How Trump Became the Pro-Infection Candidate

Those who take the first view, including most medical and public-health professionals, advocate a temporary, science-driven restructuring of society, …

Nine months into the pandemic, it’s a truism to say that America’s response has been politicized. Even so, with an election looming, the virus surging, and President Trump and others in government recently infected, our divisions now stand out with a startling, even brutal, clarity. There have always been two basic ways of looking at the coronavirus crisis. The first sees the minimization of death as a paramount goal; the second holds that significant death is inevitable and acceptable. Those who take the first view, including most medical and public-health professionals, advocate a temporary, science-driven restructuring of society, designed to save lives; those who take the second view, including the President and those in his circle, say that people die all the time, from car crashes, drug addictions, diseases, and the like, and argue that we don’t stop living to prevent them from dying. “Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu,” the President tweeted, earlier this month, after he was discharged from the hospital. “Are we going to close down our Country?” (Twitter flagged the tweet as misinformation since, in fact, far fewer than a hundred thousand people die from the flu each year.)

There are different ways of holding the we-all-gotta-go-sometime view. Someone who grasps it lightly might incline a little more toward risk-taking than caution in her personal choices. But over the course of the pandemic, the President and many of his followers have come to cling to it tightly, even triumphantly, brandishing it as a kind of ideology. In the final weeks of the campaign, they’ve taken the outlook to a new, disturbing place. Erin Perrine, the communications director for his campaign, has faulted Joe Biden for not getting infected, arguing that Trump “has experience now fighting the virus as an individual. Those firsthand experiences—Joe Biden, he doesn’t have those.” Shortly before leaving the hospital, the President tweeted that his own infection had left him feeling “better than I did 20 years ago!” Trump has turned against government scientists with a new ferocity, referring to them as “idiots” and calling Anthony Fauci, the nation’s top infectious-disease expert, a “disaster.” The President has always seemed not to take the virus seriously. But, in recent weeks, something has changed.

An especially telling moment occurred on October 13th. According to the Times, two senior White House officials cited, in a background conversation with reporters, the Great Barrington Declaration—a document that argues for the pursuit of herd immunity through widespread infection instead of a vaccine. Although most Americans haven’t heard of the declaration, many in the medical community have; Fauci captured the consensus view when, speaking to George Stephanopoulos, he called its core ideas “ridiculous.” Although its primary authors are three professors at Harvard, Stanford, and the University of Oxford, respectively, the declaration hasn’t received the imprimatur of a medical or scientific institution; instead, it’s been sponsored by the American Institute for Economic Research, a libertarian think tank situated in Great Barrington, Massachusetts. The declaration proposes that society should stay more or less open and that the virus should be allowed to infect the vast majority of the population while public-health officials focus on protecting the elderly and others who are especially vulnerable. (The details of the protective strategy go unspecified.) Francis Collins, the director of the National Institutes of Health, told the Washington Post that, although the declaration is sometimes presented as a “major alternative view that’s held by large numbers of experts,” it is, in fact, “fringe.” Infectious-disease specialists have signed it, but many of its thousands of signatories are either unqualified or fake (“Dr. Johnny Bananas,” “Dr. Person Fakename”).

The declaration has its roots in the early days of the pandemic, when some scientists asked whether herd immunity—which occurs when so many people have been infected or vaccinated that viral spread becomes unlikely—might be achievable more quickly and less painfully than was widely supposed, and without a vaccine. Perhaps the virus had already spread more than tests indicated, in which case it was more asymptomatic than we thought; perhaps certain people, having previously been infected by other, similar viruses, had some level of preëxisting immunity to it.

