New England Journal of Medicine embarrasses itself

An editorial in the New England Journal of Medicine signed by 35 editors is a thinly veiled attempt by the authors to call for President Donald Trump to be voted out of office for what they call his “dangerously incompetent” handling of the coronavirus pandemic.

Especially coming from scientists, a standard of “dangerously incompetent” is ridiculous. It’s entirely subjective, like Governor Jay Inslee’s fabled COVID-19 dials that the Washington Policy Center rightly ridiculed and forced him to drop.

Sure Trump has made mistakes, but so have so many other leaders during this crisis. Trump has made calls that in hindsight turned out to be correct, but other politicians criticized at the time. It’s easy to find countless examples of others getting things wrong, with serious consequences for their residents.

Not until May 10 did New York governor Andrew Cuomo reverse his policy of requiring nursing homes to accept discharged patients with COVID-19. He did so only because it had become politically untenable to maintain it, not because it was the right thing to do.

Other examples:

• New York City mayor Bill de Blasio Mar. 2: “Since I’m encouraging New Yorkers to go on with your lives + get out on the town despite Coronavirus, I thought I would offer some suggestions. Here’s the first: thru Thurs 3/5 go see ‘The Traitor’ @FilmLinc. If ‘The Wire’ was a true story + set in Italy, it would be this film.”
• Barbot, the top New York City health official, declares March 4, “There’s no indication that being in a car, being in the subways with someone who’s potentially sick is a risk factor.”
• Bernie Sanders, March 9, says he would not close the border, even if it were necessary to halt the spread of coronavirus. He then attacked Trump’s “xenophobia.”
• Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, March 9, says campaign rallies may not be a bad idea.

Fauci and others have reversed course on other guidance as well, such as masks.

If Trump is getting conflicting advice and his advisers are reversing course, how responsible is he and how responsible should we consider them to be?

None of this is to say Trump has been perfectly competent or to say he’s not been incompetent in some areas. Clearly there’s been some of both.

What to do about his performance is for voters to decide. However, this bunch of academics is not being in the slightest bit principled in what they’re doing. This is purely sleazy politics masquerading as academics and all they’re doing is embarrassing themselves.

In some areas Trump has been competent (and gone against conventional wisdom and later been proved right), while in others he’s not been competent. But we’re not in a position to be able sort through everything and determine what and whose decisions led to higher death rates, and what we could have differently to lead to any precisely different outcome. Most likely that will be possible later and history can be the judge.

In the meantime, let me pose some questions that in time will help us get there. The US doesn’t even place in the top five countries for deaths per capita from COVID-19. Does that mean that the New England Journal of Medicine would rate all of the leaders of countries with worse death rates per capita (Belgium, Spain, Peru, Chile, Mexico and more), as incredibly dangerously incompetent?

To be sure, the US has been hit hard by the coronavirus. he country’s population is only around 4% of the world’s, but accounts for about 20% of COVID-19 deaths, approaching 5X what we’d expect if COVID deaths were proportionate to a country’s percentage of global population. But are we an extreme outlier in that regard? The answer is no. Peru’s deaths are even more disproportionate at about 8X what we’d expect. Belgium’s are too, at about 7X what we’d expect. Other countries are also well above the US’s 5X. Is the explanation the incompetent leadership of all of those countries, or could something else explain it?

If incompetent leadership is the explanation for why the US overall has a disproportionate number of deaths relative to population, then why have some states got death rates per million so much lower than almost every country in Europe and indeed most countries in the world, while other states have death rates worse than most countries in the world. If federal policy were so critical to either the success or the failure of a state to manage this pandemic, we would expect to see all states performing roughly equally. Why have some states done so well while others, like New York and New Jersey, have performed miserably?

Other questions we need to ponder include how much the climates of different countries play into this. The US is unusual in that because of our size we have many areas that are temperate and many that are semi-tropical. Science tells us that flu and coronavirus transmission happens differently across climates, with temperate climates seeing a very large spike at the start that rapidly declines over time. Tropical/semi-tropical climates tend to spike later and not as high, but the spike persists a little longer before bottoming out. (This explains why New England and Washington for example spiked very high and early, whereas the sunbelt states spiked over summer and the spike wasn’t nearly as severe, but it persisted longer). Other countries tend to have just one of these climates. Does this play a part in how the US has fared?

The US also has a very different demographic makeup than most countries and we know that blacks and Hispanics are more susceptible to the effects of COVID-19. Other countries like those in Scandinavia have a more homogeneous demographic population. Could this have some explanatory power?

There are likely other hypotheses worth exploring and in time we’ll have the data to do so. The bottom line is that the NEJM hasn’t produced anything here that has any shred of credibility and it’s nothing but shallow political gamesmanship, which should be beneath them.