And with case numbers spiking from coast to coast and fears mounting of additional outbreaks this fall and winter, Trump’s most clearly articulated plan to end the covid-19 pandemic is to predict the virus will “just disappear” and to bank on a vaccine being ready “very, very soon.”
While most developed countries have managed to control the coronavirus crisis, the United States under Trump continues to spiral out of control, according to public health experts, with 3.3 million Americans infected and more than 133,000 dead.
There is no cohesive national strategy, apart from unenforced federal health guidelines. Instead, the administration is offering a patchwork of solutions, often in reaction to outbreaks after they occur. Although Trump and his team declare sweeping objectives, such as reopening schools, they have largely shirked responsibility for developing and executing plans to achieve them, putting the onus instead on state and local authorities.
Ilhem Messaoudi, an immunologist at the University of California at Irvine, likened the absence of a national plan to “going on a road trip and not having a map,” a circuitous and sickening journey that has left everyone from governors to schools superintendents to local hospital leaders “stuck in the mud” and “flailing around.”
“It’s a complete disaster,” Messaoudi said. “This is how this administration has handled this entire pandemic — conflicting messages, knee-jerk reactions, lack of cohesive plans and undermining the CDC and attacking science on a regular basis.”
Trump’s approach was on display Tuesday in the White House Rose Garden, where the president delivered a rambling, stream-of-consciousness set of remarks for 54 minutes on a medley of topics, only briefly addressed the current coronavirus surge and offered no agenda to arrest it other than a vague promise of a vaccine. Meanwhile, Trump’s advisers inside and outside the White House advanced a character assault on Anthony S. Fauci, the government’s top infectious-disease expert.
In response to a request for details of the administration’s plans on a range of coronavirus challenges — including school reopenings, testing, contact tracing and managing future outbreaks — the White House press office offered a lengthy list of actions the federal government has taken or is planning to take to support states and localities.
“President Trump has led an historic, whole-of-America coronavirus response — resulting in 100,000 ventilators procured, sourcing critical PPE [personal protective equipment] for our front line heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world,” White House spokeswoman Sarah Matthews said in an emailed statement. “This leadership will continue as we reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate.”
The challenges the administration is facing, however, were underscored Sunday when Education Secretary Betsy DeVos struggled in an interview with CNN’s Dana Bash to articulate a plan for schools to reopen safely for the 2020-2021 academic year starting soon.
Just as Trump has been, DeVos was adamant about schools reopening and warned against school leaders becoming “paralyzed” by fear of spreading the virus.
But when Bash peppered her with questions about how schools could do so safely, especially in hot spots, DeVos repeatedly stammered, making clear the administration was deferring the more difficult decisions to state and local leaders.
“We’re a country of action,” DeVos said. “We have education leaders who can work hard and figure this out.”
In many ways, the president is simply reactive — pushing his own priorities and leaving public health officials scrambling to catch up in devising policy. After some economists advised Trump that the economy could not fully recover until schools reopen, because most parents need child care to return to their jobs, the president suddenly made schools a focus.
White House aides said the administration is advocating for tens of billions of dollars to be added to the next phase of federal stimulus for schools to help fund safety precautions. Still, Trump slammed the Centers for Disease Control and Prevention over its health guidelines for schools, which he considered overly stringent and therefore obstacles to reopening. Vice President Pence said the CDC would be issuing new guidelines because Trump did not want the recommendations “to be too tough.”
“The federal government has outsourced planning to states and regions,” said Kenneth Bernard, an epidemiologist who led the National Security Council’s biodefense and health security office in the Bill Clinton and George W. Bush administrations. “When they say every region has different requirements and needs, it’s basically excuses for not laying out a plan for which it would be held accountable. This is almost entirely tinged by how the administration wants to appear to its base and to the voting population, and it’s just unconscionable.”
Governors and local leaders are assessing the risks in their communities and beginning to make their own decisions about schools. In California, for instance, Gov. Gavin Newsom (D) announced Monday that schools in Los Angeles and San Diego, the state’s two largest public schools districts, would offer only online instruction this fall.
