surpassed NY... and TX is right behind at 394k. FTR, NJ is 5th at only 179k cases. All of this is true.
What we don't talk about is the fact that 'deaths per 100,000' for NY and NJ are 168 and 178, while for the other states, they are fewer than 30.
We also don't talk about 'deaths per case' (because we're being told that higher cases leads to higher deaths) for CA, FL and TX are all below 2%, while for NY it's almost 8% and NJ, almost 9.
Those are HUGE differences... and we're being told that it is mostly because of 'poor local responses/rush to reopen' etc.
Some possibilities that come to my mind... and of course it could be 'a combination' and other possibilities
1) the older tests didn't catch minor infections and the newer ones do
2) the original strain was much deadlier than the newer ones
3) NY/NJ hit their peak early as we began to shut down... so most of the people being tested were highly symptomatic. Fl, Ca and Tx are peaking as we're beginning to open up, as more people are being tested to go back to work... and we're catching vastly more asymptomatic/low infection people as a result. NY and NJ now would likely see vastly more antibodies, but we aren't testing as many for that.
4) Summer MAY be weakening the disease greatly.... just not eradicating it. Maybe the original, deadly strain is gone, but the one that is surviving the heat is much less deadly.
The number varies, but the reported number of deaths from flu per case of flu is in that same 1-2% range that southern states are seeing for covid.
And more importantly, I think it says that NY/NJ didn't really flatten their curve as much as 'the virus' simply did what viruses do.
Of course the rate for southern states could still rise, but its got a long way to go before we're seeing 180 deaths per 100,000 people and 8-9% death rates per positive test.

I think the other factor is that NY and some other states sent CV-19 patients to nursing homes, which were full of high-risk people, so the disease got transmitted to those most at risk.

(07-27-2020 11:04 AM)RiceLad15 Wrote:  I'm neither ignoring the separation of powers or missing the forest through the trees. And maybe it's because I'm not explaining myself clearly.

Your entire responses hinges on the idea that the federal government runs the entire show - and that's not what I'm promoting. Notice how I continue to use words like "provide," "guide," etc.?

Wrong. My premise comes from the idea that the average person has absolutely no idea what 'guidance' was being sent from the CDC or any other Federal agency to local health departments.

Quote:I don't doubt that this is Monday morning quarterbacking, but we have seen governors talk about the lack of federal support, and how that it making their lives harder. We've mainly had a federal government response that was slow, or weak, and it hasn't ever increased to a point where governors have said, "No thanks, we can handle this now." Let the states say no, we don't want this, we'll do it our own way. The federal government barely gave them the opportunities to do that - the rope that states were given to hang themselves with was nearly non-existent.

Wait... so you're saying that politicians are deflecting any blame away from themselves and towards others? That they want other people to pay for their things? How unprecedented! That has NEVER happened before. When hurricanes come, we all hear states say how the feds have done perfectly and that any issues were the result of local mistakes.

I specifically point out examples where iirc, Oregon went a different direction with testing and some states go in a different direction in reporting, and you ignore those and instead refer to the 'rope' being 'non-existent', when you have no idea what that rope looked like. You have absolutely no idea nor understanding that (as an example) many local health departments didn't want the feds conducting local testing because that meant that 'someone else' was deciding when their patients could be seen/treated... that there are issues when a patient on Medicaid (state funded) go to Federally funded providers for a small part of their coverage (the testing)... The feds simply wrote a check for it all for about 3-4 months, and the states had time to work it out. I'm sure many states would prefer that the feds simply keep writing that check... lots of state medicaid funds got 'healthy'.

Quote:The federal government is currently being led by an executive branch that has continually downplayed the severity of the virus and whose only goal was to try and minimize the potential responsibility they could receive. And we know that the current executive is a big fan of having significant influence over the agencies it oversees.

As I said... this all stems from this position.

Quote:Do you think there was nothing more or different the federal government could have done to improve the response? If the answer is no, then what was the biggest factor in why it didn't respond? My money is not on a lack of knowledge, resources, etc, but a clear lack of direction/leadership. A clear feature of government agencies is to only jump when they're told to jump - and the person at the top was basically yelling not to jump.

An argument in the absurd.

Perhaps you can present such a situation, where someone at the CDC says that they 'didn't do the right thing' because they were waiting for instructions from the White House to 'jump'? I think that you're doing an incredible dis-service to the people at the CDC with this sort of comment.

(07-24-2020 04:39 PM)Hambone10 Wrote:  

(07-24-2020 04:18 PM)greyowl72 Wrote:  I’m not sure this is anybody’s fault. It’s a new disease. With piles of data from new sources being reported daily. But being analyzed using the same old Public Health paradigms.

