In its destruction of American lives, treasure and well-being, the coronavirus pandemic marks the greatest failure of U.S. governance since Vietnam. Photo / Max Loeffler, The New York Times.
OPINION:
One of the most lethal leadership failures in modern times unfolded in South Africa in the early 2000s as AIDS spread there under President Thabo Mbeki.
Mbeki scorned science, embraced conspiracy theories, dithered as the disease spread and rejected lifesaving treatments. His denialism cost about 330,000 lives, a Harvard study found.
None of us who wrote scathingly about that debacle ever dreamed that something similar might unfold in the United States. But today, health experts regularly cite President Donald Trump as an American Mbeki.
"We're unfortunately in the same place," said Anne Rimoin, an epidemiologist at UCLA. "Mbeki surrounded himself with sycophants and cost his country hundreds of thousands of lives by ignoring science, and we're suffering the same fate."
One role of journalism is to establish accountability, and that's particularly important before an election. Trump says he deserves an A-plus for his "phenomenal job" handling the coronavirus, but the judgment of history is likely to be far harsher.
"I see it as a colossal failure of leadership," said Larry Brilliant, a veteran epidemiologist who helped eliminate smallpox in the 1970s. "Of the more than 200,000 people who have died as of today, I don't think that 50,000 would have died if it hadn't been for the incompetence."
There's plenty of blame to go around, involving Democrats as well as Republicans, but Trump in particular "recklessly squandered lives," in the words of an unusual editorial this month in the New England Journal of Medicine. Death certificates may record the coronavirus as the cause of death, but in a larger sense vast numbers of Americans died because their government was incompetent.
As many Americans are dying every 10 days of Covid-19 as U.S. troops died during 19 years of war in Iraq and Afghanistan, and economists David Cutler and Lawrence Summers estimate that the economic cost of the pandemic in the United States will be $16 trillion, or about $125,000 per American household — far more than the median family's net worth. Then there's an immeasurable cost in soft power as the United States is humbled before the world.
"It's really sad to see the U.S. presidency fall from being the champion of global health to being the laughingstock of the world," said Devi Sridhar, an American who is a professor of global health at the University of Edinburgh. "It was a tragedy of history that Donald Trump was president when this hit."
The United States has made other terrible mistakes over the decades, including the Iraq War and the War on Drugs. But in terms of destruction of American lives, treasure and well-being, this pandemic may be the greatest failure of governance in the United States since the Vietnam War.
America Was the Leader in Pandemic Preparedness.
The paradox is that a year ago, the United States seemed particularly well positioned to handle this kind of crisis. A 324-page study by Johns Hopkins found last October that the United States was the country best prepared for a pandemic.
Credit for that goes to President George W. Bush, who in the summer of 2005 read an advance copy of "The Great Influenza," a history of the 1918 flu pandemic. Shaken, Bush pushed aides to develop a strategy to prepare for another great contagion, and the result was an excellent 396-page playbook for managing such a health crisis.
The Obama administration updated this playbook and in the presidential transition in 2016, Obama aides cautioned the Trump administration that one of the big risks to national security was a contagion. Private experts repeated similar warnings. "Of all the things that could kill 10 million people or more, by far the most likely is an epidemic," Bill Gates warned in 2015.
Trump has accused the Obama administration of depleting stockpiles of medical supplies so that "the cupboard was bare." It's true that the Obama administration did not do enough to refill the national stockpile with N95 masks, but Republicans in Congress wouldn't provide even the modest sums that Obama requested for replenishment. And the Trump administration itself did nothing in its first three years to rebuild stockpiles.
We in the media also blew it: We didn't do enough to warn about the risks of pandemics.
Trump argues that no one could have anticipated the pandemic, but it's what Bush warned about, what Obama aides tried to tell their successors about, and what Joe Biden referred to in a blunt tweet in October 2019 lamenting Trump's cuts to health security programs and adding: "We are not prepared for a pandemic."
The First Alarm Bells From Wuhan
When the health commission of Wuhan, China, announced on Dec. 31 that it had identified 27 cases of a puzzling pneumonia, Taiwan acted with lightning speed. Concerned that this might be an outbreak of SARS, Taiwan dispatched health inspectors to board flights arriving from Wuhan and screen passengers before allowing them to disembark. Anyone showing signs of ill health was quarantined.
If either China or the rest of the world had shown the same urgency, the pandemic might never have happened.
