The Washington Post National Weekly. April 12, 2020

SUNDAY, APRIL 12, 2020

. IN COLLABORATION WITH

ABCDE National Weekly

the coronavirus pandemic

Put to the test

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The Fix

Evaluating Trump’s briefings BY

A MBER P HILLIPS

H

ave President Trump’s daily coronavirus briefings become a liability for him? Some of his Republican allies think so, reports the New York Times: “Many view the sessions as a kind of original sin from which all of his missteps flow, once he gets through his prepared script and turns to his preferred style of extemporaneous bluster and invective.”

Instead of letting the health-care professionals take center stage, Trump “sometimes drowns out his own message,” Sen. Lindsey O. Graham (R-S.C.), a Trump ally, told the Times.

The Wall Street Journal editorial board called them “wasted” time for the president.

But Trump clearly likes the briefings. He appears to derive energy from them. So let’s walk through the pros and cons, from his perspective, of keeping these going.

Pro: It’s a way for him to project that he’s in control of the crisis Coronavirus and its economic impacts will very likely define the November election, and Trump’s slow reaction has been well documented in numerous media outlets.

To contrast that damaging narrative, seven days a week, a serious-looking Trump stands at the lectern at the White House, surrounded by medical experts, and talks about ramping up testing, shipping ventilators to states and starting clinical trials for treatments.

Con: He quickly loses the focus of the briefing Only the first 20 minutes or so of these sometimes hours-long briefings are about ventilator shipments and the like. At some point, he turns the briefing over to his task

KLMNO Weekly

Jabin Botsford/The Washington Post

President Trump’s daily covid-19 briefings give him a way to respond to the media in real time, but journalists can also respond back.

force and other Cabinet secretaries. The rest, Trump devotes to sparring with the media, throwing out completely unfounded theories about voter fraud by mail-in ballots and getting many of his facts wrong, like the number of tests the United States has done, or that other countries are hiding the number of cases they have.

And then he attacks his political opponents, like former vice president Joe Biden or Democratic governors and leaders of Congress. That particularly irked the conservative Wall Street Journal editorial board, which writes: “The President’s outbursts against his political critics are also notably off key at this moment.

This isn’t impeachment, and Covid-19 isn’t shifty Schiff. It’s a once-a-century threat to American life and livelihood.”

As a result of his factual inaccuracies, some cable news outlets have stopped consistently carrying all of his remarks live.

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2020 The Washington Post / Year 6, No. 27

Pro: He can respond to the media in real time It’s a chance for him to defend himself from those damaging media reports about his administration’s slow responses. When The Washington Post published its chronicle of how the administration fumbled 70 days of warnings about the virus, he started his briefing by deriding “fake news.”

To the extent that bashing journalists is a pro for him, he’s done it a lot in these briefings.

Trump snapped at NBC’s Peter Alexander last month when Alexander asked Trump what he’d say to Americans who are scared: “I’d say you’re a terrible reporter.”

And he continued his habit of delivering particularly harsh rebukes to black female reporters: “Don’t be threatening. Be nice,” he said in March when PBS “NewsHour” reporter Yamiche Alcindor asked about his comments on how many ventilators New York needs.

Con: Journalists can respond to him in real time Journalists can and have been rereading Trump’s own damaging words about the virus back to him, forcing him to either deny what he has clearly said (which Trump has done on several times, including to Alcindor’s question), or to defend why he downplayed the virus for so long. Those moments have created awkward and even potentially politically damaging moments for Trump.

On Tuesday, a reporter read Trump his own comments from around the time intelligence reports and a top adviser were warning of the virus: “You said within a couple of days, the cases will be down to zero.”

“Well, the cases really didn’t build up for a while,” he said, which isn’t true. They have grown exponentially. n

Contents the coronavirus 4 Books 18 Opinion 20 Five Myths 23

On the cover Military personnel walk among cubicles being prepared at the Javits New York Medical Station at the Jacob K. Javits Convention Center in Manhattan on April 3. Photo by ANDREW KELLY of Reuters

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The coronavirus pandemic

Cause of TP shortage? It’s threefold BY

M ARC F ISHER

W

hen the history of the coronavirus pandemic is written, the vanishing of toilet paper might rank as just a footnote in an otherwise dark and frightening account. But it might be a very long, complex and even wise footnote, because toilet paper — or rather, the lack of it — turns out to reveal a great deal about who we are and how we behave in a crisis.

It showed David Cohen something about the nature of humanity: As a checkout guy at a supermarket in Asheville, N.C., he saw people buying absurd amounts of toilet paper, but he also saw people reach the cashier’s counter and decide suddenly to consider those who have less.

“Some people said, ‘Wait, I’m going to put these rolls back on the shelf so somebody else can get some,’” said Cohen, who was happy to wait while his customers made a quick return visit to Aisle 14.

It inspired Leslie Klein to poetry: “The store shelves are bare of necessities / Fear took the helm driving shopping to insanity / So, a cushion of paper gives a sense of security.” Klein, an artist — and poet, if she didn’t already know it — in West Stockbridge, Mass., isn’t finding any rolls in her local stores, but she’s been cheered to find that a sort of underground market in TP info has developed.

“Friends pass along hot tips,” she said. “Like, ‘You can find some wholesale at this place.’ It’s something people really feel they can’t do without.”

It confirmed Ronald Blumer’s view that “people have deep emotional connections to what goes into and comes out of our bodies.

It sounds highfalutin, but it’s part of your being.”

Blumer, a writer in Manhattan who actually wrote a book about toilet paper in 2013, managed to find a stash of the stuff the other day in, of all places, a little hardware store.

Dustin Franz for The washington post

Hoarding, displacement and a changing industry share in the blame “People don’t know they carry it, so they still have some,” he said. “Or maybe it’s because it’s not the best TP. Single-ply, oh dear!”

It has become something of an obsession. You can’t find it at your local market, which can’t get nearly enough from its distributors, which are getting their normal supply from the manufacturers, which isn’t remotely sufficient.

The economics and logistics of the problem are a bit controversial, though there are good and plentiful theories to explain why your favorite supermarket’s bland assurance that “more is on the way” — Google finds more than half a million hits for that bit of corporate hype about

the easing of the TP shortage — is misleading.

Fleets of experts, working from home, already are examining the question from as many perspectives as a university has departments. The quants — who have studied “the toilet paper problem” for years, asking why some people in public restrooms take from the larger, fuller roll while others, known as “little choosers,” use the roll that’s closer to empty — are focused on why the supply chain has broken down. Psychologists are curious why TP — not exactly essential to sustaining human life — ranks right up there with milk and bread in our panic-buying behaviors. Social historians look at why people came to view toilet tissue

Like many stores in the country, this Target in Wadsworth, Ohio, saw its shelves devoid of toilet paper last month.

as vital when it didn’t even become a household staple until the 1940s.

All of which is interesting enough, but doesn’t bring you any closer to scoring an eightpack of Charmin Mega Ultra Strong or the elusive brick of Cottonelle Ultra ComfortCare. Or even a roll or two of the scratchy, see-through, single-ply cheap stuff.

