COVID-19 Is Surging. Donald Trump’s Response Is Shrinking
Dr. Peter Hotez tuned into last Friday’s White House Coronavirus Briefing hoping he might learn something new. Hotez is the dean of the National School of Tropical Medicine at Baylor’s College of Medicine and one of the leading vaccine researchers in the world. He and a team of scientists are currently working to develop a coronavirus vaccine candidate, but that breakthrough could be months or years away. For now, Hotez wanted to know what federal leaders had planned to deal with the new spike in COVID-19 infections.
Sixty days had gone by since the American public had last heard from the White House Coronavirus Task Force. During that two-month lacuna, almost 70,000 of us died from COVID-19 and more than 1.5 million of us tested positive for the virus. Now, while the countries that were first hit by the virus — China, Italy, Spain — began to reopen their economies and send children back to school, the U.S. plateaued and then entered what appears to be a deadly new phase of the worst pandemic in a century.
But as Hotez listened to the briefing’s rotating cast of administration officials last Friday, he struggled to discern any cogent, consistent message about fighting the virus. What he heard instead, he says, was a mix of self-congratulation, stale science, and spin.
Vice President Mike Pence said the country had “flattened the curve,” even though the trend line of new cases was aimed unmistakably upward. Health and Human Services Secretary Alex Azar described the recent surge in cases as localized “hotspots,” even though the places experiencing the largest new outbreaks — Houston, Miami, Los Angeles, Phoenix — ranked among the top-ten largest metropolitan areas in the country. Pence cited the declining fatality rate as evidence of progress, even though the data is unequivocal that virus-related deaths can lag behind infections by several weeks.
What Hotez didn’t hear, he told me, was anything like a coherent national strategy for fighting COVID-19. There were ongoing efforts by FEMA and other federal agencies focused on procuring critical medical supplies and expanding testing capacity, as well as the administration’s breakneck push to develop a coronavirus vaccine. But top administration officials offered no discussion of which response measures might make the most impact and should therefore be prioritized, leaving Hotez with the impression that they were chipping around at the edges of the problem. “This is not easy for me to criticize them,” he says of senior officials in the administration. “But even after almost six months, they cannot articulate a cogent plan. I have never gotten a sense of what their plan is.”
Last week’s Task Force briefing was emblematic of a larger problem with the administration’s response to the pandemic. At a time when national leadership, consistent communication, and a well-defined strategy are needed more than ever, doctors, scientists, and public-health experts say the Trump administration is missing in action, content to play a supporting role and to let states and cities take the lead. All the while, President Trump spreads misinformation about testing (“If we did very little testing, we wouldn’t have the most cases”) and insists the pandemic will just “fade away.”
While it’s impossible from the outside to see everything underway inside the federal government, there are clear indications that the administration has scaled back its response even as the COVID-19 crisis worsens. After meeting daily for much of March and April, the Coronavirus Task Force now meets one to three times a week, according to a Task Force official. Dr. Anthony Fauci, the top scientist on the Task Force, has seen his access to the president shrink. And a spokeswoman for FEMA tells Rolling Stone that there are 1,000 fewer employees currently assigned to support COVID-19 work than there were at the peak of the agency’s response.
In response to questions from Rolling Stone, an official with the White House Coronavirus Task Force highlighted the administration’s national blueprints for COVID-19 testing, this week’s listening tour of hard-hit states by Pence and Dr. Deborah Birx, and Pence’s statement on Friday that thanks to the work of FEMA and other agencies there were “no outstanding requests from any state at this time” for PPE. The Task Force official summed up the administration’s approach as “supporting the locally-executed, state-managed response work.”
Dr. Ashish Jha, director of the Harvard Global Health Institute, says the governors, state health officials, and members of Congress he’s spoken with have felt “a sense of disbelief” at the absence of a stronger federal strategy. “My sense of the federal response at this moment is you largely have a government that is trying to move on from the pandemic, trying to put the pandemic behind it,” he says. “The problem is that the pandemic is not done with us.”