These were appealing possibilities. But, as time has passed, persuasive evidence for them has failed to materialize. In New York City, the original epicenter of the American pandemic, the vast majority of the population remains susceptible to the virus, even in parts of the city, such as Borough Park, that have experienced high rates of infection. In the U.S. as a whole, as many as nine in ten people still lack immunity to the virus. In this context, the swift reopening proposed by the declaration would result in a sharp spike in cases, with hundreds of thousands dying and tens of millions suffering serious and debilitating illness. This is likely to occur even if officials try to focus on protecting the vulnerable. The problem, ultimately, is that society cannot be easily divided into separate layers of medical risk. Sweden adopted lighter restrictions while seeking to protect its elderly citizens—and yet the coronavirus found ways around the barriers put in front of it. The country’s COVID-19 death rate is an order of magnitude higher than its neighbors’, and it has not achieved anything like herd immunity.

Throughout the pandemic, Trump and his team have often denied that they are pursuing herd immunity as a strategy. And yet their words and actions have belied their disavowal. “Once you get to a certain number—we use the word ‘herd’—once you get to a certain number, it’s going to go away,” the President told Fox News, in August. At a town hall in September, he promised the audience, “You’ll develop herd, like a herd mentality. It’s going to be—it’s going to be herd-developed, and that’s going to happen.” On October 5th, the day after the declaration was released, its primary authors met with Alex Azar, the Secretary of Health and Human Services, who later said, “We heard strong reinforcement of the Trump Administration’s strategy.” Scott Atlas, a top White House coronavirus adviser, has said that “the thrust of the declaration is exactly aligned with the President.” (Atlas and Jay Bhattacharya, one of its authors, are colleagues at Stanford, where Bhattacharya studies health policy, not infectious diseases.) Speaking on the condition of anonymity, an Administration official told the Times that the White House wasn’t so much endorsing the declaration as acknowledging that the declaration “is endorsing what the President’s policy has been for months.” This is an extraordinary admission—appalling for Americans but perhaps freeing for Trump. He is granting himself license to move into an even higher register of incompetence, not just downplaying the threat but actively encouraging Americans to embrace it.

As a physician, of course, I take the medical view of the pandemic; in a sense, I’ve experienced it firsthand. Caring for COVID-19 patients at the height of New York City’s first wave, I watched as the medical profession, so often fragmented by ego and hierarchy, coalesced around the certainty that any loss of life is a tragedy. Nurses and doctors worked for weeks on end with little respite, often separated from their families to avoid infecting them. Clinicians poured in from across the country to help. Health-care leaders held daily briefings, scrambled for P.P.E., and searched for ventilators. Facilities crews reorganized hospitals. Everyone—even those who weren’t seeing patients—started wearing masks. On the coronavirus wards, we went further, donning goggles, gowns, gloves, respirators, and shoe coverings. Contagious patients were placed in negative-pressure rooms and sometimes seen through telemedicine; infected people who didn’t need hospitalization but couldn’t isolate from their loved ones at home were offered hospital-based housing. Husbands, wives, parents, and siblings died alone. Women gave birth without their partners present. All this was done not out of fear but out of concern. We didn’t want even a single person to get the virus unnecessarily. Our commitment was sharpened by the knowledge that we were witnessing many preventable deaths.

As the virus surged around the country, millions of Americans upended their lives and adopted new habits to protect one another. All the while, the President and his team pursued a different path. Declining to wear a mask or follow basic social-distancing guidance, Trump tweeted about “liberating” states and promoted discredited therapies. Overwhelmed by the task of fighting the virus, he pulled from the playbook of tobacco companies and climate-change deniers, casting doubt on the statistics. The rise in cases reflected only increased testing; the number of deaths had been doctored; the virus’s lethality had been overstated—as his dodges piled up, it became clear that he had no interest in grappling with the reality of hundreds of thousands of deaths.

Atlas, a neuroradiologist without training in epidemiology or infectious diseases, came to the White House at the end of the summer, having spent much of the year offering pandemic commentary on Fox News. He gained regular access to Trump and began wielding greater influence over the Administration’s coronavirus strategy. Atlas has repeatedly voiced skepticism of fundamental public-health principles, such as testing, mask-wearing, and social distancing. (“Everything he says is false,” Robert Redfield, the director of the C.D.C., has said.) Fauci and Deborah Birx, the coronavirus-response coördinator, have confronted him about many of his unfounded claims—among them that parts of the country, including New York City, are approaching fifty-per-cent immunity. But they have been largely sidelined. Trump no longer regularly meets with the White House coronavirus task force; Atlas is now the President’s primary health adviser.

