In late May, former World Bank president Jim Yong Kim, an American who has served in Democratic and Republican administrations, waxed incredulous at the lack of a coordinated U.S. strategy aimed at combating the novel coronavirus.
Kim was making an opening statement during an online roundtable with public health experts from academia, local U.S. health departments and hospital systems about tried-and-true infection containment strategies like testing, contact tracing and isolation, which have been employed effectively in other countries.
“The thing that’s been driving me crazy is that we’ve just decided that the standard health response – the only thing that’s worked in any of the countries that suppressed the virus – is something that we’re just not going to do,” said Kim, who headed the World Health Organization’s HIV response during the second George W. Bush administration and led the World Bank for parts of the Obama and Trump administrations.
Sara Cody, head of the public health department in California’s Santa Clara County, known now for orchestrating one of the country’s earliest coronavirus shutdowns, was also on the call. She seemed relieved to hear him say so.
“I begin to feel like, am I the one that’s not thinking straight? It feels a little lonely,” Cody said then.
Cody is not alone among U.S. health officials, epidemiologists, virologists and other experts in feeling like she missed the memo saying the world’s richest nation really couldn’t do much to keep this virus from paralyzing it. Many local officials are still asking the same question Kim posed that day: “Why have we given up on containment?”
So far, that political will has been largely lacking, from President Donald Trump down to many state and local officials trying to limit the virus’s spread without destroying the economy. The country as a whole sets a new high in cases almost every day. The virus is spreading unchecked in states as distant geographically and ideologically as California and Alabama. Arizona has diagnosed more cases per capita than any European country.
A new influential model released Tuesday from the University of Washington’s Institute for Health Metrics and Evaluation predicts 208,255 American deaths by Nov. 1 if no further mitigation efforts are enforced. If mask use becomes widespread, then those projected deaths would drop to 162,807 people.
“The key is we did not have to be here right now,” Leana Wen, a Washington Post contributing columnist and former Baltimore health commissioner and head of Planned Parenthood, told CNN. Wen argued that if the United States employs effective containment measure – including social distancing and mask wearing – “that 200,000 number doesn’t have to be inevitable.”
Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, said Monday that the country is still experiencing the beginning stages of the pandemic.
“We are still knee-deep in the first wave of this, and I would say this would not be considered a wave – this is a surge and resurgence of infections, superimposed on a baseline that never got down where we wanted to go,” Fauci said.
The Trump administration isn’t aggressively messaging around or clamping down on the virus, as the president has violated recommendations from his own health officials to wear a mask in public, not to attend crowded gatherings and to distance from others. Indeed, the Trump administration seems bent on getting Americans to forget about the contagion, even as cases surge in some states.
“White House officials also hope Americans will grow numb to the escalating death toll and learn to accept tens of thousands of new cases a day, according to three people familiar with the White House’s thinking, who requested anonymity to reveal internal deliberations. Americans will ‘live with the virus being a threat,’ in the words of one of those people, a senior administration official,” according to the Washington Post’s Yasmeen Abutaleb and Josh Dawsey.
But the virus didn’t have to become so widespread that officials aren’t sure they will be able to offer full in-person teaching at American schools in the fall, although Trump is pressuring state and local officials to do so. Just look at other places like Taiwan, South Korea and Hong Kong that have successfully contained the virus. The United States, experts say, was not doomed to lose control.
“Other countries have taken it seriously, and we have not,” said Ashish Jha, director of the Global Health Institute at Harvard University. “Other [countries] have had a very aggressive shutdown. We have not. Other countries have taken an aggressive approach to testing and tracing and isolation. We have not. Some countries have universal masking laws, and we don’t.”
Kim led the HIV response in Haiti. He oversaw implementation of contact tracing for Ebola in Liberia and Sierra Leone. Still, he said the coronavirus pandemic in the United States is still one of the most difficult public health challenges he has ever encountered, in part because of a convoluted health insurance system and political dysfunction.
Certainly, the effort required to contain the virus in the United States sooner would have qualified as Herculean – adjusted upward for 3,000 years or so of inflation. But there were a host of missed opportunities, from not recognizing the threat early enough, to a botched testing strategy rolled out by the Centers for Disease Control and Prevention, to a patchwork of erratic orders from states and not the central government.
Containment would have required coordinated mobilization of federal and state resources to acquire or manufacture enough personal protective equipment and testing supplies to avoid shortages if at all possible. It would have required outfitting a nation of long understaffed and underfunded health departments. It would have required a cohesive public messaging campaign strong enough to unify to a divided nation behind the common cause of eradicating the virus before hundreds of thousands could die from it.
After the 2014 Ebola outbreak in West Africa, experts from the nonprofit Nuclear Threat Initiative and Johns Hopkins University partnered with the Economist Intelligence Unit and philanthropic groups to develop a Global Health Security Index measuring countries’ readiness to combat dangerous outbreaks based on the answers publicly available data yielded to 140 questions across six categories. In a report published in 2019, the United States ranked as the most prepared country overall.
“One of the things they didn’t think about was political inaction and political ineptitude,” Jha said of that report, echoing other experts who say the United States has lacked the “political will” to meet the covid-19 moment.
Local officials and nationally visible epidemiologists alike say that when federal and state officials downplayed the public health threat posed by the virus, they undermined the sense of urgency necessary to mobilize a country of this size and keep it focused on the problem.
