As a physician on the front lines, l have watched in dismay as many U.S. states have begun to reopen from the lockdown. This is despite the fact that most of them do not fulfill the recommendations set forth by the White House. Those guidelines ask for a “downward trajectory” in newly diagnosed cases or in the percentage of positive tests. Some have criticized the guidelines for not being binding. Others have pointed out that they are overly vague and unambitious. Even then, many governors are ignoring them, while simultaneously claiming that they are listening to their own experts.
But who are these so-called experts? Certainly, it’s not the countless medical professionals, epidemiologists, and scientists who have publicly insisted that the current testing and tracing infrastructure is insufficient for a reopening.
The truth is that our public health decisions are currently being made by politicians, the overwhelming majority of whom do not have relevant medical or scientific expertise. This reality has negative consequences. When there is a clash between political and public health interests, the former seems to take precedence. Look no further than the experts who have been sidelined or re-assigned to lesser roles under this administration when they disagree with politically-driven – but ultimately medically-harmful – policies. Even the CDC is not immune. They recently submitted detailed reopening guidelines, but the recommendations were rejected by the White House for being too restrictive.
Given this atmosphere, what can we do to ensure an evidence-based scientific approach is taken with respect to our public health policies? In the short term, there needs to be continued pressure from the media, the scientific community, and the public to hold politicians accountable for their decisions. We must demand science-based policies with our voice and, ultimately, the vote.
In the long term, there needs to be a concerted effort to have a more balanced governing body, one where there is no shortage of scientists and medical providers.
One quick look at the 116th Congress shows us how far we are from that reality. Of the 541 individuals in Congress, there are only three physicians in the Senate and 14 physicians in the House of Representatives. If we include other medical providers, there are an additional five dentists, three veterinarians, two psychologists, two nurses, an optometrist, a pharmacist, and a physician assistant. The numbers of scientists, even defined broadly, is equally discouraging. There are 11 engineers, a chemist, a physicist, a mathematician, and a handful of doctorate degree holders in political science and education. Where are the public health experts? What about the virologists, immunologists, or biochemists?
By contrast, there are 161 members of the House (37% of the House) and 53 Senators (53% of the Senate) who hold law degrees. A sizable number have spent their careers in politics, including 41 former mayors, 20 former state governors or lieutenant governors, and at least 89 former congressional staffers. Many others come from various business backgrounds. Similarly, among America’s governors, only one is a physician, whereas 16 are lawyers.
Certainly, a deep knowledge of legal and economic matters is crucial to everyday governing. No one denies that. But as the last few months have shown us, so is an understanding of public health, pharmacology, biotechnology, and medical therapeutics.
We have already seen evidence that science-based leadership can pay off during a crisis. Germany has become an envy of the world for its aggressive, early testing and containment efforts, resulting in relatively few deaths compared to the U.K., Italy, Spain, France, and U.S. A quick look at Germany’s curve confirms this. The death rate in the U.S., for example, has been 23 per 100,000 population, whereas it is as low as 9 per 100,000 in Germany. Part of the country’s success lies in its leader Angela Merkel, previously a quantum chemist. As has been reported, her scientific acuity, combined with her deference to experts, have helped save tens of thousands of lives.
It is certainly true that we must reopen the country as soon as it is safe to do so. The economic toll from this pandemic has been devastating. The staggering unemployment numbers and bankruptcies speak for themselves. But how useful is a short-term jolt to the economy if a reopening causes the pandemic to be much longer? And what about the loss of productivity associated with the tens of thousands of American lives that may be lost due to preemptive reopening?
Americans deserve answers to these questions. And they deserve a strategy that puts public health interest at the center. Instead, sound scientific reasoning has increasingly taken a backseat to political and economic considerations. But things must change. And they will do so when scientists and medical providers begin to hold important political positions. Only then can we serve the public without being sidelined.
Shahdabul Faraz, MD, is a surgery resident and can be reached on Twitter @shahdabulf. This post appeared on KevinMD.
Last Updated May 26, 2020