Thanks Grey.... Absolutely not anybody's fault and you're right about the paradigms.

We obviously can't report antibodies discovered 7/24 from a previous infection any earlier because we didn't know until 7/24. We can't post them on 7/24 for an earlier date either because that's an inexact science and people would say we were manipulating data...

so we report data when we know the data.

It doesn't change the fact that cases are rising... I'm just trying to throw caution to the micro-analysis of this data. In my professional opinion, rising hospitalizations are the greatest indicator of the strain on resources, and I similarly warn that focusing on certain hospitals as opposed to an areas hospital 'system' (not one named system, but all of the available healthcare in an area) is potentially misleading as well.

So basically, it increases the cases of known COVID infection. It gets added to the running total of known cases. This in turn decreases the mortality and morbidity numbers and thus minimizes future predictions of hospital utilization and lethality as the antibody tests are convalesced cases.
Knowing ALL the cases more accurately predicts the need for future resources by knowing the "true" nature of the infection.
Like I said months ago, the delivery of healthcare is managed on a state level with each state regulating it by their own state board. The federal government does not affect the delivery of health care nor do they manage it (with the exception of prescribing medicine which is regulated by the FDA).
So what we have is problems with the type of system for healthcare delivery that the US has developed. It isn't going to change overnight. And as such, each state is going to report whatever it is that they care to report based on their own state medical board's emphasis and understanding.
What is the old saying? Too many cooks spoil the broth. Healthcare has too many "state experts" and the "national experts" are unable to change actions within a state without the approval of the state experts. Now throw in the county health officers and you have a whole lot of opinions in the mix. This process is good for local flexibility but horrible for global management.

Here's a problem I see that has not been discussed very much that I have seen.

CDC and other agencies are primarily bureaucratic agencies, not emergency response agencies. Those are two very different thought processes. So our focus was on models and projecting possible consequences, instead on doing something today, with what we have available here and now, to combat it.

For example, consider testing. CDC insisted upon developing its own test, and controlling the distribution and interpretation, and FDA insisted on jumping through all the approval hoops before releasing it to the public. That's a bureaucratic mindset. An emergency response mindset would be, "We need to be testing on a widespread basis today. What is the best thing we have available today (probably the WHO test at the time) and what is the best way to get it out by the millions, and get results interpreted, in a short time frame." So you give the WHO formula to as many labs as possible, and you encourage as many labs and others as possible to develop their own tests. Dr. Chu, who developed the test that discovered the cases in Seattle, received a "cease and desist" letter. That's a very bureaucratic action, but it's 180 degrees out from an emergency response action.

(07-27-2020 02:00 PM)Owl 69/70/75 Wrote:  Here's a problem I see that has not been discussed very much that I have seen.

CDC and other agencies are primarily bureaucratic agencies, not emergency response agencies. Those are two very different thought processes. So our focus was on models and projecting possible consequences, instead on doing something today, with what we have available here and now, to combat it.

For example, consider testing. CDC insisted upon developing its own test, and controlling the distribution and interpretation, and FDA insisted on jumping through all the approval hoops before releasing it to the public. That's a bureaucratic mindset. An emergency response mindset would be, "We need to be testing on a widespread basis today. What is the best thing we have available today (probably the WHO test at the time) and what is the best way to get it out by the millions, and get results interpreted, in a short time frame." So you give the WHO formula to as many labs as possible, and you encourage as many labs and others as possible to develop their own tests. Dr. Chu, who developed the test that discovered the cases in Seattle, received a "cease and desist" letter. That's a very bureaucratic action, but it's 180 degrees out from an emergency response action.

I here what you are saying.....but.

The FDA is regulatory and isn't involved in healthcare delivery. The CDC is not regulatory, mostly research oriented, monitors disease and offers guidelines, but isn't designed to deliver healthcare. The delivery of healthcare has been delegated to each state for each state by the federal government.
The system you describe is much like the military. Senior leadership sets the goals and provides resources to an objective. Smaller units do the actual work and must adapt with the resources they have to reach the goal.
Local healthcare providers do the work and treat the patients. They are regulated by the states. They will say what they need and the higher entities will try and procure the needed resources. In Dr. Chu's case, her research was studying the flu virus and her lab had been set up to do testing for this virus. Once she learned of a serious health problem, she retooled her lab to identify COVID. She already had nasal swabs from the population and she could have provided additional information about the disease in an area of the initial entry point into the US. In an ideal world, the regulatory agency, the FDA, would have said to run with her test and give us more info while we validate the info you collect. But as you say, an agency went by the book and followed the regulatory rules. Without a crisis, this practice would have been fine. But in this case, COVID was a crisis and turned out to be such. By letting Dr. Chu test people and gather info on COVID, healthcare could have had valuable information earlier. It still wouldn't have changed treatment which was being done by the local hospitals and providers. Basically, this would be clinical trials and this data would have given additional information.
So, the failure was recognizing this as a crisis early (CDC issue for not doing their job of disease control) and unnecessary regulation in a unique and new crisis (FDA in blocking testing and administration of medicines which could have given invaluable information early on).

