On the menu today: HIPAA, the American Medical Association’s code of ethics, and other factors that prevent the president’s doctor, Sean Conley, from revealing too many details of President Trump’s condition without the patient’s permission; wondering just how reliable the rapid tests used by the White House are; Andy McCarthy elaborates on FBI director Christopher Wray and his definition of Antifa; and a painfully plausible commercial in the sports world.
Why the President’s Doctors Can’t Lay Out Every Detail of His Condition
In 1996, Congress passed the Health Insurance Portability and Accountability Act, or HIPAA, which took steps to ensure patient privacy and set rules for the handling of “protected health information.” Personal health information is exactly what it sounds like — medical history, test and laboratory results, clinical notes, insurance information and other data that a health-care professional collects in the process of providing care. HIPAA applies to the president’s doctors, and under the law, the president is entitled to the same right to privacy as every other American citizen. We can argue about whether that should be the case, but that is indeed the law right now; there is no presidential exception to HIPAA.
In addition to HIPAA limitations, the American Medical Association’s code of ethics declares, “Physicians have an ethical obligation to preserve the confidentiality of information gathered in association with the care of the patient . . . In general, patients are entitled to decide whether and to whom their personal health information is disclosed.” The exceptions listed are when the doctor is required by law or when “the patient will seriously harm him/herself or the patient will inflict serious physical harm on an identifiable individual or individuals.” There is no exception listed for when the patient is the president of the United States and there is great public interest in his condition.
In other words, the president’s doctor, Sean Conley, can only release information the president is comfortable releasing. (We can surmise that if the president is telling his doctor not to release certain information, that the president is awake and alert.)
The fact that the president is tweeting again this morning, in ALL CAPS, is another good sign. In at least one habit, he seems very much “back to normal.” Those stretches of Twitter silence this weekend were a little ominous. We know this guy; we’ve been living under him as president for almost four years now. If he’s awake, he’s tweeting.
On Sunday, the president’s doctor said: “late Friday morning when I returned to the bedside, the president had a high fever and his oxygen saturation was transiently dipping below 94 percent.” Conley later elaborated “about 93 percent” and “it wasn’t down in to the low 80s or anything, no.” He did say, “I was concerned for possible rapid progression of the illness.” You want your blood oxygen level to be somewhere between 95 and 100.
You’re going to hear a lot of doctors and medical students of Social Media University make sweeping conclusions about the president’s health. A few pieces of common sense:
- Each day the president’s condition doesn’t worsen is a good sign, and further indication he will pull through. He’s in a top-tier medical center with the best doctors and every piece of equipment and every treatment they could ever want.
- The president is a 74-year-old man who suffered drops in his blood oxygen levels and “a high fever,” and his doctor was “concerned for possible rapid progression of the illness.” This is not something that can be hand-waved away as mere precautions.
- The president wouldn’t be in the hospital if people responsible for his health didn’t think he needed to be there, and he wouldn’t be given these medicines — the Regeneron treatment, remdesivir, and dexamethasone — if they didn’t think they were necessary or a good idea to help with recovery.
What has people raising their eyebrows about the use of dexamethasone is this:
The effect of dexamethasone was most striking among critically ill patients on ventilators. Those who were receiving oxygen therapy but were not on ventilators also saw improvement: their risk of dying was reduced by 20%. The steroid had no effect on people with less severe cases of COVID-19 — those not receiving oxygen or ventilation.
Shortly after the results were released, the UK government announced that it had immediately authorized the use of dexamethasone for patients hospitalized with COVID-19 who required oxygen, including those on ventilators. The researchers say that they are also sharing their findings with regulators in the United Kingdom and internationally.
There is this odd and somewhat absurd futility in attempting to spin the president’s condition as better or worse than it is; as Trump said of the pandemic death toll: “It is what it is.” If, God forbid, the president doesn’t pull through, or he has lingering health issues because of his fight with the virus, there won’t be any way to put a positive spin on those scenarios. If, in the coming days, the president walks out of the hospital and returns to the White House in visible full health, his recovery will be clear, and no one will be able to argue the doctor’s assessments were excessively optimistic or misleading.
When Was the President Infected?
Ideally, by now we would have a complete and accurate timeline of the president’s recent coronavirus tests, so that contact tracers could identify a window when he was infected and figure out who he caught the virus from — to ensure others who have been in contact with this person are informed, and also to determine where the protective efforts have failed. Trump may have caught the virus from Hope Hicks, or it may be someone else.
This report, in the Wall Street Journal, is troubling. The whole point of contract tracing is to quickly notify those who have been exposed to a potentially contagious person. There is little or no indication of a swift and comprehensive contact-tracing effort going on:
President Trump didn’t disclose a positive result from a rapid test for Covid-19 on Thursday while awaiting the findings from a more thorough coronavirus screening, according to people familiar with the matter.
Mr. Trump received a positive result on Thursday evening before making an appearance on Fox News in which he didn’t reveal those results. Instead, he confirmed earlier reports that one of his top aides had tested positive for coronavirus and mentioned the second test he had taken that night for which he was awaiting results.
“I’ll get my test back either tonight or tomorrow morning,” Mr. Trump said during the interview. At 1 a.m. on Friday, the president tweeted that he indeed had tested positive.
As the virus spread among the people closest to him, Mr. Trump also asked one adviser not to disclose results of their own positive test. “Don’t tell anyone,” Mr. Trump said, according to a person familiar with the conversation.
The White House uses rapid tests, Abbott Laboratories ID NOW COVID-19 tests, and those tests can give false negative results. One study in August concluded that the ID NOW test catches 74 percent of positive samples — meaning about one in four is not caught.
I initially wondered if the rapid tests created a sufficient number of false positives, so that an initial positive rest turned into the equivalent of a car alarm — an emergency alert that occurred so often in so many non-emergencies, that people started to tune them out. But apparently the rate of false positives is pretty darn rare, no matter what the test is; a false positive usually indicates a cross-contamination at the lab doing the testing.
Unfortunately, it appears the testing at the White House offered a false negative, probably at the ceremony for Amy Coney Barrett. And the attendees, believing everyone in attendance had tested negative, let their guard down and did not practice social distancing.
‘We Can’t Delude Ourselves into Thinking We Can Beat It by Taking Out Any Particular Organization’
Over the weekend, our Andy McCarthy elaborated on how FBI director Christopher Wray’s assessment of Antifa is being misstated and misconstrued by Joe Biden and other Democrats:
Wray is not denying that Antifa is infecting and driving violent anti-American anarchists. Those anarchists, he indicated, include collections that range from ad hoc groups of individuals who self-identify as Antifa to more regimented “nodes” that are “coalescing regionally.”
Does that sound familiar? It should. On a global stage, it mirrors in many ways the Muslim Brotherhood. Not a precise reflection, but it is similar (and bear in mind that these movements are in very different stages of their historical development) . . .
Regarding Antifa, what Wray appears to be saying is that, if the FBI is going to counter Antifa effectively, it has to recognize, first and foremost, the ideological thread that knits all the militants together. You can’t kill it by arresting ten guys in balaclavas mixing Molotov cocktails in Portland.
If that is the FBI’s logic, it’s not only right; it is progress . . .
Chris Wray is right. He is not saying that the FBI is making no cases on violent insurrectionists who are driven by Antifa’s anti-American ideology. He is saying that if we’re confronted by a movement, and we want to protect the country, we can’t afford to delude ourselves into thinking we can beat it by taking out any particular organization. It’s bigger and more insidious than that.
ADDENDUM: Yes, everyone, I saw the Forgetitol commercial on Fox Sports this weekend. Thanks for asking.