Tuesday, April 14, 2020

The Islamic Revolution vs. Donald Trump Iran and Ayatollah Khamenei are more influential today than at any time since 1979. By Reuel Marc Gerecht

The Islamic Revolution vs. Donald Trump  Iran and Ayatollah Khamenei are more influential today than at any time since 1979. By Reuel Marc Gerecht

The Islamic Revolution vs. Donald Trump


Iran and Ayatollah Khamenei are more influential today than at any time since 1979.
By Reuel Marc Gerecht, Foundation for the defense of democracy   April 2020
Part I: The Coming Collision
The Islamic revolution recently celebrated its 41st birthday. The upheaval, especially the hostage-taking and the failed attempt to rescue American diplomats, may have cost Jimmy Carter the election in 1980. In 2020 the Islamic Republic may already be trying to enter the presidential campaign by challenging Donald Trump in Iraq and through its nuclear ambitions. After slowly pushing forward the atomic program beyond the confines of Barack Obama’s now defunct nuclear deal, the clerical regime is advancing more vigorously; another murderous assault upon Americans, via Iran’s Iraqi proxies, just happened. Given the president’s determination to keep maximum economic pressure on Iran, more attacks are surely coming.
If Ayatollah Khamenei wants to try to bring the Democrats to power, and he believes that challenging Donald Trump is the best way to weaken his chances of victory, then it’s a near certainty that the supreme leader is going to attack something more significant than what he has before November. President Hassan Rouhani’s and foreign minister Mohammad-Javad Zarif’s extraordinary effort to engage and bend U.S. and European officials to their goals ultimately failed because of the unexpected election of Trump, but the Iranian political elite became much more attuned to U.S. politics because of the nuclear negotiations.  Where once Khamenei was an inattentive, bipartisan hater of America, he became more nuanced in his contempt for Democrats and Republicans. The Iranian regime’s understanding of how American politics function has improved a lot.
Also, the coronavirus has hit Iran hard. If the regime senses that its deceit and ineptitude in handling the malady could cause civil unrest once people can again safely gather, it’s not unlikely that the regime will strike Americans in the hope of recapturing the ardent emotions vented during the massive funeral processions for Qassem Suleimani, the Islamic Revolutionary Guard commander killed in Baghdad in January by a U.S. drone. Khamenei’s druthers are to go bold. Numerous factors are coming together to superheat the 41-year-old struggle between the Islamic Republic and the United States over the next eight months. But the most important factor by far is the supreme leader—his unrelenting conspiratorial hatred of the United States, his particular distaste for Trump, and his determination to preserve his impressive accomplishments.
Khamenei is prideful. He has maintained the legacy of the theocracy’s founder, Ruhollah Khomeini, and, despite enormous resistance from his compatriots, kept the revolution from sliding into Thermidor. Khamenei has thwarted every attempt to reform the Islamic fundamentals of the state. He has confronted massive pro-democracy street demonstrations, as large as those that brought down the shah, and overcome them. He has also bent the Iranian senior clergy, which had little respect for him when he became supreme leader in 1989, to his will. He has outmaneuvered his rivals and advanced his men among the ruling ulama, the intelligence service, and the Revolutionary Guards, the theocracy’s praetorians. VIP mullahs and guardsmen hold vast wealth and power and yet haven’t become seditious. A student of European literature, a poet manqué who has tormented and likely killed dissident poets, Khamenei is capable of promoting men of widely differing scruples and religiosity.
The Islamic Republic is more influential today than at any time since 1979. Most of his countrymen may have zero respect for him as a divine, but Khamenei, with the indispensable assistance of Suleimani, successfully oversaw the creation of foreign Shiite militias throughout the Middle East, subjugated the Shiite Iraqi elite and gained de facto control of Shiism’s holiest shrine cities. Khamenei held firm in Syria when it appeared the Allawi government of Bashar al-Assad was going down. A Sunni victory in Syria could have been catastrophic for the clerical regime in Lebanon and Iraq. Adverse repercussions at home could have been substantial. The regime’s resolve enabled Russia’s decisive entry into the conflict in 2015.
And, perhaps above all else, Khamenei humbled the United States. No factor was more important in tormenting Americans in Iraq than the Iranian. Tehran provisioned and sometimes captained a wide array of militant Shiite groups attacking American soldiers. These forces were defeated or beaten into quiescence by George W. Bush’s “surge” from 2006–2008, but deep, lasting damage was done to America’s psyche. Barack Obama’s election in 2008; his calamitous withdrawal from Iraq in 2011; the rampant anti-war and isolationist sentiments on both the American left and right; Donald Trump’s political rise; the bipartisan indifference to Iranian and Russian imperialism that in Syria watched hundreds of thousands of civilians perish, millions put to flight, the foundation of the European Union crack, and right-wing populism rise—all happened in part because of Khamenei’s determination to make America bleed in Iraq. For this achievement alone, the cleric is one of the most consequential rulers in the Middle East since World War II. Only his predecessor may have had a greater global impact.
And yet Khamenei has been discombobulated by Trump. The cleric initially saw something in the New Yorker to inspire hope: His “endless wars” rhetoric suggested that America might really be departing the Middle East, that the retrenchment Obama started might become a full-on retreat. Trump’s revocation of the nuclear agreement, re-imposition of punishing sanctions, and killing of Suleimani—the commander of the Quds Force, the special-forces/terrorist-liaison branch of the Guard Corps, who’d become a son to the supreme leader—dashed Khamenei’s hope that the Great Satan was a spent force.
And the supreme leader has surely noted that since Trump took office he has had to deal with nearly continuous internal protests, some of them regime-threatening. There is an intensity to Khamenei’s distaste for Trump that may spring from surprise: The supreme leader, who has been a good judge of men and taken down his betters, probably didn’t envision Trump as a catalyst for nation-wide protests against theocracy. Khamenei may well have expected renewed U.S. sanctions to give Iranians, to quote the prediction of Philip Gordon, the former Middle East coordinator on Obama’s National Security Council, “a reason to rally to — rather than work against — the government they might otherwise despise.” Trump will likely prove pivotal for the Islamic Republic: If the clerical regime makes it through his presidency, then the American threat to Iran’s theocracy may well be over.
Democrats have made the Iran issue, and Obama’s nuclear deal, the Joint Comprehensive Plan of Action, a partisan litmus test. There’s little chance that the Democrats, if they win in November, can revive a nuclear agreement since the clerical regime has moved on. Tehran is far wiser about the limitations and inherent turbulence of American politics and the utility of an executive agreement, like the JCPOA, and the United Nations Security Council resolution 2231 supposedly ratifying it. It would take an isolationist–Rand Paul–Tucker Carlson takeover of the Republican Party for Republican senators to agree to another Democrat-delivered nuclear accord with the clerical regime. Tribal pride, let alone the likely conditions of any such agreement, would make a binding treaty with Iran’s theocracy impossible. And only a Senate-ratified treaty would give large corporations, especially energy firms, the needed sense of normalcy and predictability for making major investments in the Islamic Republic.
And the clerical regime may well expect that the next Democratic president might just give up. Joe Biden didn’t reveal a lot of spine on the Iraq War. Biden initially backed the invasion; he wanted to throw in the towel early. His proposal for a confessional/ethnic division of the country, beyond making no historical and geographical sense, was really a cover for a U.S. withdrawal. And Biden preferred a more cautious, patient approach in the hunt for Osama bin Laden than the SEAL-team raid that killed the Al-Qaeda leader.  Given the disquiet and palpable fear that almost all Washington Democrats evinced after Trump took out Suleimani, it’s increasingly hard to imagine a Democratic president telling Tehran in the prelude to any new negotiations that “all options are on the table.” A Democratic president would, more likely, just try to “engage” the Iranian regime through substantial sanctions relief before any nuclear talks started, which is essentially what Bill Burns and Jake Sullivan, the tandem who conducted the secret diplomacy in Oman in 2012, which kicked off Obama’s nuclear diplomacy, recommended last October.
And as Ray Takeyh at the Council on Foreign Relations has pointed out, a new nuclear deal wouldn’t align now with Tehran’s nuclear progress. In 2012 the clerical regime was years away from developing advanced centrifuges, which require small cascades and are easily concealed. That’s not true today. Ali Salehi, an MIT Ph.D. in nuclear engineering who heads Iran’s Atomic Energy Organization, led the technical discussions at the nuclear talks. Unfailingly loyal to the supreme leader, not averse to highlighting his cleverness, and determined to push the development of more advanced centrifuges, Salehi backed the JCPOA precisely because it overlapped well with the development of higher velocity machines, which the agreement allows. In 2015 Iranian nuclear engineers needed about eight years; the accord granted an eight-year provision for the construction of advanced centrifuges. Salehi is pretty sanguine now about Iran’s capacity to make considerable progress quickly. He may be lying about getting closer to a take-off point, but when it comes to verifiable technical achievements, and reflections on the Islamic Republic’s accomplishments, he’s not been particularly mendacious. A new agreement, which would be pointless unless it freezes the development of high-velocity centrifuges, wouldn’t be deemed by Iran’s physicists and engineers as helpful.
No new deal, billions of dollars in sanctions relief, no meaningful restrictions on Iran’s oil sales, occasional meetings among U.S., European, and Iranian diplomats, and adamant opposition to the elongation of any limitations on Tehran’s ability to purchase advanced weaponry (the clerical regime can legally purchase heavy weaponry and advanced fighters in October 2020 per UNSCR 2231) mightbe acceptable to the supreme leader. Probably not much more.
No Diplomatic Exit
If Khamenei were more clever than principled, he would, of course, engage Trump and see whether the American’s love of deal-making could lead him to substantial compromises, most importantly, splitting the nuclear question from Iranian imperialism and again allowing short sunset clauses, which would grant the Islamic Republic a massive nuclear-weapons infrastructure down the road. If Khamenei were to commit to talks, the vast inertia of Washington’s arms-control community would come into play. The isolationist right and its amplifiers on Fox would cheer. And a telephone call from Rouhani might just tweak the president’s vainglory. It would, however, entail for Khamenei and many other VIP Iranians a massive loss of face.
The supreme leader, who has never been cracked up about his country’s dependence upon oil and how that commodity ties Iran to Western companies, markets, and the dollar and opens the country to coercion (first Great Britain and then the United States have used sanctions to punishing effect), can seem almost relieved that Trump’s actions have obliged greater self-reliance and industry. Khamenei didn’t try to prevent President Akbar Hashemi–Rafsanjani’s efforts in the 1990s to bring in Western commerce and cash to fuel the Islamic Republic’s recovery from the Iran–Iraq War (1980–1988); he accepted, if with some reservation, Rouhani’s argument that the clerical regime with the JCPOA could simultaneously achieve its nuclear aspirations, propel greater economic growth, and become a more modern and powerful Islamist state. Although always concerned about insidious Western penetration and perfidy, Khamenei didn’t let his cultural paranoia and autarkist instincts get the better of him. The odds are poor he would do so again.
And Khamenei’s resilience has an economic basis, too. Washington’s sanctions have, so far, barely dented the non-oil component of Iran’s economy. Non-oil exports are still bringing in around $40 billion per year (the big three are petrochemicals, distillates, and metals), and Tehran’s accessible foreign-currency reserves may be well above the $10 billion figure that the State Department cites as a hopeful datum signaling an imminent hard-currency meltdown. The Islamic Republic’s vast welfare state, which is essential for maintaining whatever loyalty the clerical regime has among the lower classes, burns cash. Yet the supreme leader and the Revolutionary Guards certainly have sufficient will, lethal intent, and likely sufficient funds to stave off financial Armageddon, at least for a few years.
The economic contraction brought on by the coronavirus may change these calculations. Less advanced economies really don’t have the option of following Rouhani’s mandan dar manzel (“stay at home”) advice. This may mean Iran is even more ravaged. It may also mean the economy adjusts, Iranians bury their dead and move on. Khamenei sermonized that this is really the only sensible course of action for his country. It’s wiser if Washington assumes that COVID-19 won’t crack the country. Sanctions against Iranian exports and imports need to become more potent, both in scope and enforcement, for the administration’s theorizing about a hard-currency meltdown paralyzing the clerical regime to be plausible. And getting the Europeans, who still have significant small- and medium-scale trade with Iran, to apply their own sanctions because of Tehran’s nuclear advance will be very challenging, especially while the coronavirus is spreading through the Old World. The clerical regime can import whatever medical supplies it wants through non-sanctioned Swiss channels. Western banks and European pharmaceutical companies, which know the Iranian market intimately, are well aware that the Trump administration has approved such transactions without reservation. But the optics of increasing sanctions on a country stricken with disease is surely too much for soft-power Europeans. Getting them to “snapback” all the pre-JCPOA U.N. sanctions against Iran, which the United States is, per the State Department lawyers who negotiated under Obama, legally entitled to do given Tehran’s violations of the JCPOA and the Nuclear Non-Proliferation Treaty, would also be arduous, which likely explains why Foggy Bottom has been avoiding even trying.
