Crises have a way of sorting the good presidents from the bad.
Historians consistently rank Abraham Lincoln and Franklin Delano Roosevelt among the top three presidents for their handling of the Civil War, the Great Depression, and World War II.
By contrast, the string of catastrophes that trailed George W. Bush, from Iraq to Hurricane Katrina to his obliviousness to warning signs in the housing market before the 2008 crash guarantee that he will have a permanent place in the bottom tier of presidents.
Also certain to be at or near the bottom of that list is Donald Trump.
Trump has been able to maintain 40% approval ratings by riding his predecessor's economic coattails and effectively manipulating the lizard brains of white Republicans, but even before the coronavirus hit, Trump was considered one of the worst presidents in the two surveys of scholars done in 2018.
Trump's attention to the coronavirus crisis since declaring a national emergency on March 13 has helped mitigate the damage, but his failures of governance from January 3 (when the administration claims to have first become aware of the virus) until March 13 made the situation exponentially worse than it should have been. With two thousand Americans dying every day and reported cases in the States increasing by a hundred thousand each week, we are only now beginning to grasp the depths of human misery unleashed by Trump's inattention to the coronavirus for those ten long weeks.
This story starts, as many tales of Republican incompetence do, with sheer ignorance and lack of curiosity. Ronald Reagan was able to ignore the AIDS crisis for years because it was "a gay disease" and didn't impact anyone close to him until his old Hollywood acquaintance Rock Hudson asked for—but did not receive—his help in 1985. Despite having spent months manipulating post-9/11 public fear with an orchestrated campaign of lies about fictitious WMDs, George W. Bush still didn't understand the historical friction between Sunnis and Shias in Iraq when he invited Iraqi guests of mixed faiths to a super bowl party two months before the invasion.
History repeated itself with Donald Trump, like Reagan and Bush a P.R.-centric empty suit lacking intellectual curiosity, policy chops, or any interest in the mechanics of governing.
It was common knowledge before Trump took office that an infectious outbreak of some kind was likely to occur during his presidency; there were concerns that he wasn't up to the task because of his ignorance of the subject and indifference to getting up to speed with this crucial part of his job.
According to Peter Nicholas of the Atlantic, "When a senior White House aide would brief President Donald Trump in 2018 about an Ebola-virus outbreak in central Africa, it was plainly evident that hardships roiling a far-flung part of the world didn't command his attention. He was zoning out. 'It was like talking to a wall,' a person familiar with the matter told me." (1)
This indifference manifested with Trump's first budget to Congress. Though the administration found money for big increases in the already-bloated defense budget and passed a $1.5 trillion tax cut overwhelmingly tilted to the 1% later that year, Trump's minions cut funding (2) for the Centers for Disease Control and Prevention (CDC), the agency tasked with protecting public health in the face of the opiate epidemic, AIDS, flu, and infectious outbreaks.
Appointed to head the CDC, in July 2017, was Brenda Fitzgerald, a right-wing Republican from Georgia who replaced interim director Anne Schuchat, a highly-experienced, long-time public health advocate (4). Fitzgerald's time at the CDC was brief: she resigned on January 31, 2018 when it came out that she had owned stocks in a tobacco company even as she ran an agency dedicated to anti-smoking campaigns (5). Politico reported that "one day after Fitzgerald purchased stock in Japan Tobacco, she toured the CDC's Tobacco Laboratory, which studies tobacco's toxic effects."
On February 1, 2018, the Washington Post reported that "CDC to cut by 80 percent efforts to prevent global disease outbreak" (6): "The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off (7) and the number of countries it was working in was reduced from 49 to merely 10. (8) Meanwhile, throughout 2018, the U.S. Agency for International Development and its director, Mark Green, came repeatedly under fire from both the White House and Secretary of State Mike Pompeo. (9) And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent (10), the disease-fighting cadres have steadily eroded as retiring officers go unreplaced." (11)
On April 10, 2018, Trump hired John Bolton, one of the architects of George W. Bush's invasion of Iraq, as his National Security Adviser. Bolton in turn fired Homeland Security advisor Tom Bossert (12), whom the Washington Post reported "had called for a comprehensive biodefense strategy against pandemics and biological attacks."
On April 17, 2018, at a bio-defense summit, Health and Human Services secretary Alex Azar said, "Of course, the thing that people ask: 'What keeps you most up at night in the biodefense world?' Pandemic flu, of course. I think everyone in this room probably shares that concern."
On April 27, 2018, at the Malaria Summit in London, Bill Gates discussed the federal government's lack of readiness for the "significant probability of a large and lethal modern-day pandemic occurring in our lifetimes."
Despite Azar's professed concern, Gates's message fell on deaf ears inside the Trump administration.
In the second week of May, 2018, "the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. (13) Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending (14) and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. (15) And the government's $30 million Complex Crises Fund was eliminated. (16)
"The White House proposal 'is threatening to claw back funding whose precise purpose is to help the United States be able to respond quickly in the event of a crisis,' said Carolyn Reynolds, a vice president at PATH, a global health technology nonprofit.
"Collectively, warns Jeremy Konyndyk, who led foreign disaster assistance at the U.S. Agency for International Development during the Obama administration, 'What this all adds up to is a potentially really concerning rollback of progress on U.S. health security preparedness.'
"'It seems to actively unlearn the lessons we learned through very hard experience over the last 15 years,' said Konyndyk….'These moves make us materially less safe. It's inexplicable.'"
That same week, on May 9, 2018, "Luciana Borio, director of medical and biodefense preparedness at the [National Security Council], spoke at a symposium at Emory University to mark the 100th anniversary of the 1918 influenza pandemic. That event killed an estimated 50 million to 100 million people worldwide.
'The threat of pandemic flu is the number one health security concern,' she told the audience. 'Are we ready to respond? I fear the answer is no.'"
On May 10, 2018, Trump's national security adviser John Bolton "re-organized" the National Security Council (NSC), or more accurately "fired the government's entire pandemic response chain of command, including the White House management infrastructure" which had been set up by the Obama administration after the Ebola crisis, by collapsing the NSC's Office of Global Security (17). In the wake of Bolton's action, the top official tasked with coordinating a response to a pandemic, Rear Adm. Timothy Ziemer from the National Security Council, resigned on the same day that a new Ebola outbreak was reported in the Congo.
The Office of Global Security had been a comprehensive crisis response team which brought together principals from the National Institutes of Health, the CDC, the National Security Council, and the Department of Homeland Security; the Trump administration replaced neither Ziemer nor the command infrastructure (18).
In January of 2019, the Office of the Director of National Intelligence put out a threat assessment warning that "the United States and the world will remain vulnerable to the next flu pandemic or large-scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support."
In September of 2019, a "study by the Council of Economic Advisers ordered by the National Security Council predicted that a pandemic similar to the 1918 Spanish flu or the 2009 swine flu could lead to a half-million deaths and cost the economy as much as $3.8 trillion."
That same month, the Trump administration ended PREDICT, a "pandemic early-warning program aimed at training scientists in China and other countries to detect and respond to such a threat." The program "gathered specimens from more than 10,000 bats and 2,000 other mammals in search of dangerous viruses. They detected about 1,200 viruses that could spread from wild animals to humans, signaling pandemic potential. More than 160 of them were novel coronaviruses, much like SARS-CoV-2." (see #133)
In their fiscal year 2020 budget, the Trump administration proposed a 20% cut to the CDC budget (19). On November 18, 2019, "an independent, bipartisan panel formed by the Center for Strategic and International Studies concluded that lack of preparedness was so acute in the Trump administration that the 'United States must either pay now and gain protection and security or wait for the next epidemic and pay a much greater price in human and economic costs.'" (20)
Though some sources claim the White House was notified of a potentially "cataclysmic event" as far back as November of 2019, the administration's story is that it was first informed of the coronavirus on January 3, 2020, when Robert Redfield, Trump's CDC head, received a phone call from China. Intelligence services began putting information about coronavirus in Trump's Daily Brief.
On January 8, the American public was made aware when the the Washington Post reported an outbreak of an "'unidentified and possibly new viral disease in central China' that was sending alarms across Asia in advance of the Lunar New Year travel season."
Already, "Taiwan, Hong Kong, South Korea, Thailand and the Philippines were contemplating quarantine zones and scanning travelers from China for 'signs of fever or other pneumonia-like symptoms that may indicate a new disease possibly linked to a wild animal market in Wuhan.'"
In response, the CDC issued a public health alert.
Health and Human Services (HHS) Secretary Alex Azar wasn't able to get Trump's ear about the coronavirus until January 18, fifteen days after the administration had been notified (22). According to the Washington Post, Trump was more concerned about short-term political pressure than public health: "When [Azar] reached Trump by phone, the president interjected to ask about [a proposed ban on] vaping and when flavored vaping products would be back on the market." (23)
On January 20, the first coronavirus case in the U.S. was confirmed by the CDC.
On January 22, though the U.S. had yet to do large-scale testing to determine rates of infection, Trump told an interviewer on CNBC, "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." (24)
On January 27, "White House aides huddled with then-acting chief of staff Mick Mulvaney in his office, trying to get senior officials to pay more attention to the virus, according to people briefed on the meeting. Joe Grogan, the head of the White House Domestic Policy Council, argued that the administration needed to take the virus seriously or it could cost the president his reelection, and that dealing with the virus was likely to dominate life in the United States for many months.
"Mulvaney then began convening more regular meetings. In early briefings, however, officials said Trump was dismissive because he did not believe that the virus had spread widely throughout the United States." (26)
On January 28, twenty five days after the administration had become aware of coronavirus, on the day that China's president met with the Director-General of the World Health Organization to map out responses to the virus, the same day that Department of Veterans Affairs senior medical adviser Dr. Carter Mecher told colleagues that "the projected size of the outbreak already seems hard to believe" and mitigation efforts would soon be necessary on a "Red Dawn" email, CNN reported that "Trump has not…named a single official within the White House responsible for coordinating the administration's response. (27) That has some wondering whether enough is being done in advance of a potential crisis, particularly since the role of the National Security Council under Trump has shifted away from leading a response to a health crisis to merely coordinating between agencies." (see #17)
Trump's indifference was a direct contrast to Barack Obama, who had "anointed a former vice presidential staffer, Ronald Klain, as a sort of 'epidemic czar' inside the White House, clearly stipulated the roles and budgets of various agencies, and placed incident commanders in charge in each Ebola-hit country and inside the United States."
On January 29, Peter Navarro, an economic adviser to Donald Trump, sent a memo to the White House warning that coronavirus could kill up to 543,000 Americans. Despite Navarro's memo, and the fact that the U.S. had yet to take any significant actions to counteract the coronavirus (28), Trump continued his narrative of false assurances with a tweet that he had "Just received a briefing on the Coronavirus in China from all of our GREAT agencies, who are also working closely with China. We will continue to monitor the ongoing developments. We have the best experts anywhere in the world, and they are on top of it 24/7!" (29)
On Thursday, January 30, World Health Organization (WHO) director-general Tedros Adhanom Ghebreyesus declared a global health emergency while praising China's efforts to contain the virus.