In the United States, the Centers for Disease Control and Prevention issued a notice about the Wuhan outbreak on Jan. 1, but not much else happened for a time. In China, President Xi Jinping issued orders on Jan. 7 for handling the coronavirus, but they were inadequate. If, at that time or soon after, Xi had ordered a more modest version of the Wuhan lockdown that was to come, it is possible that the virus could have been stifled before it spread around the globe.
Instead, Wuhan held a banquet for 40,000 people on Jan. 18, and by the time the lockdown was ordered on Jan. 23, some 5 million people had already left Wuhan for the Chinese New Year. In hindsight, two points seem clear: First, China initially covered up the scale of the outbreak. Second, even so, the United States and other countries had enough information to act as Taiwan did. The first two countries to impose travel restrictions on China were North Korea and the Marshall Islands, neither of which had inside information.
That first half of January represents a huge missed opportunity for the world. If the United States, the World Health Organisation and the world media had raised enough questions and pressed China, then perhaps the Chinese central government would have intervened in Wuhan earlier. And if Wuhan had been locked down just two weeks earlier, it's conceivable that this entire global catastrophe could have been averted.
The Defiance of Science
Perhaps the original sin of America's response to the coronavirus came with the bungling of testing.
Without testing, health officials fight an opponent while blindfolded. They don't know where the virus lurks, and they can't isolate those infected or trace their contacts.
But the CDC devised a faulty test, and turf wars in the federal government prevented the use of other tests. South Korea, Germany and other countries quickly developed tests that did work, and these were distributed around the world. Sierra Leone in West Africa had effective tests before the United States did.
Trump supporters note, correctly, that within the United States, the states with the highest mortality rates have been Democrat-led: New Jersey has had the most deaths per capita, followed by New York. It's true that local politicians, Democrats and Republicans alike, made disastrous decisions, as when Mayor Bill de Blasio of New York City urged people in March to "get out on the town despite coronavirus." But local officials erred in part because of the failure of testing: Without tests, they didn't know what they faced.
It's unfair to blame the testing catastrophe entirely on Trump, for the failures unfolded several paygrades below him. Partly that's because Trump appointees, like Dr. Robert Redfield, director of the CDC, simply aren't the A team.
In any case, presidents set priorities for lower officials. If Trump had pushed aides as hard to get accurate tests as he pushed to repel refugees and migrants, then America almost certainly would have had an effective test by the beginning of February and tens of thousands of lives would have been saved.
Still, testing isn't essential if a country gets backup steps right. Japan is a densely populated country that did not test much and yet has only 2% as many deaths per capita as the United States. One reason is that Japanese have long embraced face masks, which Redfield has noted can be at least as effective as a vaccine in fighting the pandemic. A country doesn't have to do everything, if it does some things right.
Yet in retrospect, Trump did almost everything wrong. He discouraged mask wearing. The administration never rolled out contact tracing, missed opportunities to isolate the infected and exposed, didn't adequately protect nursing homes, issued advice that confused the issues more than clarified them, and handed responsibilities to states and localities that were unprepared to act. Trump did do a good job of accelerating a vaccine, but that won't help significantly until next year.
Trump's missteps arose in part because he channelled an anti-intellectual current that runs deep in the United States, as he sidelined scientific experts and responded to the virus with a sunny optimism apparently meant to bolster the financial markets.
"It's going to disappear," Trump said on Feb. 27. "One day — it's like a miracle — it will disappear."
The false reassurances and dithering were deadly. One study found that if the United States had simply imposed the same lockdowns just two weeks earlier, 83% of the deaths in the early months could have been prevented.
A basic principle of public health is the primacy of accurate communications based on the best science. Chancellor Angela Merkel of Germany, who holds a doctorate in physics, is the global champion of that approach. Trump was the opposite, sowing confusion and conspiracy theories; a Cornell study found that "the President of the United States was likely the largest driver of the Covid-19 misinformation."
Instead of listening to top government scientists, Trump marginalised and derided them, while elevating charlatans: One senior health department official, Michael Caputo, who had no background in health, was ousted only after he denounced government scientists for "sedition" and advised Trump supporters, "If you carry guns, buy ammunition."
Trump recruited as a Covid-19 adviser a regular guest on Fox News, Dr. Scott Atlas, who is not a specialist on infectious diseases but a radiologist who is an expert on magnetic resonance imaging. You wouldn't want an epidemiologist reviewing your MRI scans, and it's equally odd to have a radiologist managing a pandemic.
A conservative commentariat echoed Trump in downplaying the virus and deriding efforts to stay safe. Brit Hume of Fox News mocked Joe Biden for wearing a large mask, and the right-wing website RedState denounced "the public health Gestapo" and called Dr. Anthony Fauci a "mask Nazi." A University of Chicago study found that watching the Sean Hannity program correlated to less social distancing, so watching Fox News may well have been lethal to some of its fans.