The problem, like the virus that spawned it, is global. In Australia, a cafe began accepting rolls of TP as payment — a cup of coffee will run you three rolls. In Hong Kong, crooks held up a supermarket at gunpoint; all they took was 600 rolls of the soft stuff. A pet store in Dornburg, Germany, set up an outdoor toilet

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The coronavirus pandemic paper drive-through in a parking lot when the owner was able to obtain a massive shipment.

Nothing seems to be unspooling in the right direction for a commodity that rarely gets much attention: In Hutchins, Tex., a tractor-trailer hauling a full load of toilet paper crashed and burned last week on Interstate 20. Rolls, most charred or reduced to cinders, splayed all over, shutting down the roadway.

Demand is as flush as supply is bare. Americans have spent $1.4 billion on toilet paper in the past four weeks, a 102 percent increase from the same period a year before, according to data collected by IRI, which tracks retail sales based on the bar codes on products. (Prices have been quite stable over that time.) Only hand sanitizers, disinfectant wipes and the like have seen substantially bigger sales boosts.

But toward the end of March, TP sales plummeted because the supply just wasn’t there.

(Only one category of products found in grocery stores saw sales go down that same week compared with a year earlier — energy drinks. Whether people are working from home or not working, they’re apparently not needing nearly as much of a boost to get through the day.)

So why do the TP shelves remain great banks of emptiness more than a month after many stores reported that customers were hoarding the stuff ?

The leading theories are: 1. We’re buying too much toilet paper because we’re panicked there won’t be any when we need it.

2. We’re actually using way more than usual at home because most people are sheltering in place rather than using the facilities while at work, school, restaurants or other public places.

“The third theory is that both of those are right,” said Doug Baker, vice president at the Food Industry Association, which represents retailers, distributors and producers — the whole chain of businesses from the factory to you.

It’s a three-part problem, Baker said. Part One, hoarding: “We have actual situations across the country where people are buying an entire case,” he said. “Demand

Ricky Carioti/The Washington Post

became unprecedented and still is.”

That’s something the industry knows well — customers regularly wipe out the toilet paper aisle ahead of big snowstorms and hurricanes, and the system can quickly rebound. But this crisis has tested limits because the spike in demand is nationwide, has been going on for some time, and is open-ended.

Part Two, displacement. The same number of people have the same need for toilet paper. But the industry is not set up for a wholesale move from work and school to home; home TP is softer, packaged in smaller rolls and is made and distributed by different companies than are the jumbo rolls seen in offices, institutional settings and public restrooms.

Part Three, adapting on the fly.

Baker said the industry is changing, fast. Manufacturers have added hours at the factories and last week, the companies that make the industrial stuff made a deal with the country’s big food distributors to get their product into grocery stores.

But it’s not as simple as putting the big commercial rolls onto trucks. Most industrial rolls don’t have bar codes on the package, so stores have trouble stocking them. They’re adapting by putting little code stickers, like the ones stuck onto pieces of fruit, on the commercial rolls.

Grocers contend that, as Ira Kress, interim president of Giant Food, put it: “There is not a supply shortage, but it does take some time for the manufacturing process and our supply chain to catch up from the significant spike in demand.”

Giant’s suppliers “are shipping far more product to us than normal, but we are also selling far more product than normal,” Kress said. “Please only purchase what you need for this week as opposed to stocking up.”

It is unlikely the shortages will go away soon.

“We’ll eventually get there,” Baker said. “We need the machines to keep going. And we need to have sales abate. It could take multiple weeks.”

Ideally, that won’t lead to too

A woman carries rolls of toilet paper in Washington, D.C. Toilet paper sales in the past four weeks have doubled from the same period in 2019, according to IRI.

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much misbehavior by the TPdesperate. Black markets in the stuff have developed in the past.

In the 1990s, a manager at Philadelphia’s Veterans Stadium stole $34,000 worth of toilet paper, leaving the ballpark short before an Eagles football game. The manager was fired after investigators determined he had been ordering double loads of toilet paper and reselling much of it. The scandal led a city official to deliver this legendary quote to a local reporter: “Man, he really wiped that stadium clean.”

Blumer, who also has written books on sweat, pee and belly buttons, said that the modern notion that TP is essential was created by the companies that first sold Americans on using the product in the 1940s.

“They had to convince people to use it,” he said. “They had an enormous ad campaign that terrified women, with surgeons with gloves and scalpels saying, ‘It’s a pity she didn’t buy her husband proper toilet paper.’”

In an emergency, today’s consumers could revert to using newspaper or book pages as their grandparents did, Blumer said. Or they could use bidets, which shoot jets of water to clean instead of paper — actually, toilet paper is mostly water, which is blended in the manufacturing process with pressure-cooked wood chips. Bidets, common in much of the world, never made big inroads into the U.S. market, but sales here have surged in recent weeks, according to makers of the devices.

But Blumer admits that a turn away from paper is unlikely in a society that many say has, like its TP, grown softer with each passing generation.

Decades of seemingly absurd television commercials portraying toilet paper as a cuddly buddy have seeped into the popular consciousness. So now, in the opening image of Philadelphia rapper Tierra Whack’s latest song, a plaintive cry about being “sick of being stuck in the house,” a turtle nuzzles up against rolls of toilet paper, which Whack gingerly removes from safekeeping in the fridge, like priceless gems hidden away, a secret protection against the dark forces that threaten us all. n

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The coronavirus pandemic

States go their own way on testing

BY J ULIET E ILPERIN, L AURIE M C G INLEY, S TEVEN M UFSON AND J OSH D AWSEY

T

hree months into the coronavirus pandemic, the Trump administration has yet to devise a national strategy to test Americans for the deadly disease — something experts say is key to blunting the outbreak and resuming daily life.

In the absence of a national plan, several states are developing their own testing systems, but the emerging picture varies widely. States with more money and robust medical sectors have devised comprehensive plans, while others lag far behind.

The White House, meanwhile, is still debating which tests should be sent to which regions and how much to focus on testing Americans to see who may have developed immunity to the disease.

“Unfortunately, states really are on their own,” said Partners in Health medical director Joia Mukherjee, whose group is working with Massachusetts to develop the country’s most extensive contact tracing network to track infected patients’ interactions with others. “It’s problematic at best and egregious at worst, because some states have more resources than others; some states have more leadership than others.”

Public-health experts say that widespread testing for the novel coronavirus is key because it would determine who is infected and needs to be isolated, as opposed to ordering the entire population to stay at home. The development and use of antibody tests, meanwhile, could identify those with immunity to the virus who are able to return to work, school and everyday activities.

Coronavirus testing in the United States started late and has been beset by a string of problems, including bureaucratic delays and ongoing shortages of materials. While testing has accelerated now that private companies are processing samples,

Joshua Lott/Reuters

With no national strategy in place, wide varriances developing in U.S. even the most aggressive states have tested just a small fraction of their residents. New York has tested 1,645 of every 100,000 people and Utah 1,043 of every 100,000, but Texas has tested just 297 and Georgia 381. On a per capita basis, the United States lags behind several other countries in the rate of testing.

“Testing is getting more available,” said Scott Becker, executive director of the Association of Public Health Laboratories. “But the demand is absolutely still outstripping supply.”