“If you look at every country that has been successful in managing this, it’s been strong federal leadership,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “While all public health is local, federal direction is huge.”
Testing and contact tracing — two of the key components of any high-functioning national virus response — is another area where the administration is still struggling.
In general, experts say the country needs to be conducting about 5 million tests a day right now, as opposed to its current daily rate of roughly 600,000. Moreover, across the nation, many people find themselves waiting seven days or more for test results, rendering them essentially useless in fighting the outbreak and containing the spread of the virus, experts added.
Some health officials suggested that the federal government could work with private companies to increase the production of point-of-care rapid tests, which typically deliver results within 15 or 20 minutes, and to help resolve chronic shortages in supplies such as swabs and reagents.
Amesh Adalja, an infectious-disease expert at the Johns Hopkins Center for Health Security, said more important than the sheer number of tests is how quickly individuals receive their results — and each day of waiting further decreases their value.
“It’s not a question of, ‘How many do you do?’ It’s a question of, ‘How actionable are those results?’ And if those results are delayed, then their value diminishes,” Adalja said. “It sort of defeats the purpose if you have to wait.”
The $2 trillion Cares Act — passed by Congress at the end of March to help manage the economic devastation from the virus — included guidance and funding for states to increase their contact-tracing abilities, noted a White House official.
The official, providing the information on the condition of anonymity, also stressed the steps the administration has taken on testing, including nearly 1,400 health centers funded by grants from the Health Resources and Services Administration that operate roughly 13,000 testing sites; 552 retail testing sites that are operational in 48 states and D.C., with more than half of them in vulnerable communities; and an additional 201 testing sites set to go live this week.
But experts such as Adalja say that simply increasing testing is not enough. He said that even the administration’s grim suggestion that Americans will have to get comfortable living with the virus will require a baseline of competence from the federal government.
“There has been an evasion at the highest levels of government about what a proper response would be,” Adalja said. “Even if there’s rhetoric about living with the virus, you still need to have certain things in place to live with the virus. You still need to have things in place like contact tracing and testing that doesn’t take seven days.”
In Arizona, Florida, Texas and a number of other states where coronavirus cases have soared in recent weeks, public health officials and experts say greater leadership is needed in Washington to help coordinate PPE and other resources, as the Federal Emergency Management Agency did this spring during the initial outbreaks.
The White House coronavirus task force, which has been severely diminished in stature — it no longer holds daily news conferences nor meets regularly with Trump — has been providing state governments with state-specific analyses and recommendations, officials said.
Deborah Birx, a physician and the White House coronavirus response coordinator, has traveled recently to a number of states, including trips this week to Georgia, South Carolina and other Southern states grappling with rising case counts. And the federal government has deployed personnel to Arizona, California and Texas and sent teams from the Department of Health and Human Services to at least 19 cities identified as hot spots, according to the White House official.
Still, health professionals have urged the White House to offer a disciplined and unified national message to help people who are fatigued more than five months into the crisis and resistant to changing social behaviors, such as wearing masks and keeping a distance from others. Trump, for instance, refused to be seen publicly wearing a mask until last weekend, when he sported one during a trip to Walter Reed National Military Medical Center.
“You can get a really strong and eloquent governor who can help at the state level, but it does seem like we need some more national messaging around the fact that for many people, this is the most adversity they’ve faced in their life,” said Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials.
The president, for his part, has expressed little interest in the specifics of the response outside of updates on a coronavirus vaccine — or the “cure,” as he frequently calls it. He has pushed health officials to move even faster than the already historically ambitious timeline of delivering hundreds of million of doses by January, several current and former administration officials said.
The administration has bet big on a vaccine and treatments, an effort known as “Operation Warp Speed,” and left most of the day-to-day response to the states. But experts caution there is no guarantee that a vaccine — even if available by the end of the year — would be effective, and it would take months if not longer to deliver it to a majority of U.S. residents.
“One could argue that we’ll just wait this out until we get the vaccine,” Osterholm said.
“Are we willing to accept the fact that we’ll let this run willy-nilly until then?” he continued. “That’s a question we’re going to have to answer.”