Dr. Anthony Fauci honored by Arthur Ashe Institute at SUNY Downstate

SportsBall, which recognizes notable leaders in sports, philanthropy, business, entertainment, and medicine, supports Arthur Ashe’s Institute’s …
NEW YORK (WABC) — SUNY Downstate Health Sciences University announced Dr. Anthony Fauci will be among this year’s honorees at the 26th Annual SportsBall event, the Black Tie & Sneakers Gala of the Arthur Ashe Institute for Urban Health (AAIUH).

Each year, the Institute honors organizations and individuals who have made significant contributions to health, education, medical research, community service, and philanthropy.

The annual SportsBall gala brings together some of the most influential leaders in sports, business, entertainment and medicine to raise funds that support critical health programs for the Brooklyn community.

Joining Dr. Fauci, officials say this year’s honorees include a posthumous award to Downstate’s beloved Clinical Assistant Professor and Hospitalist Dr. James A. Mahoney, and another, to the Law Firm of Vladeck, Raskin & Clark PC. Former New York City Mayor Michael R. Bloomberg will introduce Dr. Fauci.

“This is a particularly poignant year for us as we celebrate Arthur Ashe’s legacy amid a pandemic that has claimed more than 215,000 lives,” said SUNY Downstate President Dr. Wayne J. Riley. “As America’s most respected infectious diseases expert, Dr. Fauci is the most important voice providing critical guidance during the COVID-19 pandemic. Despite his own underlying health risks, Dr. Mahoney served patients during the pandemic, ultimately losing his life in the battle. The Law Firm of Vladeck Raskin & Clark continues to fight for more equity and diversity in the workplace. We are proud to welcome these esteemed honorees into the Arthur Ashe Institute for Urban Health family. We continue to be grateful for their work on behalf of others.”

SportsBall, which recognizes notable leaders in sports, philanthropy, business, entertainment, and medicine, supports Arthur Ashe’s Institute’s community health and research initiatives. Due to COVID-19 restrictions, SportsBall will take place virtually on Wednesday, October 14, at 7 p.m.

Dr. Fauci has served as the Director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984. He oversees an extensive portfolio of basic and applied research to prevent, diagnose, and treat established infectious diseases such as HIV/AIDS, Ebola, Zika, and, most recently, COVID-19.

RELATED:Fauci says his words were taken out of context in new Trump campaign ad


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How to Make Society’s Risk Capital Riskier

Her model only requires foundation capital for a few years, until there can be information about the performance of the students so investors will know …

(Photo by iStock/Eoneren)

Rob Reich has argued that philanthropic foundations have a special role in discovery and experimentation: As society’s “risk capital,” they can afford to enable innovation in ways that companies and governments can’t or won’t. In response to both COVID-19 and to the global call to address racial inequality and exclusion, philanthropy’s unique role will be more important than ever. But are contemporary foundations wired for their purpose?

The weight of the evidence suggests that they are not. Because they often favor “anti-political” practices that unwittingly entrench unequal power relations, foundation officials are only incentivized to recognize certain solutions, to define certain problems as worthy of addressing, and to see only particular entrepreneurs and organizations as worthy of funding. To be transformational, foundations must maximize their own humility, reduce the tendency to plant flags on—and lay claim to—solutions in silos, and shift internal incentives. More practically, they must optimize for hiring diverse, lateral thinkers, writing the first check, and taking unsolicited applications. And across the board, they should bias in favor of lived experience and away from herd behavior.