RICH BESSER HAD PREPARED for this moment. It was 2009 and Besser was the new acting director of the nation’s leading public-health agency, the Centers for Disease Control and Prevention. Besser had climbed the ranks at CDC, working as a “disease detective” in Epidemic Intelligence Service and later leading the office of Terrorism Preparedness and Emergency Response under President George W. Bush. Three months into his role running the CDC, Besser was charged with leading the agency’s response to a global H1N1 swine-flu pandemic.
When I asked Besser what he remembered about helping run the federal government’s swine-flu response, he said that one of the most important tools he had at his disposal was direct communication with the public through the media. Scientists delivered clear, consistent information that was echoed by elected officials across the government. “That was the way we convinced people to do things to protect their health and save lives,” Besser says. “It wasn’t by putting things on a website. CDC has a ton of great information on the website, but if it’s not being reinforced by political leaders, we get what’s happening now — pandemic fatigue has set in.”
The new surge in cases, Besser says, makes the current moment perhaps the most critical time for public-health experts in the federal government to have a daily conversation with Americans. Not only does constant communication help build the collective will needed to take painful but necessary steps such as self-quarantine and temporary lockdowns, but it builds trust between the public and the nation’s top scientists.
“Some of the things the public’s asked to do may turn out to be incorrect,” Besser says. “If the public is along on the journey and understanding why decisions are being made, then as new evidence comes to light and recommendations change, people go along with that.”
Take the recommendations by Dr. Anthony Fauci and Surgeon General Dr. Jerome Adams earlier this winter that Americans shouldn’t wear masks. When the Trump administration later changed its recommendation, Besser says, it never fully explained why. “They weren’t out front and center with: Why did you change your recommendation?” Besser says. “What is the science? What are the downsides to changing the mask?” Worse, some administration officials — including President Trump and Vice President Pence — haven’t followed the CDC’s latest recommendation to wear a mask in public.
Today, there isn’t anything close to the national ongoing conversation that Besser sees as so vital. If there were, and if the CDC had played a more central role in the response as it typically did, senior scientists there like Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, Dr. Jay Butler, deputy director for Infectious Diseases, or Dr. Anne Schuchat, principal deputy director, might be household names like Tony Fauci. These scientists would have hammered home a basic message that has gone missing in this crisis, says Dr. Tom Frieden, the CDC director from 2009 to 2017. As Frieden puts it, “This is not about public health getting in the way of economic recovery. Public health is the road to recovery.”
Instead, scientists like Messonier, Schuchat, or Butler have been sidelined. “The fact that we haven’t had the CDC either at the key decision-making table or at the podium explaining things is one reason we are so divided as a nation,” says Dr. Frieden. “Fighting this without CDC in the role it has played in every other health emergency is like fighting with one hand tied behind your back.” (CDC did not respond to a request for comment.)
Even Dr. Fauci, one of the few scientists given significant airtime during the first months of the pandemic, said his access to the president has “dramatically decreased” in recent weeks. “There’s no substitute for those meetings when Fauci got up there and said, ‘This is real and this is not,’” says Dr. W. Ian Lipkin, director of the Center for Infection and Immunity at Columbia University.
BUT THE PITFALLS of the Trump administration’s new approach run deeper than a failure to communicate. Inside the bureaucracy, the sense of urgency has waned, according to public-health experts who track the government’s response and the federal government’s own data.
Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security who speaks with federal government officials, says the administration’s COVID-19 response has returned to a more normal operating structure even though the virus is surging in more than a dozen states. Toner says that much of the emergency-response work that had been handled by FEMA was moving back to HHS, and that some individuals who had been reassigned to deal with the pandemic have gone back to their previous jobs and previous areas of responsibility.
“From what I understand, they are standing down from the high level of emergency response that they had implemented just a couple of months ago,” Toner tells Rolling Stone. “That’s the way it appears from the outside and from what I understand from people who work there.”
In response to questions from Rolling Stone, a spokeswoman for FEMA said the agency currently had 2,500 employees “supporting COVID-19 pandemic response,” down from 3,500 at the height of FEMA’s coronavirus response effort. The spokeswoman said FEMA employees could be quickly mobilized into coronavirus relief efforts, and echoed the White House’s talking point about the need for a “locally-executed, state-managed and federally-supported” response.