In recent days, the White House coronavirus task force has begun debating what a national testing strategy would look like, according to several senior administration officials. Leading

that effort are Deborah Birx, the White House coronavirus response coordinator, and Brett P. Giroir, the assistant secretary for health at the Department of Health and Human Services.

At a Monday task force meeting, according to a participant who spoke on the condition of anonymity to discuss internal deliberations, Birx and Giroir debated where to send the newest coronavirus tests — a version produced by Abbott Laboratories that can deliver results on-site in as little as five minutes, as opposed to tests that can take hours and must be processed by a laboratory.

One senior administration official said the government hopes to devise recommendations for dif-

People wait to receive testing during the outbreak of the coronavirus disease outside Roseland Community Hospital in Chicago, April 7.

Coronavirus testing in the United States started late and has been beset by problems including bureaucratic delays and supply shortages.

ferent populations in rural, suburban and urban areas. Officials also plan to pick different spots in the country to collect data so they can be better prepared to respond in the fall, when the virus could make a return.

The administration has launched a separate effort to test for antibodies, using a process known as serology testing, to identify people with probable immunity to the virus. While these tests could be critical for longerterm decisions about lifting stayat-home orders, there is a debate about the accuracy of the tests and how they should be used.

At a White House briefing Monday evening, Giroir said an interagency working group was closely examining the new serolo-

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The coronavirus Pandemic

William Widmer for The Washington Post

gy tests because “we have reason to believe that not all of them are going to perform well.”

In late March, the FDA adopted an “enforcement discretion” policy on serology tests, saying they could be sold without prior authorization as long as the companies validated their data, notified the agency and made clear the tests should not be used as the “sole basis” for diagnosing active infections and had not been approved by the agency.

Since then, several tests of dubious value have appeared on the market, said the lab association’s Becker, who also said he recently shared his concerns about the “wild, wild West” environment with Giroir and FDA Commissioner Stephen Hahn.

Giroir told reporters that he was confident this effort would give the United States a reliable tool by next month to determine who had been exposed to the virus and could reenter society safely.

“We will have millions on the market by May, in a sophisticated way and a prospective way, that

we get the surveillance we need,” he said. “We can test people to see if they have been exposed, [are] immune and [can] go back to work. And a combination of that kind of test, with the current kind of test we have now, is how America opens back up.”

Officials have also indicated they want major laboratories, such as Roche Diagnostics, to provide serology tests.

In the meantime, Joe Bresee, the deputy incident manager for the CDC’s pandemic response, said the agency has begun testing blood samples from people in coronavirus “hot spots” to determine whether those people, whether they know it or not, may have antibodies that give them some immunity.

“We hope it will give a sense of the area of water under the iceberg,” Bresee said.

But some experts warn that the promise of the serological tests, which use blood samples and are relatively simple to administer and process, may be overstated.

And they emphasize that the federal government must invest re-

sources now to create the capacity for widespread diagnostic tests so the nation is prepared in the coming months to try to head off a resurgence of the virus later in the year.

“Coronavirus testing should be as ubiquitous as strep testing, and maybe more so,” said Scott Gottlieb, who headed the Food and Drug Administration early in Trump’s presidency and is informally advising the White House as well as the governors of Massachusetts and Maryland.

Gottlieb, in a new paper written with experts including Mark McClellan, FDA chief during the George W. Bush administration, argues that the nation needs to create a massive testing and surveillance infrastructure by late May to try to get ahead of the epidemic and prevent an autumn comeback. He said the government should focus on the mass distribution of rapid point-ofcare tests to hospitals, clinics and doctors’ offices.

Some Trump officials said it is too late to create a national testing strategy and that it should

National Guard members monitor a drive-through coronavirus testing center in Louis Armstrong Park in downtown New Orleans in March.

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have been done weeks, if not months, ago.

“We were a month behind on getting testing set up, and now we’re just trying to ramp up testing every single day,” said one official, speaking on the condition of anonymity to be frank.

In the meantime, several states have adopted their own plans.

In Utah, the University of Utah and Intermountain Healthcare worked with ARUP Laboratories to develop mobile testing sites.

On Thursday, TestUtah.com was launched to allow residents to fill out an online survey to determine whether they need coronavirus tests and to book an appointment to be tested. The venture is similar to one Trump described a month ago that has not materialized nationwide.

California Gov. Gavin Newsom (D) assembled a task force Saturday, co-chaired by the assistant director of the California Department of Public Health, Charity Dean, and by Blue Shield of California chief executive Paul Markovich.

One member of the state task force, who spoke on the condition of anonymity to avoid disrupting help from the federal government, said California pressed ahead with initiatives such as establishing eight testing hubs in collaboration with public and private universities and Kaiser Permanente because it had no choice.

“We’re making up our strategy because the federal government has been completely out to lunch,” the task force member said. “We can’t mobilize a health response without knowing how this disease is spreading.”

Connecticut’s governor has also formed a task force to develop a testing strategy. One focus, called Project Haystack, is aimed at detecting contagious individuals.

“The tragedy that we find ourselves in is that we didn’t do the testing early enough,” said task force member David Scheer, the president of a venture capital and advisory firm.

And in Maryland, where Gov. Larry Hogan (R) initially requested a testing site, state officials are now working with Gottlieb to implement their own plan.

“The request for the federal testing site is no longer our top priority,” Hogan said in a recent interview. n

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Five Myths

Insider trading BY

D ONNA M . N AGY

Last month, news broke that lawmakers — including Sens. Richard Burr (R-N.C.) and Kelly Loeffler (R-Ga.) — had sold off stocks early in the coronavirus crisis. Because these sales came in the wake of confidential briefings the senators received about the developing pandemic, they have raised the specter of unlawful insider trading, which can be prosecuted in civil proceedings by the Securities and Exchange Commission or in criminal actions by the Justice Department. Insider trading is an offense surrounded by many familiar myths. Here are five of the most common.

Myth No. 1 Only corporate insiders can engage in insider trading The federal prohibition against insider trading applies to anyone who trades securities on the basis of “material” nonpublic information, in breach of the trust and confidence of either the issuing corporation’s shareholders or the source of the information. For example, a psychiatrist who trades on information confided to him by a patient in a therapy session would be “misappropriating” that information and engaging in securities fraud.

The test for materiality is broad, so any not-yet-announced federal activities or developments that would probably affect stock prices can count. One recent prosecution involved an official at the Centers for Medicare & Medicaid Services who disclosed nonpublic information about planned changes to how much the government would reimburse for certain medical procedures.

Lawmakers are subject to the same trading restrictions, according to the Stock Act of 2012.

Myth No. 2 Investment managers insulate lawmakers from these issues Loeffler describes the criticism of her stock trading as “a ridiculous and baseless attack,” because “investment decisions” for her portfolio “are

made by multiple third-party advisors” without her “knowledge or involvement.”

To be sure, lawmakers can avoid allegations of unlawful insider trading by placing their holdings in a “qualified blind trust” or by trading only through a written plan, which gives a broker complete trading authority, as described by an SEC rule. But very few lawmakers put their holdings in qualified blind trusts or otherwise comply with the technical requirements that would allow them to legally trade securities despite their “awareness” of information derived from their government service.