Precisely the point I'm trying to make.

The system can always be improved, no doubt... but to blame 'a lack of leadership' for following the rules and protocols that were set up by experts in the various fields... developed over decades... things that nobody 'set off an alarm' about previously and instead expect ANY government, in the face of an unknown event... to go against many years of advice from experts and to force a different plan down their throats is unreasonable.

Since ANY plan can be second-guessed and tweaked and improved, I am 100% convinced that had Trump said... FORGET all that and instead do it THIS way, that the left would still be blaming him for ANY 'sub-par' outcomes. The only difference is we'd be talking about 'dictator' Trump rather than 'do nothing' Trump

(07-27-2020 03:53 PM)Hambone10 Wrote:  Precisely the point I'm trying to make.

The system can always be improved, no doubt... but to blame 'a lack of leadership' for following the rules and protocols that were set up by experts in the various fields... developed over decades... things that nobody 'set off an alarm' about previously and instead expect ANY government, in the face of an unknown event... to go against many years of advice from experts and to force a different plan down their throats is unreasonable.

Since ANY plan can be second-guessed and tweaked and improved, I am 100% convinced that had Trump said... FORGET all that and instead do it THIS way, that the left would still be blaming him for ANY 'sub-par' outcomes. The only difference is we'd be talking about 'dictator' Trump rather than 'do nothing' Trump

So, who are the federal experts? Who is the leading healthcare agency in the government?

The Surgeon General in the Office of the Surgeon General within the HHS.

The Office of Infectious Disease within the NIH which is within the HHS as well.

The CDC.

The FDA.

People seek out second opinions all the time because medical decisions aren't binary. Good luck getting 4 doctors to agree on a theoretical answer to deal with something that has never been seen before. And if they don't agree, do you really think someone not trained in treating disease to know the best course of action?

(07-27-2020 02:43 PM)ruowls Wrote:  

(07-27-2020 02:00 PM)Owl 69/70/75 Wrote:  Here's a problem I see that has not been discussed very much that I have seen.
CDC and other agencies are primarily bureaucratic agencies, not emergency response agencies. Those are two very different thought processes. So our focus was on models and projecting possible consequences, instead on doing something today, with what we have available here and now, to combat it.
For example, consider testing. CDC insisted upon developing its own test, and controlling the distribution and interpretation, and FDA insisted on jumping through all the approval hoops before releasing it to the public. That's a bureaucratic mindset. An emergency response mindset would be, "We need to be testing on a widespread basis today. What is the best thing we have available today (probably the WHO test at the time) and what is the best way to get it out by the millions, and get results interpreted, in a short time frame." So you give the WHO formula to as many labs as possible, and you encourage as many labs and others as possible to develop their own tests. Dr. Chu, who developed the test that discovered the cases in Seattle, received a "cease and desist" letter. That's a very bureaucratic action, but it's 180 degrees out from an emergency response action.

I here what you are saying.....but.
The FDA is regulatory and isn't involved in healthcare delivery. The CDC is not regulatory, mostly research oriented, monitors disease and offers guidelines, but isn't designed to deliver healthcare. The delivery of healthcare has been delegated to each state for each state by the federal government.
The system you describe is much like the military. Senior leadership sets the goals and provides resources to an objective. Smaller units do the actual work and must adapt with the resources they have to reach the goal.
Local healthcare providers do the work and treat the patients. They are regulated by the states. They will say what they need and the higher entities will try and procure the needed resources. In Dr. Chu's case, her research was studying the flu virus and her lab had been set up to do testing for this virus. Once she learned of a serious health problem, she retooled her lab to identify COVID. She already had nasal swabs from the population and she could have provided additional information about the disease in an area of the initial entry point into the US. In an ideal world, the regulatory agency, the FDA, would have said to run with her test and give us more info while we validate the info you collect. But as you say, an agency went by the book and followed the regulatory rules. Without a crisis, this practice would have been fine. But in this case, COVID was a crisis and turned out to be such. By letting Dr. Chu test people and gather info on COVID, healthcare could have had valuable information earlier. It still wouldn't have changed treatment which was being done by the local hospitals and providers. Basically, this would be clinical trials and this data would have given additional information.
So, the failure was recognizing this as a crisis early (CDC issue for not doing their job of disease control) and unnecessary regulation in a unique and new crisis (FDA in blocking testing and administration of medicines which could have given invaluable information early on).