Earlier this month, NPR reported that the administration’s testing czar, Admiral Brett Giroir, had informed his colleagues he was being “demobilized” from his role. Giroir would remain partly involved in COVID-19 testing as part of his day job at the Department of Health and Human Services, but “many of the day-to-day management and operations of testing are being transitioned to HHS operating divisions,” according to an HHS spokesperson. (HHS did not respond to a request for comment.)
The administration has reportedly considered whether to scale back the national emergency declaration made in March to grapple with the virus. More recently, days after Trump at a campaign rally said he’d ordered his staff to “slow down” coronavirus testing, the administration said it would let funding expire for drive-through testing facilities in Illinois, Colorado, New Jersey, and Pennsylvania. (After an outcry by members of Congress, HHS agreed to extend funding for testing in Texas after initially planning to let it run out.)
And in May, an administration official, Navy Rear Adm. John Polowczyk, said there were plans to wind down Project Airbridge, which coordinated imports of personal protective equipment and other medical supplies from overseas to meet rising demand in the U.S. But the demand for PPE has not vanished — if anything, it’s gone up. “We need high quality masks for the public and for people in specific industries to use,” Dr. Toner says. “Whether anybody is actually working on that is not apparent at this point.”
HHS Sec. Azar said on Friday that the administration had “dramatically expanded American manufacturing of PPE” in recent months. Still, state officials say there is more the federal government can do. On Monday, Arkansas Gov. Asa Hutchinson, a Republican, called on the Trump administration to use the Defense Production Act to ensure that there is sufficient PPE available with infections spiking again.
Maryland Gov. Larry Hogan, a Republican, told Rolling Stone in May that governors on both sides of the aisle had felt like the federal government gave them little help when it came to acquiring PPE or testing materials. Hogan, for his part, resorted to negotiating his own deal with a South Korean manufacturer to purchase 500,000 test kits. “It was a unique period in time where the federal government left it up to the states in many ways, and said to a certain extent, ‘You’re on your own, and go out and get it done,’” Hogan recalls. (The Task Force official said the White House had supported states by developing its COVID-19 testing blueprint and helping them procure PPE.)
But Hogan insisted that the federal government can take on certain roles far more efficiently than individual states can. “On testing, on PPE, maybe even on contract tracing — all these kind of building blocks that we need to get our economy back on track — those are things that we have been doing at the state level, but where the federal government could have played and can still play more of a role,” Hogan said.
Dr. Tom Frieden, the former CDC director, says the CDC may have taken a secondary role at the national level, but still deploys experts into states dealing with outbreaks and issues guidance that reflects the latest data and science. Dr. Hotez, the Baylor vaccine expert, echoes this, saying what he’s seen of the federal response tends to be more specific interventions for, say, meatpacking plants or cruise ships.
The centerpiece of the federal response right now is Operation Warp Speed, an initiative to develop a vaccine by the end of 2020 or early 2021. But even if a vaccine does come to market on that accelerated timetable, it’s quite possible that an early COVID-19 vaccine is 60 to 70% effective like a typical flu shot, not 90 to 95% effective like the measles vaccine. There’s no guarantee that all Americans will agree to be vaccinated, with one-third of respondents in a recent CNN poll saying they would not.
Dr. Rich Besser, the former acting CDC chief, says the administration’s emphasis on finding a vaccine can create an unrealistic impression that everything will go back to normal once a vaccine finally arrives. “That’s the plotline from the movie Contagion where in the last 20 minutes there’s a vaccine and everyone can get back to their normal life,” he says. “That’s not how science works.”
As the frightening surge in new infections escalates, senior administration officials have begun to change their tune. Sec. Azar told CNN last weekend that the “window is closing” to get the pandemic under control. Pence urged Americans to “wear a mask” this weekend after declining to directly do so in last Friday’s briefing. Yet by all indications, that newfound sense of urgency has not reached the president.
Washington state Gov. Jay Inslee, a Democrat, told Rolling Stone that the U.S. needs a World War II-style national mobilization to defeat the virus. Trump’s denial, Inslee said, “is akin to Franklin Delano Roosevelt on December 8th, 1941, and for months thereafter, to say that Pearl Harbor was a hoax and that the battleships weren’t important and that the Japanese were going to surrender miraculously the next Monday.” He adds, “If you can imagine Roosevelt doing that, we’ve had an equivalent of that in response to this existential crisis.”