Myth No. 3 Disclosure sufficiently deters insider trading More than four decades ago, congressional committees contemplated conflict-of-interest restraints that would have required lawmakers to divest certain stocks. But Congress instead adopted the Ethics in Government Act of 1978, which converted existing congressional rules on financial disclosures into stricter reporting laws on the assumption that they would alleviate troubling conflicts.

Many congressional trading scandals later, it’s clear that the increased transparency wasn’t enough to stop some lawmakers from trading stocks during the

Al Drago/Bloomberg News

Sen. Richard Burr (R-N.C.) has defended his recent stock trades, saying they were based on public information and not on anything he learned in early briefings on the coronavirus.

frequent times when they are aware of material nonpublic facts.

The requirement to report a securities transaction no later than 45 days after its execution does allow the SEC or the Justice Department to more easily spot suspicious trades by lawmakers.

But neither the SEC nor the Justice Department has ever prosecuted a lawmaker for trading on government information.

Myth No 4.

You can know inside secrets but trade on public reports Burr claims that his welltimed stock trades were based solely on news reports about the coronavirus rather than anything he learned as chairman of the Senate Intelligence Committee.

But the relevant question isn’t whether public information prompted other investors to sell. The issue is whether Burr was aware of both public and relevant secret information at the time of his stock sales. If so, he would be akin to a stock trader who gets a tip about a probable takeover from a

corporate insider, even as takeover rumors are circulating in the press.

Myth No. 5 Voters are the best judges of lawmakers’ trading The House Ethics Manual points to “the discipline of the electoral process” as an effective check on shady financial dealings.

But a lawmaker’s actions in chamber leadership or on a congressional committee affect the entire nation. And the beneficiaries of a lawmaker’s duty of trust and confidence include not only the voters in that lawmaker’s district or state but also the public at large. SEC or Justice Department enforcement of the federal securities laws is currently the most powerful safeguard against congressional insider trading. A new federal law prohibiting lawmakers from owning stocks in individual companies would thwart such trading in the first place. n Nagy is the C. Ben Dutton professor of business law at Indiana University Maurer School of Law.

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The coronavirus pandemic

VOICES FROM THE PANDEMIC

‘Every second becomes crucial’ AS TOLD TO

E LI S ASLOW

I

could be the last person some of these patients ever see, or the last voice they hear. A lot of people will never come off the ventilator.

That’s the reality of this virus. I force myself to think about that for a few seconds each time I walk into the ICU to do an intubation.

This is my entire job now.

Airways. Coronavirus airways.

I’m working 14 hours a night and six nights a week. When patients aren’t getting enough oxygen, I place a tube down their airway so we can put them on a vent. It buys their body time to fight the virus. It’s also probably the most dangerous procedure a doctor can do when it comes to personal exposure.

I’m getting within a few inches of the patient’s face. I’m leaning in toward the mouth, placing my fingers on the gums, opening up the airway. All it takes is a cough. A gag. If anything goes badly, you can have a room full of virus.

So, there’s a possibility I get sick. Maybe a probability. I don’t know. I have my own underlying condition when it comes to this virus, but I try not to dwell on that.

Up until a few weeks ago, I was the anesthesiologist people would see when they were having babies. I’d do five to seven deliveries a day, mostly ­C-sections and epidurals. We’re a large state hospital at University of Illinois-Chicago, and we end up doing a bunch of highrisk deliveries. You’re trained to be the calmest person in the room. They teach us: “Don’t just rely on medication to calm a person. Use your voice, your eye contact, your whole demeanor.”

We give people positive ideas and positive expectations. It sounds corny, but it works.

Our team had a meeting on March 16 to figure out a staffing plan, once it was clear where this was going. Chicago’s be-

Kyle Monk For the Washington Post

Inside one of the pandemic’s most dangerous jobs: Anesthesiologist coming a hot spot now. Our ICU is almost full with covid patients. The pediatric ICU has been cleared out to handle overflow. The wave is just starting, and we need to limit our exposure or we’re going to run out of staff. Everyone basically agreed we should dedicate one person to covid intubations during the day and another at night, and I started thinking: I’m 33 years old. I don’t have any kids at home. I don’t live with older relatives. About an hour after the meeting, I emailed my supervisor. “I’m happy to do this.

It should be me.”

Now my pager goes off throughout the night. Nine

o’clock, midnight, 2, then again at 3:30. Most of the time, I do several airways in a shift. By next week or the week after that, they’re saying it could be 10.

It’s a common procedure. Intubations are routine for us, at least most of the time. You can be in and out of the airway in 10 or 15 seconds if everything goes right. But when you’re dealing with a patient who isn’t getting enough oxygen — which is everyone at this point — every second becomes crucial.

As soon as I get the page in my call room, I grab my backpack of medications and my duffle bag of protective gear and run for the stairs. There isn’t

Cory Deburghgraeve, an anesthesiologist in Chicago, now intubates covid-19 patients to provide respiratory support.

time to wait for the elevator. I go two floors up to ICU and get into my protective gear outside the room: mask, face shield, hood, secondary hood, personal air filter, gown, two sets of sanitized gloves. I tape everything together, because a few times the gown has risen up and exposed my wrists. There are so many opportunities to contaminate yourself. I monitor my heart rate, and it goes from like 58 to 130 by the time I get into the ICU. I’m stressed and rushed and hot inside the protective gear. I’m trying not to show it.

I’ve been shocked sometimes when I walk in and see the

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The coronavirus pandemic patients. Most of the ones I’ve intubated are young — 30s, 40s, 50s. These are people who walked into the ER because they were coughing a day or two ago, or sometimes hours ago. By the time I come into the room, they are in severe respiratory distress. Their oxygen level might be 70 or 80 percent instead of 100, which is alarming. They are taking 40 breaths a minute when they should be taking 12 or 14. They have no oxygen reserves. They are pale and exhausted. It puts them in a mental fog, and sometimes they don’t hear me when I introduce myself. Some are panicky and gasping. Others are mumbling or incoherent. Last week, one patient was crying and asking to use my phone so they could call family and say goodbye, but their oxygen levels were dropping, and we didn’t have time, and I couldn’t risk bringing my phone in and contaminating it with virus, and the whole thing was impossible. I kept apologizing. I just —. I don’t know. I have to find a way to hold it together in order to do this job. I tear up sometimes, and if I do, it can fog up my face shield.

The first thing I do is pull up a stool and get right down to their level at the bed. Most of the time, the look in their eyes is fear. But sometimes, honestly, it is relief, like, “Thank God. I can’t do this anymore.” They don’t have the energy to be hysterical.

I put an oxygen mask on the patient and give 100 percent oxygen for a few minutes. You want to tank them up, because they won’t be able to breathe on their own. Next I give medication to put them to sleep. We’re trained to touch the eyelashes a bit to make sure they’re down.

Then I give a muscle relaxer and take a look down the airway for the vocal cords. With this virus, I see significant upper airway swelling, tongue swelling, lots of secretion.

When I start to put the tube in, that gives an opportunity for the virus to release into the air.

The patient’s airway is wide open at that point — no mask or anything. People can cough when the tube goes in toward the trachea, a deep, forceful cough. My mask and hood can get covered in fluid. Usually it’s

Courtesy of Cory Deburghgraeve

tiny droplets. Aerosolized virus can float around. You’re basically right next to the nuclear reactor. I go in confident and fast, because if you miss on the first try, you have to do it again, and then you’re bringing out a ton more virus.

