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Sunday, December 27, 2020

Opinion | The U.S. was supposed to be equipped to handle a pandemic. So what went wrong?

The U.S. was supposed to be equipped to handle a pandemic. So what went wrong?


President Donald Trump waves as he boards Air Force One at Joint Base Andrews in Maryland on Wednesday.

"WHEN A group of experts examined 195 countries last year on how well prepared they were for an outbreak of infectious disease, the United States ranked best in the world. Today, after being engulfed by the coronavirus pandemic, the United States is among the hardest-hit nations in the world, with more than 327,000 deaths, 18 million infected, the fourth-highest per capita mortality among nations and more suffering to come.

The answer is, almost everything. President Trump is not responsible for how the outbreak began but bears a large burden for the catastrophic pandemic response. From the start, he squandered valuable time, silenced public health experts and scientists, politicized the regulatory agencies, abandoned a concerted federal response, botched diagnostic testing, lifted restrictions too early, and engaged in deception, illusion and confusion that left the American people fatigued and divided.

Before the coronavirus infected anyone, the world was not prepared. As the 2019 Global Health Security Index showed, most nations were unready for a pandemic. Public health systems have been chronically starved for resources here and abroad. Mr. Trump closed the National Security Council Directorate for Global Health Security and Biodefense. Warnings in several studies during 2019 were ignored. And when the outbreak began, China’s authoritarian party-state covered up the early signs of human transmission, delaying vital information — with devastating consequences.

But once the virus began spreading, Mr. Trump failed to adequately warn people, to take the threat seriously or to mount a pandemic response equivalent to the danger. Instead, he retreated to the realm of his own interests: his reelection campaign, his personal grievances, his misguided instincts and magical thinking.

The result was a presidency of delusion and deception. Mr. Trump deliberately lied to the public about the grave dangers they faced. In an interview with The Post’s Bob Woodward on Feb. 7, the president said he knew the virus could be more lethal than the flu and that it spread through the air. “This is deadly stuff,” he said. But he told the nation Feb. 25, “I think that’s a problem that’s going to go away.” On Feb. 27: “It’s going to disappear. One day, it’s like a miracle, it will disappear.” On March 9, he said the “common flu” was worse than covid. On March 19, he told Mr. Woodward he did not want to be honest with the American people about the severity. “I wanted to always play it down,” he said. “I still like playing it down.” On June 20, he said, “Many call it a virus, which it is. Many call it a flu, what difference?”

This mind-set led to cascading policy failures. The Trump administration was caught off guard when global supply chains broke down for personal protective equipment such as face masks and chemical reagents for testing kits — shortages that lasted for months. Mr. Trump boasted of his orders to ban travel from China and Europe, which at best may have slowed the viral spread, but he then neglected to exploit the gains for better preparation. Rather than launch a concerted, federal response that could marshal supplies, Mr. Trump left it to overwhelmed states, cities, hospitals, universities and others to compete against each other. The result was chaos. Meanwhile, the president’s son-in-law, Jared Kushner, oversaw a group of young consultants from the private sector who volunteered to work on the supply chain bottlenecks. They were in way over their heads, were not supplied government emails or laptops, and were swamped by tips and requests from celebrities. Jeanine Pirro, a Trump booster who hosts a Fox News show, repeatedly called and emailed until 100,000 masks were sent to a hospital she favored.

When the virus broke out in February at the Life Care Center of Kirkland, Wash., where 37 people died over four weeks, it should have set off alarms. Nursing homes lacked sufficient diagnostic testing kits. They isolated residents with symptoms, while asymptomatic residents and staff moved about — spreading more virus. “Nursing homes were left chasing their tails,” Morgan Katz of Johns Hopkins University School of Medicine told the AARP. When she set out to check Baltimore nursing homes using a Hopkins test, she was astounded to find more than 38 percent of residents were positive, the majority of them asymptomatic. Nursing home residents account for about 40 percent of all U.S. deaths through early December.

Diagnostic testing is vital for finding who is sick and isolating them. Some countries, such as South Korea, used testing to rapidly trace and contain outbreaks, keeping overall disease and deaths low. But the United States suffered a testing debacle. The Trump administration struggled to ramp up the number of tests, always behind what was necessary to get a handle on the pandemic. The president announced a grand plan for drive-through testing sites at CVS, Target, Walmart and Walgreens parking lots, but in the end only 78 sites materialized. Mr. Trump even suggested at one point “Slow the testing down, please” because he didn’t like the rising case counts. Slowing the testing was the opposite of what the nation needed.

For political reasons, the White House muzzled the Centers for Disease Control and Prevention, the nation’s premier source of public health guidance and crisis management expertise. On Feb. 25, Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, warned of massive disruption from the oncoming pandemic, saying it was not a question of whether it would happen but when. Mr. Trump was enraged — and the agency was stifled. The CDC had given 13 news conferences in one month during the West Africa Ebola outbreak six years ago, but during the coronarivus pandemic, it didn’t conduct a single news conference in four separate months. Even worse, the White House began to meddle with CDC guidance documents, editing what scientists had written on such matters as the dangers of spreading the virus by singing in church choirs, and on requirements for social distancing in bars and restaurants. The edits favored Mr. Trump’s political message not to restrict activity. Kyle McGowan, former CDC chief of staff, told the New York Times recently, “Every time that the science clashed with the messaging, messaging won.”

Mr. Trump took to the White House podium to advertise a “game changer”medicine, the anti-malarial drug hydroxychloroquine, which studies have shown is useless in treating the virus. The Food and Drug Administration was bullied into approving an Emergency Use Authorization for the drug, which it later withdrew. It was a sorry spectacle, squandering valuable presidential time and leadership, erroding trust in the FDA, and wrongly raising expectations of a quick and easy cure. So much else could have been done. A plan to purchase and deliver 650 million three-ply cotton face masks by U.S. mail to every household reached the White House, but then was killed because aides thought Mr. Trump didn’t trust the U.S. Postal Service. The president politicized wearing face masks and ridiculed those who wore them.

After properly urging Americans to “flatten the curve” with shutdowns in March, Mr. Trump pivoted to a campaign to “liberate” states, as he put it, and open up — abandoning the gating criteria and metrics for opening that the White House itself had announced and established. Vice President Pence took the media to task for worrying about a second wave. “Such panic is overblown,” Mr. Pence said. Then it came: The virus surged into the Sun Belt in the summer and into the Midwest in the autumn. The viral tsunamis swamped any hope of a more precise test-and-trace strategy. Mr. Trump stumped for reelection with a misleading claim the United States was “rounding the corner” on the virus. He pulled out of the World Health Organization amid the worst health crisis of a century. On top of all this, Mr. Trump then hired as a White House adviser the Hoover Institution senior fellow Scott W. Atlas, a neuroradiologist without experience in infectious diseases, who advocated an approach of natural “herd immunity,” avoiding lockdowns while trying to protect the vulnerable and letting the virus run free among everyone else. It was madness then, and still is.

Fighting a pandemic is treacherous and challenging. This particular virus harbored some unexpected tricks that took time to detect, such as the large share of asymptomatic cases. It was always going to be hard. But the worst did not have to happen. It happened because Mr. Trump failed to respect science, meet the virus head-on and be honest with the American people.

The death and misery of 2020 should be taught to future generations as a lesson. What went wrong, making this the deadliest year in U.S. history, must not happen again."

Opinion | The U.S. was supposed to be equipped to handle a pandemic. So what went wrong?

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