On a flight to campaign appearances in the Midwest, Trump received a call from Alex Azar, who warned him a second time (see #22) of the destructive potential of the pandemic. Trump dismissed Azar as "alarmist." Later that day, speaking in front of Michigan auto workers the day the WHO declared a global health emergency, the day the CDC reported the first person-to-person transmission in the U.S., Trump said, "We think we have it very well under control. We have very little problem in this country at this moment — five. And those people are all recuperating successfully. But we're working very closely with China and other countries, and we think it's going to have a very good ending for it. So that I can assure you." (30)
Commerce Secretary Wilbur Ross doubled down on Trump's denial, telling Fox Business News that the virus "will help to accelerate the return of jobs to North America." (31)
Though Ross thought the virus would increase job growth, and Trump was confident that the U.S. had "very little problem" with the virus, the Trump Administration delivered one of a string of mixed messages (32) when they announced the formation of a Coronavirus Task Force on the same day.
In contrast to the efficient and responsive crisis management model Obama had set up, where Ron Klain coordinated actions among diverse agencies, Trump's commission had confusing lines of authority, where "at least three different people—[Health and Human Services head Alex] Azar, Vice President Mike Pence and coronavirus task force coordinator Debbie Birx—can claim responsibility." (33) In a crisis where immediate, decisive action was needed, the administration chose a slow-moving model choked with discussion and deliberation which focused on closing off borders rather than test kits or medical supplies (34).
Klain offered a prescient prognosis of what was to come at the Atlantic Monthly: "The U.S. government has the tools, talent, and team to help fight the coronavirus abroad and minimize its impact at home. But the combination of Trump's paranoia toward experienced government officials (who lack 'loyalty' to him), inattention to detail, opinionated rejection of science and evidence, and isolationist instincts may prove toxic when it comes to managing a global-health security challenge. To succeed, Trump will have to trust the kind of government experts he has disdained to date, set aside his own terrible instincts, lead from the White House, and work closely with foreign leaders and global institutions—all things he has failed to do in his first 1,200 days in office."
Writing in Foreign Policy the next day, January 31, Laurie Garrett (see #36) posed an important question: "The epidemic control efforts unfolding today in China—including placing some 100 million citizens on lockdown, shutting down a national holiday, building enormous quarantine hospitals in days' time, and ramping up 24-hour manufacturing of medical equipment—are indeed gargantuan. It's impossible to watch them without wondering, 'What would we do? How would my government respond if this virus spread across my country?'"
Her government that day declared a public health emergency and restricted Americans who had been in China over the past two weeks from re-entering the country.
Speaking to Fox's Sean Hannity on February 2, Trump said, "We pretty much shut it down coming from China."(35) In fact, as Ron Klain would mention to Congress a few days later, over 100,000 people* had come to the States from China in the month before the ban, so "the horse is already out of the barn." (*the Washington Post put this number even higher, at 300,000)
Trump would go on to brag repeatedly about the China ban as an example of a gutsy leadership move, but he wouldn't restrict travel from Europe, which would provide the bulk of New York's cases, for six more weeks.
In a February 3 interview with Amy Goodman on Democracy Now, Laurie Garrett explained that John Bolton's dissolution of the pandemic response office (see #17) was done out of spite: "it was a big mistake by the Trump administration to obliterate the entire infrastructure of pandemic response that the Obama administration had created. Why did he do it? Well, it certainly wasn't about the money, because it wasn't a heavily-funded program. It was certainly because it was Obama's program." (36)
Pressed by Goodman to provide more detail about the Global Security Office, Garrett continued:
"It was a special division inside the National Security Council, a special division inside of the Department of Homeland Security…and collaborating centers in HHS, headquarters in Washington, the Office of Global Health Affairs, and the Commerce Department, Treasury Department. But what Obama understood, dealing with Ebola in 2014, is that any American response had to be an all-of-government response, that there were so many agencies overlapping, and they all had a little piece of the puzzle in the case of a pandemic….
"…What the Obama administration realized was that you can't corral multiple agencies and things from private sector as well as public sector to come to the aid of America, unless you have some one person in charge who's really the manager of it all. And in his case, it was Ron Klain, who had worked under Vice President Biden. And he was designated, with an office inside the White House, to give orders and coordinate all these various things….Well, that was all eliminated. It's gone. And now they're hastily trying to recreate something."
On February 4, the Wall Street Journal posted an op-ed by Trump's former FDA commissioner, Scott Gottlieb, titled "Stop a U.S. Coronavirus Outbreak Before It Starts," in which he stressed the importance of ramping up testing for the virus so that public health officials would know where to focus their efforts.
That same day, the administration rolled out new regulatory guidelines. Any lab that wanted to test needed to meet strict criteria to get an Emergency Use Authorization (EUA). Though Trump had gutted every environmental regulation in sight, and scaled back oversight of Wall Street, his FDA over-regulated this crucial public health function (37), forcing public health labs to re-run their tests, which would delay reporting of the number of confirmed cases (38), robbing public health officials of vital information about the spread of infection in their areas. The EUA also slowed down private labs by demanding that they get CDC approval before using their tests (39).
On February 5, Democratic senators met with administration officials and proposed emergency funding "for essential preventative measures, including hiring local screening and testing staff, researching a vaccine and treatments and the stockpiling of needed medical supplies."
HHS secretary Azar declined the funding, claiming it wasn't needed (40).
After the meeting, Senator Chris Murphy of Connecticut tweeted "Just left the Administration briefing on Coronavirus. Bottom line: they aren't taking this seriously enough. Notably no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now."
On February 6, the CDC shipped out 90 test kits. The World Health Organization shipped out 250,000.
On February 7, Secretary of State Mike Pompeo tweeted about "the transportation of nearly 17.8 tons of donated medical supplies…including masks, gowns, gauze, respirators, and other vital materials"—to China. (These shipments represented just a fraction of the vital medical supplies, now desperately needed inside our borders, which were exported from the U.S. in January-March due to the Trump administration's failure to plan ahead and ban exports, as Germany, South Korea, and twenty-two others countries did, 41).
On February 9, "a group of governors in town for a black-tie gala at the White House secured a private meeting with [Dr. Anthony] Fauci and [CDC head Robert] Redfield. The briefing rattled many of the governors, bearing little resemblance to the words of the president."
On February 10, Trump repeated a false talking point multiple times. "Trump said on Fox Business: 'You know in April, supposedly, it dies with the hotter weather.'" (42) He told state governors: 'You know, a lot of people think that goes away in April with the heat — as the heat comes in. Typically, that will go away in April.' (43) And he told supporters at a campaign rally: 'Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away. I hope that's true.'" (44)
On February 11, Federal Reserve chairman Jay Powell contradicted Commerce Secretary Wilbur Ross (see #31) when he said that the coronavirus would "very likely" impact America's economy.
On February 12, the New York Times reported that Trump's CDC had sent state labs flawed test kits, further slowing down the testing process (45).
HHS secretary Alex Azar appeared before a Senate committee on February 13 and said, "As of today, I can announce that the CDC has begun working with health departments in five cities to use its flu surveillance network to begin testing individuals with flu-like symptoms for the Chinese coronavirus….This effort will help see whether there is broader spread than we have been able to detect so far."
The statement gave the impression that the Trump administration was making progress in combating the virus, which was false, as the cities still lacked functional tests and the surveillance systems weren't in place. Azar knew this, but was desperate to create positive spin for the administration (46).
On Valentine's Day, as deaths from the virus were at 1,000 and climbing, Trump spoke before the National Border Control Council. He again wheeled out the false assertion that warm weather would douse the virus (47) and said, "We have a very small number of people in the country, right now, with it. It's like around 12. Many of them are getting better. Some are fully recovered already. So we're in very good shape." (48) Even as his administration was clearly fumbling the response (see #1-#46), he said, "And 61 percent of the voters approve of Trump's handling of the coronavirus. And, you know, we did a very early move on that. We did a — I was criticized by a lot of people at the beginning because we were the first. We'd never done it before." (49)
On February 18, Atlantic contributor Peter Nicholas offered perceptive summations of the Trump Administration's failures of governance so far and the challenges ahead: "He has hollowed out federal agencies (see #7 and #10) and belittled expertise (50), prioritizing instead his own intuition and the demands of his political base. But he'll need to rely on a bureaucracy he's maligned to stop the virus's spread."
The article cited the ramifications of Trump's allergy to bad news: "'We have a president who doesn't particularly care about competent administration, and who created a culture in which bad news is shut down,' (51) says Democratic Senator Brian Schatz of Hawaii, whose state is home to one of multiple airports screening passengers for the coronavirus. 'And when you're dealing with a potential pandemic, you need to know all the bad news. If this disease ends up not overwhelming us, that would be a blessing. But it would not be because the Trump administration was ready. They were not.'"
Nicholas also addressed Trump's continual lies and distortions about the scope of the virus: "Since Trump's first upbeat assessment, the number of people sickened by the virus has spiraled. At the time of the CNBC interview (see #24), 17 people in China had died from the virus and about 540 were infected. Today, the death toll is about 1,900 and the number of infections tops 73,000. At least 15 cases have been reported in the U.S., and an additional 14 Americans infected with the virus arrived yesterday following their evacuation from a cruise ship in Japan."
Undeterred by scientific facts, Trump pushed the warm weather myth again on February 19: "I think it's going to work out fine. I think when we get into April, in the warmer weather, that has a very negative effect on that and that type of a virus. So let's see what happens, but I think it's going to work out fine." (52)
On February 20, Politico reported on the flawed test kits the CDC had sent out (see #45) and mentioned that the cost of the kits was so high ($250/each) that Trump's Health and Human Services department was starting to run out of money (53)—which could have been avoided if Azar had accepted additional congressional funding proposed on February 5 (see #40).
The coronavirus task force met on February 21. Reviewing the escalation in cases abroad, the group "concluded they would soon need to move toward aggressive social distancing, even at the risk of severe disruption to the nation's economy and the daily lives of millions of Americans."
Early on the morning of February 23, Michael Mina, an epidemiologist and professor at Harvard, tweeted that "the US remains extremely limited in #COVID19 testing. Only 3 of 100 public health labs have @CDC test kits working (54) and CDC is not sharing what went wrong with the kits. (55) How to know if COVID19 is spreading here if we are not looking for it." (56)
On Monday, February 24, trying to make up for previous short-sighted budget cuts (57), the administration "asked Congress for $2.5 billion in emergency funds to handle coronavirus in the United States. (To compare to a recent health crisis, the Obama administration requested $6 billion in emergency funding for the 2014 Ebola outbreak and eventually received $5.4 billion.) Though Democrats in Congress have pushed the administration to call for emergency coronavirus funding since early February, Politico states that 'White House officials have been hesitant to press Congress for additional funding, with some hoping that the virus would burn itself out by the summer.'" (58)
The $2.5 billion request was a pittance, approximately 1/600th the size of Trump's tax cut (59), most of which went to the wealthiest 1% of Americans. Azar knew the funding was inadequate, but was hamstrung by administration officials who didn't grasp the seriousness of the virus and lacked pull with Trump to override them in favor of the public interest.
Even as the news grew worse, Trump continued to give false assurances, tweeting "The Coronavirus is very much under control in the USA….Stock Market starting to look very good to me!" (60). In fact, Trump had no idea if things were "under control" because his administration had failed to get functional test kits out.
That same day, the stock market had its second biggest drop in its history.
The following day, February 25, the stock market cratered for the fourth consecutive day, losing 879 points to end at 27,081.
