COVID Chronicles, or, a Suggested Presidential Speech

Today, 150 days since I began my Covid tweets, I’m going to do something odd: write the speech that Trump should give.

My fellow Americans:

It’s been six months since the coronavirus – the virus that causes COVID – first entered our country. In that time, the disease has killed more than 160,000 of our fellow citizens, sickened millions, devastated our economy, & exposed a number of fault lines in our society.

The toll – in years unlived, families shattered, people dying alone, healthcare workers and hospitals pushed to the edge, changes to our lives and lifestyles – is unspeakable. We have been attacked by a foe we cannot see, but one that is devastatingly good at what it does.

The brutal summer surge that has killed tens of thousands in the South & West shows signs of abating. But the experts tell us that we may be in for another surge, perhaps the worst yet, in the fall. We may have a short window to change course before the next wave hits.

In retrospect, faced with a foe like the coronavirus, the right thing to do would have been to recognize our commonality of purpose, and to bring the full measure of American resources – financial, intellectual, communal, and creative – to bear to defeat the virus.

But we have not done that. We have instead locked horns in partisan battles that are both unnecessary and unproductive: public health vs. the economy, masks vs. “freedom,” the opening of schools, the closing of borders. As we fought, we lost sight of our common enemy.

Our actions should have been dictated by what the best science – which, given the nature of science, evolves over time – told us about how best to defeat the virus and save the most lives. But too often it was not.

I take full responsibility for this misguided course. And I vow, in my time left in office, to rectify my mistakes, to bring us together to fight our shared enemy, to focus on saving as many lives as possible – knowing that doing so offers the best chance of bolstering our economy, opening our schools, and unifying our nation.

Armed with the hard-earned knowledge that we now have about the virus and the pandemic, I hope you’ll give me an opportunity to change tack, turning to a new path that allows us all

Robert Wachter, MD

to work as one. Here’s what we need to do: First, the debate about masks must end. By wearing them, we can slash transmission rates & save thousands of lives. Starting today, I am enacting a national mandate: everyone who will come in close contact with others outside their home must wear a mask. I will do so myself. I have instructed the federal government, working with private industry, to begin production of millions of high-quality cloth and surgical masks (along with other needed PPE for healthcare settings). We will make these masks freely available to those who cannot afford them.

Additionally, we will launch a major program to rapidly build our COVID testing capacity, with a goal – in the next three months – of deploying hundreds of millions of low-cost, rapid turnaround viral tests that can be used at home or in businesses.

I have asked @US_FDA to create a regulatory path to approve such tests if they can reliably identify individuals capable of transmitting the virus. We will also bolster our contact tracing capacity and access to alternative housing for quarantined individuals who need it.

To oversee our federal Covid-19 efforts, I am enlisting the help of several outstanding individuals. I am asking @ASlavitt, former head @CMSGov, to assume leadership of the interagency Coronavirus Task Force. Andy will have the full resources of the U.S. govt at his disposal.

We desperately need @CDCgov to reestablish its traditional role as the key agency tracking the pandemic and guiding our national prevention activities. Toward that end, I’ve asked @ ashishkjha, head of the Global Health Institute at @HarvardSPH, to become the new CDC director.

The CDC will revise its guidelines on school openings, using the best evidence to inform districts when it is safe to resume in-person instruction. We will provide the funding needed for schools to modify their spaces and procedures to make them as safe as possible.

I am also creating a new position of Covid Disparities Czar to study the toll of Covid on minority populations and make recommendations about how best to address them. I’m asking @ KBibbinsDomingo, Chair of the Dept. of Epidemiology/Biostat @UCSF, to assume this crucial role.

I’m proud of our support for vaccine research, manufacturing & distribution. We will redouble this effort, hoping to identify at least 1 safe & effective vaccine by early 2021. I pledge not to interfere w/ FDA’s vaccine approval process – this must be guided by science alone.

It’s clear that much of our success in battling Covid will depend on people’s willingness to change behavior: wear masks, avoid crowds, maintain distancing and, ultimately, be vaccinated. To that end, I will ask a group of highly respected “influencers” from diverse fields – including sports, entertainment & social media – to develop a campaign to engage the public in these crucial measures, and increase the public’s trust that following these health guidelines is the best way to save lives, end the scourge of Covid-19, and restore our economy.