OK with all of that except the word "but." I think you just agreed with me,

To state my larger point, what we need for any number of emergencies, but really don't have for any of them, is a dedicated emergency response agency.

(07-27-2020 04:30 PM)ruowls Wrote:  

(07-27-2020 03:53 PM)Hambone10 Wrote:  Precisely the point I'm trying to make.

The system can always be improved, no doubt... but to blame 'a lack of leadership' for following the rules and protocols that were set up by experts in the various fields... developed over decades... things that nobody 'set off an alarm' about previously and instead expect ANY government, in the face of an unknown event... to go against many years of advice from experts and to force a different plan down their throats is unreasonable.

Since ANY plan can be second-guessed and tweaked and improved, I am 100% convinced that had Trump said... FORGET all that and instead do it THIS way, that the left would still be blaming him for ANY 'sub-par' outcomes. The only difference is we'd be talking about 'dictator' Trump rather than 'do nothing' Trump

So, who are the federal experts? Who is the leading healthcare agency in the government?

The Surgeon General in the Office of the Surgeon General within the HHS.

The Office of Infectious Disease within the NIH which is within the HHS as well.

The CDC.

The FDA.

People seek out second opinions all the time because medical decisions aren't binary. Good luck getting 4 doctors to agree on a theoretical answer to deal with something that has never been seen before. And if they don't agree, do you really think someone not trained in treating disease to know the best course of action?

I'm not disagreeing with you... I'm merely taking a different perspective.

I don't expect a President, especially one who isn't remotely an expert in pandemic response or healthcare (like every President) to disregard the protocols that those agencies (and more) all got together over years and decided to put into place. That's the 'system'... i.e. whether we should have 50 different state departments of health, all of whom have general support and direction from the Federal government all making their own decisions, with the same general support and direction when something specific comes up.... or whether we should have one central DOH deciding for everyone either all the time, or only in the event of a crisis. They decided how it should happen, and I don't expect a President ANY president to ignore that.

This is more about the 'how' (the system) than about the 'what' (defining what is best).

When it comes to current decisions, I agree that you could have 50 different answers to 'what is best' from each state, plus the different entities within it, and that is also the point. I don't expect every expert to agree 100% on anything.... nor do I expect the CDC to always do the right things for each state. What is best for one place might be horrible for another... especially as things like diseases don't always behave the same in NYC in March as they do in Florida in July.... or in a relatively healthy population with an average age of 42 and an average income of 80k versus a relatively unhealthy population with an average age of 62 and an average income of 42k.

We've already seen people feign 'confusion' or claim 'inconsistency' over Fauci's original comment (when we had just a few hundred cases in the US) that the average person didn't need a mask... to a few months later when we have millions of cases saying everyone does... this would only be worse if he were giving dozens of different responses based on population density, how long the disease had been active there and other factors.

What we're seeing is just more of the same old political double-speak... where 'whether it was the right decision or not' or 'whom should be responsible for it' is primarily determined by the party in charge.

(07-28-2020 09:06 AM)Hambone10 Wrote:  

(07-27-2020 04:30 PM)ruowls Wrote:  

(07-27-2020 03:53 PM)Hambone10 Wrote:  Precisely the point I'm trying to make.

The system can always be improved, no doubt... but to blame 'a lack of leadership' for following the rules and protocols that were set up by experts in the various fields... developed over decades... things that nobody 'set off an alarm' about previously and instead expect ANY government, in the face of an unknown event... to go against many years of advice from experts and to force a different plan down their throats is unreasonable.

Since ANY plan can be second-guessed and tweaked and improved, I am 100% convinced that had Trump said... FORGET all that and instead do it THIS way, that the left would still be blaming him for ANY 'sub-par' outcomes. The only difference is we'd be talking about 'dictator' Trump rather than 'do nothing' Trump

So, who are the federal experts? Who is the leading healthcare agency in the government?

The Surgeon General in the Office of the Surgeon General within the HHS.

The Office of Infectious Disease within the NIH which is within the HHS as well.

The CDC.

The FDA.

People seek out second opinions all the time because medical decisions aren't binary. Good luck getting 4 doctors to agree on a theoretical answer to deal with something that has never been seen before. And if they don't agree, do you really think someone not trained in treating disease to know the best course of action?

