It is unfair to lay all of the blame on Trump for some of the problems that have arisen in the last month, but with a more aggressive and proactive approach in January and February, we would probably be in far better shape.
After all, US policymakers and health officials have had previous scares whether it be Ebola or H1N1 where new diseases arose that could have become huge threats. That is not just a failure of Trump but of Clinton, Bush and Obama.
We have been fortunate so far that previous viruses were not nearly as contagious as coronavirus—but our luck has run out and we are caught without an effective plan, safety net, or response.
Problem 1: Downplaying the risk and not listening to the scientific community early on
On January 22, when the first American case was announced the day before, President Trump was asked, “Are there worries about a pandemic at this point?”
His response: “No. Not at all. And we have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.”
But even at the time he was wrong—the virus had spread to four other countries, China was taking drastic measures and closed off the city of Wuhan.
Had he taken the threat seriously enough to plan, we would have had nearly six additional weeks to address many of the next things on the list. Instead he repeatedly told the country that this was no worse than the flu—and even spread conspiracy theories and suggested it was a hoax.
On January 31, he said that “we pretty much shut it down coming in from China.”
On February 10, he said, “Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”
On February 19, he said, “I think the numbers are going to get progressively better as we go along.”
On March 6, he said, “There is no testing kit shortage, nor has there ever been.” That was a false statement. There had been a problem with the testing for over a month. That speech was filled with inaccurate and misleading statements by the president.
Problem 2: Testing shortfalls
The testing shortfall is really the first key problem. Yesterday, the NY Times ran an article, “Aggressive screening might have helped contain the coronavirus in the United States. But technical flaws, regulatory hurdles and lapses in leadership let it spread undetected for weeks.”
This was a critical failure because, as the virus spread between late January and early March, had they been able to test people they might have been able to contain the virus before it spread like it has.
Writes the Times, “[L]arge-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels…”
The result was “a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.”
Problem 3: Failure to implement stay-at-home orders
This week, he stunned many by calling for an Easter return to normal. The reality is that the president can say whatever he wants, but the states that have imposed their own orders are going to follow the advice of the health experts and, as we saw yesterday, even a state like Kansas, which currently has just 200 cases, is implementing the order.
Does early and aggressive stay-at-home orders work? We can see from California compared to, say, New York that it does. California currently has 5500 identified cases (again, we are hamstrung by the lack of testing). New York with half the population has 53,300.
California in absolute terms has the third most, but when you consider population California has done remarkably well.
About 20 states have 1000 or more cases. It may have started in coastal and urban states, but we are seeing more and more midwestern and rural states impacted.
The number of deaths doubled from 1000 to 2000 in just two days.
Instead of opening things up, we need to shut things down to prevent the spread. This week Trump already said he won’t do that and it is going to be left up to the states to decide—at least for now. More critical time to slow the curve is being squandered.
Problem 4: Ventilators
This is a ticking bomb. At least for much of the country.
Nothing really illustrates the problem with ventilators more than the order to GM to produce more ventilators. The problem of course is that when he finally issued the order, first, GM had already agreed to do it (he then criticized GM for wasting time) and second, the order really comes a month too late to make a difference.
Here again is an issue that if he had acted on January 22 instead of downplaying the threat, he might have been able to avert the problem.
Again, he got caught flatfooted.
President Trump said: “Where you have a problem with ventilators, we’re working very hard trying to find — nobody in their wildest dreams would have ever thought that we’d need tens of thousands of ventilators. This is something that’s very unique to this, to what happened.”
But as CNN reported yesterday, there are “10 government reports from 2003 to 2015, federal officials predicted the United States would experience a critical lack of ventilators and other lifesaving medical supplies if it faced a viral outbreak like the one currently sweeping the country.”
In other words not just President Trump but the administration itself should have known this would be a problem. And again, this is not just on President Trump—President Bush and President Obama have some blame here. But on January 22, President Trump had the tools to know that ventilators would be a problem and failed to act.
California is moving in the right direction. The governor announced yesterday, “At the onset of the pandemic, California had approximately 7,500 ventilators across its hospital systems.”
The state set a goal of adding an additional, 10,000 ventilators.
So far, the state has added 4,252 ventilators, approximately 1,000 of which needed to be refurbished.
The governor announced, “Through a partnership with the state, Bloom Energy is working to refurbish ventilators in real time. Yesterday, Bloom Energy refurbished 80 ventilators and it expects to refurbish an additional 120 ventilators today.”
The bottom line message here was important. Governor Newsom on Saturday expressed confidence that California will produce sufficient ventilators to meet projected needs, but, at the same time, he cautioned that the state’s need could expand significantly if the public doesn’t maintain social distancing and the crisis worsens.
Problem 5: Failure to create temporary hospital space in advance of the flood
New York in a lot of ways is our own Italy. The reality is that both have a critical problem—lack of resources and hospital space.
The key problems are going to be the rationing of lifesaving equipment and interventions.
“These decisions run counter to everything that we stand for and are incredibly painful,” wrote Meredith Case, an internal medicine resident at Columbia/New York-Presbyterian Hospital, in a March 25 Twitter thread. “Our ICU is completely full with intubated Covid patients. … We are rapidly moving to expand capacity. We are nearly out of PPE. I anticipate we will begin rationing today.”
Experts now warn that New York City hospitals are basically at capacity and the peak may still be three weeks away.
As a side point to how ill-prepared the administration is: earlier this week, Trump said his goal was to open things by Easter. Yesterday, he started the day by proclaiming that there would be a quarantine of New York. He did this, reportedly without consultation of his advisors, and then by the end of the day, he flipped and they announced a travel advisory.
Problem 6: Stimulus could have been used for triage and other response
The economy is a key concern. The US passed a $2 trillion stimulus plan. But that largely means that some Americans will get a one-time check. While both parties passed this, I would argue this approach is next to useless.
A $1200 check is not going to do much for the economy. Hey, it’s a nice to have thing, if you get it—and a lot of people won’t.
But they could have done something more profound—taken people who were laid off and hired them to help distribute food and triage the sick coming into the understaffed and overworked health care system.
The people impacted by this don’t need a one-time handout for a six-month crisis, they need an income stream and the stimulus package could have been used to provide one.
How bad will this thing get? It is hard to know. There are really three numbers I am watching right now. The New York cases and when the pandemic starts to peak there. The California cases and whether we can continue to keep the rate of spread low. And three, what happens in the smaller and more rural states.
I think if we can get enough testing capacity, ventilators with a general stay-at-home directive, we can still reduce the curve here. But the numbers nationally are bad and getting worse.
—David M. Greenwald reporting