The Health 202: The science on coronavirus is still murky. That puts public officials in a bind.

with Paulina Firozi

Political leaders determining how to protect their constituents during this pandemic are getting a lot of heat. But making decisions in the coronavirus era is far from easy.

The coronavirus pandemic has given rise to statistics, trends, models and projections that evolve daily. Yet local, state and federal leaders don’t have the luxury of waiting for more complete information. Instead, they’ve been forced to rapidly make hugely consequential economic and public health decisions and hope they were the right ones.

“Science takes time,” my colleague Joel Achenbach writes. “By tradition, it is a deliberate endeavor, and not designed for emergencies, quick answers and certainty, however much that may be craved.”

He adds: “Not only do experiments take time to devise, execute and analyze but the broader scientific community usually has a chance to scrutinize and potentially falsify the results. This process has been largely abandoned during the pandemic.”

Confusion has been rampant since the virus started spreading in the United States three months ago. 

Modelers gave varying predictions for how many infections and deaths could result. Epidemiologists are still debating the true infection and fatality rates. Medical professionals don’t fully understand why the virus hits some hard and not others, and the extent to which children without symptoms can pass it along.

And the state of American politics is making things worse: “The ideologically divisive media ecosystem does not help in a crisis like this,” Joel writes. “Distrust of the numbers, and of institutions that rely on professional expertise, is widespread. Science has been dragged into partisan politics and the culture wars, and special interests cherry-pick the data to advance their arguments.”

“What’s crazy is, we’re three months in, and we’re still not able to calibrate our risk management. It’s a mess,” Brian Nosek, who runs the Center for Open Science at the University of Virginia, told Joel. “Tell me what to do! Please!”

As a result, governors haven’t always been clear in their guidance about what should reopen and what should stay closed. 

Virginia Gov. Ralph Northam (D) announced that communities in Northern Virginia can begin loosening their lockdowns on Friday. Virginia had reported a second straight spike in daily new cases — and rates in Northern Virginia remain far higher than in the rest of the state — but he argued that the region is seeing a decline in the percentage of positive tests for the disease.

“The virus clearly is still here, but overall the numbers are trending in the right direction,” Northam said. Later, he added: “Just because you can open doesn’t mean that you have to open.”

“The seemingly contradictory moves and statements highlighted the confusing nature of efforts to both fight the pandemic and begin reopening the economy in the nation’s capital region, which has been particularly hard-hit,” Gregory S. Schneider and Antonio Olivo write.

While it’s clear the virus has killed a lot of Americans in a short time, its true lethality rate is still hotly debated.

Joel reports that in a document released last week, the Centers for Disease Control and Prevention estimates that 0.2 to 1 percent of people who develop covid-19 will die, putting its “current best estimate” for the fatality rate at 0.4 percent.

But the agency estimates the infection fatality rate is closer to 0.26 percent, based on its guess that 35 percent of people infected never develop symptoms. That’s lower than other estimates produced by scientists and modelers.

The difficulties in estimating lethality stem from the earlier lack of testing and shortcomings in data on how many people were infected, Joel writes. Researchers are starting to gather more data — but it all takes time.

Different assumptions about fatality rates are one reason models — especially early on — varied so wildly.

Officials relied on a dozen or so models to predict the virus’s toll as they made quick lockdown decisions in March. The models make assumptions about how infectious the virus is, the rate at which people die once infected and the extent to which people will continue socially distancing in the coming months.

Scientists like to say that all models are wrong but that some are useful, Joel writes. The Trump administration used modeling in the president’s March 16 order for an initial 15-day national shutdown. At the time, there were only 85 deaths, but models predicted many thousands more.

“The pandemic has cast a bright light on epidemiology and the computer models that played a key role in spurring the massive shutdowns in March,” Joel writes. “Some critics of the models have called them flawed and incorrect.”

The uncertain data have led public officials to caveat their guidance.

“With stay-at-home orders expiring and businesses reopening, all the scientific data is being scrutinized anew,” Joel writes. “But the numbers are often ambiguous, with large margins of error. And because this is still an early phase of the pandemic, scientific findings have to be couched in tentative, provisional, sometimes squishy language that is festooned with caveats and admitted limitations.” 

The CDC document gave a wide range of estimates for the virus’s contagiousness and lethality. And it warned that the data is far from firm.

“Information about [covid-19’s] biological and epidemiological characteristics remain limited, and uncertainty remains around nearly all parameter values,” the agency wrote. 

Ahh, oof and ouch

AHH: President Trump announced the administration will move to cap out-of-pocket insulin costs for seniors with diabetes. 

“The administration has brokered an agreement between insulin manufacturers and some Medicare prescription drug plans that would lower insulin costs for some seniors by capping co-pays at $35 for a monthly supply for insulin — a figure that administration officials said would lead to roughly a two-thirds drop in out-of-pocket costs and would encourage seniors to continue taking insulin,” Seung Min Kim and Yasmeen Abutaleb report

During an event at the Rose Garden yesterday, Trump called it a “breakthrough agreement,” citing skyrocketing costs of the lifesaving drug. 

Also, he mused about taking insulin himself: 

The announcement also comes as the president has struggled with older voters, they write. Trump took a jab at former vice president Joe Biden, the presumptive Democratic nominee, during the event, saying “Sleepy Joe can’t do this. That I can tell you.”

“Before the pandemic struck, Trump and his administration were focused on lowering drug prices, which consistently polled as a top voter concern — especially among older voters,” Seung Min and Yasmeen write. “The price of insulin has become a frequent focus for politicians who complain about high drug prices because of insulin’s ubiquity.”