Once I’m done, sometimes I’ll go back to the call room and do squats or lunges. I try to keep my lungs strong. It’s hard not to think about, because I’ve had bad asthma since I was a kid.

I use an inhaler twice a day.

I’m very in tune with my breathing, and whenever I’m getting sick, the first symptom is I start wheezing. My whole family was like, “Why are you volunteering for this? What are you doing?”

My dad and brother got a bunch of tools and built a Plexiglas intubation box based on a model out of Taiwan. It sits above

the patient’s face, like a shield to reduce your exposure. I haven’t been able to use it yet, but they’re worried. They’re trying to protect me.

Last week, I called to tell them about my end-of-life wishes. Then I emailed them, just in case. I said, “If I have to be intubated, I’m fine with that.

But if I’m going through liver and kidney failure, and if I’m cognitively impaired at that point, and if you can tell my body is failing and I’m not going to get back to being who I am . . . ” Well. It was a hard conversation. But I know how this virus can go.

Each night, I try to do rounds with the doctors in the ICU to check on the patients I’ve intubated. They’re not allowed to have family or visitors. I’m not a religious person, but I do like to

stand there for a minute outside the room and think about them and what they’re going through.

I try to think about something positive — a positive expectation. Mostly they’re unconscious on the vent, but each day for an hour or two, they get what we call a sedation holiday, which means we bring down their medications so we can check on their baseline level of consciousness and see how they’re doing on their own. In other words, for a little while, they might wake up.

They can’t talk with the tube in, but I have seen a few patients before write messages on a piece of paper. “Vent?” Or: “Surgery?”

Or: “How much longer?”

Usually, before this, patients would be on a vent for three to five days. Now we’re seeing 14 to 21. Most of these people have acute respiratory distress syndrome. There’s inflammation, scar tissue, and fluid building up in the lungs, so oxygen can’t diffuse easily. No matter how much oxygen you give them, it can’t get through. It’s never enough. Organs are very sensitive to low oxygen. First comes kidney failure, then liver failure, and then brain tissue becomes compromised. Immune systems stop working. There’s a look most people get, called mottling, where the skin turns red and patchy when you only have a few hours left. We have a few at that point. Some have been converted to “do not resuscitate.”

In between intubations, I’ll sit in my call room and watch the monitors. I can see all of the patients’ vitals and check on how they’re doing. We’ve had some successes. A younger patient came off the vent earlier this week and just got sent home. The staff at this hospital is amazing. Even so, it usually goes the other way. I’m looking at the monitor right now, and there’s one patient who isn’t going to make it through the night. Three others are tipping toward the edge.

It’s a powerless feeling, watching someone die. The oxygen level drops, the heart rate drops, the blood pressure drops.

These patients are dying on the ventilator, and sometimes when they take away the body, the tube is still in the airway. n

KLMNO Weekly

“You’re basically right next to the nuclear reactor.”

Cory Deburghgraeve

]Deburghgraeve in the protective gear he wears when performing intubations on covid19 patients at the University of Illinois Hospital in Chicago.

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KLMNO Weekly

The coronavirus pandemic

Tips for managing pandemic anxiety BY

J ELENA K ECMANOVIC

I

f you’re feeling anxious, that’s understandable — and you are not alone. In late March, even before the coronavirus had reached the frightening benchmark of infecting more than 1 million people worldwide, 77 percent of American women and 61 percent of men were reporting personal stress, according to a Washington Post-ABC News poll. Sixtynine percent of Americans were worried about themselves or their family members becoming infected, and a majority thought the economic impact would be worse or the same as the 2008 Great Recession.

As a psychologist, I’m seeing firsthand how the pandemic is increasing anxiety among my patients and others. A recent American Psychiatric Association poll found that more than one-third of Americans think the coronavirus crisis is seriously affecting their psychological health. And calls and texts to mental health hotlines have dramatically increased.

“It’s very hard to focus these days, especially when what’s needed is sustained concentration for a bigger project. I have to separate work into discrete tasks,” said Bonnie Lawhorn, a nonprofit marketing and communication director from Gaithersburg, Md. Most adults recognize persistent worry and physical sensations such as increased heart rate, sweating, gastrointestinal distress, muscle tension and throat tightness as manifestations of anxiety. But they might not understand the ways anxiety fuels other problems. “People often don’t realize that their difficulties with focus, memory, sleep and relationships can all be related to anxiety,” said Amelia Aldao, a clinical psychologist and the founder of Together CBT in New York City.

Let’s look at four problems that can be caused or exacerbated by anxiety, and steps you can take to address those issues.

iStock

Psychologists recommend setting bedtimes, paring to-do lists and checking the news less Sleeplessness Most of us are aware that anxiety leads to insomnia and other sleep problems. “People can experience a range of sleep problems when they’re anxious: difficulty falling asleep, middleof-the-night awakenings with mind racing and ruminating, and having a hard time falling back asleep,” said Jill Stoddard, a clinical psychologist and the director of the Center for Stress and Anxiety Management in San Diego. In a cruel cycle, the less sleep we get, the stronger our anxiety can become.

The good news is that “focusing on improving sleep can make both sleep and anxiety better,” said Brandon Peters, a neurologist and sleep medicine doctor in Seattle and the author of “Sleep Through Insomnia.” He recommends maintaining a consistent bedtime, limiting caffeine and alcohol intake, removing visible alarm clocks, exercising and getting at least some exposure to daylight each day, if possible.

Studies have also shown that keeping your bedroom cool, dark and quiet, as well as staying off screens and practicing mindfulness before bedtime can promote good sleep.

Difficulty focusing Humans have evolved to focus their attention on a threat — that’s how our ancestors survived dangers in their environment. Because the coronavirus threatens our health, livelihoods and way of life, we are consumed by reading and watching news about it and by thinking about ways to protect ourselves from it.

The problem is that we might also need to be teleworking, home-schooling our kids and attending virtual meetings.

“The brain can do only so much. When our attention is absorbed by coronavirus, we will have a harder time concentrating on anything else we are trying to do in the moment,” said Jonathan Abramowitz, a professor of

“People often don’t realize that their difficulties with focus, memory, sleep and relationships can all be related to anxiety.”

Amelia Aldao, a clinical psychologist and founder of Together CBT

clinical psychology at the University of North Carolina.

To improve your concentration, start by reducing your tasks to the most essential ones. “Each evening, list the things that need to be done the next day, and rank them by importance and urgency,” Aldao said. Then, schedule specific times when you will do the most important and urgent chores, making sure to give yourself breaks about every 45 minutes. Be kind to yourself, accepting that it is completely normal for our functioning to be compromised during this stressful time.

Limit your consumption of news — including social media — to two to three pre-scheduled times a day, not to cumulatively exceed one hour. When you find yourself struggling with an urge to check the news while you’re doing something else, notice where you feel that urge in your body, and note what thoughts are showing up. Then see if you can allow them to be there for a while, delaying your action for at least 10 minutes. You will notice that the urge lessens in intensity with time and eventually goes away. This process is called “surfing the urge.” If 10 minutes is too long, start with two minutes and increase over time.