President Trump is only in the early stages of dealing with increasingly truculent mullahs. It’s not clear that he has the mettle—but after the killing of Suleimani, one has to presume that he might—to handle Khamenei’s murderous machinations likely coming our way. It’s unlikely that the Democrats have the will to handle the supreme leader’s bloody-minded obstinance. The Iraq War burned Biden. If he wanted to be more cautious about killing bin Laden, it’s difficult imagining him checkmating the supreme leader.
As erratic as he can be, Trump probably can’t compromise much with Tehran on the nuclear question; it’s conceivable, depending on what Khamenei does, that he will even be bolder in trying to contain the clerical regime’s ambitions. The reasonable fear that many Iran hawks and conservatives had about Trump, that he would be inclined to cut a really bad deal with Tehran and label it “perfect,” seems much less likely after the death of Suleimani and the imposition of an ever-expanding array of sanctions. Even Trump is subject to momentum and gravity. For him to switch course now, to become more Obama than Obama, would reduce him to a laughing stock on an issue—the clerical regime’s 41-year knack for making the United States look weak—that deeply annoys the president.   The supreme leader could change this situation, by surrendering to talks without massive sanctions-relief, but the odds of that are near zero. Trump may not seek out new ways to punish the regime before November, fearing an escalation that may be politically adverse, but his Iran policy—just keep squeezing—seems set in stone, if for no other reason than Khamenei probably won’t give him any other choice.
Supporters of the president, and just supporters of a tougher approach to the Islamic Republic, often air the view that if Khomeini could relent against Saddam Hussein and drink from the “poisoned chalice,” Khamenei, under severe economic pressure, could accept negotiations with Trump. This “realist” rendering of the clash between the United States and the Islamic Republic isn’t, however, compelling.  The clerical regime was on the verge of collapse in 1988: Hundreds of thousands had died, a million men had been maimed; Revolutionary Guard forces were coming undone; the regular army had cracked; children were fighting in the trenches; Iranian cities were wide open to Iraqi chemical-weapons attacks, which Saddam had demonstrated that he was prepared to undertake; Washington had sunk a good part of the Iranian navy and (accidentally) blown out of the air an Iranian civilian jet liner; and the mullahs had no allies offering weapons, cash, or even moral support in the United Nations.
There is no indication today that the Revolutionary Guards have lost their mojo. Just the opposite. In November and December 2019, the Guards and the morals police, the Basij, the regime’s Brown Shirts, mowed down hundreds of demonstrators, who’d originally taken to the streets to protest a drop in gasoline subsidies. Security forces reportedly shot 400 protesters in just three days. Particular ferocity was used against the demonstrators in Iranian Kurdistan and the heavily Arab province of Ahvaz. It’s still impossible to confirm the reported figure of 1,500 dead. If that number is accurate, it’s a significant increase in the fallen from 2009, when Khamenei crushed the pro-democracy Green Movement, which put millions onto the streets of Tehran. Surely a big reason for the regime’s quick savagery last year is that the petrol demonstrations almost immediately turned into riots aimed at state institutions and the clergy, and in Ahvaz and Kurdistan, into armed encounters between oppressed, deeply embittered ethnic minorities and the security forces.
During and after the 2009 suppression, Khamenei removed several senior Guard commanders, it appears for either refusing or failing to show the requisite severity. That hasn’t happened with the 2019 protests. The Guards’ leadership appears today more ideologically harmonious and ruthless. Khamenei appears harsher. In 2009 he allowed for a certain official remorse about the crackdown (the videoed shooting of the beautiful Neda Agha-Soltan and the verified stories of torture, including rape, of jailed protesters, some of whom were the children of the ruling class, shocked many); in 2019, Khamenei mocked the protesters for their revolutionary faithlessness.
If the supreme leader were to make the concessions that the Trump administration has demanded, on the nuclear program, ballistic missiles, and regional aggression, including the support to radical Shiite militias and Sunnis throughout the Middle East, which would permanently shut down the clerical regime’s nuclear-weapons quest and ensure that the United States and Europe aren’t subsidizing Tehran’s imperialism, then he could well be toppled in a coup since Khamenei would have betrayed everything he has declared holy. In 1988 senior Revolutionary Guard commanders were begging for the war to end; when Rafsanjani, then the second most powerful cleric in Iran, and Khamenei, then the president, went to Khomeini to argue for a ceasefire and a de facto surrender, they represented a broad consensus within the ruling elite that war had to end quickly or the theocracy would collapse. In contrast, the supreme leader and the Guard generals today appear unified in taking a hard line towards their own citizens and the United States.
Trump is obviously not a regime changer and doesn’t appear to care really whether Iranians, or foreigners anywhere, live in a democracy. Discussions about the causes of Islamic militancy or how to corral it (for example, through the ballot box), don’t appear to interest him in the slightest. But Trump’s willingness to take risks rivals Khamenei’s. And there is something about the Islamic Republic, perhaps rooted in memories of America being laid low in the embassy hostage crisis, that makes Trump at least qualify his view of the Muslim Middle East as a sandbox not worth the fight. It’s not inconceivable that as Khamenei approves more operations that kill Americans — and given what’s already happened, that’s likely—in response Trump abandons his aversion to adopting a containment strategy. Depending on how bloody and ambitious Khamenei’s actions are, it’s conceivable that Congress could again even authorize covert action and allow for a larger, more assertive US military commitment in Syria.  Such a policy might bring serious pressure on Iran in the Persian Gulf and bleed the Revolutionary Guards and Shiite militias in Syria through CIA-delivered military aid to Sunnis. A patient policy of regime change isn’t unthinkable.
Insufficient Dissuasion
Trump is currently caught in a contradictory situation: He has shocked the Iranian ruling elite with his strike against the Quds Force commander, the operational overlord of the Islamic Republic’s foreign adventures. Yet the president has diligently avoided any containment effort, which would constrain Iranian actions—except near Dayr az-Zor at the Syrian–Iraqi border, where U.S. troops still remain, blocking an Iranian “land bridge” between Iraq’s primary highway system and Syria’s. In the southern Middle East, the White House has refrained from making any direct, defensive commitment to the Sunni Gulf states or non-American shipping in the Persian Gulf, despite Iranian mining and missile attacks. More U.S. troops have been sent to the region, but it’s uncertain that President Trump would use them to defend foreigners.
Such restraint surely made it more likely that Tehran would aggressively test the United States, which is exactly what happened before Suleimani’s death, when Iran-backed Shiite Iraqi militias repeatedly rocketed U.S. forces, eventually killing an American contractor. The president’s preference for such “strategic caution,” coupled with an aggressive use of sanctions, which has become Washington’s preferred coercive tool because it has allowed the United States to bring pressure without using armed force, makes it much more likely, however, that Khamenei will again target Westerners in the Middle East, including U.S. soldiers and civilians. As the diplomatic historian Robert Kagan has noted about U.S. actions toward Japan before Pearl Harbor: The United States did enough to anger the Japanese empire but not enough to intimidate it. Trump really annoys Khamenei, but it is becoming increasingly clear that the strike against Suleimani, as unexpected and shocking as it was, wasn’t enough to implant paralyzing fear.
And American attacks against Iraqi Shiite militias tied to Iran aren’t likely to have any lingering dissuasive effect on the mullahs’ intentions and actions. A tit-for-tat game with these forces, where the administration refrains from striking Iran for the lethal actions of Shiite militias that Iran controls or subventions, will undermine the perception that Trump is willing to kill Iranians. For Trump to deter Tehran, he must strike the Revolutionary Guards directly. Jerusalem has fundamentally changed Iranian calculations and plans in the Levant by its continuous bombing of Iranian bases, vehicles, and personnel. According to Israeli defense and intelligence officials, Tehran had plans to open major Revolutionary Guard Corps bases in Syria; they have shelved them. What is striking and instructional is the significant damage and fatalities Israel has inflicted upon the clerical regime, and Khamenei’s understated response.  How Trump does what is required to deter, assuming he is willing to, given opposition in Congress, is an open question. A classic containment strategy against the Islamic Republic may require new legislation. It may be politically impossible.
Continuing doubts about America’s commitment to the region will also likely encourage the clerical regime’s penchant for terrorism, particularly assassinations of dissident Iranian expatriates. The supreme leader greenlighted a terrorist attack against an Iranian opposition group outside Paris in June, 2018—a bombing operation that could have killed dozens, possibly hundreds, if Western European security services hadn’t thwarted it. The Iranian regime has never forsaken terrorism. There was a pause when the clerical reformer Mohammad Khatami unexpectedly won the presidential election in 1997 and flustered the ruling hierarchy, including the Ministry of Intelligence, which was then the primary agency for killing surreptitiously.  The attempted attack in Villepinte was bold and signaled, at a minimum, that Khamenei had grown bored with Europeans as counterweights to America.
And President Trump is unlikely to escape his bind: The more effective sanctions are against the Islamic Republic, and the administration’s unilateral measures have proven more costly to the clerical regime than combined U.S.-European-U.N. sanctions were in the lead up to the nuclear negotiations under Obama, the more likely it is that Khamenei decides to unleash more attacks against Americans, Europeans, and Sunni Gulf Arabs, which could oblige the White House to escalate, which Trump doesn’t want to do. Any American policy that actually tries to thwart the Iranian regime’s ambitions, which includes its three-decade effort to develop atomic arms, will risk war. Americans who judge the rightness of any policy by its risk of conflict are really saying that no policy that effectively challenges Iranian supremacy in the region is acceptable. This is essentially the position taken by the Obama administration; it was emphatically the stance taken by Senator Bernie Sanders and others on the left.
And Khamenei has little to lose by being aggressive, especially if he doesn’t directly target Americans, since doing nothing leaves him in a losing status quo, where his economy slowly crashes, his people become angrier and possibly more rebellious, and the more religiously militant forces in his own society demand vengeance against Washington’s “maximum pressure” campaign.  Wounding the United States, driving back its physical and cultural presence in the Muslim Middle East, remains a raison d’être of the Islamic Republic; this is über true when the ruling mullahs and senior officers in the Guards feel the need to reassert their dominion at home. The supreme leader may not want a big head-on collision with Washington since the odds disfavor Iran so enormously and so much of the Islamic Republic’s leadership, especially in its domestic-security apparatus, would be prey to America’s high-tech weapons. But he is clearly willing to risk a lot, which was shown in his reprisal for Suleimani’s death.  The Iranian missiles used against the Ayn al-Assad base may have had primitive gyroscopes, but they easily could have done more than concussed American soldiers. And there were Americans all over the opposition gathering at Villepinte, including Rudy Giuliani; they, too, could have died if not for Western security measures.
Fortunately, the Islamic Republic no longer has the capacity to launch suicide bombers/live-to-die assassins against its enemies: Iran’s and Lebanon’s more traditional “12ver” Shiite clergy recoiled from this practice in the 1990s, as it also vetoed women becoming agents of jihad a decade earlier. State-sponsored terrorism, either direct or through third parties—and ballistic missiles, drones, and cruise missiles, openly claimed or camouflaged through proxies—is how the clerics prefer to respond when angry. The Islamic Republic’s capacity to inflict pain, vastly greater than Al-Qaeda’s or the Islamic State’s, has always been corralled by its understanding of American red lines. The Revolutionary Guards open fondness for jang-e namotaqaren, or asymmetrical warfare, grew out of their own conventional weakness and the need to dodge American might through clandestine or third-party actions. The common wisdom, for example, that Tehran would never invade Bahrain, a strategic gateway to the Arabian peninsula with its badly oppressed Shiite population, which Iran controlled in the 17th and 18th centuries, is questionable the moment the American naval base there closes. If Riyadh isn’t up to the task of checking Tehran, and Crown Prince Muhammad bin Salman did nothing after the Iranians droned and cruise-missiled the Abqaiq and Khurais oil facilities in September, then Iran, armed openly by Russia, could rapidly and permanently change the region. The entire way we think the oil-rich Middle East functions, even after the retrenchment of Obama and Trump, is premised on sufficient countervailing U.S. force. Take it away and the inconceivable becomes thinkable. The Israeli Air Force just doesn’t have the dissuasive power. And the Europeans no longer matter.
Reuel Marc Gerecht a senior fellow at the Foundation for the Defense of Democracies and one of the country’s leading experts on Iran and its Islamic revolution.

