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World How Trump let Covid-19 win

23:30  22 september  2020
23:30  22 september  2020 Source:   vox.com

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a person wearing a costume © Christina Animashaun/Vox

As America, and even his own administration, woke up to the threat of Covid-19, President Donald Trump still didn’t seem to get it. Within weeks of suggesting that people social distance in mid-March, the president went on national TV to argue that the US could reopen by Easter Sunday in April. “You’ll have packed churches all over our country,” Trump said in March. “I think it’ll be a beautiful time.”

The US wasn’t able to fully and safely reopen in April. It isn’t able to fully and safely reopen in September.

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The virus rages on, affecting every aspect of American life, from the economy to education to entertainment. More than 200,000 Americans are dead. Many schools are closing down again after botched attempts to reopen — with outbreaks in universities and K-12 settings. America now has one of the worst ongoing epidemics in the world, with the second most daily new Covid-19 deaths among developed nations, surpassed only by Spain.

America does not have the most Covid-19 deaths of any rich country, but it’s doing worse than most. The US reports about seven times the Covid-19 deaths as the median developed country, ranking in the bottom 20 percent for coronavirus deaths among wealthy nations. Tens of thousands of lives have been needlessly lost as a result: If America had the same death rate as, for example, Canada, nearly 120,000 more Americans would likely be alive today.

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a close up of a map © Our World in Data

The Easter episode, experts said, exemplified the magical thinking that has animated Trump’s response to the Covid-19 pandemic before and after the novel coronavirus reached the US. It’s a problem that’s continued through September — with Trump and those under him flat-out denying the existence of a resurgence in Covid-19, falsely claiming rising cases were a result of more tests. With every day, week, and month that the Trump administration has tried to spin a positive story, it’s also resisted stronger action, allowing the epidemic to drag on.

A pandemic was always likely to be a challenge for the US, given the country’s large size, fragmented federalist system, and libertarian streak. The public health system was already underfunded and underprepared for a major disease outbreak before Trump.

Yet many other developed countries dealt with these kinds of problems too. Public health systems are notoriously underfunded worldwide. Australia, Canada, and Germany, among others, also have federalist systems of government, individualistic societies, or both — and they’ve all fared much better.

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Instead, experts said, it’s Trump’s leadership, or lack thereof, that really sets the US apart. Before Covid-19, Trump and his administration undermined preparedness — eliminating a White House office set up by the previous administration to combat pandemics, making cuts across other key parts of the federal government, and proposing further cuts.

Once the coronavirus arrived, Trump downplayed the threat, suggesting that it would soon disappear “like a miracle.” The Centers for Disease Control and Prevention (CDC) took weeks to fix botched tests, and the administration actively abdicated control of issues to local, state, and private actors.

“There was a failure to realize what an efficiently spreading respiratory virus for which we have no vaccine and no antiviral meant,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “From the very beginning, that minimization … set a tone that reverberated from the highest levels of government to what the average person believes about the virus.”

Several developed countries — including Belgium, France, Italy, and Spain — were caught off-guard by the pandemic and were hit hard early, suffering massive early outbreaks with enormous death tolls. But most developed countries took these crises seriously: adopting lengthy and strict lockdowns, widespread testing and contact tracing, masking mandates, and consistent public messaging about the virus. (Though parts of Europe are now seeing second waves, seemingly because they prematurely relaxed social distancing measures.)

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America did not take the steps necessary, even after an outbreak spiraled out of control in New York. So the US suffered a wave of huge cases over the summer that other developed nations generally avoided, leading to new and continued surges in both cases and deaths. And while other developed countries have seen spikes in cases as fall neared, America also has seen cases start to rise once again.

“If George W. Bush had been president, if John McCain had been president, if Mitt Romney had been president, this would have looked very different,” Ashish Jha, the faculty director of the Harvard Global Health Institute, told me, emphasizing the failure to act after Covid-19 hit the US hard was a phenomenon driven by Trump.

a person standing in front of a computer: President Donald Trump talks to journalists during a news conference about his administration’s response to the coronavirus pandemic on July 22, 2020, in Washington, DC. © Chip Somodevilla/Getty Images President Donald Trump talks to journalists during a news conference about his administration’s response to the coronavirus pandemic on July 22, 2020, in Washington, DC.

Experts worry that things will again get worse: Colder weather is coming, forcing people back into risky indoor environments. So are holiday celebrations, when families and friends will gather from across the country. Another flu season looms. And Trump, experts lamented, is still not ready to do much, if anything, about it.

