With the coronavirus pandemic highlighting the inadequacies of America’s healthcare and social support systems, and with an election on the horizon, you’d expect president Donald Trump and his administration to take special care to show the leadership appropriate to a crisis. This isn’t the kind of threat that can be drowned out by spin and dissembling, it isn’t a foreign plot to bring down America, and it’s hard to shift the blame to Barack Obama, Hillary Clinton or the Mueller report (though the president has made some attempts).
In the event, Trump’s prime-time address to the nation last week failed spectacularly to reassure Americans and unify the nation. Over the subsequent twenty-four hours, corrections had to be issued to errors in his statement, the European Union protested that it hadn’t been consulted about the new travel ban, and another early-morning collapse gutted the stock market. Then, not long after Trump claimed that testing had “been going very smooth [sic],” expert witness Anthony Fauci told a congressional hearing that it was “failing.”
This speech was followed by a hastily organised media event in the Rose Garden at which Trump announced a national emergency and touted his business links. The outcome was little better — the stock market rose but the public health messages were garbled. (“Trump is breaking every rule in the Centers for Disease Control and Prevention’s 450-page playbook for health crises,” said one public health expert.) The president also denied responsibility for coronavirus testing delays.
Trump and his advisers seemed to panic as they realised that the declining economy and lack of trust in his leadership on this issue could pose a threat to his re-election chances.
“Who would have thought?” the president had mused during a recent visit to the Centers for Disease Control and Prevention, apparently blind to the fact that he and his administration have ignored repeated high-level advice about the threat of a pandemic. In 2017, for instance, the global health security unit of the National Security Council, set up by President Obama after the Ebola crisis, advised that the threat of a pandemic was “the number one health security concern.” Soon enough, the unit was abolished, for reasons Trump can’t now explain.
A January 2019 report from the office of the Director of National Intelligence warned that the United States would “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.” Two months later the prestigious Washington-based Center for Strategic and International Studies predicted a coronavirus pandemic and worked through what the impact would be.
When it became obvious in January that the coronavirus had spread from China to the United States, the very defensible first response, and the one preferred by Trump, was to impose travel restrictions and institute incoming passenger screenings and quarantine. So far, so good — but the administration failed to follow through by enhancing readiness and creating a reliable surveillance strategy.
The first outbreak of coronavirus, in Seattle, was identified in sentinel surveillance work by independent scientists. But this type of monitoring, which has the potential to detect viral hotspots quickly, isn’t common, and restrictions on who could access the testing left public health officials blind to the spread that had already occurred.
Preparedness for the inevitable spread was hindered by Trump’s insistence on viewing coronavirus as an outside threat that was under control within the United States. Evidence also suggests that Trump didn’t take early advice about testing — which would inevitably have meant more cases were discovered — because he thought low infection numbers would boost his re-election chances. In any case, approved testing kits were not then (and are still not) available in anywhere near the numbers needed.
Several factors helped create the kit shortage. The Centers for Disease Control and Prevention chose to develop its own test for the virus and then, when this was found to be flawed, insisted on taking time to revamp the test rather than adopting the WHO test or allowing other US-based labs to develop their own. Only now is the availability starting to ramp up. But the daily number of tests remains limited and varies by testing facility, partly because of a shortage of key chemicals needed to run the tests. As Dr Fauci, the only straight talker on the White House coronavirus task force admitted, “The idea of anybody getting [testing] easily the way people in other countries are doing it — we’re not set up for that.”
This leaves the United States with two possible paths: to emulate South Korea, which appears to have reversed the outbreak, or to be like Italy, where the situation has deteriorated rapidly and healthcare rationing is proposed.
Realistically, the possibility of stopping the spread of the disease is now all but lost. As of 11 March, 7695 tests had been conducted in a population of 329 million people, whereas South Korea had conducted 189,236 tests in a population of 51.3 million. South Korea is now seeing a steady decline in the number of new cases reported each day.
The main goal now must be to slow the spread of infection, or “flatten the curve” using social distancing, quarantining, proper hygiene and other initiatives. These measures reduce the number of cases at any given time, easing the pressures on hospital services that have been assessed as inadequate for the task.
But it’s not only a question of the adequacy and appropriateness of the measures being introduced by the president and his coronavirus task force; it’s also about whether reliable advice will be adopted across a country in which so many people don’t have affordable access to healthcare and other social services.
“Stay home from work if you get sick,” says the Centers for Disease Control and Prevention. “See a doctor. Use a separate bathroom from the people you live with. Prepare for schools to close, and to work from home.” But many Americans don’t have health insurance, many more are underinsured or have substantial deductibles that have not yet been met. And many don’t get paid sick leave or care leave and don’t have the ability to work remotely.
A 2019 survey of private industry and state and local government workers found that while paid sick leave is nearly universal for high earners, the figure is just 31 per cent among people earning US$10.80 an hour or less. Some 33.6 million people have no cover, and a significant percentage of them work in the food industry and hospitality and have close interactions with many people.