As with most public health responses, success is not usually measured in what does happen but what doesn’t. In this case, success would be measured in people not suffering and dying from a virus they needn’t have been exposed to in the first place. Beating the virus, therefore, would feel significant only in hindsight and by comparison, when what could have been is juxtaposed with what was.
Fighting a pandemic, therefore, requires commitment to consistency and delayed gratification – something public health experts like Kim and Jha say federal leadership has not modeled for the public. Each day now costs the country more than 500 lives. The country no longer has weeks to prepare testing, tracing and isolation strategies. Our nationwide public health infrastructure cannot fit into a few panicked weeks what it needed to do over months.
So far, the cost of American apathy has been 128,566 lives in the United States in four months – or a fourth of what the country lost to World War II in three and a half years.
In the meantime, local officials who haven’t given up on containment are being forced to lead the massive undertaking themselves, knowing that whatever they achieve in their own jurisdictions, they can’t control what happens in the next county over. Some have been rewarded with criticism and even death threats from those who believe their efforts cratered the economy or are imposing on individual freedoms.
Health departments from Louisville to Portland, Ore., to Sauk County, Wis., are trying to hire more staff on the fly – in some cases more than doubling the size of their departments – so they will also have enough staff to trace cases, assuming they have the testing supplies to identify them in the first place.
Mayors are begging citizens to wear masks, even as their state governments won’t mandate them. A country’s worth of local officials with tired arms is holding tiny umbrellas they must patch as they go, hoping it will prevent their localities from being inundated with the virus.
So far, it isn’t really working.
“The current state is really not good,” Fauci said. “. . . We went up, never came down to baseline, and now are surging back up. It’s a serious situation we have to address immediately.”
“Nearly 1 out of every 100 residents is infected with the virus, hospital intensive care units are full or filling up, and big-name visitors who chose Florida for their first post-isolation events are now mired in questions and controversies about safety. Amid escalating infections, Florida, once held up by Trump as a model for how to manage the novel coronavirus, is faring poorly. Residents worry the situation will get much worse,” Cleve R. Wootson Jr., Isaac Stanley-Becker and Lori Rozsa report. “On Tuesday there were 213,794 cases of the coronavirus in Florida, according to Washington Post data. . . . 52 intensive care units across more than a third of the state’s counties had reached capacity. . .
“Hospital leaders, lawmakers, physicians, epidemiologists, advocates and others familiar with the state’s response said a false sense of security set in when grim predictions about the virus’s spread in Florida did not come to pass in March and April. . . . Sports leagues that opted to restart their seasons in Florida will now play in a state that is in worse shape than when the pandemic began. . . . The Republican National Convention, scheduled to take place in Jacksonville next month, faces similar questions about safety . . . Several hundred doctors have signed a petition that says the convention needs stronger safety measures . . . Disney World has announced it would begin to allow visitors back into the Magic Kingdom this week. . . .
“There has been a rise in cases affecting older Floridians as well as those living in nursing homes and other long-term care facilities . . . Testing sites across the state are seeing shortages, and the wait time for results is now as long as 10 days . . . There were also acute shortages of the antiviral drug remdesivir in parts of the state, causing Democratic members of Florida’s congressional delegation to send a letter Tuesday to HHS Alex Azar asking him to speed the shipment of emergency supplies. . . . Amid the array of old and new concerns, teachers across Florida learned they would have to begin preparing their classrooms for an influx of students. . . . ‘I’ve spoken with a lot of my teacher friends, and a lot of them don’t want to go back,’ [first-grade teacher Cara Conlogue said]. ‘We love our students, we miss them, and we love our jobs. But we don’t feel safe.'”
“Trump pitted America against the world [by] moving to pull the United States out of the WHO while his FBI director accused China of hacking U.S. health-care companies that are researching the novel coronavirus,” the Washington Post’s Joshua Partlow reports. “‘At this very moment, China is working to compromise American health-care organizations, pharmaceutical companies and academic institutions conducting essential covid research,’ [FBI Director Christopher] Wray said in remarks at the Hudson Institute…
“His remarks came as cases and hospitalizations in the United States continued to mount . . . Arizona reported 117 deaths on Tuesday, a daily record for the state, as more than 3,000 people were being treated in hospitals and ICU beds neared capacity. Texas canceled its annual state fair, the longest-running fair in the country, as more than 8,000 Texans were hospitalized on Monday, a third higher than last week. Ohio Gov. Mike DeWine, R, issued an order Tuesday requiring residents to wear masks in public in seven counties, including those that are home to Cincinnati and Cleveland. . . . More than 890 U.S. deaths were reported Tuesday, the highest total in 12 days, amid signs the country’s death rate might be creeping up after falling for the past three months.
“Trump has repeatedly complained that not enough attention is being paid to the country’s death rate. … Scientists say many countries have lower death rates than the United States. . . . Anthony S. Fauci, said that although the fatality rate of the coronavirus has dropped, Americans should not be complacent. ‘It’s a false narrative to take comfort in a lower rate of death,’ Fauci [said] . . . The lower mortality rate is a result of two factors, he said. The country has gotten better at treating people, particularly through therapies that work in the advanced stages of the disease. And, Fauci said, the mean age of those getting infected has dropped by about 15 years.”