The White House disputes the criticisms. Spokesperson Sarah Matthews claimed Trump “has led an historic, whole-of-America coronavirus response” that followed experts’ advice, boosted testing rates, delivered equipment to health care workers, and remains focused on expediting a vaccine.

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She added, “This strong leadership will continue.”

The US wasn’t prepared for a pandemic — and Trump made it worse

During the 2014 Ebola outbreak, President Barack Obama’s administration realized that the US wasn’t prepared for a pandemic. Jeremy Konyndyk, who served in the Obama administration’s Ebola response, said he “came away from that experience just completely horrified at how unready we would be for something more dangerous than Ebola,” which has a high fatality rate but did not spread easily in the US and other developed nations.

The Obama administration responded by setting up the White House National Security Council’s Directorate for Global Health Security and Biodefense, which was meant to coordinate the many agencies, from the CDC to the Department of Health and Human Services to the Pentagon, involved in contagion response.

But when John Bolton became Trump’s national security adviser in 2018, he moved to disband the office. In April 2018, Bolton fired Tom Bossert, then the homeland security adviser, who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then in May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and dismantled his global health security team. Bolton claimed that the cuts were needed to streamline the National Security Council, and the team was never replaced.

In the months before the coronavirus arrived, the Trump administration also cut a public health position meant to detect outbreaks in China and another program, called Predict, that tracked emerging pathogens around the globe, including coronaviruses. And Trump has repeatedly called for further cuts to the CDC and National Institutes of Health, both on the front lines of the federal response to disease outbreaks; the administration stood by the proposed cuts after the pandemic began, though Congress has largely rejected the proposals.

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The Trump administration pushed for the cuts despite multiple, clear warnings that the US was not prepared for a pandemic. A 2019 ranking of countries’ disaster preparedness from the Johns Hopkins Center for Health Security and Nuclear Threat Initiative had the US at the top of the list, but still warned that “no country is fully prepared for epidemics or pandemics.”

A federal simulation prior to the Covid-19 pandemic also predicted problems the US eventually faced, from a collapse in coordination and communication to shortages in personal protective equipment for health care workers.

a man holding a bag of luggage: A doctor tests a patient at a drive-through testing center for Covid-19 at Lehman College on March 28, 2020, in the Bronx, New York. © John Moore/Getty Images A doctor tests a patient at a drive-through testing center for Covid-19 at Lehman College on March 28, 2020, in the Bronx, New York.

Bill Gates, who’s dedicated much of his Microsoft fortune to fighting infectious diseases, warned in 2017, “The impact of a huge epidemic, like a flu epidemic, would be phenomenal because all the supply chains would break down. There’d be a lot of panic. Many of our systems would be overloaded.”

Gates told the Washington Post in 2018 he had raised his concerns in meetings with Trump. But the president, it’s now clear, didn’t listen.

There are limitations to better preparedness, too. “If you take what assets the United States had and you use them poorly the way we did, it doesn’t matter what the report says,” Adalja said, referring to the 2019 ranking. “If you don’t have the leadership to execute, then it makes no difference.”

As Covid-19 spread, Trump downplayed the threat

On February 25, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters that Americans should prepare for community spread of the coronavirus, social distancing, and the possibility that “disruption to everyday life might be severe.”

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Six months later, Messonnier’s comments seem prescient. But soon after the briefing, she was pushed out of the spotlight — though she’s still on the job, her press appearances have been limited — reportedly because her negative outlook angered Trump. (Messonnier didn’t respond to a request for comment.)

The CDC as a whole has been pushed to the sidelines with her. The agency is supposed to play a leading role in America’s fight against pandemics, but it’s invisible in press briefings led by Trump, Vice President Mike Pence, advisers, and health officials like Anthony Fauci and Deborah Birx who are not part of the organization. CDC Director Robert Redfield acknowledged as much: “You may see [the CDC] as invisible on the nightly news, but it’s sure not invisible in terms of operationalizing this response.”

University of Michigan medical historian Howard Markel put it in blunter terms, telling me the US has “benched one of the greatest fighting forces against infectious diseases ever created.”

Meanwhile, the president downplayed the virus. The day after Messonnier’s warning, Trump said that “you have 15 people [with the coronavirus], and the 15 within a couple of days is going to be down to close to zero.” This type of magical thinking appears to have driven Trump’s response to Covid-19 from the start, from his conviction that cases would disappear to his proclamation that the country would reopen by Easter.