Forgetfulness Many of us are also having difficulty remembering and managing relevant information, such as all the steps required for our kids’ online learning or the important points from a recent work conversation. These are tasks that require what psychologists call working memory, and a 2016 research review found that anxiety adversely affects such memory. “Anything that relaxes you will also help with memory, as relaxation engages the parasympathetic nervous system,” said Aleksandra Parpura, a gerontologist and the founder of Aging Perspectives in Chevy Chase, Md. Good examples of relaxation activities include yoga, mindfulness, exer-

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The coronavirus pandemic cise and spending time in nature, if possible.

We can also implement strategies we know work for people with existing memory impairments. So, if you are a fan of crossword puzzles, Sudoku, crafts, video games or playing the piano, make sure to find some time to devote to them now.

Increased irritability and anger Are you finding yourself easily frustrated these days, with a shorter fuse? Although cabin fever and everybody being on top of each other certainly contribute to the irritability and anger, studies show that anxiety can also fuel these emotions. Unfortunately, our relationships with partners, children and co-workers can suffer as a result, during a time we need to rely on them most.

The first step in preventing your anxiety from hurting your relationships is noticing and acknowledging that anxiety before it turns into anger. Once you “catch” yourself, you can choose to either temporarily distance yourself from others and use a calming strategy on your own, or share those feelings with the people in your surroundings.

To help yourself relax, try slowly and deeply breathing by moving your stomach and keeping your chest still, making sure that your exhale is twice as long as your inhale. Or visualize a safe, beautiful place, preferably one that you can remember visiting, and imagine yourself moving through it, focusing on the experiences of all five senses. Alternatively, you can engage in a vigorous cardio exercise, such as running up and down the stairs; this can serve to expend excess energy, which is characteristic of both anxiety and anger.

In addition to contributing to these four problems, anxiety can fuel panic attacks, increased alcohol and drug use, abuse and depression. If your psychological difficulties are starting to significantly affect your life, or you are experiencing self-harming thoughts or feelings, please contact a mental health provider; most of them are now available via video. You can also reach out to the federal Disaster Distress Helpline or call 1-800-9855990. n

KLMNO Weekly

No sports until next year?

That is a possibility.

BY

A DAM K ILGORE

A

s fields, arenas and stadiums sit vacant and silent, the desire for sports to return far exceeds the capacity among those who oversee them to determine when they will.

Assessing probability is futile, but public health leaders indicate that fans and leagues should prepare for sports to remain absent not just for the coming months but into next year.

The novel coronavirus pandemic already has canceled or postponed the NCAA tournament, the Masters, the Olympics and Wimbledon. It has jeopardized the NBA playoffs, the Stanley Cup playoffs, and the baseball and soccer seasons. It is possible that the rest of the 2020 sports calendar, including college football and the NFL, also will be lost, according to interviews with and public comments from more than a dozen sports leaders and public health experts. Most stressed the uncertainty in such a fluid situation.

Sports bodies at the professional and collegiate levels have planned for a range of contingencies that include playing in empty stadiums and canceling seasons altogether, and they are bracing for the impact of the worst of them. They are driven by both business and altruistic motivations, eager to salvage financial losses and to provide diversion to the public.

The yearning among fans for sports’ reappearance collides with reality. The U.S. Tennis Association said in March that it still plans to stage the U.S. Open as scheduled from late August through mid-September in New York. The site of the tournament, Billie Jean King National Tennis Center in Queens is being converted to a temporary hospital.

The leaders of the NFL have expressed confidence that its season would begin as scheduled, without conditions. But ESPN college football analyst Kirk Herb-

Gastón Mendieta for The Washington Post

streit, a bellwether for the sport, said in a radio interview that he would be “shocked” if any NFL or college football was played this fall.

Pac-12 Commissioner Larry Scott told the Mercury News this past week that the conference has reviewed multiple models for how the college football season could unfold. In the most optimistic, training camp will be standard and the season will start on time.

“The most pessimistic,” Scott said, “has no season at all.”

U.S. experts said opening stadiums in this country would be among the last stages of lifting pandemic-related restrictions.

The first step would be letting people go back to work, with social distancing still in place. Travel restrictions would thaw. Only after those changes could authorities consider allowing stadiums to open.

The NFL has an easier path to return than college football. It would be unlikely and maybe impossible to start the season if students are not allowed on campus; Ohio State is one of several schools that have declared all summer classes will be taken online. The NFL has an option to try to sepa-

rate players from the broader public that college football does not.

“I can’t see us playing football without students, because athletes are students,” West Virginia University President E. Gordon Gee said.

The possibility of a canceled NBA postseason, coupled with lost sponsorship from China after a preseason ordeal, could push the NBA’s total revenue loss over $1 billion. The NBA has made it clear that it is considering all manners of rescheduling, including delays that could push the 2019-20 season into the late summer or early fall and require, in turn, that the start of the 2020-21 season be delayed until Christmas.

In early March, MLB officials considered the option of playing games without fans to be a last resort. But in recent days, with the regular season on indefinite delay and concerns becoming more urgent, baseball officials have softened their stance toward the notion of playing games without fans.

“Very open,” MLB Players Association chief Tony Clark said when asked about the possibility of playing in empty stadiums. “That possibility exists.” n

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KLMNO Weekly

The coronavirus Pandemic

Work from home? Not in Japan.

S IMON D ENYER in Tokyo BY

W

hen it comes to working from home, Japan simply doesn’t get it.

In the midst of a coronavirus epidemic, with a state of emergency imposed, commuter trains in Tokyo are still pretty packed, and many companies are acting like nothing has really changed.

This is a nation where you still have to show up in person.

Japan’s work culture demands constant face-to-face interaction, partly to show respect. Employees typically are judged on the hours they put in, rather than their output. Managers don’t trust their staff to work from home, and many companies are just not set up for telework.

“My boss said it loud and clear: ‘If I allow you guys to go home, you might not be focusing on your work. Who knows? You might even be drinking,’ ” said one investment banker, who spoke on the condition of anonymity to be candid.

Clients don’t want face-to-face meetings anymore, the banker said, but his boss still thinks the team should be in the office to take their phone calls, just to show them respect.

“Otherwise, my boss says, it’s just giving clients the idea that you’re taking time off and making things easy for yourself,” the banker said. “It’s Japanese pride.”

The uniquely rigid work culture has left this country among the least prepared in the developed world to embrace the remote-working realities of the coronavirus age.

Prime Minister Shinzo Abe finally declared a state of emergency on Tuesday to cover Tokyo, Osaka and other parts of the country most severely affected by the coronavirus.

But he added, “We will not lock cities down as has been done overseas.”

His decision followed two weeks of surging infections in

Carl Court/AFP/Getty Images

A rigid work culture and an IT blind spot hold the nation back Tokyo and growing calls for much firmer government action.

Part of the reason Abe has been reluctant to act sooner and more decisively may be a realization of just how unprepared many businesses are for telework, said management consultant Rochelle Kopp.

Technology is an important factor. Despite the image of Japan as a high-tech nation, it simply is not set up for telework.