The Risk Needed to Build a Global Health Reserve Corps for Africa

To understand the challenges of philanthropic foundations, as currently structured, let’s imagine an African entrepreneur who hears Bill Gates’ famous Ted Talk on preparing for the next global health crisis and is inspired to help build a medical reserve corps, deciding that every African country needs their own Anthony Fauci, and a world-class team around them. Our imaginary entrepreneur is aware of the stiff competition for traditional, dollar-in-dollar-out grant funds, so she decides to innovate on the Pay-for-Success model, to unlock affordable loan financing to African public health and the science, technology, engineering, and math (STEM) students to study at leading programs across the world, both online and on campus. Thousands of African students receive offers to these schools but cannot afford to attend, a missed opportunity for students, investors, and countries. It is also a much needed but missed opportunity to diversify college campuses and pipelines from which global workplaces hire.

However, debt investors will simply not lend to these students at scale without better data. While the African continent will soon be home to the fastest-growing number of 18-23-year-olds in the world—who are going to university in increasing rates—their repayment behavior is not yet known. But because debt investors’ priority is to make a return on their investment, they will worry that African students may not be able or willing to make loan repayments. The money will not come from conventional lenders.

Enabling Potential Through Pay-for-Success

In this scenario, our entrepreneur may decide that foundations are important partners in the short term. She may therefore develop a model through which they can use both their grant and investment capital to remove risk from this market, demonstrate its existence through data, and incentivize additional lending, with positive externalities on both diversity and sustainable development:

In this model, investors are bifurcated. Senior debt is mobilized from private impact investors and banks, conditioned on receiving some downside protection. Our entrepreneur invites foundation mission and program-related investment capital to invest junior debt in a first loss position. She also gets some universities to provide some risk reserve. This de-risking arrangement allows senior debt investors to target their desired return level without passing on the risk premium to the students in the form of a high interest rate.

The outcome payer is also bifurcated. She seeks to raise one part from foundations grants, which can pay for a student’s loan obligations only when, for example, a graduate completes her Hopkins graduate degree and works at the Ministry of Health in Monrovia. (Some US law and business schools already have similar arrangements to incentivize graduates into the public service.) The second part comes from the well-remunerated graduates who choose to work at Novartis or the Gates Foundation, whose loan repayments are income-contingent while targeting a particular rate of return on the debt. These graduates would belong to the upper-middle class of their society.

As in traditional pay-for-success models, the intermediary structures and coordinates the program: partnering with universities that offer target programs, negotiating concessional tuition costs, networking with employers, and critically, managing an SPV for pooled debt. It contracts all service providers needed to run an efficient student financing entity: originators, servicers, and mentors, as well as verify income and employment for the outcome payer, in order to decide the students whose loans convert to grants, and when.

After our entrepreneur pilots a mini-version of the program to demonstrate that the plumbing works, she turns to raising capital in order to lend more and start tracking the data on repayment habits.

She expects foundations to like this approach because it passes three additional tests:

  1. It has a multiplier effect on grant dollars, the kind of innovative financing that is wired to catalyze, mobilize, and crowd in private and public capital. The number of students educated because of a grant in the form of a contingent outcome payment—that unlocks debt that would be otherwise unavailable—will be 2x to 10x the number that would be educated under traditional philanthropy. (The multiplier depends on how many students stay and work in Pfizer vs how many go into a national health ministry.)
  2. The model is autonomy-respecting, avoiding the paternalism of telling a Liberian where they must live. It recognizes that in the knowledge economy of a post-pandemic 21st century, problems will have no borders, and so, solutions to our common problems must come from everywhere. Graduates with the lived experience of Monrovia who choose to settle in Zurich or Seattle can still be part of the global health response corps when the next health crisis breaks out because there will be great value in people who understand the dynamics both at global health macro-level and at the country level in Monrovia.
  3. The model can scale dramatically and can be as useful in South-East Asia and the Caribbean as in Africa. The limit is less how many students can get accepted into the target health and STEM programs, and more how much capital private investors are willing to commit, which, in early days, depends on how much foundations are able to support a genuinely pioneering approach to social change.