This was deliberate. As Trump later acknowledged in recorded interviews with journalist Bob Woodward, he knew that the coronavirus was “deadly stuff,” airborne, more dangerous than the flu, and could afflict both the young and old. Yet he deliberately downplayed the threat: “I wanted to always play it down,” he told Woodward on March 19. “I still like playing it down, because I don’t want to create a panic.”

Trump has long said he believes in the power of positive thinking. “I’ve been given a lot of credit for positive thinking,” he told Axios reporter Jonathan Swan during a wide-ranging discussion about Covid-19 in July. “But I also think about downside, because only a fool doesn’t.” Pressed further, he added, “I think you have to have a positive outlook. Otherwise, you have nothing.”

The concern, experts said, is the signal this messaging sends. It tells the staffers under Trump that this issue isn’t a priority, and things are fine as they are. And it suggests to the public that the virus is under control, so they don’t have to make annoying, uncomfortable changes to their lives, from physical distancing to wearing masks.

It creates the perfect conditions for a slow and inadequate response.

The CDC botched the initial test kits it sent out, and it took weeks to fix the errors. The Food and Drug Administration (FDA) also took weeks to approve other tests from private labs. As supply problems came up with testing kits, swabs, reagents, machines, and more, the Trump administration resisted taking significant action — claiming it’s up to local, state, and private actors to solve the problems and that the federal government is merely a “supplier of last resort.”

South Korea, which has been widely praised for its response to coronavirus, tested more than 66,000 people within a week of the first community transmission within its borders. By comparison, the US took roughly three weeks to complete that many tests — in a country with more than six times the population.

Asked about testing problems in March, Trump responded, “I don’t take responsibility at all.” In June, Trump claimed that “testing is a double-edged sword,” adding that “when you do testing to that extent, you’re going to find more people — you’re going to find more cases. So I said to my people, ‘Slow the testing down, please.’”

The testing shortfall was a problem few thought possible in the wealthiest, most powerful nation on earth. “We all kind of knew if a biological event hit during this administration, it wasn’t going to be good,” Saskia Popescu, an infectious disease epidemiologist, told me. “But I don’t think anyone ever anticipated it could be this bad.”

Trump also consistently undermined the advice of experts, including those in his administration. When the CDC released reopening guidelines, Trump effectively told states to ignore the guidance and reopen prematurely — to “LIBERATE” their economies. When the CDC recommended masks for public use, Trump described masking as a personal choice, refused to wear one in public for months, and even suggested that people wear masks to spite him. (He’s changed his tone recently.) While federal agencies and researchers work diligently to find effective treatments for Covid-19, Trump has promoted unproven and even dangerous approaches, at one point advocating for injecting bleach. Trump’s allies have even held up CDC studies that could contradict the president’s overly optimistic outlook.

a man standing in front of a screen: Health and Human Services Secretary Alex Azar and CDC Director Robert Redfield leave a press conference on the coordinated public health response to Covid-19 on February 7, 2020, in Washington, DC. © Olivier Douliery/AFP via Getty Images Health and Human Services Secretary Alex Azar and CDC Director Robert Redfield leave a press conference on the coordinated public health response to Covid-19 on February 7, 2020, in Washington, DC.

The most aggressive steps Trump took to halt the virus — travel restrictions on China and Europe imposed in February and March, respectively — were likely too limited and too late. And to the extent these measures bought time, it wasn’t properly used.

The federal government is the only entity that can solve many of the problems the country is facing. If testing supply shortfalls in Maine are slowing down testing in Arizona or Florida, the federal government has the resources and the legal jurisdiction to quickly act. Local or state offices looking for advice on how to react to a national crisis will typically turn to the federal government for guidance.

But the inaction, contradictions, and counterproductive messaging created a vacuum in federal leadership.

In the months after Trump’s prediction that coronavirus cases would go down to zero, confirmed cases in the US grew to more than 160,000. As of September 22, they stand at more than 6.8 million.

Months into the pandemic, Trump has continued to flail

After the initial wave of coronavirus cases began to subside in April, the White House stopped its daily press briefings on the topic. By June, Trump’s tweets and public appearances focused on Black Lives Matter protests and the 2020 election — part of what Politico reporter Dan Diamond described, based on discussions with administration officials, as an “apparent eagerness to change the subject.”

Then another wave of coronavirus infections hit beginning in June, peaking with more than 70,000 daily new cases, a new high, and more than 1,000 daily deaths.