Friday, April 10, 2020

Opinion | Russian Disinformation Fed the FBI’s Trump Investigation Ron Johnson Wall Street Journal 4-11-20


Opinion | Russian Disinformation Fed the FBI’s Trump Investigation


Ron Johnson  Wall Street Journal  4-11-20

Declassified footnotes to a Justice Department inspector general report show that the Federal Bureau of Investigation team investigating members of the Trump campaign received classified reports in 2017 identifying key pieces of the Steele dossier as products of a Russian disinformation campaign. This might be only the tip of the iceberg because other recently declassified information demonstrates that even more disinformation may have been planted in Christopher Steele’s reporting.

Let that sink in. The FBI knew that at least some of its evidence against the Trump campaign, and maybe more, was likely part of a Russian disinformation campaign—evidence from a source that was “central and essential” for getting the first FISA warrant. It isn’t clear what if anything the FBI did to determine whether their investigation was based in substantial part on Russian disinformation.

Yet the FBI assistant director in charge of the investigation, Bill Priestap, told the inspector general that as of May 2017 (when Robert Mueller took over as special counsel), the FBI “didn’t have any indication whatsoever” that their evidence was part of a Russian disinformation campaign.

I first learned all this in late December 2019, when a member of my staff reviewed the classified version of the inspector general’s report and asked me to meet him in a secure room under the Capitol. As he walked me through the four footnotes, my immediate reaction was that the American people needed to know this information as soon as possible. My colleague Sen. Chuck Grassley and I began pressing Attorney General William Barr, and eventually acting Director of National Intelligence Richard Grenell, for full declassification of these footnotes. That’s why they’re now public.

The FBI team’s handling of these intelligence reports seems consistent with how it ran the entire investigation. From the opening of the investigation, the FBI team kept accumulating exculpatory information. Yet rather than wind the investigation down, they ramped it up. Minimally intrusive open-source searches became Foreign Intelligence Surveillance Act warrants and confidential human sources targeting campaign staffers.

Then it got worse. The FBI team excluded exculpatory information from its FISA application; it ignored exculpatory evidence provided by another U.S. government agency; and, when that later became an issue, an FBI attorney doctored an email to cover it up. Given all that, it’s not surprising that the FBI, on learning their evidence was the product of a Russian disinformation campaign, simply shrugged it off.

As Mr. Grassley and I wrote in our declassification request to Mr. Barr, these footnotes provide “insight essential for an accurate evaluation of the entire investigation.” Consider these questions:

• Why did former FBI Director James Comey and former FBI general counsel James Baker refuse to have their security clearances reinstated before they were interviewed by the inspector general? Was it so they wouldn’t have to explain this information?

• Which members of the FBI team reviewed these reports? Did Lisa Page and Peter Strzok, who referred to the opening of the investigation as an “insurance policy”? Did the FBI attorney who doctored the email? Did Mr. Mueller?

• What, if anything, did the FBI do to follow up on these reports?

• Did the FBI team have access to other reports like this?

• Is this another example of the FBI team’s sloppiness, or is it sufficient to show their ignorance was willful?

The Steele dossier already ranks as one of the dirtiest political tricks of all time. The Democratic National Committee and Hillary Clinton campaign paid for it, laundered it through friends and allies in the Justice and State departments, and spun it into a full-blown FBI investigation of her political rival. Then, after Donald Trump was elected, it was used as a political cudgel to bludgeon his administration and set up an 18-month special counsel investigation. Now it’s been revealed the FBI had evidence that it was based in substantial part on a Russian disinformation campaign.

Last month, my committee’s vote to obtain a subpoena for Andrii Telizhenko—a former Ukrainian diplomat who later worked for a U.S. Democratic political consulting firm—was delayed because of last-minute concern that information he might provide could be part of Russian disinformation (a cloak-and-dagger operation to derail that subpoena also needs to be revealed). So I’ve heard a lot of concern and outrage from my colleagues across the aisle about the perils of “foreign interference” and the need to steer well clear of anything remotely suggestive of Russian disinformation.

Clearly, the FBI did not exhibit similar concern and act accordingly. It also will be interesting to see how many of my Democratic colleagues will join tenacious oversight efforts to determine how the FBI misused actual Russian disinformation.

Mr. Johnson, a Wisconsin Republican, is chairman of the Senate Homeland Security and Governmental Affairs Committee.

Thursday, April 9, 2020

National Center for Medical Intelligence Issues Rare Rebuttal of ABC Network News

National Center for Medical Intelligence Issues Rare Rebuttal of  ABC Network News


After ABC News claimed  “As far back as late November, U.S. intelligence officials were warning that a contagion was sweeping through China’s Wuhan region, changing the patterns of life and business and posing a threat to the population, according to four sources briefed on the secret reporting” (ABC News)...... 

 The National Center for Medical Intelligence responded “As a matter of practice the National Center for Medical Intelligence does not comment publicly on specific intelligence matters.

 However, in the interest of transparency during this current public health crisis, we can confirm that media reporting about the existence/release of a National Center for Medical Intelligence Coronavirus-related product/assessment in November of 2019 is not correct. No such NCMI product exists” (Twitter).  

From Dan McLaughlin: There are three possibilities I can see:
 (1) U.S. intelligence was aware of an outbreak in Wuhan large enough to disrupt daily life and business before the local government was, 
(2) the scale of the Chinese coverup of what happened initially in Wuhan is significantly greater than we have been led to believe, or 
(3) ABC News got a big story very wrong. Because if ABC is right, everything we have been told by the medical community, the news media, and the Chinese and international health authorities to date about the timeline is wrong (National Review).  