Our entrepreneur has done everything she could be asked to do. But she is likely to receive little to no support from foundations. Even plain vanilla pay-for-success programs are relatively new, but the challenge goes beyond a new approach, into broader anti-political practices of many foundations that stand in the way of innovation.

Below are three barriers to innovation that our entrepreneur will encounter, and suggestions on how they might be corrected:

1. Silos and a Lack of Lateral Thinkers

The first meeting our entrepreneur is likely to have is with the education program officer. For an Anthony Fauci in Burundi, Eswatini, and every last country in the world, we need to invest in relevant graduate degrees. But in a typical foundation, the portfolio of international projects tends to focus on primary and secondary education. The very few cases that focus on tertiary education are usually domestic, and the program officer is likely only authorized to commit foundation grants. Thus, even if our entrepreneur gets through the door armed with a warm introduction (more below), she is likely to be tuned out when she talks about grants to be used as contingent outcome payments for students who work in the public sector in low-income countries, or program-related investments to be used as downside protection to train a world-class health workforce. The officer with a great grasp of education and its inequities, will not likely extend to financial innovation or what human capital the health sector might require, and will decide that this is not in his wheelhouse, and point the entrepreneur in the direction of the health team (if there is one).

With few exceptions, foundations do not invest in human capital for health and science. The health team will likely have experience funding the building of innovative gadgets and the planning of meetings about those innovations, but not people who can be shaped to be the future inventors of those gadgets. The few who fund human capital for health might support community health workers, or research on, and hold meetings about the subject of human capital—such as which categories you need or how to measure whether the competencies are met—but they will not provide guarantees to allow investment capital to pay for the master’s education of the next world-leading virologist. That is an education issue, but since it would be absurd to send her back to the education team, our entrepreneur will be passed on to the financial inclusion team.

The solution? Foundations need more lateral thinkers. They need diverse people whose real life has exposed them to a multiplicity of disciplines lived experiences. Program officers should be rewarded for identifying collective outcomes that provide ladders to shared prosperity, championing programs that need more than one team, and for uncovering deals that unlock private financing from both inside the foundation and outside it, rather than just for spending down their time-bound budget. A checklist for selecting programs should be to interrogate their biases by weighing heavily the types of programs they would NOT have identified pre-COVID.

2. Herding and Traction

Months later, when our entrepreneur finally gets on the calendar of the financial inclusion team, she will be relieved to find that they are comfortable with the idea of lending. But she will soon discover that financial inclusion only refers to the bottom of the pyramid, for the basket weaver, not for the woman who might one day build a woven basket industry with supply chain to Target and Burberry’s (using her global connections together with her lived experience to create other pathways out of poverty that do not include charity). She will find that financial inclusion teams are comfortable financing organizations that offer micro-credit loans (a ceiling of a few hundred dollars) and those that support small- and medium-sized enterprises, not in unlocking funding for education for Africans, at world-class universities.

As our entrepreneur continues on, she meets the Program Related Investments and Missions Related Investments teams. Her model only requires foundation capital for a few years, until there can be information about the performance of the students so investors will know how to price the risk. And this team, finally, gets it: They know the structures and the vocabulary and have written case studies about how they use their downside protection dollars to incentivize investors into low-income housing. However, they will not have seen a use case of education, for Africans, in tertiary education: They inhabit a world where “world-class education” and “African” do not sit comfortably with their idea of what their capital is for. They struggle with uninterrogated, received wisdom about African brain drain that they might not hold about any other region of the world, wisdom inconsistent with the direction of travel that Africans might want for themselves. They are likely to end her journey with regret that, even if human capital is a cross-cutting enabler, they nonetheless only invest narrowly in areas of existing programmatic grant giving, and since the foundation does not have a grant-giving portfolio for students, their hands are tied.