I'm not disagreeing with you... I'm merely taking a different perspective.

I don't expect a President, especially one who isn't remotely an expert in pandemic response or healthcare (like every President) to disregard the protocols that those agencies (and more) all got together over years and decided to put into place. That's the 'system'... i.e. whether we should have 50 different state departments of health, all of whom have general support and direction from the Federal government all making their own decisions, with the same general support and direction when something specific comes up.... or whether we should have one central DOH deciding for everyone either all the time, or only in the event of a crisis. They decided how it should happen, and I don't expect a President ANY president to ignore that.

This is more about the 'how' (the system) than about the 'what' (defining what is best).

When it comes to current decisions, I agree that you could have 50 different answers to 'what is best' from each state, plus the different entities within it, and that is also the point. I don't expect every expert to agree 100% on anything.... nor do I expect the CDC to always do the right things for each state. What is best for one place might be horrible for another... especially as things like diseases don't always behave the same in NYC in March as they do in Florida in July.... or in a relatively healthy population with an average age of 42 and an average income of 80k versus a relatively unhealthy population with an average age of 62 and an average income of 42k.

We've already seen people feign 'confusion' or claim 'inconsistency' over Fauci's original comment (when we had just a few hundred cases in the US) that the average person didn't need a mask... to a few months later when we have millions of cases saying everyone does... this would only be worse if he were giving dozens of different responses based on population density, how long the disease had been active there and other factors.

What we're seeing is just more of the same old political double-speak... where 'whether it was the right decision or not' or 'whom should be responsible for it' is primarily determined by the party in charge.

This whole post is built on the premise that the executive branch actively listened to its resources and effectively coordinated/directed them. We have evidence they have done the exact opposite of that, and have been adversarial to the experts within the executive branch and advocated against their resources/experts.

Remember this from about a week ago?

Quote:In the latest move from the Trump administration to push for states to reopen schools this fall, Vice President Pence couched guidance from the Centers for Disease Control and Prevention on how to safely reopen schools, saying it shouldn't be used as a "barrier" to students returning to classrooms.

Speaking to reporters during a White House Coronavirus Task Force meeting at the Department of Education on Wednesday afternoon, Pence stressed that states and local governments should "tailor their plans" to enable to students to return to in-person instruction.

"None of the CDC's recommendations are intended to replace state and local rules and guidance," Pence said.

https://www.npr.org/2020/07/08/888898194...ng-schools

The executive branch has not been clear in what decisions it has made, what advice it is recommending, what support it is providing, what levers it is pulling, or who should be the general authority for guidance.

Theoretically that general authority should be the Coronavirus Task Force, as they should be coordinating the response and on the same page as the expert agencies. But that quote above makes it clear that they are not coordinating with the CDC if they basically reject the CDC's guidelines once they were released. Or look at the testing issues between the FDA and CDC - leadership and direction could have squashed that and resolved whatever dispute there was.

We have a clear lack of coordination within the federal government, which clearly extends down to the state level (see governors outbidding each other for PPE).

(07-28-2020 11:13 AM)RiceLad15 Wrote:  This whole post is built on the premise that the executive branch actively listened to its resources and effectively coordinated/directed them. We have evidence they have done the exact opposite of that, and have been adversarial to the experts within the executive branch and advocated against their resources/experts.

Remember this from about a week ago?

Quote:In the latest move from the Trump administration to push for states to reopen schools this fall, Vice President Pence couched guidance from the Centers for Disease Control and Prevention on how to safely reopen schools, saying it shouldn't be used as a "barrier" to students returning to classrooms.

Speaking to reporters during a White House Coronavirus Task Force meeting at the Department of Education on Wednesday afternoon, Pence stressed that states and local governments should "tailor their plans" to enable to students to return to in-person instruction.

"None of the CDC's recommendations are intended to replace state and local rules and guidance," Pence said.

https://www.npr.org/2020/07/08/888898194...ng-schools

The executive branch has not been clear in what decisions it has made, what advice it is recommending, what support it is providing, what levers it is pulling, or who should be the general authority for guidance.

Theoretically that general authority should be the Coronavirus Task Force, as they should be coordinating the response and on the same page as the expert agencies. But that quote above makes it clear that they are not coordinating with the CDC if they basically reject the CDC's guidelines once they were released. Or look at the testing issues between the FDA and CDC - leadership and direction could have squashed that and resolved whatever dispute there was.

We have a clear lack of coordination within the federal government, which clearly extends down to the state level (see governors outbidding each other for PPE).