 From Frank Luntz: Journalists need to care about getting the facts more than they care about getting Trump (Twitter).  

Meanwhile, CBS News, embarrassed for what they called an “editing mistake” by showing an Italian hospital when talking about overcrowded hospitals in New York, did it again.  Same footage, this time calling it Pennsylvania (Washington Examiner). 

7 ANSWERS TO QUESTIONS ABOUT [HYDROXYCHLOROQUINE]




7 ANSWERS TO QUESTIONS ABOUT [HYDROXYCHLOROQUINE] THE Malaria Drug Trump Keeps Pushing 
By Denise Grady, Katie Thomas and Patrick J. Lyons    New York Times  • April 8, 2020


RED= Inappropriate anti-Trump or anti-hydroxychloroquine editorial comments  inserted by the New York Times in  a news story  AND  clarifying comments that the New York Times SHOULD  have presented to you  for your consideration


Here are the  some facts  and lots of negative anti-Trump editorial comments  on hydroxychloroquine, which the president has promoted despite little evidence that it works against the coronavirus. … .This NYT  statement is an example of the New York Times editorial pollution of what should be a straight forward recitation of information.

Hydroxychloroquine was approved decades ago to treat malaria, and it is also used to treat autoimmune diseases like rheumatoid arthritis and lupus.

There is no proof that any drug can cure or prevent infection with the coronavirus. True, but  more appropriate questions  are: can a medication significantly reduce the symptoms exhibited by a patient and/or the length of his/her illness and/ or improve the outcome and/or reduce the probability of death.  But in the face of an exploding pandemic with a frightening death toll, people are desperate for a bit of hope, a chance to believe there is something that will help.

The drug that has received the most attention is hydroxychloroquine, which President Trump has recommended repeatedly, despite warnings from his own health officials that there is little data to support its widespread use as a treatment against the virus.

Drug companies across the world have begun donating tens of millions of doses of hydroxychloroquine to the United States, and the president said on April 4 that 29 million doses had been added to the National Strategic Stockpile, a cache of medical supplies maintained by the government to respond to emergencies.

What is hydroxychloroquine?
Hydroxychloroquine is a prescription medicine that was approved decades ago to treat malaria. It is also used to treat autoimmune diseases like rheumatoid arthritis and lupus. It is sometimes referred to by its brand name, Plaquenil, and is closely related to chloroquine, which is also used to treat malaria.

Why has hydroxychloroquine even been considered as a possible treatment for the coronavirus?

There are several reasons. A promising laboratory study, with cultured cells, found that chloroquine could block the coronavirus from invading cells, which it must do to replicate and cause illness. However, drugs that conquer viruses in test tubes or petri dishes do not always work in the human body, and studies of hydroxychloroquine have found that it failed to prevent or treat influenza and other viral illnesses.


Reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients. But those studies were small and did not use proper control groups — patients carefully selected to match those in the experimental group but who are not given the drug being tested. Research involving few patients and no controls cannot determine whether a drug works. And the French study has since been discredited: The scientific group that oversees the journal where it was published said the study did not meet its standards.  

1.      ON THE OTHER HAND,   MORE THAN   2,304    PHYSICIANS WHO ARE CURRENTLY SUCCESSFULLY TREATING  PATIENTS INFECTED WITH THE COVID-19  REPORTED  THEIR  "ANECDOTAL EVIDENCE" OF THEIR  SUCCESS WITH THEIR PATIENTS UTILIZING HYDROXYCHLOROQUINE


"Hydroxychloroquine rated ‘most effective therapy’ by doctors for coronavirus” (by Valerie Richardson  Washington Tmes    4-2-20) 

An international poll of more than 6,000 doctors released Thursday found that the antimalarial drug hydroxychloroquine was the most highly rated treatment for the novel coronavirus.

The survey conducted by Sermo, a global health care polling company, of 6,227 physicians in 30 countries found that 37% of those treating COVID-19 patients rated hydroxychloroquine as the “most effective therapy” from a list of 15 options.

The U.S. Food and Drug Administration gave chloroquine and its next-generation derivative, hydroxychloroquine, emergency-use authorization Monday for treating the novel coronavirus, although the drug was already being used off-label by some doctors and hospitals for COVID-19 patients.

“Outside the U.S., hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients,” the survey found.

The 30 nations surveyed included those in Europe, Asia, North America and South America, as well as Australia. No incentives were provided to participate in the poll, conducted March 25-27, according to Sermo.

Hydroxychloroquine usage was most widespread in Spain, where 72% of physicians surveyed said they had prescribed it, followed by Italy at 49%, and least popular in Japan, where 7% had used it to treat COVID-19.

The poll found 23% of U.S. medical professionals had prescribed the drug, which has been FDA-approved for malaria, lupus and rheumatoid arthritis.


Sermo CEO Peter Kirk: “ Physicians should have more of a voice in how we deal with this pandemic and be able to quickly share information with one another and the world,” he said. “With censorship of the media and the medical community in some countries, along with biased and poorly designed studies, solutions to the pandemic are being delayed.”


2.     AS AN EXAMPLE, a report from a  board-certified physician  with 30 years of experience in treating infectious diseases, including current Corona  virus cases:

AS A PHYSICIAN ON THE FRONT LINES OF THIS COVID PANDEMIC, I AM SHARING MY THOUGHTS ABOUT HOW TO IMMEDIATELY END THE EPIDEMIC AND THE QUARANTINE PROTOCOLS. 

I can confirm that the vast majority of patients infected with Covid19 have minimal, mild or modest cold and flu-like symptoms, requiring little to no medical intervention.  The planet is being systematically shut down because a very small percentage of those infected may have serious or grave reactions to the viral infection.  When these seriously ill patients contract the disease over a short period of time, the healthcare system can become overwhelmed as was the experience in China, Korea and Italy.

The Chinese have largely completed their Covid19 experience and some significant science has come from their doctors and researchers as to the virology, epidemiology and treatment of Covid19.  The most important of which is the recent study showing a 100% cure rate for Covid19 patients (n = 20) treated with the combination of chloroquine and azithromycin.

Now that a cure has been established (and is being confirmed in other areas hard hit with Covid19 — to my understanding), this new finding should be the antidote for public and political panic regarding any significant downside human costs (grave illness, casualties) of the pandemic.

As we no longer have the domestic capacity to manufacture these medications in the quantities needed on the timeline required, the Federal government should immediately work to re-tool US chemical factories that are capable of retrofitting to manufacture these two drugs.  The raw materials of these medicines can then be shipped directly to vitamin manufacturers who have the capacity to conservatively and collectively make 5 - 10 millions pills daily.  As a contract manufacturer of vitamins, I know first hand that these facilities follow strict FDA guidelines that are equivalent to the regulations of Big Pharma. Therefore, quality control will not be a concern.  Compound pharmacies are also capable of participating in this effort.

If this protocol were to be adopted, some 150M doses of these life-saving medications would be available in the next two weeks to treat all patients in need and any first responder/front line healthcare worker.

While not scientifically proven, it has also been anecdotally observed that chloroquine may offer significant prophylaxis so that those most at risk (the vulnerable patients and front-line healthcare workers) may never develop a primary infection during the epidemic.   This preventive intervention should be immediately offered to vulnerable populations and healthcare workers in an open-label, observational study.

With the cure in the hands of pharmacies, hospitals and first responders, the concern for the health and wellness of the vulnerable population (whose characteristics have been well described) can be assured. By treating these vulnerable patients in the early part of the 5 day prodrome (when mild symptoms begin), demands on hospital resources will be effectively countered.

Governmental authorities can then begin to immediately prepare the population for a systematic roll out of return-to-work orders while releasing the healthy, general public from quarantine.

It is my opinion, the vulnerable populations should remain quarantined for the next one month while the treatments are used and proven on a mass scale.

The concern of patients (and their providers) with an infectious disease is always the success and availability of the treatment for their condition.  Now that a treatment has been Now that a treatment has been identified and can be made widely available at minimal cost (but with considerable public-private coordination issues) the End Game for this pandemic is within our collective reach.


A recent study from China did include a control group, and suggested that hydroxychloroquine might help patients with mild cases of Covid-19, the disease caused by the coronavirus. But that study had limitations: It was also small, with a total of only 62 patients, and they were given various other drugs as well as hydroxychloroquine. The doctors evaluating the results knew which patients were being treated, and that information could have influenced their judgment. Even if the findings hold up, they will apply only to people who are mildly ill. And the researchers themselves said more studies were needed. All true…but meant to mislead.For example, if a physician had to wait for a FDA approved clinical trial, 99.5% of your clinical medical practice could not take place.

Another reason the drug has been considered for coronavirus patients is that it can rein in an overactive immune system, which is why it is used to treat lupus and rheumatoid arthritis. In some severe cases of Covid-19, the immune system seems to go into overdrive and cause inflammation that can damage the lungs and other organs. Doctors hope hydroxychloroquine might calm the condition, sometimes called a cytokine storm, but so far there is no proof that it has that effect. What has been proven is that in a large number of cases the  severity of the infection appears to be reduced. If  the medication slightly reduces the effects of the virus and  thus keeps a patient off a  ventilator this will substantially increase the survival rate.
,
Can hydroxychloroquine protect you from catching the virus?


There is no evidence that hydroxychloroquine can prevent coronavirus infection. However, researchers at the University of Minnesota are testing the drug in people who live with coronavirus patients to see whether it can protect them.

Is hydroxychloroquine approved by the Food and Drug Administration?

