Theory versus reality: The mayhem Trump's first week *did* and *did not* cause in public health.

An update on what's really happened, as of January 27th, 2025.

Many HIV tests in Uganda are funded by PEPFAR. Getty Images/Anadolu.

President Trump stifled, interfered, and otherwise rendered important public health resources within his own government less effective and efficient last week, through a slew of executive orders. The stated rationale was to give the new administration time to look things over. But none of these actions was required to do that. You don’t need to ground all airplanes to study the airline industry. Instead, these actions just caused chaos and confusion (at best) and immediately harmed people (at worst).

On the political extremes, I observed two reactions (even among people on the Right who ostensibly support and believe in many government efforts in public health):

The Left: “Everything is terrible, people are dying right now because of this.”

The Right: “This is fine because nothing bad has happened yet. Just relax.”

So what actually happened? Theory versus reality. Let’s go Inside Medicine.

Has the gag order suppressed public data? Yes. Real impact.

The federal public health gag order that went into place on January 21 implied that government websites that publish public health data would not be updated—things like Covid, influenza, RSV, and norovirus surveillance. Bird flu trackers were also under threat, which was pretty bad timing considering New York just joined the states with cases in poultry.

Meet my friend Dr. Carter Mecher.

Few people poke around public health and disease datasets with more interest, dexterity, and commitment than my friend Dr. Carter Mecher. (If you don’t believe what a force of nature he is, just ask Michael Lewis. Carter is a major reason many of us are alive right now.) To my delight, Carter occasionally sends me (and others in his tight network) detailed memos describing his latest insights from whatever obsession happens to be occupying the high-powered super-processor that occupies the real estate situated in his prefrontal cortex.

With permission, here are excerpts from a few emails from Carter in recent days (edited, amended, and addended by me): Per Carter: “I have seen the concerns from a number of high profile public health folks regarding the pause in reporting surveillance data by HHS/CDC. Their greatest concern (understandably) seems to be related to H5N1. So, I was curious and went back to the sources I usually follow and found that were are being kept up to date (last update for most sources was Thursday, 1/23). That means a lot of information on H5N1 is readily available and as current as it has ever been over the past year.”

So that’s good. But from there, it’s a mixed bag. Here is Carter’s list (with some updates/addendums and reorganization by me):

Data websites that were updated after the January 21st gag order.

1. CDC Wastewater (flu, RSV, SARSCoV-2, mpox): Last update: 1/23. From this data one can see where in the country the latest positive tests are for H5N1 bird flu. But you can also click on the various tabs to see trended data for influenza, RSV, mpox, etc.

2. USDA Highly Pathogenic Avian Influenza Confirmed Cases in Livestock: Last update: 1/21. [Faust addendum: Carter said 1/23, but I think that’s actually not right. The website says 1/16 and I know this is wrong. Crazy that we have a website that is not even correct about its last update, but data degrades quickly.]

3. CDC RESP-NET (Influenza, RSV, SARS-CoV-2 hospitalizations): Last update: Friday 1/24 (thru MMWR Week 3). You can see trended data for influenza, RSV, and SARS-CoV-2. You can also get RSV-NET data on its own site.

4. CDC Respiratory Virus Activity Levels: Last updated 1/24. These data include respiratory activity maps, wastewater trend maps, epidemic trend maps, percentage of ED visits, and percentage positive tests for Influenza, RSV, and SARS-CoV-2): https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

5. CDC Respiratory Illnesses Data Channel [Added by Faust]: Last updated 1/24. National overview of respiratory illnesses, including emergency department visits. You may have seen these visual reports in other online resources, as they are quite popular.

Data websites that were not updated after the January 21st gag order.

Per Carter, “the CDC is not refreshing or updating other sites that incorporate this data into the more prominent sites that most people are familiar with.” Those include:

1. CDC COVID Data Tracker (usually updated on Mondays and Fridays): Last update: Prior to gag order, likely 1/17 or 1/20.

2. CDC FluView (usually updated every Friday at noon): Last update: 1/17.

3. CDC RespVaxView [added by Faust] (updated on Wednesdays): Last update: 1/15. This site provides access to Covid-19, flu, and RSV vaccination dashboards, including data by age.

Weird stuff in data updates.

Then there are strange inconsistencies that Carter found. “Wastewater data from CDC is thru 1/18 and was last updated 1/23. But the COVID wastewater data from the CDC COVID Data Tracker site is only through 1/11 (a week earlier). I can say the same for some flu data.”

“Also vaccine data. Why is the vaccine data updated on this site (updated Friday 1/24 with data through 1/18) but not on the more familiar site (data through 1/14)?”

[Note: Do you not already appreciate how great Carter is? To know him is to be his huge fan].

Overall data assessment.

Carter’s overall take on the state of public data in light of the Trump gag order is this: “It looks like there is no blanket pause on all data. A little odd that the updated data is on one CDC website and not on another. I think the CDC COVID Data Tracker site and the CDC FluView site are better known and serve as go-to sites for most people for Covid and flu data/information. I suspect that some of the sites listed above are lesser known (except the wastewater sites).”

