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STRONG PRESIDENTS… Weak Health Care Systems… Global Tragedy

As the world grapples with the reality of SIX MILLION ‘reported’ Covid-19 cases, internationally coordinated “misinformation” campaigns have been orchestrated to deflect attention from the lack of national preparedness and inadequately funded medical/health systems.   The most notable example is the strident promotion of various combinations of hydroxychloroquine, chloroquine, and antibiotics as both prophylactics and as active medical treatments of the deadly virus.  The so-called cost-effective “silver bullet” in the battle against the exponential growth of the Covid-19 pandemic.


Touted by US President Donald Trump, who announced his personal use of the drug hydroxychloroquine, it is instructive that other autocratic “strongmen” such as Russian President Vladimir Putin and Brazilian President Jair Bolsonaro have followed President Trump’s lead in advocating the drug’s use in their nations’ futile efforts to combat the Covid-19 plague.  This defies the scientific evidence of clinical trials and medical reports of the drug’s ineffectiveness against Covid-19.   For example, the US Federal Drug Administration (FDA) asserts that “there's no proof that it works and it's not authorized for at-home use."  The US Center for Disease Control’s (CDC) has removed its guidance for using hydroxychloroquine in the treatment of the Coronavirus from its official website.  The US Veterans Administration (VA) recently conducted the largest US clinical study of veterans that were prescribed hydroxychloroquine and found more patients died and experienced serious side effects than those that were not prescribed the drug. 


The largest peer-reviewed study by Australian infectious disease researchers, published in the prestigious medical journal Lancet, found Covid-19 patients who received the malaria drug were dying at higher rates and experiencing more heart-related complications than other virus patients. These findings were based on data from nearly 15,000 patients with Covid-19 who received the drug alone or in combination with antibiotics when compared with data from 81,000 patients in control groups who did not receive the drug.  The findings prompted researchers from around the world to reassess their own clinical trials of the drug for preventing and treating Covid-19.   Accordingly, the World Health Organization (WHO) responded by halting all of its clinical trials involving hydroxychloroquine at the end of April due to its concerns over the efficacy and safety of prescribing the drug to human patients.  This is one of the reasons that President Trump announced the withdrawal of the United States from WHO at the end of May.  That is, kill the messenger and ignore the message!


So, what are the health consequences of these political regimes?  First, even with the significant case undercounts of Brazil (438,238) and especially Russia (135,399), these three countries account for 2,547,787 of 5,974,938 cases or an astounding 43.7% of the worldwide reported cases of Covid-19.  Yes, the US is number 1, Brazil is number 2 and Russia is number in the world.  No matter how strident and vociferous is their criticism of the “fake” news media and “biased” clinical researchers, the statistics cannot hide the underlying consequences of these leaders’ COVID-19 policies. Similarly, these three countries report 135,399 or 36.9% of the 367,097 reported coronavirus-related deaths.  These data are confirmed by The Johns Hopkins University Covid-19 Global Dashboard.  Furthermore, each of these Presidents dismissed the Coronavirus as nothing more than a “little flu.”  In fact, they all proclaimed that the Covid-19  virus would “miraculously disappear” with the warm weather in the Spring and Summer.


Second, all three Presidents have sought to secure millions of dosages of hydroxychloroquine rather than ensuring adequate supplies of Personal Protective Equipment (PPE) for medical professionals of their respective countries.  In fact, President Trump persuaded Indian Prime Minister Narendra Modi to export millions of hydroxychloroquine pills to the US over domestic protests to limit their distribution within India.  Yet, President Trump refused to respond to urgent requests for PPE even when medical professionals throughout the United States pleaded for basic protective supplies.

       

More poignantly, President Putin dismissed the severity of the pandemic by sending a shipment of Russian-made PPE supplies to the US on April 1st.  This highly publicized action, intended to demonstrate that President Putin was firmly in control of the virus in Russia, belied the crisis that surged through Moscow only one month later.  Today, the Coronavirus is spreading exponentially throughout the country where the state health care system is woefully unprepared to handle the surge of infected patients.  Similarly, President Bolsonaro dismissed the seriousness of the pandemic in São Paulo while it rapidly expanded to other provinces including indigenous tribes deep in the Amazon.  Instead, he urged the use of hydroxychloroquine while Brazilian doctors and nurses begged for PPE supplies as Covid-19 patients quickly overwhelmed their hospitals.


Third, the plight of the “front-line” medical staff—who routinely work six and seven days per week—underscores the lack of public funding and inadequate staffing of their respective national health systems.  As a result, all three countries have suffered very high infection rates among their medical doctors, nurses, and other health practitioners—largely due to the lack of PPE supplies.  This includes the widely publicized suicides of several doctors in each country; three Russian doctors jumped to their death from Moscow hospital buildings.   The soaring incapacitation and death rates of medical staff underscore the lack of vital medical resources (including ventilators and oxygen compressors) allocated for national health emergencies.  During their Presidencies, moreover, these “strong men” increased national military budgets while underfunding their public health care programs.  Also, their signature economic policies have exacerbated national income inequality that have purposively benefited their personal economic and political networks of supporters.

 

In sum, all three Presidents have sought to reinforce their image of autocratic control by downplaying the severity of the health and economic impacts, undermining journalistic reports of the pandemic, criticizing scientific analyses of the epidemiological crisis, and extolling the effectiveness of their policy responses.  Nevertheless, the catastrophic impact of the Covid-19 pandemic has exposed that the respective “Emperor has no clothes.”   Years of underfunding and neglect of national health care systems have exposed widening racial and economic disparities that have further exacerbated unequal health outcomes.   “Front-line” workers such as grocery store clerks, delivery workers, hospital nurses, police officers, bus drivers, and retirement home staff are more likely to be from racial/ethnic/immigrant groups with low incomes and pre-existing medical conditions (eg, diabetes, hypertension, heart problems) with the least access to affordable health care.   Therefore the current crisis highlights the importance of strengthening national health systems so that those exposed to Covid-19 can obtain necessary health care and, in the process, provide crucial information that that can be used to reduce the spread of the virus.



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