Like the hare in the fable, it often feels like a country that raced headlong into the future and then in the early 1990s, when the asset price bubble burst, took a nap and let everyone else overtake it.

Japanese companies lag behind their Western counterparts

in IT investment, and many are still stuck 20 years in the past, with old software and little awareness of cloud computing or video conferencing tools.

IT departments are so paranoid about protecting intellectual property and confidential client information that they allow employees to access work systems only on office computers.

Many employees do not even own laptops — partly because of the risk of losing them during after-work drinking sessions — and many don’t have WiFi at home. Even if they did, many — especially in Tokyo — would be forced to work on the dining room table in a cramped apartment.

Commuters wearing masks walk to work in Tokyo on Monday, the day before a state of emergency was imposed in parts of Japan.

This is a country where businesses still send faxes, and where documents have to be stamped with a seal, or hanko, dipped in ink.

Even people working from home have to go into the office to get documents stamped by a manager, according to local media.

Schools have closed, but they have little or no provision for online learning.

Despite the neon lights and bullet trains, Japan’s broader corporate culture also seems stuck in the past, with widespread discrimination against women and power mostly in the hands of conservative, elderly men.

That culture might explain

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The coronavirus pandemic

KLMNO Weekly

A subdued Easter for Pope Francis C HICO H ARLAN in Rome BY

T Jae C. Hong/Associated Press

Commuters ride a train in Tokyo on Tuesday. Commuter trains remain filled as employers still require workers to show up to the office.

why, according to media reports, one salaryman has to wear a shirt, tie and office lanyard while working at his kitchen table or why one woman had to defy the government’s request to stay home because she needed a new suit — to wear while working at home.

Meanwhile, the government repeatedly summons journalists to reinforce its anti-virus message — that people should avoid crowded, poorly ventilated spaces where strangers converse for extended periods — at news conferences that clearly violate all those conditions.

Despite repeated entreaties, journalists have been told, the Ministry of Health, Labor and Welfare “has no plans to livestream this news conference.”

Japanese work culture is based on a concept known as ho-ren-sou, an acronym for report-inform-consult.

Rather than being given discrete tasks and the autonomy to execute them, subordinates are expected to consult with managers every step of the way.

That is harder when they are not in the same location.

Job descriptions tend to be vague, and there is a premium on teamwork over individuality.

That is one reason employees

tend to be judged on the hours they put in — it is tougher to evaluate what they produce when everything is a collaboration.

Some of these differences are not necessarily any worse than Western ways of working. But Kopp, who advises Western and Japanese companies on how to bridge the cultural divide, said many are long-standing problems that the coronavirus — and the demand to work from home — have exposed: “It looks like when the tide goes out — and leaves all the junk on the beach.”

If a lockdown comes, she said, some companies are ready, and some will adapt. But others could simply close down operations, she said, with employers forcing staff to take vacations or unpaid leave.

Until then, though, many are simply behaving as if nothing has changed.

“My boss went for drinks with my colleagues twice last week,” the banker said. “He likes drinking a lot; he likes to take out others and talk about work. I don’t have any issue with that. But my point is, if you’re going to tell me, ‘Do this, do that,’ and be strict on certain things, then why don’t you be strict on yourself ?” n

he novel coronavirus has forced Pope Francis to scrap his public appearances and postpone his first overseas trip of the year, to Malta. He now recites his Sunday Angelus not from a window overlooking St. Peter’s Square, but from a Vatican library. This year for Holy Week, he conducted the ceremonies leading up to Easter largely via live stream.

But as Francis guides the global Catholic Church through the pandemic, he has made it clear he has no interest in full-on papal social distancing.

He continues to hold in-person meetings, sometimes sitting almost knee-to-knee with guests.

He eschews wearing a mask, according to photographs and people who have met with him. He has tried to maintain a near-normal daily schedule even as the virus has reached closer — with one positive case discovered in March in Santa Marta, the residence hall where Francis lives.

Among world leaders, Francis — 83 years old and missing part of a lung — has faced one of the most delicate calculations about how much to pull back. He has groused in recent weeks about feeling “caged,” and his sociable, off-the-cuff personal style runs counter to the best guidance about how to contain the virus.

Vatican insiders say the pope has indeed reduced his interactions but is also trying to appear present — and not self-concerned — during a dark period of global grief and mounting social tensions. They also suggest he is seeking to set an example to priests of how to find creative ways to stay involved even as their churches are shuttered.

Still, some worry he is taking too many chances with the virus.

“Let’s hope he doesn’t catch it,” said one Vatican official, speaking on the condition of anonymity.

“Can you imagine a conclave in a

time of epidemic? It would look like a sci-fi Vatican novel.”

“Quod Deus avertat,” he added, switching to Latin. God forbid.

Another official who spoke anonymously said the pope now eats alone. Archbishop Vincenzo Paglia, who has met twice with Francis in recent weeks, said that during his visits the two maintained a “a certain distance, but it’s not as if there were particular measures.”

According to his publicly released schedule, Francis has met with more than 80 people since the beginning of March. . On March 9, he hosted a group of French bishops, including one who tested positive for the virus soon after. Francis appears to have since stopped large-scale meetings but has kept up more intimate gatherings: one-on-one sit-downs at a desk, as well as audiences with a dozen or so priests and prelates, each seated roughly six feet apart from one another in a circle, none wearing masks.

Despite the pope’s refusal to go into a bunker, the virus has nevertheless upended life inside the Vatican, where eight employees have tested positive. The citystate lagged behind Italy in enforcing a stringent lockdown but said on March 24 that it was encouraging remote work “as much as possible.” Critical offices are operating with drastically reduced staffing.

That has led, this year, to a subdued Holy Week, one of the most important annual periods in Catholicism. For Francis, the week usually means appearances before crowds in St. Peter’s Square, as well as a Good Friday procession at the Colosseum. Last year, he celebrated the Mass of the Lord’s Supper at a prison and washed the feet of 12 inmates.

But this year, in a move unprecedented in the modern church, the ceremonies were closed to the public. Francis will preside over Easter Mass — but pilgrims will see him only via WiFi. n

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KLMNO Weekly

Opinions

Trump’s dismissals are an attack on accountability David Ignatius is a Washington Post opinion columnist.

President Trump’s vengeful dismissal of the intelligence community’s inspector general was part of a relentless campaign — waged even in the midst of the pandemic — against people and institutions that can hold him accountable. ¶ Critics often describe Trump as disruptive, erratic and poorly focused. But in concentrating on these weaknesses, opponents understate Trump’s success in using power aggressively to reward his friends and hurt his enemies, perhaps more than any president since Lyndon B. Johnson.

Trump is even gutting the monitors who are providing accountability for the spending programs to combat the economic effects of the coronavirus. His latest move came Tuesday, when he sacked Glenn Fine, the acting Pentagon inspector general who had been chosen by his fellow IGs to lead a panel overseeing the $2 trillion pandemic bailout effort.

Trump’s campaign against accountability has been especially heavy-handed with the intelligence community. That culminated in the dismissal of ­Michael Atkinson, a highly regarded government career attorney who since 2018 had served as watchdog of the 17 agencies that report to the Office of the Director of National Intelligence (ODNI).