America’s response to the initial rise of infections was slow and inadequate. But other developed countries also struggled with the sudden arrival of a disease brand new to humans. The second surge, experts said, was when the scope of Trump’s failure became more apparent.

By pushing states to open prematurely, failing to set up national infrastructure for testing and tracing, and downplaying masks, Trump put many states under enormous pressure to reopen before the virus was under control nationwide. Many quickly did — and over time suffered the consequences.

a building with a store on the floor: A restaurant worker wears a face covering and gloves for handling takeout orders on April 5, 2020, in Los Angeles. © Mario Tama/Getty Images A restaurant worker wears a face covering and gloves for handling takeout orders on April 5, 2020, in Los Angeles.

Rather than create a new strategy, Trump and his administration returned to magical thinking. Pence, head of the White House’s coronavirus task force, wrote an op-ed titled “There Isn’t a Coronavirus ‘Second Wave’” in mid-June, as cases started to increase again. Internally, some of Trump’s experts seemed to believe this; Birx, once a widely respected infectious disease expert, reportedly told the president and White House staff that the US was likely following the path of Italy: Cases hit a huge high but would steadily decline.

Trump trotted out optimistic, but misleading, claims and statistics. He told Axios reporter Jonathan Swan in July that the US was doing well because it had few deaths relative to the number of cases. When Swan, clearly baffled, clarified he was asking about deaths as a proportion of population — a standard metric for an epidemic’s deadliness — Trump said, “You can’t do that.” He gave no further explanation.

Seemingly believing its coronavirus mission accomplished, the Trump administration, the New York Times reported, moved to relinquish responsibility for the pandemic and leave the response to the states — in what the Times called “perhaps one of the greatest failures of presidential leadership in generations.”

“The biggest problem in the US response is there is not a US response,” Konyndyk, now a senior policy fellow at the Center for Global Development, told me. “There is a New York response. There’s a Florida response. There’s a Montana response. There’s a California response. There’s a Michigan response. There’s a Georgia response. But there is not a US response.”

When the coronavirus first hit the US, the country struggled with testing enough people, contact tracing, getting the public to follow recommendations such as physical distancing and masking, delivering enough equipment for health care workers, and hospital capacity. In the second wave, these problems have by and large repeated themselves.

Consider testing: It has significantly improved, but some parts of the country have reported weeks-long delays in getting test results, and the percentage of tests coming back positive has risen above the recommended 5 percent in most states — a sign of insufficient testing. The system once again appeared to collapse under the weight of too much demand, while the federal government failed to solve continuing problems with supply chains. Months after Congress approved billions of dollars in spending to deal with testing problems, the Trump administration has not spent much of it.

Some of Trump’s people seemed to listen to his calls to slow down testing: On August 24, the CDC updated its guidelines to suggest people exposed to others with Covid-19 don’t necessarily have to get tested — a move for effectively less testing that experts described as “dangerous” and “irresponsible.” Only after weeks of criticism did the CDC back down and, on September 18, once again call for testing people without symptoms.

Mask-wearing also remains polarized. While surveys show that the vast majority of Americans have worn masks in the past week, there’s a strong partisan divide. According to Gallup’s surveys, 99 percent of Democrats say they’ve gone out with a mask in the previous week, compared to 80 percent of Republicans. Leveraging surveys on mask use, the New York Times estimated that the percentage of people using masks in public can fall to as low as 20, 10, or the single digits — even in some communities that have been hit hard. Anti-mask protests have popped up around the country.

a group of people holding a sign posing for the camera: Supporters of Patriot Prayer, a far-right group, rally outside Vancouver City Hall in protest against the Washington state mask mandate on June 26, 2020, in Vancouver, Washington. © Karen Ducey/Getty Images Supporters of Patriot Prayer, a far-right group, rally outside Vancouver City Hall in protest against the Washington state mask mandate on June 26, 2020, in Vancouver, Washington.

Testing and mask-wearing are two of the strongest weapons against Covid-19. Testing, paired with contact tracing, lets officials track the scale of an outbreak, isolate those who are sick, quarantine their contacts, and deploy community-wide efforts as necessary to contain the disease — as successfully demonstrated in Germany, New Zealand, and South Korea, among others. There’s also growing scientific evidence supporting widespread and even mandated mask use, with experts citing it as crucial to the success of nations like Japan and Slovakia in containing the virus.

