How Deadly Is COVID-19? Birx’s Rose-Colored Glasses; CMS Broke Gov’t Rules

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

How Deadly Is COVID-19?

Researchers have been chipping away at the true infection fatality rate (IFR) for COVID-19, and are now settling on a range of 0.3% to 1.5%, according to the Wall Street Journal.

Most studies put the rate between 0.5% and 1%, which translates to about 10 people dying out of every 1,000 who are infected, the Journal reports. That’s in line with an estimate of “around 1% or less” offered earlier this week by Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, in a talk to cancer researchers.

This range was pieced together from studies of cruise ship outbreaks; analyses of reported cases and deaths paired with estimates of asymptomatic infections; and antibody prevalence surveys.

One meta-analysis of 26 studies published through June 16, posted to the medRxiv preprint server, came up with an IFR of 0.68%. The CDC is using this non-peer-reviewed report as the basis for the IFR of 0.65% that it published on its website — a figure that would be more than six times higher than the 0.1% IFR estimated for influenza (though infections and deaths for both illnesses are counted differently, making comparisons hard to interpret).

Experts also cautioned that mortality risk ranges widely, especially depending on risk factors like age and pre-existing conditions. The contagiousness of the disease also plays a major role in the pandemic’s impact, Eric Toner, MD, of Johns Hopkins University in Baltimore, told the Journal.

“It’s the combination of the fatality rate and the infectiousness that makes this such a dangerous disease,” Toner said. The Journal‘s report, however, didn’t address effects on death rates from hospital overcrowding — now happening again in some locations — or from improved treatment protocols.

Did Birx Shape White House’s Rosy View of Pandemic?

The Trump administration’s push to reopen the economy in mid-April allowed the COVID-19 pandemic to spin out of control, the New York Times reports — and coronavirus task force coordinator Deborah Birx, MD, is partly to blame.

The administration was keen to shift responsibility for tackling COVID-19 to the states, and that transition was “at once a catastrophic policy blunder and an attempt to escape blame for a crisis that had engulfed the country — perhaps one of the greatest failures of presidential leadership in generations,” according to the Times.

The Times paints a damning picture of Birx, whose main job is in the State Department, describing her as a “constant source of upbeat news for the president and his aides, walking the halls with charts emphasizing that outbreaks were gradually easing.”

Birx, who was given an office near the Situation Room, was reportedly “more central than publicly known to the judgment inside the West Wing that the virus was on a downward path.” In early April, for example, she touted a projection of 61,000 total U.S. deaths from COVID — a figure that was surpassed within just 3 weeks.

Many have criticized her reliance on models from the University of Washington, which didn’t account for how Trump’s “push to return to normal would help undercut social distancing and other measures that were keeping cases low,” according to the Times. Christopher Murray, MD, DPhil, who leads that modeling, warned it was only a snapshot based on key assumptions, like people continuing to social distance.

Instead, Birx supported the idea that the U.S. would follow Italy’s trajectory. That country, however, managed to suppress the virus before slowly starting to reopen.

“Americans, by contrast, began backing away by late April from what social distancing efforts they had been making, egged on by Mr. Trump,” according to the Times.

“Not until early June did White House officials even begin to recognize that their assumptions about the course of the pandemic had proved wrong,” the article states. “Even now there are internal divisions over how far to go in having officials publicly acknowledge the reality of the situation.”

CMS Broke Federal Contract Rules: OIG

The Centers for Medicare & Medicaid Services (CMS) mishandled contracts connected to its communications initiatives, according to the HHS Office of the Inspector General (OIG).

The agency — including its administrator, Seema Verma, MPH — “did not administer and manage the contracts in accordance with Federal requirements,” according to OIG. Specifically, it allowed a contractor to perform what are inherently governmental functions, such as making managerial decisions and directing CMS employees.

One such example: a contractor told staff members that he should clear their Twitter messages before posting. Those employees questioned whether it was “legal for a contractor to direct federal personnel.”

CMS also administered some of the work as personal services contracts, and “paid some questionable costs” for the work, the OIG report said.

Overall, CMS awarded $7 billion in contracts in fiscal year 2019; OIG audited three contracts for strategic communications totaling $6.4 million awarded from June 2017 through April 2019.

The investigation follows a Politico report from last year that raised questions about the legality of those contracts.

OIG called for a review of the department’s contracts and a closer look at whether CMS overpaid contractors.

According to Politico, Verma defended the contracts in a response to OIG, saying they were consistent with previous communications arrangements and focused on promoting the agency rather than on promoting herself.