Yeah... you're completely missing it. Is that intentional?

Here is what the CDC thinks about it:

https://www.cdc.gov/coronavirus/2019-nco...hools.html

The best available evidence indicates if children become infected, they are far less likely to suffer severe symptoms. Death rates among school-aged children are much lower than among adults. At the same time, the harms attributed to closed schools on the social, emotional, and behavioral health, economic well-being, and academic achievement of children, in both the short- and long-term, are well-known and significant. Further, the lack of in-person educational options disproportionately harms low-income and minority children and those living with disabilities. These students are far less likely to have access to private instruction and care and far more likely to rely on key school-supported resources like food programs, special education services, counseling, and after-school programs to meet basic developmental needs.

Before you try, the article was updated 7/23. I don't know when it was written, but it was clearly before then... at least, around the time of your article. In addition, look at the dates on some of the supporting documentation...

WUSA (2020) Child abuse is likely going to underreported during the coronavirus pandemic. 7/8/2020

Suffering in Silence: How COVID-19 School Closures Inhibit the Reporting of Child Maltreatment (May 14, 2020).

Return to School During COVID-19, American Academy of Pediatrics, Healthy Children website: 7/8/2020

COVID-19 and student learning in the United States: the hurt could last a lifetime. Retrieved July 4, 2020 (A McKinsey report)

My point here being
- there are many experts...
- there are many opinions...
- The ultimate decisions lie locally...
- Trump supports reopening (this seems to be where your real issue is) though he has not ordered them to open (he can't)
- Trump has asked the nation's accepted authorities on the issue to offer advice to those choosing to open, on how to do it safely. Your previous complaint was that the feds aren't advising the states.
- Pence makes it very clear that "None of the CDC's recommendations are intended to replace state and local rules and guidance," Pence said... so it's not remotely 'an order'.

So tell me, does this evidence really suggest to you that they ARE NOT listening to their advisors?

So what is your complaint, other than you seem to reach a different conclusion than Trump, when you seem to have considered less information than he has? I say that only because you seemed completely unaware of any 'expert' opinions supporting the re-opening of schools.

(07-28-2020 12:26 PM)Hambone10 Wrote:  

(07-28-2020 11:13 AM)RiceLad15 Wrote:  This whole post is built on the premise that the executive branch actively listened to its resources and effectively coordinated/directed them. We have evidence they have done the exact opposite of that, and have been adversarial to the experts within the executive branch and advocated against their resources/experts.

Remember this from about a week ago?

Quote:In the latest move from the Trump administration to push for states to reopen schools this fall, Vice President Pence couched guidance from the Centers for Disease Control and Prevention on how to safely reopen schools, saying it shouldn't be used as a "barrier" to students returning to classrooms.

Speaking to reporters during a White House Coronavirus Task Force meeting at the Department of Education on Wednesday afternoon, Pence stressed that states and local governments should "tailor their plans" to enable to students to return to in-person instruction.

"None of the CDC's recommendations are intended to replace state and local rules and guidance," Pence said.

https://www.npr.org/2020/07/08/888898194...ng-schools

The executive branch has not been clear in what decisions it has made, what advice it is recommending, what support it is providing, what levers it is pulling, or who should be the general authority for guidance.

Theoretically that general authority should be the Coronavirus Task Force, as they should be coordinating the response and on the same page as the expert agencies. But that quote above makes it clear that they are not coordinating with the CDC if they basically reject the CDC's guidelines once they were released. Or look at the testing issues between the FDA and CDC - leadership and direction could have squashed that and resolved whatever dispute there was.

We have a clear lack of coordination within the federal government, which clearly extends down to the state level (see governors outbidding each other for PPE).

Yeah... you're completely missing it. Is that intentional?

Here is what the CDC thinks about it:

https://www.cdc.gov/coronavirus/2019-nco...hools.html

The best available evidence indicates if children become infected, they are far less likely to suffer severe symptoms. Death rates among school-aged children are much lower than among adults. At the same time, the harms attributed to closed schools on the social, emotional, and behavioral health, economic well-being, and academic achievement of children, in both the short- and long-term, are well-known and significant. Further, the lack of in-person educational options disproportionately harms low-income and minority children and those living with disabilities. These students are far less likely to have access to private instruction and care and far more likely to rely on key school-supported resources like food programs, special education services, counseling, and after-school programs to meet basic developmental needs.

Before you try, the article was updated 7/23. I don't know when it was written, but it was clearly before then... at least, around the time of your article. In addition, look at the dates on some of the supporting documentation...

