America and the
Virus: ‘A Colossal Failure of Leadership’
In its destruction of American lives, treasure and
well-being, this pandemic marks the greatest failure of U.S. governance since
Vietnam.
Opinion
Columnist
- Oct. 22, 2020
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 Trump as an American
Mbeki.
“We’re unfortunately
in the same place,” said Anne Rimoin, an epidemiologist at U.C.L.A. “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 the 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 five 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
Organization 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 C.D.C. 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 pay grades
below him. Partly that’s because Trump appointees, like Robert Redfield,
director of the C.D.C., 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 percent as many deaths per capita as the United States. One
reason is that Japanese have long embraced face masks, which Dr. 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 channeled 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 percent 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 marginalized 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 M.R.I. 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 the
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 re-election.
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 one in
seven 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 percent of adults reported in June that they
were struggling with mental health, and 13 percent have begun or increased
substance abuse, a C.D.C.
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 percent 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 polarization 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 unraveling, 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. Dehumanize them. Close temples
and churches …. Empty the prisons because of the virus and fill the streets
with criminals. Send in Antifa to vandalize 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 mobilization. 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 mobilization. “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 organized a surrender. He even held a super-spreader 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 C.D.C., wrote to
Dr. Redfield. Dr. 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.
Nicholas Kristof has been a columnist for The
Times since 2001. He has won two Pulitzer Prizes, for his coverage of China and
of the genocide in Darfur. You can sign up for his free,
twice-weekly email newsletter and follow him on Instagram. His latest book is "Tightrope: Americans Reaching
for Hope." @NickKristof • Facebook
