By Dr. John M. Livingston | Medical policy adviser
C. S. Lewis once opined that in contentious discussions, more often than not the issues aren't of facts or process, but rather of underlying principles that serve as the basis for opposing points of view.
Gov. Brad Little is a good man, but after the initial 2 weeks of the stay-home and social distancing orders, I have differed with our good governor in the way he has publicly presented facts, the process that has been deployed, but most of all the underlying principles that have guided his actions.
First, the facts specifically pertaining to his most recent change of state mandate. There is no reason for a State wide upgrade of mitigation strategy. Comparing the Idaho Department of Health and Welfare data and Central District Health statewide coalesced numbers between May 29 and June 19, I see some very encouraging trends.
On May 29, Idaho had completed 45,000 tests. As of June 19, the state had completed 70,000 tests. The absolute number of total positive tests went up. The data was cumulative, but the percent positive went down from 6.21% to 5.47%.
Total hospitalizations went from 240-279 (over 3 weeks!). Intensive care unit admissions went from 3.42% to 2.61% and empty available hospital beds jumped from 307 to 397. Statewide best estimates show ICU's continue to be manned at 150% and are only 33% full.
There were 7 new deaths in that 3 week period. Accumulated deaths rose from 82 to89. The case fatality rate went from 2.93% to 2.30%. The overall Idaho fatality rate stayed the same: 0.005%.
Yesterday the head of the Centers for Disease Control, Dr. Robert Redfield, said that he felt that the true number of people who are now immunologically positive is 10 times higher than what can be confirmed. This, by the way, is an example of faux science promulgated by a very good scientist. How do you confirm something you haven't measured? If true that improves case fatality rates by a factor of 10 and puts this right in line with seasonal flu.
The only difference would be that the Ro factor — infectivity rate of Covid-19 is higher than flu.The percent of people testing positive went from 20% to 17.7%.
Idaho is the only state where the absolute number of positive cases went up, but where the incident rates went down. Finally, Ada County shows the highest rate of increase and is in fact an outlier. Also, 62% of deaths are in long-term care facilities. No one under the age of 49 has died and only two under the age of 59 have died. Roughly 80% of deaths have occurred in those over 70 or with comorbid conditions..
The mitigation strategy in Ada county needs to be adjusted a little. If type 3 mitigation strategy had been followed after the initial two weeks of shutdown, these accommodations would have been built into the policy.
The underlying principles of our governor confound me. Does he believe that individuals are better able to make decisions that best serve themselves, their families, and their business or does he believe the government is best able to do this? What do conservatives believe?
New York Congresswoman Alexandria Ocasio Cortez recently invoked the concept of economic externalities as a guiding principle for mitigating public health conflicts between the individual and society. It is a long stretch to apply an economic concept to a rule of governing, but even then conservatives don't believe that the negative externality implied in this argument is even present in reality. Does our governor side with Ocasio Cortez? when balancing individual sovereignty versus the public good? So far, he has.
The process the governor used from the beginning has been flawed. He placed stakeholders on his advisory committee who, with the exception of Dr. Hahn, had no expertise in public health, virology, or epidemiology. How about an ICU nurse or emergency room nurse on that committee to tell the governor every day that there were almost no patients in the ICUs statewide---every day since the beginning of mitigation.? After about six weeks, I would have asked Dr. Hahn to find a colleague in her medical specialty community who she respected and who differed with her on the recommended mitigation strategy being deployed---there are many academicians who don't agree with current mitigation strategy statewide or nationally. The Governor could get a second opinion, and then proceed as he felt best for his state.
And that brings up one final important concept regarding process. Leaders don't defer to experts; leaders consult with experts. At Normandy, President Dwight D. Eisenhower consulted with the engineers, the medical corps, the air corps. And the logistics group. He never "deferred" to them. Deferring places the responsibility on someone else. In this case the experts who the governor has been "deferring" too have never been elected. Consult, decide, and lead.
Don't defer.
Deference is a strategy looking for an excuse.
Accountability is the basis of leadership. Great leaders are especially accountable to themselves — they don't defer to experts or lobbyists, or special interests.