Yes, but for malaria, lupus and rheumatoid arthritis, not for Covid-19. For decades, doctors have been legally allowed to prescribe it for any condition they think it might help, a practice called off-label use. Currently, physicians  prescribe thousands of drugs for “off label use “.  This is standard medical practice and there is nothing controversial  about physicians  doing this. However,  to raise this as an objection in the current epidemic situation is a political  device to delay  the rapid and widespread testing of hydroxychloroquine. Another objection, possible side effects, is also political since the attending physician knows his patients and their underlying conditions and thus carefully observe them alter treatments which might be also damaging to them

 However, because of hoarding and high demand for hydroxychloroquine, some states like New York have ordered pharmacists to fill prescriptions only for F.D.A.-approved uses of the drug or for people participating in clinical trials. Again, this action was   a misguided political hit  job.  A physician with extensive experience in producing medications and supplements states:"As we no longer have the domestic capacity to manufacture these medications in the quantities needed on the timeline required, the Federal government should immediately work to re-tool US chemical factories that are capable of retrofitting to manufacture these two drugs.  The raw materials of these medicines can then be shipped directly to vitamin manufacturers who have the capacity to conservatively and collectively make 5 - 10 millions pills daily.  As a contract manufacturer of vitamins, I know first hand that these facilities follow strict FDA guidelines that are equivalent to the regulations of Big Pharma. Therefore, quality control will not be a concern.  Compound pharmacies are also capable of participating in this effort."

In late March, the F.D.A. granted emergency approval to allow hospitals to use hydroxychloroquine from the national stockpile to treat patients who would not otherwise qualify for a clinical trial. Under the approval, patients and their families will receive information about the drug, and hospitals have to track information about the patients who received the drug, including their health condition and serious side effects. But that F.D.A.’s authorization for emergency use is not equivalent to meeting federal requirements, including scientific evidence through trials, that would deem hydroxychloroquine a proven treatment against the virus.

Is hydroxychloroquine being given to coronavirus patients now?

Yes. Many hospitals are giving it to patients because there is no proven treatment, and they hope it will help. Clinical trials with control groups have begun across the world. A nationwide trial began on April 2 in the United States; it is to enroll 510 patients at 44 medical centers. Had this medication  been offered to 5,000 patients this week is likely that a majority would have accepted the treatment and within three weeks we would have a definitive answer. The Centers for Disease Control is slow rolling our ability to find  immediately find a medication that  might reduce the severity  of the infection and the  length of time that the patient is suffering from the symptoms. Any mention of  a shortage of the  medication is hypocritical. There is plentiful stores  on hand  or available within a very short time period to  immediately  service 5,000 to 10,000 patients. Any  statements about money is also hypocritical. The medication is extremely inexpensive.

Researchers say those studies are essential to find out whether the drug works against the coronavirus. And thousands of patients , their families and  physicians in the field say that this  CDC  argument is irrelevant and dangerous academic nonsense 
since we have an inexpensive, very low risk way  to to evaluate hydroxychloroquine. And in three weeks we could definitely know whether hydroxychloroquine it is a improved treatment for any significant portion of the affected patients…  And  even very limited improvements in patient condition  and/or length of illness would  result in a substantial reduction in the burden on medical resources and on the death rate  resulting from Covid-19  infection.

See: "Dr.Anthony Fauci versus more than 2304 practicing physicians who are currently successfully treating their patients for the Covid-19 virus UTILIZING HYDROXYCHLOROQUINE”  http://ltgjcmilopsg3.blogspot.com/2020/04/dranthony-fauci-versus-more-than-2304.html

 If it does not, time and money can be redirected to other potential treatments. This statement  may sound reasonable to some, but it is profoundly stupid. …  Currently  Dr. Fauci’s  budget is between five and $6 billion annually.  An extensive test  of  possible effectiveness of utilizing hydroxychloroquine can be conducted in real time  at trivial financial cost.  The additional  pain  and  suffering of  the  patients and their families   resulting from delayed decisions is substantial.  Yet the CDC  approach, which  is endorsed by the New York Times,  is to perform a small  study which will lead to another study, which will then  lead to another study,  which will then result in a flood of academic papers.[ Dr Fauci is on the editorial boards of many scientific journals and is the  author,  or coauthor, or editor of more than 1,300 scientific publications, including several textbooks.]


Is there any danger in taking hydroxychloroquine?

Like every drug, it can have side effects. It is not safe for people who have abnormalities in their heart rhythms, eye problems involving the retina, or liver or kidney disease.   This is a false objection. The treating physician would balance the risks against the possible rewards prescribing this drug for each individual patient. Further, he would monitor and discontinue should such action be warranted.  This is a false objection.

Other possible side effects include nausea, diarrhea, mood changes and skin rashes.  BIG DEAL!!!

Overall, it is considered relatively safe for people who do not have underlying illnesses that the drug is known to worsen.

 But it is not known whether hydroxychloroquine is safe for severely ill Covid-19 patients, who may have organ damage from the virus. The hope is to reduce the severity and length of the symptoms so that organ damage is avoided.




Tuesday, April 7, 2020

Dr.Anthony Fauci versus more than 2304 practicing physicians who are currently successfully treating their patients for the Covid-19 virus UTILIZING HYDROXYCHLOROQUINE



 Dr.Anthony  Fauci  versus more than  2304    practicing physicians who are currently  successfully treating their  patients for the Covid-19 virus UTILIZING HYDROXYCHLOROQUINE

To: Michael Rich , natalie crawford


A.  Dr.Anthony  Fauci
  Dr.Anthony  Fauci has more than 50 years of extensive and impressive experience in  medical research as well as in the financial, administrative and political realities of the sprawling US federal public health bureaucracy.

Dr. Fauci comes from Brooklyn where  developed his “Street Smarts"  in part by  working (with the rest of his family) at his father's small pharmacy [ delivering prescriptions, sweeping the floor, waiting on customers and doing everything else necessary to keep a struggling family business alive].

He  attended  Cornell University Medical College where he graduated first in his class with a Doctor of Medicine in 1966. He then completed an internship and residency at the New York Hospital-Cornell Medical Center

In 1968,  Dr. Fauci joined the National Institutes of Health as a clinical associate in the Laboratory of Clinical Investigation (LCI) at the National Institute of Allergy and Infectious Diseases.

Dr.Fauci was appointed director of  National Institute of Allergy and Infectious Diseases in 1984. [The NIAID budget for fiscal year 2020 is an estimated $5.9 billion. —The National Institute of Allergy and Infectious Diseases (NIAID) is one of the 27 institutes and centers that make up the National Institutes of Health (NIH)]

In addition to Dr. Fauci’s  extensive technical and administrative responsibilities of overseeing complex organization [$5.9 billion annual budget ]  Dr Fauci is very active in many  technical organizations and  as serving as a public face for the US government public health / public relations activities. Some examples:

        * delivers major lectures all over the world

         *recipient of numerous prestigious awards, including  45 honorary doctoral degrees from universities in the United States and abroad.

         *is a member of the National Academy of Sciences, the National Academy of Medicine, the American Academy of Arts and Sciences, and the American Philosophical Society, as well as other professional societies including the American College of Physicians, the American Society for Clinical Investigation, the Association of American Physicians, the Infectious Diseases Society of America, the American Association of Immunologists, and the American Academy of Allergy, Asthma & Immunology

         *serves on the editorial boards of many scientific journals; as an editor of Harrison's Principles of Internal Medicine; and as author, coauthor, or editor of more than 1,300 scientific publications, including several textbooks.


 B. ON THE OTHER HAND 

1. MORE THAN   2,304    PHYSICIANS WHO ARE CURRENTLY SUCCESSFULLY TREATING  PATIENTS INFECTED WITH THE COVID-19  REPORTED  THEIR  "ANECDOTAL EVIDENCE" OF THEIR  SUCCESS WITH THEIR PATIENTS UTILIZING HYDROXYCHLOROQUINE


"Hydroxychloroquine rated ‘most effective therapy’ by doctors for coronavirus: Global survey” (by Valerie Richardson  Washington Tmes    4-2-20) 

An international poll of more than 6,000 doctors released Thursday found that the antimalarial drug hydroxychloroquine was the most highly rated treatment for the novel coronavirus.

The survey conducted by Sermo, a global health care polling company, of 6,227 physicians in 30 countries found that 37% of those treating COVID-19 patients rated hydroxychloroquine as the “most effective therapy” from a list of 15 options.

The U.S. Food and Drug Administration gave chloroquine and its next-generation derivative, hydroxychloroquine, emergency-use authorization Monday for treating the novel coronavirus, although the drug was already being used off-label by some doctors and hospitals for COVID-19 patients.

The survey also found that the most commonly prescribed treatments are analgesics (56%), azithromycin (41%) and hydroxychloroquine (33%).

Azithromycin, known by the brand name Zithromax or Z-Pak, was rated the second-most effective therapy at 32%, followed by “nothing,” analgesics (including acetaminophen), anti-HIV drugs and cough medicine.

Hydroxychloroquine, which is sold under the brand name Plaquenil, was prescribed mainly in the United States for the most severe cases, but not so in other countries.

“Outside the U.S., hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients,” the survey found.

The 30 nations surveyed included those in Europe, Asia, North America and South America, as well as Australia. No incentives were provided to participate in the poll, conducted March 25-27, according to Sermo.

Hydroxychloroquine usage was most widespread in Spain, where 72% of physicians surveyed said they had prescribed it, followed by Italy at 49%, and least popular in Japan, where 7% had used it to treat COVID-19.

The poll found 23% of U.S. medical professionals had prescribed the drug, which has been FDA-approved for malaria, lupus and rheumatoid arthritis.

Debate about hydroxychloroquine has raged in the United States since President Trump touted it two weeks ago as a potential “game-changer” in the fight against the deadly pandemic, prompting critics to accuse him of peddling unproven remedies, or “snake oil,” as USA Today put it.

Sermo CEO Peter Kirk called the polling results a “treasure trove of global insights for policy makers.”

“Physicians should have more of a voice in how we deal with this pandemic and be able to quickly share information with one another and the world,” he said. “With censorship of the media and the medical community in some countries, along with biased and poorly designed studies, solutions to the pandemic are being delayed.”

2.     AS A PHYSICIAN ON THE FRONT LINES OF THIS COVID PANDEMIC, I AM SHARING MY THOUGHTS ABOUT HOW TO IMMEDIATELY END THE EPIDEMIC AND THE QUARANTINE PROTOCOLS.  [from a  board-certified physician  with 30 years of experience in treating infectious diseases, including current Corona  virus cases)

I can confirm that the vast majority of patients infected with Covid19 have minimal, mild or modest cold and flu-like symptoms, requiring little to no medical intervention.  The planet is being systematically shut down because a very small percentage of those infected may have serious or grave reactions to the viral infection.  When these seriously ill patients contract the disease over a short period of time, the healthcare system can become overwhelmed as was the experience in China, Korea and Italy.