While the Dow Jones tanked, Nancy Messonier, the director for the National Center for Immunization and Respiratory Diseases, made the case for community mitigation and told reporters that the virus would cause "severe" disruptions in American's lives. Unaware that his public health officials were planning to propose mitigation efforts, Trump scolded Messonier's ultimate boss, Alex Azar, for the toll her announcement had on the stock market (61) and the next day demoted Azar, putting Mike Pence in charge of the coronavirus task force. As a result of Trump's temper tantrum, the task force's time-sensitive recommendations for social distancing, school closures, and cancellations of crowded events was put on hold. It would be three long, deadly weeks before Trump would finally announce social distancing recommendations on March 16 (62).
At a time when bipartisan harmony was more important than ever, Trump trolled Senate minority leader Chuck Schumer on Twitter for pointing out that $2.5 billion wasn't remotely adequate to the task: "Cryin' Chuck Schumer is complaining, for publicity purposes only, that I should be asking for more money than $2.5 Billion to prepare for Coronavirus. If I asked for more he would say it is too much. He didn't like my early travel closings. I was right. He is incompetent!" (63)
And even as it was reported that "Trump spent the past 2 years slashing the government agencies responsible for handling the coronavirus outbreak," Trump tweeted that "CDC and my Administration are doing a GREAT job of handling Coronavirus." (64)
While in India that day, Trump told reporters, "You may ask about the coronavirus, which is very well under control in our country. We have very few people with it, and the people that have it are…getting better. They're all getting better….As far as what we're doing with the new virus, I think that we're doing a great job." (65)
Trump's economic adviser Larry Kudlow echoed Trump's lies and contradicted CDC officials when he told CNBC, "We have contained this, I won't say airtight but pretty close to airtight." (66)
Meanwhile, the Washington Post reported on the severe shortage of N95 masks American hospitals were facing due to onerous federal regulations (67) and a lack of support from the Trump administration (68), and the administration's lack of a plan going forward, which was causing confusion and panic among state and local officials (69).
The next day, February 26, Politico reported that the "U.S. isn't ready to detect stealth coronavirus spread" due to poor coordination among crisis management staff, the administration's failure to get functional test kits out in a timely fashion, and needlessly strict test criteria (see #37): "Just 12 of more than 100 public health labs in the U.S. are currently able to diagnose the coronavirus because of problems with a test developed by the CDC, potentially slowing the response if the virus starts taking hold here. The faulty test has also delayed a plan to widely screen people with symptoms of respiratory illness who have tested negative for influenza to detect whether the coronavirus may be stealthily spreading."
Only six states were testing for the virus and the testing was limited to people who had been to China or were experiencing symptoms, which was allowing the virus to spread undetected. Harvard epidemiology professor Marc Lipsitch told Politico, "China tested 320,000 people in Guangdong over a three-week period. This is the scale we need to be thinking on."
Meanwhile, Trump continued to compare coronavirus to the flu, though the virus has approximately 20 times the mortality rate (70), and told White House reporters, "Because of all we've done, the risk to the American people remains very low….When you have 15 people, and the 15 within a couple of days is going to be down to close to zero. That's a pretty good job we've done." (71) In reality, the States had 60 cases at the time, the number was increasing, and the real number was far greater but undetected due to the administration's failure to get functional test kits out.
The poor communication among officials overseeing the coronavirus response continued, as "[Health and Human Services Secretary Alex] Azar didn't know until late in the afternoon that Vice President Mike Pence would be in control of the process. The HHS secretary was reportedly 'blindsided' by the news." (72)
In picking Pence to lead the administration's response to coronavirus, Trump referred to his vice president as an "expert" and someone with "a certain talent for this," though Pence's reluctance to support needle exchange and steep cuts to Planned Parenthood (which provides HIV testing in addition to birth control) as governor of Indiana had contributed to an HIV outbreak there (73).
With Pence's ascension, FDA commissioner Stephen Hahn was finally brought into the coronavirus committee. For weeks the FDA's powers to work with private companies to increase production of test kits, PPE, and other necessities had been ignored (74).
As of February 27, 2,800 people had died from the virus, while 82,000 cases had been reported worldwide. Business Insider had the following headline: "Trump defends huge [19%] cuts to the CDC's budget (75) by saying the government can hire more doctors 'when we need them' during crises." (76) Trump responded to criticisms of the budget cuts by saying, "I'm a businessperson. I don't like having thousands of people around when you don't need them….When we need them, we can get them back very quickly." (77)
Despite the increasing gloom, Trump continued to play pretend. He told an audience attending an African American History Month event at the White House, "It's going to disappear. One day it's like a miracle, it will disappear." (78) He tweeted "Only a very small number in U.S., & China numbers look to be going down. All countries working well together!" (79)
On Friday, February 28, nearly two months after the administration had first been informed of the coronavirus, NBC reported that the U.S. had done fewer than 500 tests, even as China had done over 300,000 and South Korea was doing 10,000 or more/day (80).
ProPublica offered one of many post-mortems to come, highlighting the grave error the administration had made in bypassing World Health Organization test kits which were ready to go (81) in favor of CDC test kits, which weren't:
"The CDC announced on Feb. 14 that surveillance testing would begin in five key cities, New York, Chicago, Los Angeles, San Francisco and Seattle. That effort has not yet begun. (see #46)
"Until the middle of this week, only the CDC and the six state labs — in Illinois, Idaho, Tennessee, California, Nevada and Nebraska — were testing patients for the virus, according to Peter Kyriacopoulos, APHL's senior director of public policy. Now, as many more state and local labs are in the process of setting up the testing kits, this capacity is expected to increase rapidly.
"There are other ways to expand the country's testing capacity. Beyond the CDC and state labs, hospitals are also able to develop their own tests for diseases like COVID-19 and internally validate their effectiveness, with some oversight from the federal Centers for Medicare and Medicaid Services. But because the CDC declared the virus a public health emergency, it triggered a set of federal rules that raises the bar for all tests, including those devised by local hospitals.
"So now, hospitals must validate their tests with the FDA — even if they copied the CDC protocol exactly. Hospital lab directors say the FDA validation process is onerous and is wasting precious time when they could be testing in their local communities." (82)
As Margaret Hamburg (Obama's FDA commissioner from 2009-2015) would later tell Olga Khazan of the Atlantic, "the [FDA] could have proactively reached out to different national and international labs to see whether their tests could be approved for use in the U.S.," but there's no evidence that they did (83), and in fact the FDA "told one Seattle infectious-disease expert, Helen Chu, to stop testing for the coronavirus entirely….Chu was not alone. Dozens of labs in the U.S. were eager to make tests and willing to test patients, but they were hamstrung by regulations for most of February, even as the virus crept silently across the nation."
Uncertainty over the virus contributed to the markets having their worst week since the crash of 2008.
Later that night, even as other countries had started social distancing in response to the virus, Trump put thousands of his supporters at risk of exposure with a political rally in North Charleston, South Carolina. It was one of eight campaign events Trump would have after being notified of coronavirus.
Asked about administration efforts to combat coronavirus before the rally, Trump told Sinclair Broadcasting, "I think it's really going well. We did something very fortunate: we closed up to certain areas of the world very, very early — far earlier than we were supposed to. I took a lot of heat for doing it. It turned out to be the right move, and we only have 15 people and they are getting better, and hopefully they're all better. There's one who is quite sick, but maybe he's gonna be fine….We're prepared for the worst, but we think we're going to be very fortunate." (84) During the rally, Trump accused Democrats of politicizing the coronavirus and said concern over the issue was a "hoax." (85)
Trump's chief of staff Nick Mulvaney used the same talking point that night, telling reporters at the Conservative Political Action conference, "The reason you're seeing so much attention to it [the coronavirus] today is [Democrats] think this is going to be what brings down the president….That's what this is all about….I got a note today from a reporter saying, 'What are you going to do today to calm the markets?' I'm like, really, what I might do to calm the markets is tell people to turn their televisions off for 24 hours." (86)
The next day, Saturday February 29, the first American death at the hand of the coronavirus "hoax" was reported.
Appearing on CBS's "Face the Nation" the next day, March 1, Alex Azar claimed that, "'In terms of testing kits, we've already tested over 3,600 people for the virus. We now have the capability in the field to test 75,000 people, and within the next week or two we'll have a radical expansion even beyond that." Like most of the Trump administration's public messaging, this was false (87). At the time, less than 1,000 tests had been completed. By comparison, South Korea, a country 1/6th the size of the U.S., which had discovered the virus within its borders on the same day—January 20—had done over 80,000 tests.
As of Monday March 2, U.S. coronavirus deaths were up to six; globally over 90,000 cases had been reported.
Dr. Matt McCarthy, a physician at New York-Presbyterian, told CNBC that he still didn't have any test kits (88): "'This is not good. We know that there are 88 cases in the United States. There are going to be hundreds by the middle of the week. There's going to be thousands by next week. And this is a testing issue.' McCarthy added, 'They're testing 10,000 a day in some countries, and we can't get this off the ground….I'm a practitioner on the firing line, and I don't have the tools to properly care for patients today.'"
Dr. Eva Lee, an infectious disease researcher at the Georgia Institute of Technology, commented in a Red Dawn email (see #27) with Trump administration public health officials: "We need actions, actions, and more actions. We are going to have pockets of epicenters across the country, West coast, East coast and the South. Our policy leaders must act now. Please make it happen!"
At a campaign rally the same day in Charleston, North Carolina, Trump said, "We had a great meeting today with a lot of the great companies and they're going to have vaccines, I think relatively soon. And they're going to have something that makes you better and that's going to actually take place, we think, even sooner." This was patently false (89), as Dr. Anthony Fauci, the chief medical expert on the coronavirus task force, had told Trump earlier that day. Fauci estimated that it would take a year-and-a-half for a vaccine to emerge.
After solid gains on Monday, the Dow lost 800 points on Tuesday, March 3, bringing it down to 25,917 at day's close. Speaking to reporters, Trump continued to minimize the virus, claiming, "There's only one hot spot, and that's also pretty much in a very — in a home, as you know, in a nursing home." In fact, the nursing home in Washington state wasn't the only cluster of known coronavirus activity, as California and Oregon had both reported areas of community contagion (90).
On Wednesday, March 4, the death toll in the U.S. reached ten and New York reported an infected community.
Speaking to airline executives at the White House, Trump continued to downplay the extent of the crisis, saying, "Some people will have this at a very light level and won't even go to a doctor or hospital, and they'll get better. There are many people like that." (91) He also blamed the Obama administration for the lag in testing, claiming an Obama regulation had slowed the administration down, which was false (92).
Trump's lies and blame shifting continued in an interview with Sean Hannity which appeared later that day. Trump falsely claimed that the Obama administration "didn't do anything about" swine flu and that based purely on his intuition, science-based coronavirus fatality rates were flawed—"I think the 3.4 percent is really a false number — and this is just my hunch — but based on a lot of conversations with a lot of people that do this, because a lot of people will have this and it's very mild, they'll get better very rapidly. They don't even see a doctor. They don't even call a doctor. You never hear about those people." (93)
On Friday, March 6, reported cases in the U.S. passed 300 and deaths were up to 17, including the first on the East Coast.
The Atlantic ran a post-mortem about the administration's failure to get functional test kits out called "The Strongest Evidence Yet That America Is Botching Coronavirus Testing."