After a meeting with the heads of some of the largest health insurance companies this week, Trump and vice-president Mike Pence announced that the companies promised to waive all co-payments for coronavirus testing and to extend coverage for treatment. But they didn’t mention that this agreement covers, at best, only around 240 million Americans; left out are the estimated thirty million people who lack health insurance, the forty-four million who have inadequate insurance, and the eleven million undocumented immigrants.
The picture quickly became more complicated. The day after the meeting, the health insurance industry group and individual companies appeared to indicate that some private health plans would still have cost-sharing requirements for the test.
Several Democrat-led states — including California, Missouri, New York and Washington — have ordered health insurers to cover the tests without cost-sharing requirements for their members. They have also made sure people covered by Medicaid are tested for free. Such initiatives are yet to be seen in Republican-controlled states.
Federal funds could be used to protect individuals from the costs of testing, quarantine and treatment in other ways, too, if only the administration chose to do so. Trump’s health and human services secretary could authorise states to expand Medicaid coverage to people with a Covid-19 diagnosis, as has been done in other emergencies. For people who are unable to pay their virus-related healthcare costs, the health and human services secretary, via the Centers for Disease Control and Prevention — which can authorise payments for testing, treatment, care and quarantine — can be a “payer of final resort.”
Meanwhile, the plunging US stock market has highlighted the economic ramifications of the pandemic and concerns about the administration’s inadequate response. By one measure, the entire rise in stock market value since Trump was elected has been erased in recent days. Trump has always claimed responsibility for jobs growth and a booming economy; now he must own the downturn.
A few days ago he promised a fiscal stimulus package of “dramatic” economic measures. But his key proposal — a temporary payroll tax cut through to the end of the year, estimated to cost nearly US$700 billion — was floated apparently without prior consultation and was very coolly received by Republican lawmakers and the president’s own economic aides. Since that pushback, he has evinced little willingness to pursue his other proposals, which include an infrastructure plan, paid sick leave for hourly employees, and help for the nation’s ocean-cruise industry and airlines.
Instead, the running has been left to congressional Democrats under House leader Nancy Pelosi and Senate minority leader Chuck Schumer, who have worked with Treasury secretary Steven Mnuchin on a multibillion-dollar economic relief package.
The package provides short-term benefits for people affected by coronavirus, including unemployment insurance, additional funding for food security for low-income children, and funds for family and sick leave. It would provide US$500 million for low-income women, mothers with young children and pregnant women who lose their jobs due to the virus, US$400 million for food banks, and a waiver of work requirements for the SNAP (food stamps) program. The bill also includes free coronavirus testing and a boost in Medicaid reimbursement to help states with testing and treatment.
Despite Mnuchin’s involvement, the White House equivocated for several days on the bill, with Trump apparently holding stubbornly to the idea of payroll tax relief. Pelosi’s leadership finally prevailed and the House passed the Families First Coronavirus Response Act, 363–40, late on Friday. The bill will go to the Senate this week, where support from Senate leader Mitch McConnell seems cool at best. He will be pushed into action because Republican senators campaigning for re-election don’t want to return home without having been seen to act — and because Trump now says, astonishingly, “Look forward to signing the final Bill, ASAP!”
Washington media report that Trump has grown increasingly irate as his attempts to contain the political fallout from coronavirus continue to fall short. He now recognises that the 2020 election campaign will be very different from what was expected just a few weeks ago.
In a response to Trump’s address to the nation, former vice-president Joe Biden highlighted how coronavirus has laid bare the shortcomings of the Trump administration. He spelt out a detailed roadmap for tackling the virus, emphasising the need for solidarity and championing science.
Eager as Trump might be to blame others for the current situation, he has directly and indirectly contributed in many ways. He has consistently sought to erode scientific expertise and cut funding for federal efforts to tackle epidemics internationally and within the United States. He and his enablers have sought to limit transparency, subvert data and minimise the importance of the issues. He continues to claim that the nation is prepared — that “we’re doing a great job with it. It will go away. Just stay calm. It will go away.”
It’s hard to believe a president who repeatedly contradicts his public health experts and blames everything on his critics. A current fact check lists twenty-eight ways Trump and his team have been dishonest about the coronavirus.
Innumerable examples show the importance to voters of how political leaders respond to national catastrophes. But, as a 2009 study showed, voters reward presidents for delivering relief spending after disaster strikes, rather than for ensuring preparedness — which means, theoretically at least, Trump still has time to respond to voters’ concerns and be rewarded. But given his inherent inability to fully grasp the issues, his unwillingness to take expert advice, and his narcissism, this is unlikely to happen.
Several commentators have described the coronavirus threat as “Trump’s Chernobyl,” arguing that prioritising ideology and myth-making during a crisis is, literally, deadly. Certainly, by putting his own beliefs above objective facts, Trump has tried to construct a reality that does not exist. Worse, scientific and public health experts have been intimidated and even muzzled and have too often failed to contradict him.
It is too soon to say if Trump’s posturing will result in unnecessary deaths and an economic recession. But the evidence to make that case could be on hand by November. If this happens, the incumbent could face a landslide defeat. •