The Chinese have largely completed their Covid19 experience and some significant science has come from their doctors and researchers as to the virology, epidemiology and treatment of Covid19.  The most important of which is the recent study showing a 100% cure rate for Covid19 patients (n = 20) treated with the combination of chloroquine and azithromycin.

Now that a cure has been established (and is being confirmed in other areas hard hit with Covid19 — to my understanding), this new finding should be the antidote for public and political panic regarding any significant downside human costs (grave illness, casualties) of the pandemic.

As we no longer have the domestic capacity to manufacture these medications in the quantities needed on the timeline required, the Federal government should immediately work to re-tool US chemical factories that are capable of retrofitting to manufacture these two drugs.  The raw materials of these medicines can then be shipped directly to vitamin manufacturers who have the capacity to conservatively and collectively make 5 - 10 millions pills daily.  As a contract manufacturer of vitamins, I know first hand that these facilities follow strict FDA guidelines that are equivalent to the regulations of Big Pharma. Therefore, quality control will not be a concern.  Compound pharmacies are also capable of participating in this effort.

If this protocol were to be adopted, some 150M doses of these life-saving medications would be available in the next two weeks to treat all patients in need and any first responder/front line healthcare worker.

While not scientifically proven, it has also been anecdotally observed that chloroquine may offer significant prophylaxis so that those most at risk (the vulnerable patients and front-line healthcare workers) may never develop a primary infection during the epidemic.   This preventive intervention should be immediately offered to vulnerable populations and healthcare workers in an open-label, observational study.

With the cure in the hands of pharmacies, hospitals and first responders, the concern for the health and wellness of the vulnerable population (whose characteristics have been well described) can be assured. By treating these vulnerable patients in the early part of the 5 day prodrome (when mild symptoms begin), demands on hospital resources will be effectively countered.

Governmental authorities can then begin to immediately prepare the population for a systematic roll out of return-to-work orders while releasing the healthy, general public from quarantine.

It is my opinion, the vulnerable populations should remain quarantined for the next one month while the treatments are used and proven on a mass scale.

The concern of patients (and their providers) with an infectious disease is always the success and availability of the treatment for their condition.  Now that a treatment has been Now that a treatment has been identified and can be made widely available at minimal cost (but with considerable public-private coordination issues) the End Game for this pandemic is within our collective reach.


3.   MANY REPORTS OF BREAKTHROUGHS IN TESTING AND TREATMENT [WITH THE POTENTIAL FOR NEAR TERM APPLICATION] ARE BEING REPORTED  IN THE GENERAL AND SCIENTIFIC MEDIA .NEARLY EVERY REPORT  INCLUDES NEGATIVE REFERENCES TO THE CDC  AND/OR THE FDA   RELATING  TO BUREAUCRATIC FOOT DRAGGING AND FOR IMPOSING UNNECESSARY  CONDITIONS AND RESTRICTIONS. SOME [ UNEVALUATED]. FURTHER, MODELING AND FORECASTING EFFORTS HAVE COMPROMISED BY OBSOLETE MODELS, LACK OF TRANSPARENCY,  MISREPORTING, ETC.

a.     EXAMPLES ARE PRESENTED FOR YOUR INFORMATION:

Houston Methodist announced this week that it was the first hospital in the nation to treat a patient in the United States with the experimental method, following the Food and Drug Administration’s (FDA) announcing approval to test the therapy.

The first patient received plasma on March 27 and a second patient received it a day later, the hospital system said in a statement.

Plasma from recovered patients may have antibodies against the CCP virus that could potentially help patients recover, according to Dr. Eric Salazar, a physician scientist with Houston Methodist’s Research Institute. Salazar and his team recruited blood plasma donors who have been in good health for more than two weeks since being diagnosed with COVID-19. Each donor gave a quart of blood plasma. Medical workers transfused the plasma into the two critically ill patients.


MIGAL and IIBR are both testing potential COVID-19 vaccinations on mammals

MIGAL's biotechnology group's team is hard at work on a vaccine for COVID-19. (photo credit: COURTESY OF MIGAL)

MIGAL's biotechnology group's team is hard at work on a vaccine for COVID-19.

A team of Israeli researchers says that they are days away from completing the production of the active component of a coronavirus vaccine that could be tested on humans as early as June 1.

“We are in the final stages and within a few days we will hold the proteins – the active component of the vaccine,” Dr. Chen Katz, group leader of MIGAL’s biotechnology group, told The Jerusalem Post.

In late February, MIGAL [The Galilee Research Institute] committed to completing production of its vaccine within three weeks and having it on the market in 90 days. Katz said they were slightly delayed because it took longer than expected to receive the genetic construct that they ordered from China due to the airways being closed and it having to be rerouted.


Doctors At University of Pittsburgh Medical Center: We've Developed a Vaccine Against CoronavirusDoctors and researchers at the University of Pittsburgh Medical Center have announced amazing news.

They are saying they’ve created a vaccine that can protect against developing COVID-19 and they want federal permission for human trials. They said they began working on it Jan. 21 and found mice had developed antibodies against COVID-19 about two weeks after receiving the vaccine. They said they based the vaccine on work previously done at UPMC that sought to create vaccines to protect against SARS and MERS, which they said are similar to the new coronavirus.

Not only that the doctors say the vaccine is easily deliverable in large quantities. They further said their vaccine is one that is easily scalable to produce in large quantities. It also includes a unique delivery method in which hundreds of tiny needles are in a patch similar to a Band-Aid, with the needles, made of sugar and protein particles, dissolving into the skin to deliver the vaccine.







The Mayo Clinic created its first-ever rapid response team. A third of the 15 members were devoted solely to the FDA’s data and paperwork demands. Like others on the team, they worked 15-hour days for three weeks.

“It’s unlike anything we’ve ever done before,” said Matt Binnicker, a director of clinical virology at Mayo.







At the University of Washington, Greninger and his fellow scientists were initially baffled by an FDA process they viewed as baroque. They had always worked under strict guidelines, aimed at protecting patients and guaranteeing quality. But the EUA was a bureaucratic puzzle they had never encountered.

“The most pernicious effect of the current regulatory environment is that it kneecaps our ability for preparedness should a true emergency emerge,” Greninger wrote to colleagues on Feb. 14.

Greninger channeled his energy into the paperwork problem, spending more than 100 hours filling out forms and collecting information needed for the application, he told The Post. But when he finally submitted the material, an FDA official told him the agency could not accept it — because he had emailed it.

“We received your email and attachments regarding the UW 2019-nCoV assay pre-EUA,” an FDA official wrote on Feb. 20. “However, we have not received the official submission through DCC.”

“What is the DCC?” Greninger wrote back.

“The Document Control Center,” came the reply.

“What is the Document Control Center?”

Greninger then learned about another requirement. Under FDA rules, he was supposed to digitally copy the electronic documents he had emailed to the FDA, burn the copies onto a disk and mail the hard disk to an office in suburban District of Columbia.

Greninger shared his exasperation in a Feb. 20 email to a colleague: “repeat after me, emergency.”






 This New York Times story is a good place to get started.[ CAUTION: , for the most part ,reporters have friends and contacts  who feed them information and thus, in  return, the reporters do everything possible to steer blame away from their symbiotic associates and  toward their rivals.Under the Obama administration ,US response to just about every outbreak was longer delayed.. Many of the laboratory and Association sources quoted are veterans of the Obama administration. They certainly will praise the Obama approach [their efforts] and attack  those of Donald Trump.  Also, the Centers for Disease Control explicitly allocated their budget to other” research” and declined the repeated  and  urgent requests from Harvard and other  researchers to  study this class of virus and to study the development of vaccines for this class of virus ]


  For example,Dr. Nancy Messonnier, the director of the agency’s National Center for Immunization and Respiratory Diseases  is very anti-Trump.
CDC Defends Its Handling Of Coronavirus Case In California…...The Centers for Disease Control and Prevention says there's been "confusion" about the handling of a coronavirus patient in California who is thought to represent the first case of the virus being transmitted in the general population, rather than through a known contact with someone who has been in China.

The case involves a woman who appears to have contracted the virus in California, apparently without having contact with anyone who had traveled abroad or was previously known to have the coronavirus.

On Friday, another patient believed to have similarly contracted the virus was reported in Santa Clara County in Northern California and a third in Oregon's Washington County was described by officials there as a "confirmed presumptive case" that also had no history of travel outside the country or close contact with an infected person.

The latest cases could be indicate a wider outbreak in the U.S.

*******The UC Davis Medical Center in Sacramento, Calif., where the woman was being treated, says its diagnosis of the patient's COVID-19, the disease caused by the novel coronavirus, was delayed for days because the patient didn't initially meet the CDC's criteria to approve a coronavirus test.

********The hospital says its staff requested a test from "public health officials" after the patient was transferred to its facility last Wednesday. However, UC Davis Medical Center added, "Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered."


The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19  By Michael D. Shear, Abby Goodnough, Sheila Kaplan, Sheri Fink, Katie Thomas and Noah Weiland March 28, 2020 New York Times

https://www.nytimes.com/2020/03/28/us/testing-coronavirus-pandemic.html?campaign_id=2&emc=edit_th_200329&instance_id=17044&nl=todaysheadlines&regi_id=60743284&segment_id=23226&user_id=17e798e489b463910587c6144722778f
WASHINGTON — Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.

The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.

But as the deadly virus from China spread with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.

The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.

The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”

And Dr. Anthony S. Fauci, a top government scientist involved in the fight against the virus, told members of Congress that the early inability to test was “a failing” of the administration’s response to a deadly, global pandemic. “Why,” he asked later in a magazine interview, “were we not able to mobilize on a broader scale?”

Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world’s most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solutio

The C.D.C. also tightly restricted who could get tested and was slow to conduct “community-based surveillance,” a standard screening practice to detect the virus’s reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were performing tens of thousands of tests daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.

Mr. Azar, 52, who chaired the coronavirus task force until late February, when Vice President Mike Pence took charge, had been at odds for months with the White House over other issues. The task force’s chief liaison to the president was Mick Mulvaney, the acting White House chief of staff, who was being forced out by Mr. Trump. Without high-level interest — or demands for action — the testing issue festered.

