Incompetent leaders kill

Dora Longo Bahia, Rio Doce, 2016 - Acrylic on linen, 300 x 500 cm


The reality is that the greatest health crisis of our time is being managed by dangerously incompetent political leaders.

O New England Journal of Medicine is one of the most prestigious medical publications in the world. Founded in 1812 and belonging to the Medical Society of Massachusetts, USA, it is also the oldest journal in the field. Publishing a complete article there greatly enhances the curriculum of any and all researchers.

The editorial that we reproduce below is a rare political manifestation of the magazine, which usually keeps itself apart from political-electoral controversies. This fact, in itself, already reveals the gravity of the medical-sanitary moment the USA is going through, and the total inadequacy of the government's response to the challenge posed by the pandemic caused by COVID-19. Not by chance, a situation very similar to that experienced by Brazil.

Luiz Augusto Marcondes Fonseca, physician
Collaborating Researcher
Institute of Tropical Medicine, USP

Incompetent leaders kill

Covid-19 generated a crisis that put leadership across the world to the test. Without good options to combat this new virus, countries were forced to make difficult choices. Here in the US our leaders failed the test: they were faced with a crisis and turned it into a tragedy.

The magnitude of this failure is staggering. According to the Johns Hopkins Center for Systems Sciences and Engineering (a research collective within the Department of Civil and Systems Engineering at the Johns Hopkins Univ), the US is the world leader in cases and deaths from Covid-19, surpassing far more populous countries like China. The mortality rate in the United States is more than twice that of Canada, almost 50 times that of Japan, a country with an elderly and vulnerable population and almost 2000 times that of countries with low or middle income, such as the Vietnam. Covid-19 is an overwhelming challenge and many factors contribute to its severity, but there is one factor we can control: how we behave, and in the US we have behaved very badly.

We know we could have done better. China, faced with the first outbreak, after an initial delay, opted for strict quarantine and social isolation. These measures were severe but effective, basically eliminating transmission in the very place where the outbreak started; thus reaching a death rate of 3 per million, much lower than the rate of 500 deaths per million found in the USA. Countries that have much greater exchanges with China, such as Singapore and South Korea, soon began to intensively apply diagnostic testing, along with aggressive contact tracing and adequate isolation, and had relatively small outbreaks. New Zealand used these same measures; also exploiting its geographical advantages (it is made up of two islands) it almost eliminated the disease, which made it possible to limit the time of isolation and return to a pre-pandemic level of social openness. In general, democracies performed many orders of magnitude better than the US.

Why did the US handle this pandemic so badly? We fail almost every time. We had already been largely prevented for a long time, but when the disease finally arrived, we were unable to apply diagnostic tests effectively and even to provide the most basic protective equipment to health professionals and the general public. We are still far short of the desirable level of application of diagnostic tests; the absolute number of tests has increased substantially, but the most useful index is the number of tests per infected person and at this point we are behind places like Kazakhstan, Zimbabwe and Ethiopia, countries that do not have by far our biomedical infrastructure or our productive capacity. Furthermore, our lack of emphasis on developing solutions leads to a long delay in verifying test results, making them useless for disease control.

Despite our preference for a technological approach, most effective interventions are not complicated. Despite this, the US instituted quarantine and isolation measures late and inconsistently, often without any effort to implement them and after the disease had already reached substantially several communities. In many places our social distancing rules have been tentative at best, and the easing of restrictions has occurred well before there has been adequate control of the disease. In much of the country, people simply do not wear masks because our leaders have expressly stated that masks are political tools and not effective infection control measures. The government has appropriately invested in vaccine development but at the same time employs rhetoric that politicizes that development process and generates distrust.

The US entered this crisis with immense advantages. In addition to having tremendous production capacity, we have a biomedical research system that is admired worldwide. We have enormous expertise in public health, health policy and basic biology, and historically we have been able to turn that expertise into new treatments and preventive measures. Most of this expertise is housed in government institutions; however our leaders chose to ignore it and even belittle the experts.

The nation's leaders' response to the crisis was consistently inadequate. The federal government has generally transferred responsibility to the states. The governors' responses varied, not so much according to the party they belonged to, but according to the competence of each one; however, whatever their respective powers, governors do not have the same resources as Washington. Instead of using these resources, the federal government preferred to sabotage them. The Center for Disease Control and Prevention, once a world leader in fighting disease, has been sacrificed and has suffered from dramatic errors in its policies and planning for the application of diagnostic tests. The National Health Institute has played a key role in vaccine development but has been excluded from crucial decisions. The Food and Drug Administration has been shamefully politicized, seeming to respond to administrative pressures rather than scientific evidence. Our current leaders have promoted a discredit on government and science that will extend well beyond their terms. Instead of relying on expertise, management has turned to “influencers” and charlatans, who obscure the truth and promote the spread of lies.

Let's be clear about the cost of ignoring even the simplest of precautions: an outbreak that disproportionately affected racial minorities exacerbated inequality-related tensions. Many of our children are unable to go to school at a critical period in their social and intellectual development. The hard work of health professionals, who have risked their lives, is being wasted. Our current leadership is proud of its economic achievements, but while in most other countries there has been some degree of resumption of activities, in the US the extent of the pandemic has hindered the reopening, resulting in the loss of hundreds of billions of dollars and millions of jobs. ; over 200 Americans died. Some Covid-000 deaths were unavoidable, but while an accurate estimate of the excess deaths caused by inoperative government policies is impossible, that number is at least in the tens of thousands, in a pandemic that has killed more Americans than any conflict since. the 19nd World War.

Anyone else who was irresponsibly destroying lives and wasting money in this way would be facing due process, but our leaders claim immunity from their actions. The upcoming election will allow us to judge them. Reasonable people can differ on the political positions taken by candidates, but the truth is neither conservative nor liberal: the reality is that the greatest health crisis of our time is being managed by dangerously incompetent political leaders. We cannot allow them to keep their jobs and continue causing the deaths of thousands of Americans.

The New England Journal of Medicine – N ENGL J MED 383;15 NEJM.ORG 8 OCTOBER 2020

Translation: Francisco JB de Aguiar, doctor.



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