The few who will entertain her will ask to see traction in the form of a robust loan book, perhaps a couple of million dollars’ worth of lending to this group of students. Never mind the inconvenient data about how many women-led entities raise that level of funding, much less minority women. Or the fact that such a loan book would mean someone else outside the “accountability regimes” of the market or the ballot box—meaning, another philanthropist—would have to have already written that high-risk check; they will still ask. But if every foundation asks the entrepreneur to somehow have already found a million dollars before she knocks on their door, it will only be a matter of time before she exits the Kafkaesque situation and gives up.

The solution? Foundations should clamor to write the first check, and reward staff who uncover deals on which there is no herd. The usual checklist we use to measure traction—how much raised and who from are technocratic and anti-political, reinforce existing structural inequalities, and have no place in justice-supporting philanthropies. Demanding a pilot of significant size only serves to perpetuate the status quo, because the wealth of “friends and family” it takes to make “meaningful” progress possible are not evenly distributed. When we engage in herd behavior, we are saying that entrepreneurs with more grit than privilege and that tend to reside outside existing power structures—which are also racialized—are not valuable sources of innovation. We are making choices about who gets to propose solutions for our problems, and therefore what kinds of problems get made visible and solved.

3. The Need for a ‘Warm Introduction’

In many cases, the journey made by our entrepreneur above will not even begin, because she will need to have a warm introduction from a trustee in order even to get through the door. Many foundations do not take unsolicited applications, justifying it as a way of managing their busy inbox. Others see it as a signaling mechanism: If an entrepreneur is good enough, or the problem she’s solving is important enough, she’ll surface.

But we intuitively know that this logic is wrong. It flattens all the structural reasons why the world looks as it does, and while some philanthropists justify herding as beneficial in sharing due diligence, the benefit in saved time is significantly outweighed by the cost in the lack of diversity in the field whose playing ground is historically exclusive, in both investment dollars and in philanthropy. And the inertia of past practice leaves this anti-political gatekeeping tactic intact.

The solution? Foundations should welcome unsolicited applications. They should have the humility to realize that there are worthy problem solvers in networks outside their own. The cost of hiring additional people to scout the field and review the proposals submitted online is worth it in the innovation it will surface. Indeed, the global call to address the exclusion of people of color requires foundations to hire a Chief Gate Opener, a senior official who is different from the majority of the foundation, and whose mandate is to constantly highlight what justice might require for the demographic groups the foundation seeks to serve.

Innovation Matters

By many accounts, foundations are underperforming in the delivery of social pioneering. Foundations should undertake the exercise of following the journey of the entrepreneur and ask themselves: If an opportunity like this knocked on their doors, would they, with their current structures, fund it?

As we work our way through the current crises, few strategies are more valuable than foundations welcoming ideas from outside the box. The guiding principle should be something like this: If a program is completely outside your normal pattern recognition universe, rather messy and hard to pin down in one sector, and if it could, if wildly successful, conceivably lead to diminishing your own importance because it would be taken up by the market or government, then you are on the right track. If, on the other hand, it’s the social equivalent of the next food delivery app presented by a younger version of yourself, your innovation has failed. Stop and reassess.

CrowdStrike APJ Report Reveals Nearly 3 out of 4 Business Leaders See Cybersecurity as a Top …

SYDNEY–(BUSINESS WIRE)–CrowdStrike® Inc. (Nasdaq: CRWD), a leader in cloud-delivered endpoint protection, today announced the release of …

Promising HIV Vaccine Comes Up Short As Study Finds It Was No More Effective Than Placebo

On Tuesday, Andreessen Horowitz launched its third fund dedicated exclusively to health and biology. Biofund III, as the $750 million investment …

CNN: HIV Vaccine Trial Ends In ‘Deep Disappointment’

“An HIV vaccine is essential to end the global pandemic, and we hoped this vaccine candidate would work. Regrettably, it does not,” Dr. Anthony Fauci, director of the NIAID, said in a written statement on Monday. “Research continues on other approaches to a safe and effective HIV vaccine, which I still believe can be achieved,” he said. (Howard, 2/3)