What’s coming at us: More Division? Or more Democracy?  Not time to say “Uncle” yet – Michael Fine

By Michael Fine

© Michael Fine 2021

Take-home points

I have a recurring nightmare.  I fear that on or about January 15, when the Omicron variant has us on our knees, Russia will invade the Ukraine, and the loss of the Ukraine will create political instability here.  There is plenty of evidence that Russia is deeply involved in manipulating public opinion in the US through our social media, inflaming both the right and the left with what used to be called propaganda, but is now only called memes and tropes.

Putin didn’t cause Covid-19, of course.  He didn’t cause our polarization, even if he does try to inflame it.  But Putin knows an opportunity when he sees one.  He understands that, as Pasteur said, “chance favors the prepared mind”.

I fear that our polarization will keep us from defending democracy in the Ukraine, and worse, I fear that we will experience more polarization here as a result.

I also know how China’s approach to Covid-19 has polarized us.  Because of some research I did for Health Care Revolt, I know that on or about January 1, 2020, Dr. George F Gao (Gao Fu), the Director of the Chinese CDC, broke into tears on a phone call with Dr Robert Redfield, the then Director of our CDC. A virus was spreading around Wuhan, China.  Dr. Gao already understood that the virus was already out of control, and that his government was not going to stop the virus in Wuhan in time to keep it from spreading around the world.

About that time, the “wet market” in Wuhan, where wild animals are sold as food, was cleaned and completely sterilized, obliterating any evidence about the virus’s origins before that evidence could be collected.  Local officials in Wuhan suppressed discussion of the new disease spreading there.  Those local officials threatened Li-Wen Liang MD, a 33-year-old ophthalmologist, who posted information about a new kind of pneumonia he was seeing and hearing about in Wuhan.  Li-Wen Liang would die of Covid-19 on February 7, 2020, a few days before Covid-19 was named by an impotent World Health Organization (WHO) – and a month before the WHO declared that a pandemic existed, even though Covid-19 was documented in more than 20 countries by the beginning of February.

400,000 people traveled from China to the US in January of 2020.  On January 18, 2020, forty thousand people came to a Chinese New Year’s dinner put on by the same local officials in Wuhan who tried to silence Dr. Li-Wen Liang, effectively spreading the virus. 

Looking backward, it’s not clear that Covid-19 could have been stopped in Wuhan, the way SARS and MERS were stopped before they spread worldwide, even if every government official did what they needed to do.  Maybe we could have stopped it.  Maybe we could have slowed its spread enough to give us the tools to manage it more effectively.  Maybe not.

In response, some of us called Covid-19 the “Chinese virus” and claimed that Covid-19 is an engineered virus that was released on purpose, or released as a lab accident, racist tropes that divide us further.

But nobody did anything.  No sanctions.  No boycotts.  No withdrawal of ambassadors.  Not ostracized by the world community.  A lot of noise, perhaps.  But no action.

I wonder if no one acted to address Chinese failures because China is our major trading partner.  China is the source of cheap TVs and cell phones and ten thousand other products that we don’t want to give up.  China is a major market for our agriculture sector.  It buys our corn and soybeans, our pork and our rice in huge quantities.

And we appear to value TVs and cell phones more than we valued the lives of 800,000 Americans.

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The failures of CDC, FDA, the Federal and State governments to manage Covid-19 have also divided us.  Talk about a swamp!  CDC messed up testing in the early days of the pandemic, which left us completely unable to respond, unable to identify cases and isolate who needed to be isolated.  CDC’s ham-fisted communications misled us on multiple occasions and lost the confidence of a nation that was desperately seeking someone, anyone, to trust. 

The early directive not to test anyone unless they had just traveled abroad was wrong.  The advice that people without symptoms could not spread disease was wrong. (WHO said the same thing.)  The business about not being able to transmit disease by coughing was wrong.  The business about masks.  And so forth.  Much of CDC’s advice and information served to cover CDC’s own failure to produce a good test and put it in the hands of state and local health departments and hospitals in a timely manner, although the business about masking was to cover the government’s inability to make or secure enough N95 masks in time to protect health care workers. 

FDA couldn’t get off its duff in time to respond to a national public health emergency and approve a very good German test in early February of 2020, as soon it was made available to us, so we stood around clueless for three more months, with no real testing, while Covid-19 was spreading across the nation and killing hundreds of thousands of Americans. 

The claim that FDA didn’t race through an emergency use authorization is also demonstrably false, and has caused us no end of headaches, because people lied about the process.  The EUAs were granted without a phase four clinical trial, the post marketing part of normal vaccination approval, which don’t seek EUAs.  FDA made an entirely correct decision when it granted the EUAs.  This was a public health emergency.  FDA appropriately weighed the risks of the EUA against the risks of millions more deaths without an EUA while waiting for phase four of the clinical trials.  FDA acted on evidence presented and on what we already knew about mRNA vaccine.  But then the entire public health apparatus of the nation lied and said this process wasn’t hurried.  They made a huge portion of the population suspicious for no reason, and likely contributed to vaccine hesitancy among the unvaccinated population and worsened the nation’s polarization.

Our president contributed to that polarization when he kept spewing out scientific nonsense while Americans were dying, not that the current occupant of that office is handling Covid-19 all that much better, as he reads from talking points about all his administration is doing, none of which was done soon enough and none of which is well thought-out enough to make a significant difference. Now we are scaling up testing and vaccination, after Omicron is everywhere?  Where were you six months ago? 