Two months after the Trump administration had first been notified of the coronavirus and one month after a task force had been formed (see #34), only 1,895 tests could be verified, a fraction of the 10,000-20,000 tests South Korea was performing daily.
According to the authors, "The figures we gathered suggest that the American response to the coronavirus and the disease it causes, COVID-19, has been shockingly sluggish, especially compared with that of other developed countries….The net effect of these choices is that the country's true capacity for testing has not been made clear to its residents. (94) This level of obfuscation is unexpected in the United States, which has long been a global leader in public-health transparency."
Earlier in the day, Trump had appeared at a signing ceremony for the Preparedness and Response Supplemental Appropriations Act, which would dedicate $8.3 billion to fighting the coronavirus. The funding was more than three times what the administration had requested (see #57) and yet still a pittance relative to the scope of the virus, roughly 1/180th of the amount Trump spent on his tax cut, the bulk of which went to the upper 1% (95).
Many public health officials felt the appropriations came a month too late (96), shortchanging localities of crucial resources for testing and personal protective equipment. (see #40)
At the signing, Trump offered false assurances and minimized the scope of the public health disaster that he was spending $8.3 billion on, saying, "And in terms of deaths, I don't know what the count is today. Is it eleven? Eleven people? And in terms of cases, it's very, very few." (97)
After the signing, Trump visited CDC headquarters in Atlanta, where he continued to lie about test kits: "Anybody that needs a test can have a test. They are all set. They have them out there. In addition to that they are making millions more as we speak but as of right now and yesterday anybody that needs a test that is the important thing and the test are all perfect like the letter was perfect." (98)
Asked about the passengers on the Grand Princess cruise ship docked in San Francisco who were forced to stay on the ship for the time being, Trump expressed concern that allowing them onshore, where they would be added to the number of confirmed cases, would make him look bad: "I would rather — because I like the numbers being where they are. I don't need to have the numbers double because of one ship. That wasn't our fault, and it wasn't the fault of the people on the ship, either. OK? It wasn't their fault either. And they're mostly Americans, so I can live either way with it. I'd rather have them stay on, personally." (99)
Trump also said "I hear the numbers are getting much better in Italy," though the country was entering a lockdown and would experience two hundred more deaths over the weekend to come.
On Saturday, March 7, Politico led with "Trump's mismanagement helped fuel coronavirus crisis," an in-depth feature by Dan Diamond exploring the impact of the Trump administration's internal dysfunctions on their crisis management response.
Diamond's exposé revealed that Mike Pence and other administration officials had wanted to evacuate the Grand Princess cruise ship (see #99) in order to keep the passengers who didn't have coronavirus from getting it from those who did, but that Trump had overruled his advisors because he didn't want the number of reported cases to increase.
The article stated that "As the outbreak has grown, Trump has become attached to the daily count of coronavirus cases and how the United States compares to other nations, reiterating that he wants the U.S. numbers kept as low as possible. Health officials have found explicit ways to oblige him by highlighting the most optimistic outcomes in briefings (100), and their agencies have tamped down on promised transparency. The CDC has stopped detailing how many people in the country have been tested for the virus (101), and its online dashboard is running well behind the number of U.S. cases tracked by Johns Hopkins and even lags the European Union's own estimate of U.S. cases."
The article confirmed that onerous regulations (see #37) and Trump's lack of policy engagement (see #1) were key elements in the test delays and that "Trump's aides discouraged [HHS Secretary Alex] Azar from briefing the president about the coronavirus threat back in January" (see #22) because Trump "rewards those underlings who tell him what he wants to hear while shunning those who deliver bad news." (see #51)
"…The pressure to earn Trump's approval can be a distraction at best and an obsession at worst: Azar, having just survived a bruising clash with a deputy [Seema Verma, head of the Centers for Medicare and Medicaid Services] and sensing that his job was on the line [see #59], spent part of January making appearances on conservative TV outlets and taking other steps to shore up his anti-abortion bona fides and win approval from the president, even as the global coronavirus outbreak grew stronger.
"Around the same time, Azar had concluded that the new coronavirus posed a public health risk and tried to share an urgent message with the president: The potential outbreak could leave tens of thousands of Americans sickened and many dead.
"The jockeying for Trump's favor was part of the cause of Azar's destructive feud with Verma, as the two tried to box each other out of events touting Trump initiatives. Now, officials including Azar, Verma and other senior leaders are forced to spend time shoring up their positions with the president and his deputies at a moment when they should be focused on a shared goal: stopping a potential pandemic. (102)
"'The boss has made it clear, he likes to see his people fight, and he wants the news to be good,' said one adviser to a senior health official involved in the coronavirus response. 'This is the world he's made.'" (103)
The closing paragraph read "'If this sort of dysfunction exists as part of the everyday operations—then, yes, during a true crisis the problems are magnified and exacerbated,' said a former Trump HHS official. 'And with extremely detrimental consequences.'"
The following day, March 8, as international cases had passed 100,000 and the importance of social distancing was becoming increasingly obvious, HUD secretary Ben Carson was asked by ABC's George Stephanopoulos about the advisability of Trump holding rallies where thousands of people were crammed together. Carson, a neurosurgeon who knew better, chose Trump's favored talking point over public safety: "…going to a rally, if you're a healthy individual and you're taking the precautions that have been placed out there, there's no reason that you shouldn't go. However, if you belong to one of those categories of high risk, obviously, you need to think twice about that." (104)
As of Monday, March 9, the tally in the U.S. was over 700 cases reported and 26 deaths. The Dow lost 2,000 points that day, the biggest one-day loss in history.
Former Republican senator and governor Judd Gregg offered a sober appraisal of Trump's handling of the coronavirus:
"The budget he recently submitted to Congress savaged the BioShield account (105). This is the program that was set up after the SARS epidemic and anthrax events well over a decade ago to allow the federal government to fund research on pharmaceutical responses to biological attacks or a pandemic outbreak.
"The program was needed because this type of research is extremely expensive and has little commercial upside. The drugs developed are unique and narrowly targeted.
"Thus, in order to get this research up and running, Congress and the prior administrations created the program. In this instance, Congress actually anticipated a serious issue and began addressing it effectively.
"But the president and his people got it wrong. In their usual naive and uninformed style, they have tried to eviscerate the program.
"This action came in the face of significant warnings from the intelligence community that a biological attack is one of the primary threats we face from terrorists. And now we know a pandemic is also a primary threat."
Gregg's key takeaway: "The president and his people also have an abysmal track record when it comes to preparing for pandemics."
While the virus spread undetected, testing continued to move at a glacial pace, and the Dow was in freefall, Trump kept busy attacking imagined foes on Twitter.
One tweet read "This is your daily reminder that it took Barack Obama until October of 2009 to declare Swine Flu a National Health Emergency. It began in April of '09 but Obama waited until 20,000 people in the US had been hospitalized & 1,000+ had died. Where was the media hysteria then?" In actuality, Obama had declared a public health emergency two days after the first swine flu death (106).
A second tweet read "The Fake News Media and their partner, the Democrat Party, is doing everything within its semi-considerable power (it used to be greater!) to inflame the CoronaVirus situation, far beyond what the facts would warrant. Surgeon General, 'The risk is low to the average American.'" (107)
Trump also tweeted his mistaken talking point about coronavirus being akin to the flu, not for the first time: "So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!" (108)
By Tuesday, March 10, over 113,000 coronavirus cases had been reported globally and more than 4,000 people had died.
At a hearing about Trump's 2021 budget proposal, Russ Vought, the administration's director of the Office of Management and Budget (OMB), defended a 15% proposed cut to the Centers for Disease Control and Prevention (109) and a steep cut to the annual contribution to the Infectious Diseases Rapid Response Reserve Fund (110).
In partnership with Brianna Ehley, David Lim of Politico had a big scoop called "U.S. coronavirus testing threatened by shortage of critical lab materials." The piece detailed how a shortage of lab materials (111) was exacerbating America's already-slow pace of testing, thereby jeopardizing public safety (112) by keeping public health officials from having accurate data about the number of cases and the areas with high concentration.
The article pointed out that seven weeks after the first case was discovered in the U.S., just over 5,000 people had been tested, though "HHS Secretary Alex Azar had told lawmakers [one week earlier] that U.S. labs' capacity could grow to 10,000-20,000 people per day by the end of the week." (113)
All evidence to the contrary, Donald Trump continued to blame his predecessor and pitch the case that his administration was doing a good job of crisis management. During a briefing at the capital, Trump said, "As you know, it's about 600 cases, it's about 26 deaths, within our country. And had we not acted quickly, that number would have been substantially more." (114) He added that "…I think the U.S. has done a very good job on testing. We had to change things that were done that were nobody's fault, perhaps, they wanted to do something a different way, but it was a much slower process from a previous administration and we did change them." (115)
The next day, Wednesday, March 11, the U.S. had over 1,000 reported cases and 32 deaths. The World Health Organization (WHO) declared the coronavirus a pandemic. The Dow lost over 1,000 points for the second time in three days, ending at 23,553. The National Basketball Association suspended its season.
CNN posted an investigative piece entitled "Confusion over the availability and criteria for coronavirus testing is leaving sick people wondering if they're infected."
The article noted that though Mike Pence had recently said on CNN's "New Day" that anyone with a doctor's order could get a test, this was not the case in practice, as the U.S. was woefully unprepared to provide tests on this scale (116).
People were also not getting tests due to strict CDC criteria: "In order to be prioritized for testing, the Centers for Disease Control and Prevention advises that one must have a fever, cough or difficulty breathing as well as have been in close contact with a person known to have coronavirus. Or, they had to 'have a history of travel from affected geographic areas within 14 days of their symptom onset.'"
As the article noted, "only 11,079 specimens [have] been tested in the U.S., paling in comparison to the more than 230,000 people tested in South Korea, which has about one sixth the US population."
Dr. Rod Hochman, the CEO of Providence St. Joseph Health, told Politico, "Testing is so critically important because it helps us as clinicians figure out the extent of the spread. It has implications for how we care for patients and where we put them….It's unraveling the detective story of how the virus spreads but we are trying to do it now with no data."
On Rachel Maddow's show that evening, Ron Klain, who had been Obama's Ebola czar (see #33 and #35), pointed out that one of the Trump administration's biggest mistakes was to privatize testing. As related by journalist Thom Hartmann, "Instead of taking the World Health Organization (WHO) test kits which are cheap and widely available all over the planet, and having them distributed across the country back in December, or January, or February when we knew this disease was spreading in the United States, Klain said that Trump has outsourced the testing to two big American companies, Quest and Labcorp." (see #81)
Trump's public appearances on Wednesday didn't inspire confidence. During a press conference with Ireland's prime minister, Trump again minimized the threat by saying, "It goes away….It's going away. We want it to go away with very, very few deaths." (117)
Though the virus was supposedly going away, Wednesday's 1,000-point drop in the Dow convinced Trump to address the nation in a prime-time speech that was roundly panned. Again he minimized the threat (claiming coronavirus had a "very, very low risk" for most Americans, 118), cast blame on China and Europe for having the disease before the U.S. (119), gave confusing information while ad-libbing that contradicted administration policy (120), and again lied about the slow pace of testing when he said, "Testing and testing capabilities are expanding rapidly, day by day. We are moving very quickly." (121) The address was meant to reassure the American public and stabilize the markets, but Trump's ill-prepared speech sent stock futures tumbling in real time.