Trump’s curt dismissal letter said he lacked “the fullest confidence” in Atkinson. Trump didn’t explain his reasons for firing him, but Atkinson said later that he was ousted as revenge for “having faithfully discharged my legal obligations” in supporting a whistleblower’s charges about Ukraine that eventually led to Trump’s impeachment.

With Atkinson’s dismissal, Trump has replaced every experienced, Senate-confirmed

official at the ODNI. Intelligence is now overseen by acting director Richard Grenell, a Trump loyalist and former State Department spokesman.

These dizzying changes have startled key members of Congress. Sen. Mark R. Warner (Va.), the top Democrat on the Senate Intelligence Committee, told me Tuesday that “both Republicans and Democrats on the . . . committee are united in our concern about the politicization of intelligence.”

Rep. Adam B. Schiff (D-Calif.), chairman of the House Intelligence Committee, told me he thought Trump was seeking to “chill dissent and neuter any oversight of his conduct.”

The makeover at the ODNI is part of a broader degradation of accountability and oversight mechanisms across government.

One little-noted facilitator of this demolition process is the Justice Department’s Office of Legal Counsel (OLC). Once a respected source of legal guidance, the OLC has become a reliably proTrump advocate under Attorney General William P. Barr and the OLC chief, Assistant Attorney General Steven A. Engel.

In an OLC opinion in September that astonished many Justice Department veterans, Engel argued that the

Jabin Botsford/The Washington Post

President Trump fired the acting Pentagon inspector general Tuesday.

DNI’s office couldn’t transmit to Congress the Ukraine whistleblower’s compliant.

Engel opined that the complaint wasn’t an “urgent concern” as defined by law. Atkinson responded with a blistering letter, and the administration eventually relented.

Engel’s other controversial OLC opinions include a ruling in June that Trump didn’t need to release his tax returns and an opinion in May that White House advisers had “absolute immunity” from testifying in the impeachment inquiry.

An invidious part of Trump’s campaign is his attempt to undermine the inspector general system itself. These officials serve in 73 agencies across the government and are supposed to provide independent, nonpartisan reporting of abuses to Congress and the executive branch. Fourteen IG positions are vacant, including those at the CIA, Defense, Treasury and the Department of Health and Human Services.

On Friday, Trump nominated officials to fill five of these open positions, but many of his nominees have administration political ties. For example, Brian Miller, his choice for a special inspector general post to audit the pandemic recovery program, serves in the White House counsel’s office and helped manage document releases

during the impeachment probe.

He also formerly served as inspector general at the General Services Administration.

Peter M. Thomson, nominated to be the CIA inspector general, is a former prosecutor who in his recent private practice, among various white-collar defense work, “defends owners, operators and crew members of motor vessels who have been charged with environmental crimes,” according to his firm’s website. He’s a regular contributor to the blog of the conservative Federalist Society.

Perhaps the most shocking attack on oversight was Trump’s denunciation of HHS Deputy Inspector General Christi Grimm. A 20-year veteran of her agency’s IG office, Grimm helped prepare a survey of 323 hospitals dealing with the covid-19 pandemic. An April 3 IG statement said the hospitals reported “severe shortages of testing supplies and extended waits for test results” and “widespread shortages of personal protective equipment [that] put staff and patients at risk.”

Trump blasted Grimm on Monday and said the 46-state survey of hospitals “could be her opinion.” In a tweet Tuesday, he questioned whether she had audited Obama administration anti-flu efforts and concluded: “Another Fake Dossier!” n

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Opinions

KLMNO Weekly

Tom Toles

An infuriating voting failure Ruth Marcus is deputy editorial page editor for The Washington Post.

Americans died to secure the right to vote. No American should have to die to exercise it. Yet that is the result, cruelly predictable and entirely unnecessary, of an obtuse pair of rulings Monday on the eve of elections in Wisconsin.

There are so many enraging aspects of the pandemic, chief among them the Trump administration’s utter failure to adequately prepare for or respond to the crisis, and the president’s wrong-headed, mixed and petulant messaging. But the Wisconsin debacle may be the most infuriating, not only because it was so avoidable but also because it is hard to escape the sense that partisan considerations infected the outcome, whether knowingly or more subtly.

Was it really a coincidence that ­ epublican-backed justices in R Wisconsin and Republicannominated justices on the U.S. Supreme Court all sided against giving voters more time to cast ballots?

The Democratic presidential primary was in some ways the least consequential aspect of Tuesday’s voting. Also on the ballot was an election for a state Supreme Court seat, with incumbent Daniel Kelly, appointed by former Republican governor Scott Walker, facing a liberal challenger in his retention bid. And so, inevitably, there was President Trump, tweeting at midday Tuesday: “Wisconsin, get out and vote NOW for Justice Daniel Kelly.

Protect your 2nd Amendment!”

It is impossible to reconcile the logic of holding an in-person election with a stay-at-home order in place, and yet that is what happened Tuesday, as long lines of would-be voters risked their health to vote. This is a choice that no one should be forced to make. But conservative justices, on the Wisconsin Supreme Court and the U.S. Supreme Court, left many wouldbe Wisconsin voters no option between danger and disenfranchisement.

First, the Wisconsin Supreme Court blocked Democratic Gov. Tony Evers’s last-minute order suspending in- p ­ erson voting and moving the deadline for mail-in ballots to June 9.

The Wisconsin court’s fourjustice conservative majority — Kelly, on the ballot, didn’t take part — ruled that Evers’s order exceeded his authority.

The two liberal justices dissented — and did not hold back in imputing motive. “The majority gives Wisconsinites an untenable choice: endanger your safety and potentially your life by voting or give up your right to vote by heeding the recent and urgent warnings about the fast growing pandemic,” wrote Justice Ann Walsh Bradley. “These orders are but another example of this court’s unmitigated support of efforts to disenfranchise voters.”

That was bad enough. Then came the U.S. Supreme Court, making the choice facing Wisconsin voters even more cruel. In response to the pandemic and the accompanying flood of requests for absentee voting, a lower court had extended the deadline for receiving mail-in ballots from Tuesday to next Monday, April 13.

The question before the justices was whether those ballots had to be postmarked by Election Day, or whether they could be postmarked afterward as long as they were received by the 13th.

In a sane world this would be a no-brainer. The deadline was extended because so many people

had requested mail-in ballots as a result of the pandemic. Elections officials advised that tens of thousands of those ballots would not arrive at voters’ homes until after Election Day, meaning they could not be postmarked in time.

But considerations of logic and fairness did not stand in the way of the five conservative justices’ conclusion that the April 7 postmark deadline could not be relaxed. “This court has repeatedly emphasized that lower federal courts should ordinarily not alter the election rules on the eve of an election,” they observed in an unsigned ruling — as if this were some ordinary time.

Justice Ruth Bader Ginsburg, in a dissent joined by the three liberal justices, called out the majority’s approach for what it was. “The court’s suggestion that the current situation is not ‘substantially different’ from 'an ordinary election’ boggles the mind,” she wrote. In fact, she noted, any theoretical problems posed by extending the postmark deadline “pale in comparison to the risk that tens of thousands of voters will be disenfranchised.

Ensuring an opportunity for the people of Wisconsin to exercise their votes should be our paramount concern.”

Should be, but wasn’t. n

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