Governors make grand proclamations about no mask mandates and no shutdowns, and even preempt local government from acting, when good public health practice, sometimes but rarely, involves closing a school or a business or even restricting movement when disease is everywhere and spreading, and where masks might actually help us reduce the spread of the disease and reduce deaths from it, when community spread is high.  That may be unpopular, but it is the truth. Governors are following the rumor mongers in this way, perhaps even echoing the fake science planted and embellished by our adversaries and it has made us more divided.

Folks on the right scream about mandates and threaten public health officials.  Folks on the left scream about racism and try to cancel public health enforcement.  Everyone else is gob smacked by the talking heads, and desperate, desperate, for someone to please stand up and just tell them what to do, to tell the truth and be clear and talk like human beings, and not just talk from talking points about my plan for this and my plan for that.  Earth to politicians:  your plans didn’t work.  800,000 dead Americans prove that they failed.  But when CDC, FDA, presidents and state governments failed to be effective, clear and direct they worsened it and they left a more divided public which doesn’t trust or believe anyone.

We’ve looked like the Keystone Cops, running around in every direction but the right one, while the culprit got away and is still stalking our cities and towns, our neighborhoods and our farms and villages.

Even so, it’s hard to know whether Covid-19 divided us or whether we failed to control Covid-19 because we are so divided.  Probably a little of both.

The Russians and the Chinese know that a divided U.S. is a weaker adversary, and weaker advocate for democracy around the world.  The pandemic is powerful proof that our polarization exposes us, about how we lose our freedoms if we don’t stand together to defend them. Argue over masks or vaccines and the virus spreads, and before long few of us feels safe to pray, congregate, learn, shop, party or petition the government about grievances.

But in crisis is sometimes opportunity.  If we ignore the tropes and the memes that divide us, if we ignore governors and presidents and even the CDC, maybe we can beat this virus ourselves.  

Say what? Beat this virus ourselves?

But I’m still pretty sure that what each of us choises to do matters: what each of us says and does every day matters more than what governors or presidents say or do. How we can choose to mask in public.  How we can choose to protect the elderly and at risk by calling them and making sure they have what they need, so they don’t have to go out until community transmission drops to less than 100 new cases. 100,000/week (from 925 new cases/100,000/week, just saying).  How we work from home and avoid stores, restaurants, and bars when community transmission is high. How we isolate FOR 10 DAYS regardless of what CDC says if we test positive. How we get vaccinated and boosted.  How we rapid test at home before spending time with other people.

But it’s more than that.  How we each characterize people we disagree with.  What we accept without challenge.  How much we engage with people we disagree with, loving them despite our disagreements.  How hard we work to keep connected to each other.  To talk to people, not machines.  To invest in people, not systems.  And to never think it is okay to profit from another person’s misfortune.

I don’t have a clue how to get governors to stop playing politics and to start working on saving lives.  But I do know that what I say and do, multiplied by what others say and do, changes how governors and presidents act.  Exactly the way what I do today, multiplied by what others say and do today, provides an opportunity for the virus to spread, or not.

Culture is hard to change.  But it doesn’t change by itself.  Changing culture takes self-discipline, leadership and followership, all together.

On Yom Kippur, after Jews recite the litany of what can go wrong in the coming year as a result of fate and the choices we each make (who shall live and who shall die, who by fire and who by water and so forth), we answer the dread and guilt we’ve stirred up in the following way: “but repentance, prayer and charity cancel the stern decree.”

That’s the only solution I know now.  Repentance, prayer, and charity.  Not strategy, tactics, leverage, position, finesse, vision, values or goals.

Choices. 

Then repentance, prayer, and charity. Practiced unrelentingly by all of us.  Starting now.

And if we, the people, do all that, guess what?  We have rebuilt democracy ourselves.  What could be better than that?  Rebuilding democracy.  That’s Build Back Better on steroids, thank you very much.

What’s coming at us may be more polarization, if we aren’t very careful, and perhaps political violence and the loss of our precious freedoms of all sorts.

Now is the time for all good people to come to the aid of our country. 

If not now, than when?

Thanks for reading,

Michael

Many thanks again to Nick Landekic, who provided me with tons of data and publications over the last twenty months, and whose knowledge of Covid-19 is encyclopedic; to Deborah Faith, MPH, for her unending editorial support and great editorial suggestions, and to Kendra Tanquay, for her support of my writing over many months.

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Michael Fine, MD was the Director of the Rhode Island Department of Health from February of 2011 until March of 2015. His career has been devoted to healthcare reform and the care of under-served populations. He served as Medical Program Director at the Rhode Island Department of Corrections; and founder and Managing Director of HealthAccessRI, the nation’s first statewide organization making prepaid, reduced fee-for-service primary care available to people without employer-provided health insurance.

Dr. Fine practiced for 16 years in urban Pawtucket, and rural Scituate, RI. He is the former Physician Operating Officer of Hillside Avenue Family and Community Medicine, the former Physician-in-Chief of the Rhode Island and Miriam Hospitals’ Departments of Family and Community Medicine. He was co-chair of the Allied Advocacy Group for Integrated Primary Care.

He currently serves on the Boards of Crossroads Rhode Island, the state’s largest service organization for the homeless, the Lown Institute, the George Wiley Center, and RICARES. Dr. Fine founded the Scituate Health Alliance.

Dr. Fine is past President of the Rhode Island Academy of Family Physicians, has served on a number of legislative committees for the RI General Assembly, chaired the Primary Care Advisory Committee for the RIDOH, and sat on both the Urban Family Medicine Task Force of the American Academy of Family Physicians and the National Advisory Council to the National Health Services Corps.