Republican journalist and former W. Bush speechwriter David Frum summed up the historical moment with uncanny precision:
"More people will get sick because of his presidency than if somebody else were in charge. More people will suffer the financial hardship of sickness because of his presidency than if somebody else were in charge. The medical crisis will arrive faster and last longer than if somebody else were in charge. So, too, the economic crisis. More people will lose their jobs than if somebody else were in charge. More businesses will be pushed into bankruptcy than if somebody else were in charge. More savers will lose more savings than if somebody else were in charge. The damage to America's global leadership will be greater than if somebody else were in charge." (#122-128)
On Thursday, March 12, the day after Trump's prime time address meant to reassure the nation and calm the stock market, the Dow Jones lost almost 1,000 points, ending at 21,200.
In an email thread with Tom Bossert, Trump's former homeland security adviser (see #12), James Lawler (director of Clinical and Bio-defense Research at the National Strategic Research Institute) said, "We are making every misstep leaders initially made in [simulations] at the outset of pandemic planning in 2006. We had systematically addressed all of these and had a plan that would work—and has worked in Hong Kong/Singapore. We have thrown 15 years of institutional learning out the window and are making decisions based on intuition. Pilots can tell you what happens when a crew makes decisions based on intuition rather than what their instruments are telling them."
The most glaring of the Trump administration's failures was its inability to get test kits out. Even Republicans were starting to grumble, as detailed in "Testing lag ignites political uproar as Trump insists process is 'very smooth.'"
Cutting against Trump's consistently self-serving narrative, Anthony Fauci, Trump's key coronavirus advisor, said, "The system is not geared toward what we need right now, what you are asking for….It is a failing. Let's admit it."
The piece pointed out that more than two months after the administration first became aware of the virus, "only about 11,000 people have been tested, according to figures shared with members of Congress on Thursday. According to statistics compiled by the American Enterprise Institute, nationwide capacity to process the test kits being distributed has so far ramped up only to about 20,000 people per day – meaning it could be weeks before any tested patient gets results.
"Lawmakers of both parties reached for the same touchstone – South Korea, which has managed to treat hundreds of thousands of its people, allowing it to avoid the rapid spread seen in China, Italy and other countries….'South Korea is able to process tests in an hour, and in the U.S. it takes more than two days – that's not adequate,' said Ben Sasse, a Republican senator from Nebraska." The article pointed out that South Korea tests in a single day the number of people the U.S. has tested in over two months, with drive-up exams which aren't possible in the U.S. due to strict testing guidelines (129).
Burdensome and deadly regulations were further discussed at ProPublica, which revealed that an FDA directive "requires that the Centers for Disease Control and Prevention, a sister agency, re-test every positive coronavirus test run by a public health lab to confirm its accuracy.
"The result, experts say, is wasting limited resources at a time when thousands of Americans are waiting in line to get tested for COVID-19." (130)
Duplicate tests were just one element of a failed operation. The Trump administration's key mistakes were summarized by Politico reporter Dan Diamond (see #99-#103) in an interview with NPR's Terry Gross:
"The Trump administration and health officials knew back in January that this coronavirus was going to be a major threat. They knew that tests needed to be distributed across the country to understand where there might be outbreaks. But across the month of February, as my colleague David Lim at Politico first reported, the tests that they sent out to labs across the country simply did not work. They were coming back with errors.
"The CDC, the Centers for Disease Control, recognized that and promised that new tests would be distributed soon. But one day turned into two days turned into three days turned into several weeks, and in the meantime, we know now coronavirus was silently spreading in different communities, like Seattle. By the time that the Trump administration made a decision to allow new tests to be developed by hospitals by clinical laboratories, it was a step that was seen as multiple weeks late." (131)
"…I don't use this word lightly, Terry, but I'd say that this testing failure and the broader response to the coronavirus has been a catastrophe.
"…the Trump administration failed to plan for this moment. There were leadership failures, like failing to think through the implications of not having a testing strategy in place. (132) There were leadership failures in allowing feuds to fester for months and months that – in the middle of a crisis, those cracks have widened and caused delays in making simple decisions.
"He cut funding for a program that predicted when viruses could jump from animals to humans basically around the same time that this new coronavirus appears to have jumped from animals to humans in China." (133)
Amid the disaster unfolding all around and because of him, Trump continued to lie to the American public. Asked about the lack of testing at a White House briefing, Trump said, "over the next few days, they're going to have four million tests out" (134) and "Frankly, the testing has been going very smooth….If you go to the right agency, if you go to the right area, you get the test." (135)
He even found a way to brag about the administration's response:
"It's going to go away….The United States, because of what I did and what the administration did with China, we have 32 deaths at this point…when you look at the kind of numbers that you're seeing coming out of other countries, it's pretty amazing when you think of it." (136)
The administration did one thing right on March 12: its Health and Human Services Department placed its first order for N95 masks. Unfortunately, the order came far too late and wouldn't be filled until the end of April, long after the pandemic had started to ravage America's emergency rooms.
Friday the 13th was again all about the test kits. Where were they?
Caitlin Owens of Axios pointed out that "less than a dozen academic labs" were doing tests because of strict administration guidelines. Medical directors discussed how their requests to test had been delayed or denied until it was too late (138).
According to the BBC, testing capacity in the U.S. was just 22,000 people/day while South Korea, which is 1/6th the size of the U.S., was testing up to 20,000 people/day. And the 22,000 projection was very optimistic, according to Andy Slavitt, Barack Obama's acting administrator of the Centers for Medicare and Medicaid Services, who tweeted, "We can at best do 10,000 tests/day. We should be able to do millions" and "All of this could have been ramped up and solved in January & February and right now we would be talking about containment."
The Atlantic reported that less than 14,000 tests had been done in the ten weeks since the administration had first been notified of the virus, though Mike Pence had promised the week prior that 1.5 million tests would be available by this time (139).
The article's key takeaway?
"Getting out lots of tests for a new disease is a major logistical and scientific challenge, but it can be pulled off with the help of highly efficient, effective government leadership. In this case, such leadership didn't appear to exist."
Speaking to one of the prime causes of that failure in leadership, Beth Cameron, who ran Obama's pandemic office in the National Security Council, explained the disastrous operational vacuum caused by John Bolton's closing of the Global Security Office (see #17): "In a health security crisis, speed is essential. When this new coronavirus emerged, there was no clear White House-led structure to oversee our response, and we lost valuable time…
"…The job of a White House pandemics office would have been to get ahead: to accelerate the response, empower experts, anticipate failures, and act quickly and transparently to solve problems.
"Our team reported to a senior-level response coordinator on the National Security Council staff who could rally the government at the highest levels, as well as to the national security adviser and the homeland security adviser. This high-level domestic and global reporting structure wasn't an accident. It was a recognition that epidemics know no borders and that a serious, fast response is crucial.
"A directorate within the White House would have been responsible for coordinating the efforts of multiple federal agencies to make sure the government was backstopping testing capacity, devising approaches to manufacture and avoid shortages of personal protective equipment, strengthening U.S. lab capacity to process covid-19 tests, and expanding the health-care workforce.
"The office would galvanize resources to coordinate a robust and seamless domestic and global response. It would identify needs among state and local officials, and advise and facilitate regular, focused communication from federal health and scientific experts to provide states and the public with fact-based tools to minimize the virus's spread. The White House is uniquely positioned to take into account broader U.S. and global security considerations associated with health emergencies, including their impact on deployed citizens, troops and regional economies, as well as peace and stability. A White House office would have been able to elevate urgent issues fast, so they didn't linger or devolve to inaction, as with coronavirus testing in the United States.
Ben Rhodes, Obama's deputy national security director, piggybacked on these criticisms with a look at the culture of mis-governance Trump bred and embodied, and Trump's fixation on his 2020 campaign to the exclusion of all else:
"As the first COVID-19 cases began to spread with alarming speed and lethality in China, President Trump evidently did not choose to make the issue a priority. Based on his public comments and Twitter feed, the incoming information that consumed his attention was more likely to come from cable television or political gossip than deep inside his intelligence briefings. (140) Presumably, he also had a certain view of what he'd be doing in early 2020—chiefly, preparing the ground for his reelection campaign—and veering off course to prepare for a pandemic would have undermined those plans. A simple presidential communication of interest in a subject can set the government in motion, but in this case, that signal apparently never came." (141)
"…Instead of seeing U.S. government expertise as a resource, Trump has routinely derided career experts as "deep state" operatives, insufficiently loyal to him and his agenda. (142) Well into the COVID-19 outbreak, he said things such as 'A lot of people think that it goes away in April with the heat,' or 'This is a flu.' I doubt that any government expert would suggest that Trump say those things. The statements, instead, suggest a president either making things up or cherry-picking things he's heard from non-experts to offer false reassurance to the public.
"…By constantly trying to get himself through the news cycle, Trump has done irreparable damage to the long-term objective of ensuring that he's a credible voice on the COVID-19 crisis." (143)
That night, spooked by another 1,000-point loss in the Dow, Trump finally declared a national emergency.
At a press conference announcing the news, Trump failed to model coronavirus safety protocols, as he had done all week, shaking hands and standing cheek-by-jowl with other administration officials (144). Trump also made a false claim about Google constructing a testing center (145) and reality aside, claimed that "…the administration expects 1.4 million tests in the next week and 5 million within the month." (ten days later, less than 300,000 tests would be completed; one month later, less than three million would be completed, 146)
Asked if he took responsibility for the lag in testing, Trump said, "I don't take responsibility at all because we were given a set of circumstances, and we were given rules, regulations, and specifications from a different time that wasn't meant for this kind of an event with the kind of numbers that we're talking about." (147)
Asked by PBS reporter Yamiche Alcindor how he could say he had no responsibility for the testing failures despite his appointee's elimination of the Global Security Office (see #17), Trump again ducked responsibility, saying "That's a nasty question…When you say me, I didn't do it. We have a group of people [in the administration]." (148)
That night, after stocks rebounded on news of the declaration, Trump "sent a note to supporters that included a chart showing the Dow Jones Industrial Average dramatically rising roughly at the time he began a news conference declaring a national emergency over coronavirus. The President signed the chart."
On the chart were the words "'The President would like to share the attached image with you, and passes along the following message: From opening of press conference, biggest day in stock market history!'" (149)
Trump's triumphalism would prove premature, as the Dow would drop 4,000 points the following week, to 19,173, nearly 700 points lower than it was on the day Barack Obama left office and bequeathed Trump with a vibrant economy.
Peter Wehner, a conservative Republican who had served under multiple Republican administrations, summed up Trump's mistakes in an Atlantic post: "…the president and his administration are responsible for grave, costly errors, most especially the epic manufacturing failures in diagnostic testing, the decision to test too few people, the delay in expanding testing to labs outside the Centers for Disease Control and Prevention, and problems in the supply chain. These mistakes have left us blind and badly behind the curve, and, for a few crucial weeks, they created a false sense of security. (150) What we now know is that the coronavirus silently spread for several weeks, without us being aware of it and while we were doing nothing to stop it. Containment and mitigation efforts could have significantly slowed its spread at an early, critical point, but we frittered away that opportunity."
On Saturday, March 14, in "From complacency to emergency: How Trump changed course on coronavirus," Gary Orr and Nancy Cook of Politico reported on Donald Trump's 180-degree turn.