WUSA (2020) Child abuse is likely going to underreported during the coronavirus pandemic. 7/8/2020

Suffering in Silence: How COVID-19 School Closures Inhibit the Reporting of Child Maltreatment (May 14, 2020).

Return to School During COVID-19, American Academy of Pediatrics, Healthy Children website: 7/8/2020

COVID-19 and student learning in the United States: the hurt could last a lifetime. Retrieved July 4, 2020 (A McKinsey report)

My point here being
- there are many experts...
- there are many opinions...
- The ultimate decisions lie locally...
- Trump supports reopening (this seems to be where your real issue is) though he has not ordered them to open (he can't)
- Trump has asked the nation's accepted authorities on the issue to offer advice to those choosing to open, on how to do it safely. Your previous complaint was that the feds aren't advising the states.
- Pence makes it very clear that "None of the CDC's recommendations are intended to replace state and local rules and guidance," Pence said... so it's not remotely 'an order'.

So tell me, does this evidence really suggest to you that they ARE NOT listening to their advisors?

So what is your complaint, other than you seem to reach a different conclusion than Trump, when you seem to have considered less information than he has? I say that only because you seemed completely unaware of any 'expert' opinions supporting the re-opening of schools.

You hit the nail on the head about the difference in the date between the article I posted and the revised CDC guidelines. These guidelines were updated by the CDC after the comments by Trump/Pence in early July (from June 15 - https://www.cdc.gov/coronavirus/2019-nco...d-care.pdf and from July 1 - https://www.cdc.gov/coronavirus/2019-nco...tool.pdf).

The June guidance document, in particular, discusses recommendations for how to act based on levels of community transmission, which is missing the the revised guidance.

The evidence that they aren't listening to advisors is that the WH continued to push for reopening of schools, without delay, until recently. The WH even argued they would withhold federal funds from schools if they did not reopen, even when the CDC initially discussed the possible need for postponing opening if community transmission was substantial. Ctrl+F "transmission" in the link you posted and you'll see the briefing ONLY discusses reopening for "low community transmission" and doesn't touch on what should be done when community transmission is substantial.

The main points are that: 1) there should be a unified message come from the top, and the fact that the CDC and the WH weren't on the same page about school reopening is problematic because it's not clear who should be followed - the WH or the CDC; 2) I know there are benefits to reopening schools - numerous ones that are wide ranging, but until a few days ago, the WH was not honestly discussing the CONS of reopening, and only focused on the PROS (which is what the WH has done this entire pandemic).

Put more succinctly, OMB!

(07-28-2020 01:07 PM)OptimisticOwl Wrote:  Put more succinctly, OMB!

Yes, all criticism is invalid and Trump does no wrong. It's not that Trump made many mistakes here in how he directed the federal government's response, it's that liberals are deranged and can't appreciate his brilliance.

(07-28-2020 01:15 PM)RiceLad15 Wrote:  

(07-28-2020 01:07 PM)OptimisticOwl Wrote:  Put more succinctly, OMB!

Yes, all criticism is invalid and Trump does no wrong. It's not that Trump made many mistakes here in how he directed the federal government's response, it's that liberals are deranged and can't appreciate his brilliance.

More a sub case of the Boy Crying Wolf Syndrome. If you find fault with everything he does or does not do, it lessens the credibility of each new criticism.

Frankly, this first pitch angst of yours seems both petty and pointless.

(07-28-2020 01:35 PM)OptimisticOwl Wrote:  

(07-28-2020 01:15 PM)RiceLad15 Wrote:  

(07-28-2020 01:07 PM)OptimisticOwl Wrote:  Put more succinctly, OMB!

Yes, all criticism is invalid and Trump does no wrong. It's not that Trump made many mistakes here in how he directed the federal government's response, it's that liberals are deranged and can't appreciate his brilliance.

More a sub case of the Boy Crying Wolf Syndrome. If you find fault with everything he does or does not do, it lessens the credibility of each new criticism.

Frankly, this first pitch angst of yours seems both petty and pointless.

Oh, it posted it for a laugh - nothing more really.

The right's inability to laugh at the absolutely inane things Trump does, is really impressive. Only more impressive is the need to respond with a spirited defense (or attack on reporting, as Ham liked to frame it).

(07-28-2020 01:42 PM)RiceLad15 Wrote:  

(07-28-2020 01:35 PM)OptimisticOwl Wrote:  

(07-28-2020 01:15 PM)RiceLad15 Wrote:  

(07-28-2020 01:07 PM)OptimisticOwl Wrote:  Put more succinctly, OMB!