At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public’s health or the nation’s economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: “It’s going to disappear. One day — it’s like a miracle — it will disappear.”

By early March, after federal officials finally announced changes to expand testing, it was too late. With the early lapses, containment was no longer an option. The tool kit of epidemiology would shift — lockdowns, social disruption, intensive medical treatment — in hopes of mitigating the harm. Now, the United States has more than 100,000 coronavirus cases, the most of any country in the world. Deaths are rising, cities are shuttered, the economy is sputtering and everyday life is upended. And still, many Americans sickened by the virus cannot get tested.

Dr. Bruce Aylward, a senior adviser at the World Health Organization, led an expert team to China last month to research the mysterious new virus. Testing, he said, was “absolutely vital” for understanding how to defeat a disease — what distinguishes it from others, the spectrum of illness and, most important, its path through populations.

“You want to know whether or not you have it,” Dr. Aylward said. “You want to know whether the people around you have it. Because you know what? Then you could stop it.”

“You can’t stop it,” he warned, “if you can’t see it.”

A Startling Setback

The first time Dr. Robert Redfield heard about the severity of the virus from his Chinese counterparts was around New Year’s Day, when he was on vacation with his family. He spent so much time on the phone that they barely saw him. And what he heard rattled him; in one grim conversation about the virus days later, George F. Gao, the director of the Chinese Center for Disease Control and Prevention, burst into tears.

Dr. Redfield, a longtime AIDS researcher, had never run a government agency before his appointment to lead the C.D.C. in 2018. Until then, his biggest priorities had been fighting the opioid epidemic and the spread of H.I.V. Suddenly, a man who preferred treating patients in Haiti or Africa to being in the public glare was facing a new pandemic threat.

At first, Dr. Redfield’s agency moved quickly.

On Jan. 7, the C.D.C. created an “incident management system” for the coronavirus and advised travelers to Wuhan to take precautions. By Jan. 20, just two weeks after Chinese scientists shared the genetic sequence of the virus, the C.D.C. had developed its own test, as usual, and deployed it to detect the country’s first coronavirus case.

“That’s our prime mission,” Dr. Redfield said later in an interview, “to get eyes on this thing.”

Assessing the virus would prove challenging. It was so new that scientists had little information to work with. China provided limited data, and rebuffed an early attempt by Mr. Azar and Dr. Redfield to send C.D.C. experts there to learn more. That the virus could cause no symptoms and still spread — something not initially known — made it all the more difficult to understand.

To identify the virus, the C.D.C. test used three small genetic sequences to match up with portions of a virus’s genome extracted from a swab. A German-developed test that the W.H.O. was distributing to other countries used just two, potentially making it less precise.

But soon after the F.D.A. cleared the C.D.C. to share its test kits with state health department labs, some discovered a problem. The third sequence, or “probe,” gave inconclusive results. While the C.D.C. explored the cause — contamination or a design issue — it told those state labs to stop testing.

The startling setback stalled the C.D.C.’s efforts to track the virus when it mattered most. By mid-February, the nation was testing only about 100 samples per day, according to the C.D.C.’s website.

Dr. Redfield played down the problem in task force meetings and conversations with Mr. Azar, assuring him it would be fixed quickly, several administration officials said.

With capacity so limited, the C.D.C.’s criteria for who was tested remained extremely narrow for weeks to come: only people who had recently traveled to China or had been in contact with someone who had the virus.

The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.

The C.D.C. announced a plan on Feb. 14 to perform the screening in five high-risk cities: New York, Chicago, Los Angeles, San Francisco and Seattle. An agency official said it could provide “an early warning signal to trigger a change in our response strategy.” But most of the cities could not carry it out.

“Had we had done more testing from the very beginning and caught cases earlier,” said Dr. Nuzzo, of Johns Hopkins, “we would be in a far different place.”

The consequences became clear by the end of February. For the first time, someone with no known exposure to the virus or history of travel tested positive, in the Seattle area, where the U.S.’s first case had been detected more than a month earlier. The virus had probably been spreading there and elsewhere for weeks, researchers later concluded. Without a more complete picture of who had been infected, public health workers could not do “contact tracing” — finding all those with whom any contagious people had interacted and then quarantining them to stop further transmission.

The C.D.C. gave little thought to adopting the test being used by the W.H.O. The C.D.C.’s test was working in its own lab — still processing samples from states — which gave agency officials confidence. Dr. Anne Schuchat, the agency’s principal deputy director, would later say that the C.D.C. did not think “we needed somebody else’s test.”

And the German-designed W.H.O. test had not been through the American regulatory approval process, which would take time.

Throughout February, Dr. Redfield shuttled between Atlanta, where the C.D.C. is based, and Washington, holding multiple calls every day with Mr. Azar and participating in the coronavirus task force.

Mr. Azar’s take-charge style contrasted with the more deliberative manner of Dr. Redfield, who lacked the kind of commanding television presence that impressed Mr. Trump. He was “a consensus person,” as one colleague described him, who sought to avoid conflict. He relied heavily on some of the C.D.C.’s career scientists, like Dr. Schuchat and Dr. Nancy Messonnier, the director of the agency’s National Center for Immunization and Respiratory Diseases.

Under scrutiny from Congress, Dr. Redfield offered reassurances. Responding on Feb. 24 to a letter from 49 members of Congress about the need for testing in the states, he wrote, “CDC’s aggressive response enables us to identify potential cases early and make sure that they are properly handled.”

Days later, his agency provided a workaround, telling state and local health department labs that they could finally begin testing. Rather than awaiting replacements, they should use their C.D.C. test kits and leave out the problematic third probe.

Meanwhile, the agency’s epidemiologists were growing more concerned as the virus spread in South Korea and Italy. On Feb. 25, Dr. Messonnier gave a briefing with a much blunter warning than usual. “Disruption to everyday life might be severe,” she said.

Mr. Trump, returning from a trip to India, was furious, according to senior administration officials. Later that day, Mr. Azar seemed to be tamping down the level of concern. All Dr. Messonnier had meant, he said at a news conference, was that people should “start thinking about, in their own lives, what that might involve.”

“Might,” Mr. Azar repeated emphatically. “Might involve.”

Barriers to Testing

Dr. Stephen Hahn’s first day as F.D.A. commissioner came just six weeks before Mr. Azar declared a public health emergency on Jan. 31. A radiation oncologist and researcher who helped turn around MD Anderson in Houston, one of the nation’s leading cancer centers, Dr. Hahn had come to Washington to oversee a sprawling federal agency that regulates everything from lifesaving therapies to dog food.

But overnight, his mission — to manage 15,000 employees in a culture defined by precision and caution — was upended. A pathogen that Mr. Trump would later call the “invisible enemy” was hurtling toward the United States. It would fall to the newly arrived Dr. Hahn to help build a huge national capacity for testing by academic and private labs.

Instead, under his leadership, the F.D.A. became a significant roadblock, according to current and former officials as well as researchers and doctors at laboratories around the country.

Private-sector tests were supposed to be the next tier after the C.D.C. fulfilled its obligation to jump-start screening at public labs. In other countries hit hard by the coronavirus, governments acted quickly to speed tests to their populations. In South Korea, for example, regulators in early February summoned executives from 20 medical manufacturers, easing rules as they demanded tests.

But Dr. Hahn took a cautious approach. He was not proactive in reaching out to manufacturers, and instead deferred to his scientists, following the F.D.A.’s often cumbersome methods for approving medical screening.

Even the nation’s public health labs were looking for the F.D.A.’s help. “We are now many weeks into the response with still no diagnostic or surveillance test available outside of C.D.C. for the vast majority of our member laboratories,” Scott Becker, chief executive of the Association of Public Health Laboratories, wrote to Mr. Hahn in late February. “We believe a more expeditious route is needed at this time.”

Ironically, it was Mr. Azar’s emergency declaration that established the rules Dr. Hahn insisted on following. Designed to make it easier for drugmakers to pursue vaccines and other therapies during a crisis, such a declaration lets the F.D.A. speed approvals that could otherwise take a year or more.

But the emergency announcement created a new barrier for hospitals and laboratories that wanted to create their own tests to diagnose the coronavirus. Usually, they faced minimal federal regulation. But once Mr. Azar took action, they were subject to an F.D.A. process called an “emergency use authorization.”

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the F.D.A.’s approval process. The new tests sat unused at labs around the country.

Stanford was one of them. Researchers at the world-renowned university had a working test by February, based on protocols published by the W.H.O. The organization had already delivered more than 250,000 of the German-designed tests to 70 laboratories around the world, and doctors at the Stanford lab wanted to be prepared for a pandemic.

“Even if it didn’t come, it would be better to be ready than not to be ready,” said Dr. Benjamin Pinsky, the lab’s medical director.

But in the face of what he called “relatively tight” rules at the F.D.A., Dr. Pinsky and his colleagues decided against even trying to win permission. The Stanford clinical lab would not begin testing coronavirus samples until early March, when Dr. Hahn finally relaxed the rules.

Executives at bioMérieux, a French diagnostics company, had a similar experience. The company makes a countertop testing system, BioFire, that is routinely used to check for the flu and other respiratory illnesses in 1,700 hospitals around the country. It can provide results in about 45 minutes.

“A lot of us said, you know, your typical E.U.A. is just much too demanding,” said Dr. Mark Miller, the company’s chief medical officer, referring to the emergency approval. “It’s going to take much too much time. And can’t you do something to shorten that?”

Officials at the F.D.A. tried to be responsive, Dr. Miller said. But rather than throw out the rules, the agency only modified the regulatory requirements, still requiring weeks of discussions and negotiations.

After conversations with the F.D.A. in mid-February, the company received emergency approval for its BioFire test on March 24. (The company also began talking to the F.D.A. in January about another type of test, but decided not to pursue it in the United States for now.) Dr. Miller said that while he was ultimately satisfied with the F.D.A.’s actions, the overall response by the government was too slow, especially when it came to logistical questions like getting enough testing supplies to those who needed them.

“You’ve got other countries — and I’m sorry, unfortunately, the U.S. is one of those — where they’ve been slow, disorganized,” he said. “There are still not enough tests available there to test everybody who needs it.”