In other words, we both think that the inconsistencies come from a combination of confusion in the agencies and some degree of PR decision-making wherein the most prominent public-facing datasets are not being updated, while some more wonky ones are. There may be more to it than that, though. My colleague and friend Dr. Katelyn Jetelina pointed out to me that the CDC categories data in terms of priority. It may be that some websites fall into certain categories, even though they contain data that overlap with ones placed in others.

Bottom line: It’s a mess, but things are better than I feared they might be.

Does the halt in foreign aid hurt people yet? Yes. Real impact.

I saw some Trump apologists saying that the sudden and inexplicable halt in foreign aid that funds PEPFAR (the US program that has saved >20 million lives from HIV/AIDS) is only a problem “on paper.” In other words, as far as they’re concerned, the programs have enough resources to carry on for the 90 day (and maybe 180-day) period during which programs like these are apparently being reassessed.

Not so, it seems. Yesterday, in my impromptu Q&A with Dr. Atul Gawande (who completed a three-year stint as the lead for global health for USAID (the United States Agency for International Development, which collaborates closely with the State Department) pointed out that the “stop work order” means that clinicians, say, in South Africa who dispense life-saving antiviral medications are not permitted to go to work. So, even though the money may not have run out yet, any US employee who helps administer the programs that PEPFAR runs can’t do their job. That means that someone who was supposed to get a refill on their meds would not be able to get them. So this is very real. It is not hypothetical.

Meanwhile, NPR reported other immediate effects. Here’s an excerpt from their story:

"They've thrown a grenade right into the middle of foreign assistance. People's lives around the world are jeopardized." This individual asked for anonymity fearing retribution against their organization for speaking out.

"We will probably have to pull our staff providing critical services in the field and lay off US staff," the leader told NPR. "We can't afford to keep funding our programs because we don't know if we will be reimbursed per our contracts with U.S. agencies."

Again, real impact. Not next year. Not next month. Not next week. Now.

Why would we do this?

People I heard from overseas assumed either that the US is cruel or has simply run out of money. I really don’t think that’s the message the Trump Administration really means to send. But that’s the message going out and it’s damaging our reputation in addition to harming people we’ve committed to helping.

NIH research starts grinding to a halt. Real impact.

The gag order on communications and meetings to adjudicate research proposals at the NIH also includes purchasing research supplies, CNN reported. This directly contradicts Trump Administration sycophants who claimed that the halt was not a real problem (especially if it led to reform in how NIH grants are decided) and that when it resumes (which could be as soon as next week), everything will be fine, and nothing bad will have happened.

Let me be clear here: the inability to purchase research supplies could mean that precious biological resources and reagents could be ruined in a matter of days. Some of these experiments take weeks or months and supplies are not always on site or deeply stocked. A simple example: food for animals that are used in research. Animal research is a highly delicate endeavor and the ethics of conducting it depend on the concept that nothing can be wasted. Animal research is a massive responsibility. If researchers cannot feed the animals in their charge because of some ill-conceived punitive executive order, I would say that we are the animals.

Some of the projects that are delayed.

I thought it might be useful for you to know what kinds of research the NIH considers funding that is now being delayed by the cancellation of meetings that fall under the gag order. I spoke to a few colleagues who are slated to have grants considered and for whom these delays may harm their careers.

• Research on acute respiratory distress syndrome (ARDS). ARDS is a life-threatening condition that arises from many problems (including Covid-19 and influenza).

• Equity in diagnostics in outpatient settings. (This project received an earlier evaluation making it likely to be funded. But with the delay and the administration’s distaste for anything that has anything to do with disparities, it’s probably toast.)

• Research on how to speed up healing from ACL injuries. This may not be cancer or heart disease research, but it is this type of innovation that makes the US the envy of the world.

For more on this, check out this piece on MSNBC.com by my colleague and friend Dr. Esther Choo.

A Kafkaesque attack on DEI officers.

One of the weird things that happened last week was President Trump firing anyone in any position focused on DEI within the federal government. Keep in mind that many people in these roles were not hired to do DEI work. Rather, they were career officials already working as experts in the various agencies who took on DEI leadership roles when they were created. So, this is not just firing people who were hired for a job that the Trump administration does not want done; it’s firing people who had other expertise relevant to those agencies before they moved to their DEI-centric roles. This, my friends is a brain drain.

ICE Update.

ICE (US Immigration and Customs Enforcement) is now permitted to enter hospitals. As I wrote before, this is an awful idea. Is it happening? Well, at least one physician reported it happening in a BlueSky post, but I have not seen this confirmed.

Meanwhile, other physicians like Dr. Alyssa Burgart have taken to Substack to write about how to handle these situations, if they arise.

Theory versus reality: Overall impressions.

The effects that President Trump’s executive orders are having are already noticeable. In some instances, impacts are milder than feared. In others, they are as bad as they sound, if not worse. One thing is certain: None of this has achieved anything good.