Just three days before he declared a national emergency, Trump had said the coronavirus "will go away" (151) and that his administration's "response was 'really working out.'" (152) In fact, Trump's indifference to the crisis had forced city and state leaders to step up before a coordinated federal response had taken shape.
Though he was purportedly now focused on helping the American people get through an economic crisis, Trump continued to advocate a payroll tax which would give more money in real dollars to the wealthy and upper-middle class, doing little for the people who need the money most (153).
The following Monday, March 16, the Washington Post led with, "How U.S. coronavirus testing stalled: Flawed tests, red tape and resistance to using the millions of tests produced by the WHO."
The key stat-line in the piece was that "From mid-January until Feb. 28, fewer than 4,000 tests from the U.S. Centers for Disease Control and Prevention were used out of more than 160,000 produced." (154)
The CDC had come up with a test quickly, by January 17, but "From there…U.S. efforts fell quickly behind, especially when compared with the efforts of the [World Health Organization], which has distributed more than 1 million tests to countries around the world based in part on the method developed by the German researchers….As early as Feb. 6, four weeks after the genome of the virus was published, the WHO had shipped 250,000 diagnostic tests to 70 laboratories around the world.
"By comparison, the CDC at that time was shipping about 160,000 tests to labs across the nation — but then the manufacturing troubles were discovered, and most would be deemed unusable because they produced confusing results. Over the next three weeks, only about 200 of those tests sent to labs would be used."
"…U.S. efforts to distribute a working test stalled until Feb. 28, when federal officials revised the CDC test and began loosening up FDA rules that had limited who could develop coronavirus diagnostic tests."
Due to the flawed test kits and CDC regulations, as of February 21, "Health officials across the country began pleading for a test that worked, or at least the authorization to use another test."
Interviewed for the article was Alex Greninger of the University of Washington. "His lab had developed its own test and began seeking approval to use it on patients on Feb. 18. But that test, along with others that had been developed in various academic centers and hospitals, could not be used on patients until the FDA relaxed its testing rules.
"[Greninger] noted that many of the state public health labs had also figured out how to use the CDC test properly — by tossing one of its components — but were not allowed to actually do so until the FDA approved the workaround that same day.
"We had all these state public health labs that had a perfectly good [test] on their hands, and they knew it, they were upset," Greninger said.
"…As late as Feb. 27, only 203 specimen tests had been run out of state labs; another 3,125 had been run out of the CDC."
Even as earlier stumbling blocks to mass testing had been overcome, new hurdles that had been overlooked by the administration (155) were appearing, as reported by David Lim at Politico:
"A potential shortage of cotton swabs and other basic supplies needed for coronavirus testing is emerging as a new threat to the Trump administration's plans to roll out high-volume testing to 2,000 sites across the country by the end of the week.
"…The materials in question include swabs that medical workers use to collect samples of patients' phlegm and saliva for testing, and disposable plastic tips for the pipettes that lab technicians use to transfer liquids. Testing labs say they're also concerned about the availability of personal protective equipment for their staff."
Asked at a press conference that day how he'd rate his response to the crisis, Trump said, "I'd rate it a ten," part of a pattern of over 100 self-congratulatory remarks he would make throughout his upcoming press briefings. (156)
The following day, Tuesday, March 17, the Washington Post published an article about another disastrous facet of the pandemic which the administration had failed to prepare for (157): "Covid-19 hits doctors, nurses and EMTs, threatening health system."
In addition to the concern about hospital overcrowding and a lack of beds, the virus was now threatening the health and lives of the clinicians tasked with administering to the sick, putting yet another strain on the system:
"Dozens of health-care workers have fallen ill with covid-19, and more are quarantined after exposure to the virus, an expected but worrisome development as the U.S. health system girds for an anticipated surge in infections.
"From hotspots such as the Kirkland, Wash., nursing home where nearly four dozen staffers tested positive for the coronavirus, to outbreaks in Massachusetts, Pennsylvania, California and elsewhere, the virus is picking off doctors, nurses and others needed in the rapidly expanding crisis.
"They have been put at risk in the United States not only by the nature of their jobs, but by shortages of protective equipment such as N95 face masks and government bungling of the testing program, which was delayed for weeks while the virus spread around the country undetected.
"Because testing has lagged, health-care workers often have no way to know whether people walking through the door with respiratory symptoms are suffering from the flu or covid-19, providers said. Even when precautions are taken, the virus has found its way into health-care facilities."
As clinicians in the trenches struggled with shortages of protective gear, swabs, and their own illnesses thanks to Trump's indifference to the virus for ten weeks, Trump said at a press conference, "This is a pandemic…I felt it was a pandemic long before it was called a pandemic." (158) One week earlier he had said that the coronavirus "will go away."
Though the president had changed his tune, many of his followers still thought the virus was a hoax (see #85). After two months in which Trump had minimized and dismissed the seriousness of the virus with a steady stream of propaganda, polling showed that 79% of Democrats understood that "the worst is yet to come," while only 40% of Republicans grasped the obvious (159). Despite Trump's numerous failures to protect the public from the virus, 81% of Republicans approved of Trump's management of the crisis.
On Wednesday, March 18, New York magazine's Jonathan Chait discussed imminent, devastating human consequences which could have been significantly reduced with proper planning in "The Hospital Deluge Is Coming. Washington Has Done Almost Nothing to Prepare." His opening paragraph summarized why America found itself in such a disastrous situation:
"The most efficient first step would have been to prevent the coronavirus pandemic from spreading in the first place. As many reports have widely documented, that first step never took place because the Centers for Disease Control and Prevention failed to deploy an effective coronavirus test. 'This is such a rapidly moving infection that losing a few days is bad, and losing a couple of weeks is terrible,' Ashish Jha, director of the Harvard Global Health Institute, tells Bloomberg News. 'Losing 2 months is close to disastrous, and that's what we did.'
"The loss of those two months deprived the government of any chance to prevent the pandemic from sweeping across the entire country. Officials have been forced into reaction mode (160), deploying blunt measures of closing public spaces to try to slow down the spread. Even so, it is highly likely that, within a few weeks, the number of infected patients will exceed the capacity of the hospital system to treat them.
"Washington has had weeks and weeks to prepare for this surge. The three most obvious and foreseeable shortages are hospital beds (161), respirator masks to protect medical staff (162), and ventilators (the machines that are needed to pump air into the lungs of patients with the most serious coronavirus symptoms). (163)
"You would think the government would have spent the last two months scrambling to produce more of all three. There is no evidence this has happened, and a great deal of evidence it has not."
The answer to the supply shortage was clear: Trump needed to invoke the Defense Production Act, which would marshal the resources of the federal government to mass-produce the medical supplies needed by American hospitals. Fifty-seven House Democrats had sent an open letter to Trump on March 13, asking him to trigger the act. Though the situation was clearly about to become desperate, Trump told a reporter, "Well, we're able to do that if we have to. Right now, we haven't had to, but it's certainly ready. If I want it, we can do it very quickly. We've studied it very closely over two weeks ago, actually. We'll make that decision pretty quickly if we need it. We hope we don't need it. It's a big step." (164)
The scale of the administration's negligence to help prepare states and localities was laid out with grim statistics:
"Oregon sent a letter to Vice President Mike Pence on March 3 asking for 400,000 N95 masks. For days, it got no response, and only by March 14 received its first shipment, of 36,800 masks. But there was a problem. Most of the equipment they got was well past the expiration date and so 'wouldn't be suitable for surgical settings,' the state said. (165)
"New York City also put in a request for more than 2 million masks and only received 76,000; all were expired, said Deanne Criswell, New York City's emergency management commissioner." (166)
Over at Axios, Bob Herman focused on just one aspect of the coming shortage in "No part of the U.S. has enough hospital beds for a coronavirus crisis."
Herman reported that, "Every corner of the U.S. is at risk for a severe shortage of hospital beds as the coronavirus outbreak worsens…
"…Why it matters: Total nationwide capacity for health care supplies doesn't always matter, because hospitals in one area can help out neighboring systems when they're overwhelmed by a crisis. But these projections indicate that won't be an option with the coronavirus — everybody will be hurting at the same time. (167)
"By the numbers: Harvard's projections show if 50% of all currently occupied hospital beds were emptied and sizable percentages of Americans were infected, the country would need at least three times more beds to care for everyone.
"Those models line up with James Lawler, an infectious disease doctor at the University of Nebraska Medical Center who forecasted in a recent presentation to hospital insiders that the U.S. may eventually have as many as 96 million cases, resulting in 4.8 million hospitalizations. He told Axios he stands by those projections.
"The U.S. has 924,000 total hospital beds, or less than three beds for every 1,000 people. Roughly 5% of those beds are in standard intensive care units, where the sickest coronavirus patients would need to go."
Due to the expected shortage in hospital beds, medical facilities were delaying heart surgeries, "slow-growing or early-stage cancers," and cancer screenings such as mammograms and colonoscopies (168).
On Thursday March 19, as the full scale of the disaster was coming into clearer focus, the New York Times documented the Trump administration's failures to act on information that was readily available in "Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded."
The piece revealed that Trump's Health and Human Services department had run a series of simulations (called "Crimson Contagion") about responding to a hypothetical respiratory virus from China from January to August of 2019. The simulations "drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed."
Further, "The draft report, marked 'not to be disclosed,' laid out in stark detail repeated cases of 'confusion' in the exercise. Federal agencies jockeyed over who was in charge. State officials and hospitals struggled to figure out what kind of equipment was stockpiled or available. Cities and states went their own ways on school closings.
"Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation's leaders. Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action."
"…Asked at his news briefing on Thursday about the government's preparedness, Mr. Trump responded: 'Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.'
"The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Mr. Trump is now scrambling belatedly to address. (169)
"But the planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress."
Just as Republicans did when George W. Bush failed New Orleans after Hurricane Katrina and contributed to the deaths of 1,800 Americans through sheer incompetence, Trump passed the buck to state governments. At a press conference that day, Trump said, "Governors are supposed to be doing a lot of this work…the federal government is not supposed to be out there buying vast amounts of items and then shipping. We're not a shipping clerk." (170)
As New York Magazine's Jonathan Chait pointed out, "It is absolutely astonishing that Trump believes state and local governments should have primary responsibility for handling a national pandemic. Those governments lack the bargaining power and national scale to take control of industrial processes that lie outside their borders."
At the same press conference, a Washington Post photographer noticed that Trump had made one change to the notes he was using while speaking to the press—crossing out the word "coronavirus" and writing the words "Chinese virus" above it, a dog whistle to his racist supporters and a needless provocation to a country we should have been collaborating with who could provide the U.S. with pharmaceuticals and personal protective equipment (171).
As of Friday, March 20, eleven weeks after administration officials were first notified of the coronavirus, states and localities were still waiting for tests so that they could know where outbreaks were concentrated. (172)
According to reporters Dan Goldberg, Brianna Ehley, and David Lim of Politico:
"…governors and public health officials say they are still being forced to dramatically ration the tests, while labs are confronting daunting backlogs that delay the results….governors have been on the phone with Vice President Mike Pence and other federal officials, begging for additional supplies, testing kits, swabs, reagents and protective equipment.