OOF: Department of Health and Human Services watchdog told lawmakers that inspectors general must work toward freedom from political intrusion. 

Christi A. Grimm, the principal deputy inspector general for HHS who is being replaced as part of Trump’s purge of IGs, testified before members of the House Committee on Oversight and Reform after issuing a report documenting “severe shortages” of supplies in April. 

“Grimm defended that inquiry and its findings, telling members of the House Committee on Oversight and Reform that it was warranted, though she said the department has since addressed some of the problems it identified,” Amy Goldstein reports

It was Grimm’s first time speaking out since she was criticized by Trump for that report.  

“Personally and professionally, I cannot let the idea of providing unpopular information drive decision-making in the work we do,” Grimm said, speaking by videoconference. 

“A career employee with the HHS inspector general’s office for more than two decades, Grimm said Tuesday that she and colleagues are pursuing 14 additional reviews of the administration’s response to the pandemic, which has resulted in more than 1.6 million cases across the country of covid-19, the disease caused by the virus, and more than 98,000 deaths as of Tuesday,” Amy adds. 

OUCH: A third of Americans are showing signs of clinical anxiety or depression during the pandemic. 

The findings from the Census Bureau point to the most alarming sign yet of the kind of psychological toll the pandemic is taking, as William Wan and Alyssa Fowers report. In short, it’s not normal for this many Americans to feel this way.

“When asked questions normally used to screen patients for mental health problems, 24 percent showed clinically significant symptoms of major depressive disorder and 30 percent showed symptoms of generalized anxiety disorder,” they write. 

The Census Bureau launched a weekly survey of U.S. households at the end of last month. Within that survey, officials included questions taken nearly verbatim from a form doctors use to screen patients for depression and anxiety. 

“Those answers provide a real-time window into the country’s collective mental health after three months of fear, isolation, soaring unemployment and continuing uncertainty,” William and Alyssa add. “… Some groups have been hit harder than others. Rates of anxiety and depression were far higher among younger adults, women and the poor. The worse scores in young adults were especially notable, given that the virus has been more likely to kill the elderly or leave them critically ill. Those results reflect a deepening of existing trends: rising depression, stress and suicide among young adults.”

Industry efforts

U.S. taxpayers helped pay for the development of remdesivir, the drug that drew international attention as a potential coronavirus treatment. 

But despite the heavy federal subsidies — three health agencies were heavily involved in the development of the drug — federal agencies have not asserted patent rights to the drug made by Gilead Sciences. 

“That means Gilead will have few constraints other than political pressure when it sets a price in coming weeks. Critics are urging the Trump administration to take a more aggressive approach,” Christopher Rowland reports. “… Gilead has acknowledged the large role of government agencies in remdesivir’s development but said the original compound was discovered by Gilead researchers years earlier and therefore the government has no potential patent rights to the drug.”

“Without direct public investment and tax subsidies, this drug would apparently have remained in the scrapheap of unsuccessful drugs,” Rep. Lloyd Doggett (D-Tex.), chairman of the House Ways and Means health subcommittee, said this month. 

Lawmakers, including Doggett, have called on HHS to provide details of the federal support provided for remdesivir’s discovery and development.

Drugmaking giant Merck is pursuing numerous avenues in search of a coronavirus vaccine.

It announced it is acquiring an experimental vaccine as part of the purchase of an Austrian company. The company also announced it’s partnering with a New York-based scientific research organization in pursuit of a second vaccine.

“Some 150 coronavirus vaccines are in development world-wide, including at Johnson & Johnson and Pfizer Inc., and more than 350 drugs are in the works or being studied, according to BioCentury, which is tracking the efforts,” the Wall Street Journal’s Jared S. Hopkins reports. “Merck is a longtime maker of vaccines and antivirals, including human papillomavirus shot Gardasil. For weeks, the company had been looking inside its own walls for promising Covid-19 candidates, before deciding to pursue programs started elsewhere.” 

Coronavirus latest

Here are a few more stories to catch up on this morning: 

Congress on the coronavirus: 
  • House Republican leaders plan to file a federal lawsuit over a Democratic plan to allow remote voting by proxy in the chamber for the first time, Mike DeBonis reports.
In the region: 
  • D.C. Mayor Muriel E. Bowser (D) is expected to announce today the gradual reopening of the District, saying it has met critical thresholds in containing new infections. “But the city has been moving the goal posts for measuring the trajectory of the virus,” Fenit Nirappil and Julie Zauzmer report. “District officials have changed their approach to calculating the spread of the virus — no longer mentioning other reopening metrics they laid out last month, including a declining rate in people testing positive and a decrease in flu-like illnesses among residents who might not have been tested.”
More industry efforts: 
  • Test developers are racing to develop the latest technology that will allow for rapid and widespread coronavirus testing. Hundreds have applied to a competition announced by the National Institutes of Health that’s “meant to speed up development of diagnostic technologies, with the goal of millions of rapid tests a week available by the end of summer, and more by flu season,” the Wall Street Journal’s Brianna Abbott and Amy Dockser Marcus report.
What’s ahead: 
  • The World Health Organization warned a too-rapid push toward normalcy and the easing of restrictions could fuel an uptick of cases. Mike Ryan, head of the WHO’s health emergencies program, warned there could be another peak of cases ahead of a presumed second wave of infections, Brady Dennis, Meagan Flynn and Rick Noack report.
The hardest hit: 
  • A report made public by the Canadian military details troubling conditions at long-term care homes, including resident abuse, cockroach-infested facilities and locked-away personal protective gear, Amanda Coletta reports.

Sugar rush

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