In an emailed statement, Dr. Hahn maintained that his agency had moved as quickly as it safely could to ensure that tests would be accurate. “Since the early days of this pandemic,” he said, “the F.D.A.’s doors have always been and still remain open to test developers.”

A Lack of Trust

Alex Azar had sounded confident at the end of January. At a news conference in the hulking H.H.S. headquarters in Washington, he said he had the government’s response to the new coronavirus under control, pointing out high-ranking jobs he had held in the department during the 2003 SARS outbreak and other infectious threats.

“I know this playbook well,” he told reporters.

A Yale-trained lawyer who once served as the top attorney at the health department, Mr. Azar had spent a decade as a top executive at Eli Lilly, one of the world’s largest drug companies. But he caught Mr. Trump’s attention in part because of other credentials: After law school, Mr. Azar was a clerk for some of the nation’s most conservative judges, including Justice Antonin Scalia of the Supreme Court. And for two years, he worked as Ken Starr’s deputy on the Clinton Whitewater investigation.

As Mr. Trump’s second health secretary, confirmed at the beginning of 2018, Mr. Azar has been quick to compliment the president and focus on the issues he cares about: lowering drug prices and fighting opioid addiction. On Feb. 6 — even as the W.H.O. announced that there were more than 28,000 coronavirus cases around the globe — Mr. Azar was in the second row in the White House’s East Room, demonstrating his loyalty to the president as Mr. Trump claimed vindication from his impeachment acquittal the day before and lashed out at “evil” lawmakers and the F.B.I.’s “top scum.”

As public attention on the virus threat intensified in January and February, Mr. Azar grew increasingly frustrated about the harsh spotlight on his department and the leaders of agencies who reported to him, according to people familiar with the response to the virus inside the agencies.

Described as a prickly boss by some administration officials, Mr. Azar has had a longstanding feud with Seema Verma, the Medicare and Medicaid chief, who recently became a regular presence at Mr. Trump’s televised briefings on the pandemic. Mr. Azar did not include Dr. Hahn on the virus task force he led, though some of the F.D.A. commissioner’s aides participated in H.H.S. meetings on the subject.

And tensions grew between the secretary and Dr. Redfield as the testing issue persisted. Mr. Azar and Dr. Redfield have been on the phone as often as a half-dozen times a day. But throughout February, as the C.D.C. test faltered, Mr. Azar became convinced that Dr. Redfield’s agency was providing him with inaccurate information about testing that the secretary repeated publicly, according to several administration officials.

In one instance, Mr. Azar appeared on Sunday morning news programs and said that more than 3,600 people had been tested for the virus. In fact, the real number was much smaller because many patients were tested multiple times, an error the C.D.C. had to correct in congressional testimony that week. One health department official said Mr. Azar was repeatedly assured that the C.D.C.’s test would be widely available within a week or 10 days, only to be given the same promise a week later.

Asked about criticism of his agency’s response to the pandemic, Dr. Redfield said: “I’m personally not focused on whether they’re pointing fingers here or there. We’re focused on doing all we can to get through this outbreak as quickly as possible and keep America safe.”

For all Mr. Azar’s complaints, however, he continued to defer to the scientists at the two agencies, according to several administration officials. Mr. Azar’s allies said he was told by Dr. Redfield and Dr. Fauci that the C.D.C. had the resources it needed, that there was no reason to believe the virus was spreading through the country from person to person and that it was important to test only people who met certain criteria.

But even in the face of a crescendo of complaints from doctors and health care researchers around the country, Mr. Azar failed to push those under him to do the one thing that could have helped: broader testing.

In a statement, Caitlin Oakley, Mr. Azar’s spokeswoman, said that the secretary had “empowered and followed the guidance of world-renowned U.S. scientists” on the testing issue. “Any insinuation that Secretary Azar did not respond with needed urgency to the response or testing efforts,” she said, “are just plain wrong and disproven by the facts.”

By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar’s chief of staff, and asked him to gather the group of officials overseeing screening efforts.

Around noon on Feb. 27, Dr. Hahn, Dr. Redfield and top aides from the F.D.A. and H.H.S. dialed in to a conference call. Mr. Harrison began with an ultimatum: No one leaves until we resolve the lag in testing. We don’t have answers and we need them, one senior administration official recalled him saying. Get it done.

By the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.

But the evening before, Mr. Azar had been effectively removed as the leader of the task force when Mr. Trump abruptly put Mr. Pence in charge, a decision so last-minute that even the top health officials in the White House learned of it while watching the announcement.

A Tacit Acknowledgment

Previous presidents have moved quickly to confront disease threats from inside the White House by installing a “czar” to manage the effort.

During an outbreak of the Ebola virus in 2014, President Barack Obama tapped Ron Klain, his vice president’s former chief of staff, to direct the response from the West Wing. Mr. Obama later created an office of global health security inside the National Security Council to coordinate future crises.

“If you look historically in the United States when it is challenged with something like this — whether it’s H.I.V. crises, whether it’s pandemic, whether it’s whatever — man, they pull out all the stops across the system and they make it work,” said Dr. Aylward, the W.H.O. epidemiologist.

But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama’s global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.

Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes. Yet hospitals and clinics across the country still must deny tests to those with milder symptoms, trying to save them for the most serious cases, and they often wait a week for results. In tacit acknowledgment of the shortage,

Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

“Testing is the crack that split apart the rest of the response, when it should have tied everything together,” said Dr. Nahid Bhadelia, ​the medical director of the Special Pathogens Unit at Boston University School of Medicine. “It seeps into every other aspect of our response, touches all of us,” she said. “The delay of the testing has impacted the response across the board.”












b. CDC GUIDANCE  [ ON HOW TO REPORT  CORVID-19 DEATHS  ] MAY RESULT IN   SUBSTANTIAL  OVER REPORTING, CORRUPTING    BOTH  THE BASIS FOR OPERATIONAL DECISIONS  AND ALL ANALYSES RELATING   TO PREVENTION, DETECTION  AND  TREATMENT
1.     CDC Tells Hospitals To List COVID as Cause of Death Even if You're Just Assuming or It Only Contribute   https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

The problem with making informed decisions about coronavirus is that we don’t have a whole lot of data on it at the moment.

The data that we do have, meanwhile, could end up being terminally skewed, particularly the data that’s been coming out of China.

The Centers for Disease Control and Prevention’s guidance on determining COVID-19 as a cause of death isn’t going to help those numbers.

Issued March 24, the guidance tells hospitals to list COVID-19 as a cause of death regardless of whether or not there’s actual testing to confirm that’s the case.

Instead, even if the coronavirus was just a contributing factor or if it’s “assumed to have caused or contributed to death,” it can be listed as the primary cause.

The International Statistical Classification of Diseases and Related Health Problems, or ICD, has established the code U07.1 for death by coronavirus infection. There’s a secondary code, U07.2, “for clinical or epidemiological diagnosis of COVID-19 where a laboratory confirmation is inconclusive or not available,” according to the CDC guidance.

“Because laboratory test results are not typically reported on death certificates in the U.S., NCHS is not planning to implement U07.2 for mortality statistics.”

Therein lies the problem.

“The underlying cause depends upon what and where conditions are reported on the death certificate. However, the rules for coding and selection of the underlying cause of death are expected to result in COVID- 19 being the underlying cause more often than not,” the guidelines read.

Is this new CDC guidance problematic?

“COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc.,” the guidance continued.

“If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II.”

Author and former New York Times reporter Alex Berenson, one of the few well-known figures to question some of the statistics on COVID-19, questioned the new CDC guidelines as well.

It doesn’t help that data when the guidelines for determining who’s actually died of the coronavirus are profoundly vague.For instance, what happens when an elderly person with numerous underlying conditions comes into the hospital and dies?



2.  IN ADDITION, USE OF   FOREIGN DATA  FOR   MODELING AND  FORECASTING   HAS BEEN A MAJOR CONTRIBUTOR TO THE  HIGHLY MISLEADING AND CONSTANTLY CHANGING  PREVALENCE AND DEATH ESTIMATES  AND    TO THE CONFUSING.AND OFTEN CONFLICTING  GUIDANCE GIVEN TO THE AMERICAN PUBLIC.

For example, Dr. Fauci and many others kept repeating: “we are only two weeks behind Italy." In fact, only 3% of the “coronavirus deaths”  reported by Italy are actually caused by it…..97% of deaths are due to  Other Serious Health conditions which are agravated by the coronavirus.


As of Wednesday morning , Italian  reported data stated 31,506 confirmed cases of coronavirus in Italy and 2,503 deaths. But new data from the Italian government shows that the people dying from the coronavirus are either the elderly or have other complications. 50% of those who died from coronavirus had THREE DIFFERENT SERIOUS HEALTH CONDITIONS and the average per person had 2.7 serious health conditions. Only 12 coronavirus fatalities had NO previous health concerns before coming down with the coronavirus.

Via Agenzia Nova from March 18: (rough translation)

Rome, 18 Mar 09:29 – (Agenzia Nova) – Only 12 deaths caused by coronavirus have been ascertained so far. The data, however, emerges from the analysis of just 355 medical records, out of 2,003 received by the Higher Institute of Health (ISS). All the other 343 patients who fell victim to the epidemic, according to the ISS, had other serious diseases, which caused their death. Almost 50 percent of the deceased had 3 previous pathologies, and the average of the 343 deaths from secondary causes is 2.7 pathologies per person. The 12 deceased patients, equal to 3.38 per cent of the sample examined, did not present any previous pathology , which means that their death was caused, precisely, by Covid-19.

Among the other victims, 84, equal to 23.7 percent of the sample, had 1 pathology; 90 patients, equal to 25.4 percent of the sample, had 2; and 169, equal to 47.6 percent, had 3 or more pathologies. Respiratory failure is the most common complication observed. The ISS, in fact, found the disease in 97.2 percent of cases; the second cause is acute kidney damage, in 27.8 percent of cases; followed by acute myocardial injury, with 10.8 percent; and from superinfection, with 10.2 percent.

The Institute also reports on the age groups of patients. As of March 17, seventeen those who died and were positive at Covid-19 under the age of 50. Specifically, 5 of these were less than 40 years old: these are male subjects between the ages of 31 and 39 with serious pre-existing diseases. Among these, cardiovascular, renal, psychiatric diseases but also diabetes and obesity.