"The shortage of tests means that in many states people who believe they might have contracted the virus can't know for sure and are told to stay home for weeks. (173) It means health care workers don't know whether they've contracted the illness even as they treat infected patients and tend to members of high-risk groups, such as the elderly, who might be in the hospital for other reasons. (174) And it means public health officials are left guessing where they should direct resources because they can't be certain whether there are clusters of cases.
"….That's left states to impose strict criteria on who can be tested, frustrating people across the country who are showing symptoms, worried but were told to wait and see if their cases worsen. In several states, only those who are hospitalized or at high risk, including those with underlying conditions, can be tested." (175)
Karen Weise and Mike Baker of the New York Times gave a preview of the severe rationing American hospitals would soon face:
"Medical leaders in Washington state, which has the highest number of U.S. coronavirus deaths, have quietly begun preparing a bleak triage strategy to determine which patients may have to be denied complete medical care in the event that the health system becomes overwhelmed by the coronavirus in the coming weeks.
"Fearing a critical shortage of supplies, including the ventilators needed to help the most seriously ill patients breathe, state officials and hospital leaders held a conference call Wednesday night to discuss the plans, according to several people involved in the talks. The triage document, still under consideration, will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die."
Not only were hospitals likely to have shortages in beds, but clinicians would be hampered from doing their jobs because of the Trump administration's failure to help states get adequate surgical masks and other personal protective equipment.
In "Where are the Masks?," Wajahat Ali revealed that to date the U.S. had tested only 82,000 people (by comparison to 270,000 tested in South Korea, 1/6th America's size), leaving clinicians in the dark about whether their patients had the virus, and that "2,629 health workers had been infected" in Italy, giving a preview of what medical workers in the States had to look forward to if stocks of protective gear weren't ramped up quickly. If clinicians get sick, "no one else will be left, especially in small communities, to take care of patients as the coronavirus exponentially spreads." (see #157)
Trump had committed to using the Defense Production Act to address this issue two days earlier, but had changed his mind later that night, tweeting that he would only invoke the Act "in a worst-case scenario in the future." (176)
Ali reported that "Almost every health-care professional I interviewed criticized the government's lack of preparedness. 'The biggest mistake we've made is that we awakened to this problem too late,' said [a] New York emergency-room doctor. 'We had three months of warning from China and then Europe, and we didn't take it seriously.'"
Another New York physician told Ali, "We have known for six weeks, and there was literally zero response and preparedness….The entire health-care system is a massive failure on a federal level.'"
Clinicians "also voiced frustration toward the CDC and its changing guidelines on personal protective equipment. A few weeks ago the CDC said physicians needed N95 masks. Later, it said surgical masks would suffice. This week, it said bandanas and scarves can be used as a last resort. The physicians said they believe these shifting guidelines are driven by equipment shortages, and not the actual safety of health-care workers." (177)
With cities and some states shutting down, reported cases increasing by the day, widespread testing still not happening, hospitals overburdened and expecting worse, adequate PPE nowhere in sight, and a record number of Americans about to file for unemployment in no small part due to administration inaction from January 3 until March 13 (178), Peter Alexander of NBC asked Trump at that day's daily coronavirus briefing, "What do you say to Americans who are watching you right now who are scared?"
Trump's response to this reasonable question was, "I say that you're a terrible reporter, that's what I say. I think it's a very nasty question, and I think it's a very bad signal that you're putting out to the American people." (179)
Saturday, March 21 featured an autopsy of executive branch failures from Politico's resident expert on the Trump administration's response, Dan Diamond (see #100 and #131).
Diamond pointed out that while Trump's sudden shift to publicly acknowledging the coronavirus with regular briefings and promises of federal assistance was assuaging gullible and uninformed Americans, behind the scenes the failures were evident:
"…no one in the White House had devised a national strategy for obtaining and distributing the necessary supplies in the likely months-long fight against the pandemic that lies ahead, said three people with knowledge of the planning efforts. Those supply-planning efforts are only now underway."
As a result of 10 weeks of inaction from the administration, Seattle and New York City "have effectively abandoned efforts to conduct broad testing on residents, instead urging them to stay home given the shortages — an acknowledgment that efforts to contain coronavirus have failed and they need to prioritize limited supplies (180). Local officials also are making unusual crowdsourcing appeals. (181)
"'We need companies to be creative to supply the crucial gear our healthcare workers need. NY will pay a premium and offer funding,' New York Gov. Andrew Cuomo tweeted on Friday. 'If you have any of these unused supplies, please email COVID19supplies@esd.ny.gov.'"
Not only was the Trump administration not using the Defense Production Act, they were actively competing with states for equipment (182), robbing states of supplies in order to build up national reserves.
Supply-chain shortages would not only negatively impact coronavirus victims, people who couldn't get surgeries due to the flood of coronavirus victims into hospitals (183), and the clinicians who serve them, but women having babies (184). According to ProPublica, "Over the next three months, nearly a million women in the United States will give birth to nearly a million babies — a huge influx of mostly healthy, highly vulnerable patients into a hospital system that's about to come under unprecedented strain. Pregnant women, not surprisingly, are anxious. Those in their third trimester, looking to deliver during an epidemic, are close to frantic."
As the crisis in our hospitals became clearer, Trump continued to blame his predecessors.
Though the Obama administration had briefed the incoming Trump administration on the importance of pandemic planning, run through a pandemic exercise with them, and left highly competent officials in charge of the CDC and the NSC's Office of Global Security, when asked about the shortage of masks in his daily briefing, Trump said, "Many administrations preceded me — for the most part they did very little, in terms of what you're talking about…We're making much of the stuff now, it's being delivered now." (185).
On Sunday, March 22, ABC reported that the U.S. "now has the third most cases worldwide," over 31,000.
Appearing on CNN, Bronx/Queens representative Alexandria-Ocasio Cortez said, "The fact that the president has not really invoked the Defense Production Act for the purpose…of emergency manufactur[ing] is going to cost lives." (186)
Because the Trump administration had failed to think ahead and was refusing to invoke the Defense Production Act—while stealing supplies from states to stock the national reserves—administration officials were tasked with coming up with contingency plans for hospitals as they run out of PPE, ventilators, and vital medical supplies.
As reported by the Washington Post, "Most disturbing for some people is the idea that the wealthiest nation in the world is leaving its caregivers unprotected in this crisis because it did not plan for it and wasted precious weeks before responding." (187)
Further into the piece, the authors looked at the Trump administration's original sin:
"CDC Director Robert Redfield heard from Chinese counterparts on Jan. 3 that a spreading respiratory illness could be caused by a novel coronavirus. Redfield told Health and Human Services Secretary Alex Azar, who sought to immediately notify the White House National Security Council, according to four senior administration officials who spoke on the condition of anonymity to discuss internal government actions. Azar briefed Trump on Jan. 18 about the virus, but the president was said to be quickly disinterested. (188) The CDC, HHS, National Institutes of Health, State Department, National Security Council and other agencies and aides began meeting to discuss the virus in January.
"Yet Trump and several of his aides were reluctant to take the virus seriously until the first confirmed U.S. case surfaced on Jan. 21, according to two senior administration officials. (189) Trump continued to downplay the threat of the virus until this month.
"Not until the first week of March did the administration and Congress agree to an $8.3 billion supplemental spending bill to address the outbreak, wasting weeks that could have been used to respond to equipment shortages…"
"…Lauren Sauer, director of operations for the Johns Hopkins Office of Critical Event Preparedness and Response, said, 'Lack of clarity from the White House has been frustrating….It feels like every decision that is being made from the administration is the first decision they've had to make on this.'"
Not only was the administration failing to provide clear guidance to hospitals as to how to cope with the manmade disaster that awaited them, but due to the shortages—which were exacerbated by the administration outbidding states—states were competing with one another and even against other countries. As Illinois governor J.B. Pritzker told CNN, "It's a wide Wild West…out there. And, indeed, we're overpaying, I would say, for [personal protective equipment] because of that competition." (190)
Trump's response to Pritzker's criticism of the grossly inadequate federal response, in the middle of a pandemic he had made infinitely worse than it needed to be (see #1-#190), was to spend his precious time trolling Pritzker on Twitter (191).
When he wasn't using Twitter to attack public officials who tried to hold him accountable, Trump added to the chaos and suffering he'd already caused by tweeting that "HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains – Thank You!"
As ProPublica reported, "Trump's push to use hydroxychloroquine to treat COVID-19 has triggered a run on the drug. Healthy people are stocking up just in case they come down with the disease. That has left lupus patients…and those with rheumatoid arthritis suddenly confronting a lack of medication that safeguards them, and not only from the effects of those conditions." (192)
This despite the fact that there was no concrete evidence that the combination was effective. As Trump's top medical coronavirus advisor, Anthony Fauci, told an interviewer, "The information that you're referring to is anecdotal. It wasn't done in a controlled clinical trial, so you can't make a definitive statement about it." (193)
Fauci's inability to keep Trump focused on facts popped up again on Monday, March 23, in an interview with Science Magazine. Asked about Trump's dubious statements about the strategic effectiveness of closing the border (194) and the timing of China's disclosures (195), Fauci said, "I know, but what do you want me to do? I mean, seriously Jon, let's get real, what do you want me to do?"
Fauci's lack of sway was again evident in Trump's messaging at that day's briefing. Despite all available information that the impact of the virus was increasing dramatically, with the country now at over 42,000 cases and 100 deaths in a day, and the warnings of health officials that a shutdown was necessary to flatten the curve, Trump minimized the scope of the pandemic by mentioning the number of fatal auto accidents annually (196), again compared the coronavirus to the flu (197), and said he would review his decision to shut the country down once the initial 15-day order was up, potentially re-opening parts of the country while the pandemic continued to spread (198). He even claimed that there would be more suicides from social isolation than deaths from the virus itself (199).
That same day, Michael Poznansky of the Washington Post reported that the administration had had access to "repeated" intelligence warnings since the beginnings of the virus, but it was unclear if Trump was aware of the information in real time because "Trump reportedly does not read intelligence assessments (see #140), does not ask probing questions of his intelligence advisers (200), and does not schedule intelligence briefings nearly as often as his predecessors." (201)
Another major (and unforced) administration error was revealed by journalist Marisa Taylor, who reported that "Several months before the coronavirus pandemic began, the Trump administration eliminated a key American public health position in Beijing intended to help detect disease outbreaks in China."
According to Taylor, "the American disease expert, a medical epidemiologist embedded in China's disease control agency, left her post in July …The first cases of the new coronavirus may have emerged as early as November, and as cases exploded, the Trump administration in February chastised China for censoring information about the outbreak and keeping U.S. experts from entering the country to help.
"'It was heartbreaking to watch,' said Bao-Ping Zhu, a Chinese American who served in that role, which was funded by the U.S. Centers for Disease Control and Prevention, between 2007 and 2011. 'If someone had been there, public health officials and governments across the world could have moved much faster.' (202)
"As an American CDC employee, they said, Quick was in an ideal position to be the eyes and ears on the ground for the United States and other countries on the coronavirus outbreak, and might have alerted them to the growing threat weeks earlier." (A follow-up article by Taylor would reveal that the disease expert was just one of many health officials in Beijing who were pulled out by the administration, which had eliminated 33 of 47 positions at that location.)
Asked about the story at a press conference, Trump said the report was "100 percent wrong" but offered no factual rebuttal of the information provided (203).