As a society and a government, we have made mistakes in the past six months. I know I have. I vow to learn from these mistakes, to chart a new path, and to unify our country as we pursue our shared goals: ending this pandemic and returning to our normal lives.

Thank you for giving me a second chance. I’ve come to understand that we are at a moment in our history that must transcend politics; that the virus doesn’t care about our party or our politics, and – when it comes to our efforts to defeat Covid – neither should we.

Thank you, and may God bless the United States of America. (That wasn't so hard, was it?)

Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at UCSF, where he is the Holly Smith Distinguished Professor in Science and Medicine and the Benioff Endowed Chair in Hospital Medicine.

REOPEN OUR SCHOOLS – FOR EDUCATION AND HEALTH

A Personal and Professional Plea

Kimberly Newell Green, MD

As a pediatrician and a mother of two girls, in second and fourth grades respectively, I have direct experience with the profound challenges that forced school closures can bring to the health and welfare

of families. As I took on the extra jobs of proctoring my daughters’ education, and providing extra hours of food preparation and household work, the quantity and quality of my other work dramatically suffered. That has been tough. But another result of “distance learning” has been much more worrisome: My husband and I observed my girls’ previous love of school and learning fall apart. At first, my daughters were frustrated with elements of their new iPad-facilitated curriculum that were difficult for them. By the end of the school year, they were resistant to, and threatening to refuse engaging with, anything related to school. In fact we were nearing two crises in our home: Educational and mental health. I fear that if distance learning continues, one or both of them may develop a lifelong aversion to school at a minimum, and potentially also chronic mental and behavioral health issues. This is in addition to their sedentary behavior and the difficulty getting them to engage in physical activity with little coach or teacher or peer influence. And at the age of 7 and 9 my girls have developed patterns of emotional eating: I watch them ask for snacks at the moment that a school lesson becomes difficult or boring. I suddenly see obesity looming.

Our children have two highly educated and deeply caring parents who have the financial resources and flexibility to shift some focus from work to school support. They also are enrolled at a wonderful school doing its best to provide a top-notch education, and they have regular access to good internet bandwidth and technology tools with which they can connect to cuttingedge online resources. We are privileged. If closed school is hard for us, it is undoubtedly much more so for families that lack our resources and face additional challenges.

When schools are closed, some less-advantaged parents - usually moms - are forced to make one of two bad choices: leave their children without adequate care or help with distance learning, or fail to be able to work enough to provide food and shelter. We all know that COVID-19 is an unprecedented pandemic with untold human consequences. As we work to mitigate

the devastating effects on our public health and economy, it is vital that we also prioritize our children and families’ health and well-being. I believe that among the many failures that our country has committed in the face of COVID-19, failing to work vigorously to prioritize schools is among the greatest. As you will read in the new SFMMS’ Principles for Reopening Schools Closed Due to COVID-19, we believe that schools are the most vital driver of health for children. They are also vital for our working parents, especially women, as evidence mounts that female parents especially are dropping out of the workforce, and precipitously. And they are vital for our economic recovery, because if a parents needs to supervise their children during school hours, holding a job over a long period of time is essentially unsustainable without help. Public health officials in San Francisco have worked tirelessly in the last months to slow the spread of this dreadful virus, and we have had great working relationships with them. In sharing our principles we have been met with gratitude and partnership. Our city has seen lower rates of COVID-19 than many other cities in our state and nation, partly because most of our community adheres to public health standards but also perhaps most significantly because of physician leaders like Grant Colfax, the Director of Public Health in San Francisco, and Tomas Aragon and Matt Willis, the Health Officers of San Francisco and Marin Counties, respectively. All of these incredible public health leaders are members of SFMMS (Drs. Aragon and Willis are currently members of our Board of Directors).

More than a dozen Marin schools are opening as I write, and at the time of this writing Dr. Aragon stated that he expects some schools in San Francisco to be able to open by the end of September. We thank all of the health department staff who have been working hard to develop a path to safe and successful reopening.

I personally feel that if our society had really taken a step back to think about the long term health and safety of our city and community, we should have focused much more energy and money on creative and innovative solutions to the difficult problem of reopening schools safely (for the entire school community including staff) and equitably. Unfortunately, due to