It’s not that other developed nations did everything perfectly. New Zealand has contained Covid-19 without widespread masking, and Japan has done so without widespread testing. But both took at least one aggressive action the US hasn’t. “While there’s variation across many countries, the thing that distinguishes the countries doing well is they took something seriously,” Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco, told me.

One explanation for the shortfalls in the US response is Trump’s obsession with getting America, particularly the economy, back to normal in the short term, seemingly before Election Day this November. It’s why he’s called on governors to “LIBERATE” states. It’s why he’s repeatedly said that “the Cure can’t be worse than the problem itself.” It’s one reason, perhaps, he resisted embracing even very minor lifestyle changes such as wearing a mask.

The reality is that life will only get closer to normal once the virus is suppressed. That’s what’s working for other countries that are more earnestly reopening, from Taiwan to Germany. It’s what a preliminary study on the 1918 flu found, as US cities that emerged economically stronger back then took more aggressive action that hindered economies in the short term but better kept infections and deaths down overall.

“Dead people don’t shop,” Jade Pagkas-Bather, an infectious diseases expert and doctor at the University of Chicago, told me. “They can’t stimulate economies.”

The window to avert further catastrophe may be closing

As cases and deaths climbed over the summer, and as the November election neared, Trump at times appeared to spring back into action — bringing back coronavirus press conferences and briefly changing his tone on masks (before going back to mocking them).

But Trump still seems resistant to focusing too much on the issue. He’s tried to change the subject to former Vice President Joe Biden’s supposed plans to destroy the “Suburban Lifestyle Dream.” He’s continued to downplay the crisis, saying on July 28, as daily Covid-19 deaths once again topped 1,000, “It is what it is.” His Republican convention continued to diminish the risks of Covid-19 and exaggerate Trump’s successes in fighting the virus. At a campaign rally in Ohio on September 21, Trump claimed the virus “affects virtually nobody.”

So while combating Covid-19 aligns with Trump’s political incentives (it remains Americans’ top priority), he and his administration continue to flounder. And White House officials stand by their response so far, continually pushing blame to local and state governments.

“There’s no national plan to combat the worst pandemic that we’ve seen in a century,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me.

The summer surge of Covid-19 has calmed now, although cases across the US flattened out at a much higher level than they were in the spring, likely a result of cities, counties, states, and the public taking action as the federal government didn’t. Still, cases have started to pick back up again.

a woman riding on the back of a bicycle: Bikers in Central Park walk their bikes past a sign that reads “Keep this far apart” on May 17, 2020, in New York City. © Dia Dipasupil/Getty Images Bikers in Central Park walk their bikes past a sign that reads “Keep this far apart” on May 17, 2020, in New York City.

Experts now worry that the country could be setting itself up for another wave of Covid-19. Schools reopening across the country could create new vectors of transmission. The winter will force many Americans indoors to avoid the cold, while being outdoors in the open air can hinder the spread of the disease. Families and friends will come together from across the country to celebrate the holidays, creating new possibilities for superspreading events. And in the background, another flu season looms — which could limit health care capacity further just as Covid-19 cases spike.

“The virus spreads when a large number of people gather indoors,” Jha said. “That’s going to happen more in December than it did in July — and July was a pretty awful month.”

There are reasons to believe it might not get so bad. Since so many people in the US have gotten sick, that could offer some element of population immunity in some places as long as people continue social distancing and masking. After seeing two large waves of the coronavirus across the country, the public could act cautiously and slow the disease, even if local, state, and federal governments don’t. Social distancing due to Covid-19 could keep the spread of the flu down too (which seemed to happen in the Southern Hemisphere).

But the federal government could do much more to push the nation in the right direction. Experts have urged the federal government to provide clear, consistent guidance and deploy stronger policies, encouraging people to take Covid-19 as a serious threat — now, not later.

“I’m really concerned that the window might be closing,” Kates said.

Without that federal action, the US could remain stuck in a cycle of ups and downs with Covid-19, forcing the public to double down on social distancing and other measures with each new wave. As cases and deaths continue to climb, America will become even more of an outlier as much of the developed world inches back to normal. And the “beautiful time” Trump imagined for Easter will remain out of reach.

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Insults and interruptions mar first Trump-Biden debate .
Insults and interruptions mar first Trump-Biden debateCLEVELAND (Reuters) - President Donald Trump and Democratic rival Joe Biden battled fiercely over Trump's record on the coronavirus pandemic, healthcare and the economy in a chaotic and bad-tempered first debate marked by personal insults and Trump's repeated interruptions.

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