Seeking to mitigate the unfolding disaster that Trump had created, Congress was at work on a time-sensitive stimulus bill. As ever, Republican Mitch McConnell played chicken with the Democrats, crafting a Senate bill that shortchanged everyday people and desperate medical facilities while directing enormous sums of taxpayer subsidies to business interests with no strings attached.
When Democrats refused to play ball, McConnell blamed the Democrats for the delay, a dishonest rhetorical thrust echoed by the president (204) which forced Nancy Pelosi to step in and shape a stimulus package that would at least try to strike a balance between public needs and private interests. With no thanks to the president, Pelosi molded a bill that spent more money on hospitals, unemployment benefits, and federal disaster management, included progressive tax cuts (in place of the regressive tax cuts Trump/McConnell wanted), and made airlines getting huge infusions of taxpayer money follow green practices.
Tuesday, March 24 offered another post-mortem on the Trump administration's failures to act on the coronavirus with "DHS wound down pandemic models before coronavirus struck" by Daniel Lippman at Politico.
The opening paragraphs tell the crux of the story:
"The Department of Homeland Security stopped updating its annual models of the havoc that pandemics would wreak on America's critical infrastructure in 2017, according to current and former DHS officials with direct knowledge of the matter.
"From at least 2005 to 2017, an office inside DHS, in tandem with analysts and supercomputers at several national laboratories, produced detailed analyses of what would happen to everything from transportation systems to hospitals if a pandemic hit the United States.
"But the work abruptly stopped in 2017 amid a bureaucratic dispute over its value, two of the former officials said, leaving the department flat-footed as it seeks to stay ahead of the impact the COVID-19 outbreak is having on vast swaths of the U.S. economy. (205) Officials at other agencies have requested some of the reports from the pandemic modeling unit at DHS in recent days, only to find the information they needed scattered or hard to find quickly." (206)
Former Obama DHS official Juliette Kayyem said the administration's blindness to the value of the models could be attributed to its singular focus on scapegoating Mexicans:
"We should not be surprised that a department that has for the last 3½ years viewed itself solely as a border enforcement agency seems ill-equipped to address a much greater threat to the homeland." (207)
This short-sightedness robbed crisis management officials of information that could have helped them from the outset of the virus's expansion into the U.S.: "The former DHS officials said if the pandemic models had been maintained properly, the administration might have had an earlier understanding of where shortages might occur, and acted accordingly to address them…(208)
"'A lot of what we're doing now is shooting in the dark, and there's going to be secondary impacts to infrastructure that are going to be felt in part because we didn't maintain these models,' (209) said one of the former DHS officials. 'Our ability to potentially foresee where the impacts are or may manifest is a result of the fact that we don't have the capabilities anymore.'"
The impact of not having these models in the present was grim, as states strained under the weight of medical supply shortages and record numbers of unemployment claims. Nowhere was this felt more acutely than New York, which was now "the U.S. epicenter of the pandemic, with 25,665 cases," and facing a disastrous shortage of ventilators and other crucial medical equipment. The state had 7,000 ventilators and needed 30,000. The administration had thus far sent just 400 ventilators (210).
Addressing the shortage, New York governor Andrew Cuomo said, "I understand the federal government's point that many companies have come forward and said we want to help, and General Motors and Ford and people are willing to get into the ventilator business. It does us no good if they start to create a ventilator in three weeks or four weeks or five weeks. We're looking at an apex of 14 days….The [Defense Production Act] can actually help companies, because the federal government can say, 'Look, I need you to go into this business. I will contract with you today for x number of ventilators. Here's the startup capital you need….Not to exercise that power is inexplicable to me.'"
Bridling, as he always does, at criticism—even when it is well-deserved—Trump falsely accused Cuomo of creating death panels during a Fox News virtual town hall that day (211) and continued to refuse to activate the Defense Production Act. This was of a piece with the administration's pattern of delay and obfuscation, as reported in "Slow Response to the Coronavirus Measured in Lost Opportunity" at the New York Times.
Had the administration called on its potential industrial power in January, when they knew about the virus's destructive power overseas, or even early February, when Democratic senators proposed emergency funding (see #40), hospitals could have had sufficient stocks of equipment when the first big wave of cases came in, but due to administration delays, the proposed partnership between GE and General Motors wouldn't produce equipment until June (212). The administration's promise to send out 60,000 test kits fell well short of the "tens of millions needed."
Even as the administration failed to get ventilators out (despite having an awareness of ventilator shortages in Chinese hospitals two months earlier), even as public health officials recommended a shutdown of up to "a year or more," even as the spokesperson for the World Health Organization had said that very day that the U.S. could be the next epicenter of the coronavirus, Trump told Fox viewers that he wanted the country to be "opened up and just raring to go by Easter." (213)
While identified cases spiraled from 7,800 to 53,268 in just one week, one of the root causes of the public health disaster was explored the next day, Wednesday, March 25, by Politico reporters Nahal Toosi and Dan Diamond (see #100, #131, and #181) in "Trump team failed to follow NSC's pandemic playbook."
According to the piece, Barack Obama's National Security Council had a plan for just these kinds of situations, but the Trump administration had ignored the playbook for the past twelve weeks, thereby enabling the catastrophe that was unfolding in New York City and other parts of the country. (214)
One excerpt from the playbook read "'Is there sufficient personal protective equipment for healthcare workers who are providing medical care?' the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. 'If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?'"
The plan consisted of "hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics….Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook."
"….The guide further calls for a 'unified message' on the federal response, in order to best manage the American public's questions and concerns. 'Early coordination of risk communications through a single federal spokesperson is critical,' the playbook urges.
"However, the U.S. response to coronavirus has featured a rotating cast of spokespeople and conflicting messages (215); Trump already is discussing loosening government recommendations on coronavirus in order to 'open' the economy by Easter, despite the objections of public health advisers.
"A former Obama official said, 'These are recommended discussions to be having on all levels, to ensure that there's a structure to make decisions in real-time.'"
Though briefed on the playbook (officially titled the Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents) by outgoing Obama administration officials, Trump's NSC never followed through on its recommendations (216).
Another example of how not to handle a coronavirus crisis appeared on ProPublica's website the following day, Thursday, March 26.
"Internal Emails Show How Chaos at the CDC Slowed the Early Response to Coronavirus" gave examples of the Trump administration's miscommunications with state health officials in Nevada and failures to gather accurate data about the number of coronavirus cases (217).
Among the key findings: 1) the CDC gave contradictory information about test guidelines to public health officials (218); 2) the CDC intended to outsource testing to state health departments, but this was slowed down because of delays with the test kits; 3) the CDC asked states to use DCIPHER, a web platform, but provided no training on how to use the platform until February 24 (219); and 4) the CDC protocol for screening passengers at Los Angeles airport returning from China was unclear and ineffective (220).
Returning to the present, hospitals were weighing universal do not resuscitate orders in order to keep clinicians safe: "The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient "codes," and their heart or breathing stops."
"'…It's extremely dangerous in terms of infection risk because it involves multiple bodily fluids,' explained one ICU physician in the Midwest, who did not want her name used because she was not authorized to speak by her hospital."
One New York nurse who died from COVID-19 worked on a unit where clinicians had to wear garbage bags due to a shortage of PPE (221).
That evening, it was reported that 3.3 million Americans had applied for unemployment, a record number, and Trump told Sean Hannity "I don't believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they'll have two ventilators. And now all of a sudden they're saying, 'Can we order 30,000 ventilators?'" (222*)(*The New York Times would report the next day that the state of New York was so short of ventilators that patients were actually sharing ventilators)
Trump's minimizing of the crisis extended to his daily briefing, where he talked about classifying areas of the country based on known infection rates and opening up the spots with lower rates, even though testing had been limited, the extent of the virus was unknown and had been underestimated in the past, and there were no guarantees of safety.
Trump's false narratives prompted a discussion at Axios, "Trump's coronavirus briefings see big audiences. Some argue that's bad." The piece explored the inability of networks to factcheck Trump's claims in real time, allowing the president's inaccurate and often unscientific statements to confuse millions of viewers with poor critical-thinking skills (223).
As just one example, one month earlier, Trump had told reporters, "when you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that's a pretty good job we've done." (see #71) As of March 26, the United States had over 1,000 deaths, the most reported cases of any country, and the numbers were increasing significantly every day.
Stories detailing Trump's denial about the scope of the crisis continued on Friday, March 27. Aaron Blake and William Wan of The Washington Post reported that Trump's steady stream of public lies and misstatements had been taken at face value by many of his supporters and other low-information voters (224), contributing to most Republican governors refusing to order shelter-in-place edicts, thereby endangering public safety (225). Further, the variance in individual states' commitments to combating the virus was making it hard to create sound epidemiology models, keeping public health officials from knowing true risk levels (226), which should be the driver of public policy. As was pointed out, the cities that lifted shelter-in-place orders too soon during the 1918 Spanish flu paid a steep price.
The same day that it was reported that the number of cases had passed 100,000, twice what they had been three days earlier (and yet still a major underestimate due to test delays), Jonathan Swan at Axios reported that "weaning Trump from setting a date for millions of Americans to get back to work is a delicate, ongoing process." One administration official said, "I don't think he feels in any way that his messaging was off….He feels more convinced than ever that America needs to get back to work." (227)
To his credit, Trump did take some productive actions Friday the 27th—nearly three months after the administration had first been informed of coronavirus.
Earlier in the day, he signed the two trillion-dollar stimulus bill with no Democrats present, as he couldn't help being petty and partisan (228) in this moment of national crisis.
Friday evening he finally invoked the Defense Production Act to have General Motors produce ventilators, more than two months after Robert Kadlec (an Air Force physician and the assistant secretary for preparedness and response at Health and Human Services) had started readying the process. The ventilator request was too little, too late (see #212), and didn't extend to any other badly-needed medical supplies or personal protective equipment (229), but it's better than what the administration had done so far, which was close to nothing.
The ventilators won't be ready anytime soon, and according to the New York Times, New York alone is estimated to need "20 million N-95 masks, 30 million surgical masks, 45 million exam gloves, 20 million gowns and 30,000 ventilators, all astronomical amounts compared to New York's current stockpile."
And to date Trump has refused to issue a national shelter-in-place order (230), a big step but realistically the most important one if we're serious about reducing the spread of this deadly virus.
In the months to come, human desperation and misery is sure to skyrocket in the United States as the informed-and-sensible quarantined suffer separation anxiety from family and friends and livelihoods, as every trip out of the house to get basic provisions carries the risk of contracting the virus, as record levels of unemployment continue and millions are unable to meet basic financial needs, as hospitals overflow, as cities and states continue to be forced to compete against each other and get gouged by private companies due to the Trump administration's delays in ramping up medical supply production, as upward of a million Americans get sick and one to two hundred thousand or more die horrible and premature deaths.
Human beings are fallible. No presidential administration is perfect.
But it didn't have to be this way. Had the Trump administration heeded advice from the outgoing Obama administration, or kept a competent disaster management team in place, or acted aggressively from the moment they were notified of the virus on January 3, or recommended social distancing sooner, or maintained consistent and transparent messaging, or used the formidable resources of the federal government early and often, we would be looking at a radically better future.
Asked by NPR's Terry Gross what went wrong with the test kits, Politico reporter Dan Diamond quoted a Trump administration official:
"Terry, the question might not be what went wrong; it's what went right?"