Yes, all criticism is invalid and Trump does no wrong. It's not that Trump made many mistakes here in how he directed the federal government's response, it's that liberals are deranged and can't appreciate his brilliance.

More a sub case of the Boy Crying Wolf Syndrome. If you find fault with everything he does or does not do, it lessens the credibility of each new criticism.

Frankly, this first pitch angst of yours seems both petty and pointless.

Oh, it posted it for a laugh - nothing more really.

The right's inability to laugh at the absolutely inane things Trump does, is really impressive. Only more impressive is the need to respond with a spirited defense (or attack on reporting, as Ham liked to frame it).

Or is said to have done, as reported by his enemies.

I used to know somebody who would Say the meanest things and then follow with a “just kidding”. Guess now Iknow two of them.

(07-28-2020 12:52 PM)RiceLad15 Wrote:  You hit the nail on the head about the difference in the date between the article I posted and the revised CDC guidelines. These guidelines were updated by the CDC after the comments by Trump/Pence in early July (from June 15 - https://www.cdc.gov/coronavirus/2019-nco...d-care.pdf and from July 1 - https://www.cdc.gov/coronavirus/2019-nco...tool.pdf).

The June guidance document, in particular, discusses recommendations for how to act based on levels of community transmission, which is missing the the revised guidance.

The June guidance document still talks about opening schools. Your very next line says...

Quote:The evidence that they aren't listening to advisors is that the WH continued to push for reopening of schools, without delay, until recently.

So you just presented a paper written in June where the CDC clearly was not telling them to close schools for the fall... so tell me again what they are ignoring? Where does it say 'don't open schools in the fall' in that piece?

The one from July doesn't open, but it's clearly a 'readiness and planning tool' for those choosing to open.

Again... where is the 'ignoring their advice' that you keep speaking about?

Quote:The WH even argued they would withhold federal funds from schools if they did not reopen, even when the CDC initially discussed the possible need for postponing opening if community transmission was substantial. Ctrl+F "transmission" in the link you posted and you'll see the briefing ONLY discusses reopening for "low community transmission" and doesn't touch on what should be done when community transmission is substantial.

Dude... this isn't the only piece offered by the CDC... You don't seem to understand the CDC documents at all. All this is is a 'best practices' for reducing transmission, which applies no matter your level of transmission.

Trump is clearly encouraging schools to open, and the CDC has specifically laid out scientific support for that position. It is not an edict nor an order. Honest people can disagree on this... and many smart and informed people do.

You're acting as if there isn't anyone in the scientific community who agrees that schools should, but should not be required to open

and again, dude... You're reading an awful lot into a simple tweet.

What does Federal funding for schools have to do with the CDC?? And yeah... Don't you think that schools that are not open and providing lunch and transportation and after-school activities and special education should not get funds designed for those purposes, but instead those funds should be diverted to organizations providing those or related services? (which in some places ARE schools, but through outreach rather than internal?

You can say 'that's not what he meant', but you have no evidence of that... My evidence is that its obvious that 'physical schools' cost money... and also that in the proposed second stimulus, he said...

"We're asking Congress to provide $105 billion to schools" in the next stimulus bill, . He said the funds would help schools that reopen with things like masks and modifications to help with social distancing among students.

But the White House is requesting that schools that don't reopen don't have access to the new funds, Trump said Thursday. "If the school is closed, the money should follow the student so the parents and families are in control of their own decisions," Trump said.

Clearly, schools that choose not to open don't need funds to help them modify their schools as if they were open.

Quote:The main points are that: 1) there should be a unified message come from the top, and the fact that the CDC and the WH weren't on the same page about school reopening is problematic because it's not clear who should be followed - the WH or the CDC; 2) I know there are benefits to reopening schools - numerous ones that are wide ranging, but until a few days ago, the WH was not honestly discussing the CONS of reopening, and only focused on the PROS (which is what the WH has done this entire pandemic).

1) a) It's not their call. b) Neither should be followed and c) see your #2

2) in 1, you complain that they're going against expert advice in saying 'open' and now your complaint is that there is no clear position. Which is it?

I don't recall Obama honestly talking about the Cons of the ACA... which was something he had control over.

So you're upset that he ignored his experts... though I've presented experts that say 'open'... and you yourself present dated material that doesn't say 'it is our consensus that we should close schools'... and you're upset that he defended his own position and didn't rush to present the other side... and you're upset that he doesn't think that schools who aren't providing education should not get paid as if they are??

Wow... I mean seriously.... you seem to want to live in an insular bubble where there is no dissent and everyone in the entire government agrees on everything, and it all stems from the top. Sounds a lot like a dictatorship.