In an interview with STAT, Gates sounded exasperated at times as he described the badly bungled launch of Covid-19 testing, the enlisting of a neuroradiologist — rather than an epidemiologist or infectious diseases specialist — to help guide the White House’s response decisions, and the recent move to discourage testing of people who have been in contact with a known case but who aren’t yet showing symptoms.
“You know, this has been a mismanaged situation every step of the way,” Gates said in the wide-ranging interview. “It’s shocking. It’s unbelievable — the fact that we would be among the worst in the world.”
He leveled his harshest criticism at Food and Drug Administration Commissioner Stephen Hahn, who mischaracterized findings from a Mayo Clinic study on Covid-19 and said researchers had seen a 35% survival benefit with the use of convalescent plasma. “Many of you know I was a cancer doctor before I became FDA commissioner,” Hahn said at the time. “And a 35% improvement in survival is a pretty substantial clinical benefit.”
“This is third grade math. I mean, are you kidding?” Gates said. “The head of the FDA got up and said it was a 35% death reduction where it’s not even a 3% reduction based on just a tiny little subset that was nonstatistical. This is unheard of.”
In fact, there are no data from randomized controlled trials to indicate whether convalescent plasma — an antibody rich blood product created from blood donations from Covid-19 survivors — actually increases survival. The as-yet unpublished Mayo Clinic study only reports that Covid patients who received plasma infusions with high levels of antibodies fared better than those whose plasma infusions contained lower levels of antibodies.
Hahn later said wider criticism of his remarks was “entirely justified,” and acknowledged his misstatement.
Early in the outbreak, as it was becoming clear the new coronavirus was spreading from China, experts from the Bill and Melinda Gates Foundation were in regular contact with the Trump administration, urging officials to come up with a plan for who to test and how to test them, and to get surveillance data up on the website of the Centers for Disease Control and Prevention.
Gates said from the start the foundation insisted that commercial laboratories should only be paid for their work if they returned test results within 24 hours — a target rarely reached in the U.S. response. Anything longer than that meant the tests were not useful for containing spread of the virus, he said, adding: “You get to write apology notes to the people you infected in the meantime.”
This advice still isn’t being heeded. “I’ve been saying this and I just don’t get why it hasn’t changed,” Gates said.
The CDC’s early missteps on testing — “they created this overly complicated test,” Gates said — was followed by a slow rollout of commercial tests. The commercial tests use polymerase chain reaction, or PCR, to look for small fragments of the genetic material of the virus in mucus swabbed out of the nasal passages of people who are tested.
“We have way more PCR machines than any country in the world. I mean, we are PCR central,” he said with emphasis. “So, the idea that we actually made it harder to get PCR tests approved by the commercial sector, it’s mind-blowing.”
Gates is also perplexed as to why testing is still being conducted using nasopharyngeal swabs — an unpleasant procedure that people liken to having your brain stabbed. The Gates Foundation led research that showed swabs circled in the nostril were as accurate and far easier to administer. They also don’t trigger bouts of coughing that can spread the virus.
“But even today in this country, that’s not 100% [of the tests],” Gates said. “So, you have health care workers getting coughed on and people are reluctant to take the test because of that obsolete approach is still quite prevalent.”
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Likewise, Gates could not believe the administration’s recent move to rewrite CDC testing guidance to state that people who weren’t displaying symptoms didn’t need to be tested. Experts said the revised recommendations will make it harder to find and isolate people who are just becoming infectious — undermining efforts to limit spread of the virus. “It blows the mind,” Gates said.
The new advice reportedly had the support of Scott Atlas, a recent addition to the White House coronavirus task force. Atlas, a neuroradiologist and a public policy fellow at Stanford University’s Hoover Institution, has reportedly been advocating a policy of allowing the virus to spread unchecked so the country can reach herd immunity quicker.
Gates is not a fan. “The administration’s now hired this Stanford guy who has no background at all just because he agrees with their crackpot theories.”
Although Gates has spoken to President Trump about a number of health issues before the pandemic — and the importance of preparedness — he said his “most active communication” these days is with Francis Collins, the director of the National Institutes of Health, and Anthony Fauci, the director the National Institute of Allergy and Infectious Diseases.
Gates did credit the administration for the work it has done to fast-track development of Covid-19 vaccines, through the initiative known as Operation Warp Speed. Even there, though, he feels the administration’s unwillingness to support efforts to help low- and middle-income countries to buy pandemic vaccine is self-defeating.
He has been pressing Congress to contribute $4 billion to Gavi, the Vaccine Alliance, to help finance that work and an additional $4 billion to the Global Fund to Fight AIDS, Tuberculosis, and Malaria to help low- and middle-income countries access Covid-19 tests and therapies.
“We did a good job funding R&D [on vaccines], but … we’re not getting any credit for the R&D funding,” Gates said. “All you have to do is the four plus four, $8 billion total. And then people will see, even though the U.S. made some mistakes, at least our desire to cooperate, help others and use our R&D capacity, at least, you know, they’ll see it in a positive light.”