Accountability Please

(The contents of this article are the opinion of the author and not necessarily of the Gem State Patriot.)

I have written earlier about my concern for the lack of introspection shown by government agencies and hospitals in Idaho as the Covid-19 pandemic winds down. Historically in the medical, surgical, and public health professions out briefs and after-action reports and reviews have been for 130 years an important tool that has been used to improve the practices and develop new techniques and processes for the future. Historically called “morbidity and mortality reviews” (M&M”S) in the clinical setting, these have been integral toward the progress medicine and surgery has made throughout modern history.

Two days ago, before a Congressional Committee a group of well credentialed academics and clinicians made a similar call for accountability and retrospection at the Federal, State, and local levels. Anecdotal histories written by participants in the pandemic response does not serve such a purpose. Members of an academic council identifying themselves as the NORFOLK GROUP have published guidelines and a checklist to be followed by government agencies and hospital boards that desire a template for such a project.

I cannot add any more to the testimony that was given before Congress this week. I would like to present for the consideration of Idaho citizens and their representatives and those who served on various advisory boards at the State and local levels the credentials of those who are IN THE NORFOLK GROUP, and then I would like to repeat their recommendations word for word. They have a Web Site and a power point presentation that may also be reviewed by those who may be interested:

Members of the NORFOLK GROUP

Jay Bhattacharya, MD, PhD; epidemiologist, health economist, and professor at Stanford University School of Medicine; founding fellow of the Academy of Science and Freedom.

Leslie Bienen, MFA, DVM; veterinarian, zoonotic disease researcher, and faculty member at Oregon Health & Science University-Portland State University School of Public Health (through December 31st, 2022). She left in January 2023 to work in healthcare policy.

Ram Duriseti, MD, PhD; emergency room physician and computational engineer for medical decision making; associate professor at Stanford School of Medicine.

Tracy Beth Høeg, MD, PhD; physician and PhD epidemiologist in the Department of Epidemiology & Biostatistics, University of California-San Francisco, clinical researcher in healthcare policy and practicing Physical Medicine & Rehabilitation physician.

Martin Kulldorff, PhD, FDhc; epidemiologist and biostatistician; professor of medicine at Harvard University (on leave); founding fellow of the Academy of Science and Freedom.

Marty Makary, MD, MPH; surgeon and healthcare policy scientist; professor at Johns Hopkins University.

Margery Smelkinson, PhD; infectious disease scientist and microscopist whose research predominantly focuses on host/pathogen interactions.

Steven Templeton, PhD; immunologist; associate professor at Indiana University School of Medicine.

This report may be freely republished, in whole or in part, with a clear reference to its original publication by the Norfolk Group at www.NorfolkGroup.org. Throughout the document, references are provided as hyperlinks.

EXECUTIVE SUMMARY

In this document we list specific questions on specific topics related to COVID-19 pandemic responses in the United States. We believe these questions are vital for the nation to ask the White House, the CDC, the FDA, and other government officials, as well as state health departments, scientists, and the media. The public deserves answers to these questions so we can learn from our mistakes. Key issues include:

1. What could have been done to better protect older high-risk Americans, so that fewer of them died or were hospitalized due to COVID-19?
2. Why was there widespread questioning of infection-acquired immunity by government officials and some prominent scientists? How did this hinder our fight against the virus?
3. Why were schools and universities closed despite early evidence about the enormous age-gradient in COVID-19 mortality, early data showing that schools were not major sources of spread, and early evidence that school closures would cause enormous collateral damage to the education and mental health of children and young adults?
4. Why was there an almost exclusive focus on COVID-19 to the detriment of recognizing and mitigating collateral damage on other aspects of public health, including but not limited to, cancer screening and treatment, diabetes, cardio-vascular diseases, childhood vaccinations, and mental health?
5. Why did the CDC fail to collect timely data to properly monitor and understand the pandemic? Why did we have to rely on studies from private initiatives and from other countries to understand the behavior of the virus and the effects of therapeutics, including vaccines?
6. Why was there so much emphasis and trust in complex epidemiological models, which are by nature unreliable during the middle of an epidemic, with unknown input parameters and questionable assumptions?
7. Could therapeutic trials have been run in a timelier manner? How was information on drug effectiveness and safety disseminated to doctors and clinicians? Were effective therapeutics easily accessible across the population? How did certain drugs become heavily politicized?
8. Why did vaccine randomized trials not evaluate mortality, hospitalization, and transmission as primary endpoints? Why were they terminated early? Why were there so few studies from the highest-quality CDC and FDA vaccine safety systems?
9. Why was the USA and Idaho slow to approve and roll out critical COVID-19 testing capacity? Why was there more emphasis on testing young asymptomatic individuals than on testing to better protect older high-risk Americans? Why was so much effort and money spent on contact-tracing efforts?
10. Why was there an emphasis on community masking and mask mandates, which had weak or no data to support them, at the expense of efficient and critical COVID-19 mitigation efforts? Why did the CDC or NIH not fund large, randomized trials to evaluate the efficacy and potential harms of mask wearing? Why didn’t policy recommendations change after the publication of randomized trial data from Denmark and Bangladesh which showed no or minimal efficacy of mask wearing by the public?
11. And for Idaho—Why did the Governor not have on his advisory board a practicing clinician and a nurse who was involved in the daily care of Covid patients to offset his appointees who represented the interests of industry?
12. Will a committee be appointed by the Governor or the Legislature to review the Covid-19 response in Idaho so that we can do better?
13. Will there be Covid-19 out briefs and morbidity and mortality (M&M) reviews by hospitals and will these be made available to the public?

I invite our legislature and those in the Department of Health and Welfare, The Governor’s Covid Advisory Board and on hospital Boards in our State to take note. I especially and respectfully ask those that have been critical of members in the medical profession who held alternative ideas about how to manage, treat and mitigate Covid-19 to take note.