Echoes of the Soviet Union
Americans have often pointed to the Soviet Union as a place where ideology trumped science, with disastrous results. Stalin backed Trofim Lysenko, an agricultural pseudoscientist who was an ardent Communist but scorned genetics — and whose zealous incompetence helped cause famines in the Soviet Union. Later, in the 1980s, Soviet leaders were troubled by data showing falling life expectancy — so they banned publication of mortality statistics. It was in the same spirit that Trump opposed testing for the coronavirus in the hope of holding down the number of reported cases.
Of course, science sometimes gets it wrong. Many experts opposed closing borders, while Trump's move to limit travel from China now appears sound — although 45 countries imposed such travel restrictions before the United States. Likewise, Fauci said on March 9: "If you're a healthy, young person, if you want to go on a cruise ship, go on a cruise ship."
Inevitably, science errs, then self-corrects. But Trump was not self-correcting.
Most striking, Trump still has never developed a comprehensive plan to fight Covid-19. His "strategy" was to downplay the virus and resist business closures, in an effort to keep the economy roaring — his best argument for reelection.
This failed. The best way to protect the economy was to control the virus, not to ignore it, and the spread of Covid-19 caused economic dislocations that devastated even homes where no one was infected. Eight million Americans have slipped into poverty since May, a Columbia University study found, and about 1 in 7 households with children have reported to the census that they didn't have enough food to eat in the last seven days. More than 40% of adults reported in June that they were struggling with mental health, and 13% have begun or increased substance abuse, a CDC study found. More than one-quarter of young adults said they have seriously contemplated suicide. Diane Reynolds, who runs an excellent addiction program called Provoking Hope, estimates that relapses have increased 50% during the pandemic.
So in what is arguably the richest country in the history of the world, political malpractice has resulted in a pandemic of infectious disease followed by pandemics of poverty, mental illness, addiction and hunger.
The rejection of science has also exacerbated polarisation and tribalism. As I write this I'm on our family farm in rural Oregon. Trump is popular in this area, and his contempt for science has contributed to a dangerous unravelling, even talk of civil war. An old school friend shared this conspiracy theory on Facebook:
Create a VIRUS to scare people. Place them in quarantine. Count the number of dead every second of every day in every news headline. Close all businesses …. Mask people. Dehumanise them. Close temples and churches …. Empty the prisons because of the virus and fill the streets with criminals. Send in Antifa to vandalise property as if they are freedom fighters. Undermine the law. Loot …. And, in an election year, have Democrats blame all of it on the President. If you love America, our Constitution, and the Rule of Law, get ready to fight for them.
Mismanagement of the virus has not only sickened millions of Americans but has also poisoned our body politic.
Taking a Threat Seriously
A pandemic is a huge challenge for any country. Spain and Brazil have both had more deaths per capita than the United States, and Europe now has slightly more new infections per capita than the United States.
Still, it's not reassuring for the country that a year ago was considered best prepared for a pandemic to hear: We're not quite as bad as Brazil!
During World War II, American soldiers died at a rate of 9,200 a month, less than one-third the pace of deaths from this pandemic, but the United States responded with a massive mobilisation. By 1945, a Ford assembly line was turning out one new B-24 bomber every hour. Yet today we can't even churn out enough face masks; a poll of nurses in late July and early August found that one-third lacked enough N95 masks.
Trump and his allies have even argued against mobilisation. "Don't be afraid of Covid," Trump tweeted this month. "Don't let it dominate your life." Attorney General William Barr compared stay-at-home orders to slavery.
Instead of leading a war against the virus, Trump organised a surrender. He even held a superspreader event at the White House, for Judge Amy Coney Barrett, and that's why the White House recently had more new cases of Covid-19 than New Zealand, Taiwan and Vietnam combined.
It didn't have to be this way. If the U.S. had worked harder and held the per capita mortality rate down to the level of, say, Germany, we could have saved more than 170,000 lives. And if the U.S. had responded urgently and deftly enough to achieve Taiwan's death rate, fewer than 100 Americans would have died from the virus.
"It is a slaughter," Dr. William Foege, a legendary epidemiologist who once ran the CDC, wrote to Redfield. Foege predicted that public health textbooks would study America's response to Covid-19 not as a model of A-plus work but as an example of what not to do.
Written by: Nicholas Kristof
Photographs by: Max Loeffler, Mark Makela
© 2020 THE NEW YORK TIMES
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