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President Trump takes questions during a news conference about the ongoing global coronavirus pandemic at the White House on March 13, 2020. | Drew Angerer/Getty Images

From insufficient testing to a lack of coordination, Trump’s response has been a disaster years in the making.

President Donald Trump’s failure to respond to the coronavirus pandemic didn’t begin with the administration’s inability to send out the millions of test kits that experts say are needed to tackle the crisis. It didn’t start with Trump’s bungled messaging downplaying the crisis even as it’s worsened.

It began in April 2018 — more than a year and a half before the SARS-CoV-2 virus and the disease it causes, Covid-19, sickened enough people in China that authorities realized they were dealing with a new disease.

The Trump administration, with John Bolton newly at the helm of the White House National Security Council, began dismantling the team in charge of pandemic response, firing its leadership and disbanding the team in spring 2018.

The cuts, coupled with the administration’s repeated calls to cut the budget for the Centers for Disease Control and Prevention (CDC) and other public health agencies, made it clear that the Trump administration wasn’t prioritizing the federal government’s ability to respond to disease outbreaks.

That lack of attention to preparedness, experts say, now helps explain why the Trump administration has botched its response to the coronavirus pandemic.

 Timothy A. Clary/AFP via Getty Images
Workers in protective suits wait for people to be tested for coronavirus as they arrive at a drive-through mobile testing center at Glen Island Park in New Rochelle, New York on March 13, 2020.

The administration has in recent days taken steps to combat criticisms about its slow and muddled response to the coronavirus, with Trump giving a televised Oval Office address on Wednesday and declaring a national emergency on Friday. But experts say that the damage has been done: The federal government is only now playing catch-up, as thousands of new cases of coronavirus are confirmed and the death toll steadily increases every day.

That failure is most abundantly clear in testing. To date, the US has tested a fraction of the people than even countries with much smaller outbreaks. Several weeks after the first community transmission within the US, the country has tested more than 16,000 people as of March 13, according to the Covid Tracking Project. By comparison, South Korea had tested more than 66,000 people within a week of its first case of community transmission.

Testing is crucial to slowing epidemics. First, it lets public health officials identify sick people and subsequently isolate them. Second, they can trace that sick person’s recent contacts to make sure those people aren’t sick and to get them to quarantine as well. It’s one of the best policy tools we have for an outbreak like this.

An infographic that shows the goals of mitigation during an outbreak with two curves. The X-axis represents the number of daily cases and they Y-axis represents the amount of time since the first case. The first curve represents the number of cases when no protective measures during an outbreak are implemented and displays a large peak. The second curve is much lower, representing a much smaller rise in the number of cases if protective measures are implemented.Christina Animashaun/Vox

It’s also something that the federal government has done well before — recently, with H1N1 and Zika. “It’s been surprising to me that the administration’s had a hard time executing on some of these things,” Ashish Jha, director of the Harvard Global Health Institute, told me.

But it’s the kind of thing that the Trump administration has screwed up, while instead trying to downplay the threat of Covid-19. Trump himself has tweeted comparisons of Covid-19 to the common flu — which Jha describes as “really unhelpful,” because the novel coronavirus appears to be much worse. Trump also called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease is much lower than public health officials projected.

And Trump has rejected any accountability for the botched testing process: “I don’t take responsibility at all,” he said on Friday.

Jha described the Trump administration’s messaging so far as “deeply disturbing,” adding that it’s “left the country far less prepared than it needs to be for what is a very substantial challenge ahead.”

It’s a playbook that has previously worked for Trump, who successfully, at least politically, fended off concerns about his handling of Hurricane Maria, the opioid epidemic, and a host of self-inflicted crises from his travel ban to the crisis at the US-Mexico border. This time, as people are getting sick and dying, and millions of Americans worry the same could happen to them, Trump’s strategy of denial and downplaying isn’t working (so far).

What it has done, instead, is left the Trump administration unprepared for the challenge ahead, whether it’s in the failure on testing or the Trump administration’s inability to calm the public and markets as the novel coronavirus continues to spread. And all of this can be traced back to the Trump administration’s decision in the spring of 2018 to deprioritize the federal government’s ability to respond to pandemics.

The White House did not respond to a request for comment.

Trump’s failures began years ago

When Bolton became Trump’s national security adviser in 2018, he quickly moved to disband the White House National Security Council’s Directorate for Global Health Security and Biodefense, which former President Barack Obama set up after the 2014-2016 Ebola outbreak to lead federal coordination and preparation for disease outbreaks.

In April 2018, Bolton fired Tom Bossert, then the homeland security adviser, who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then, in May of that year, Bolton let go of the head of pandemic response, Rear Admiral Timothy Ziemer, and his global health security team. The team, the Directorate for Global Health Security and Biodefense, was never replaced.

 Jabin Botsford/The Washington Post via Getty Images
Tom Bossert, then the homeland security adviser, was fired by John Bolton in 2018. Bossert had called for a strategy against pandemics.

At the time, the Trump administration and Bolton argued that the cuts were needed to streamline the National Security Council.

But, according to experts, the work of a global health security team, or something like it, is crucial to responding to any disease outbreak. Since the federal government is sprawling and large, it helps to have centralized leadership in case of a crisis. That leadership could ensure all federal agencies are doing the most they can and working toward a single set of goals.

But it’s important to have this kind of agency set up before an outbreak. Setting up an agency takes time; it requires hiring staff, handing out tasks and expected workloads, creating internal policies, and so on. A preexisting agency is also going to have plans worked out before an outbreak, with likely contingencies in place for what to do. That’s why it was so important to have this agency in place even during years, like 2018, when disease pandemics didn’t seem like a nearby threat to everyone.

“The basic systems need to be in place for global, state, and local responses,” Jennifer Kates, a senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, told me. “When you don’t shore those up, you’re not starting from scratch, but you’re catching up every single time.”

The Trump administration has since put Vice President Mike Pence in charge of handling the coronavirus pandemic, building out a team that includes well-respected experts like Deborah Birx. But the problem is this is in reaction to the epidemic, instead of something that a preexisting agency within the administration was working on for years.

Even some officials within the Trump administration have voiced concern about the team’s dismantling. “It would be nice if the office was still there,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a congressional hearing. “We worked very well with that office.”

The cuts are part of Trump’s broader policy agenda, focused largely on trimming the size of the federal government. He has repeatedly proposed cuts to agencies, like the CDC and National Institutes of Health, on the front lines of the federal response to disease outbreaks. Trump’s most recent budget proposals asked for similar cuts — and the administration has stood by them.

Even without such cuts, experts and advocates argue the US generally underfunds disease outbreak preparedness and public health programs more broadly. Further cuts just deepen the risks of pandemics.

By repeatedly undercutting outbreak preparedness, Jha said, the Trump administration signaled “to the government and all the agencies this is not a priority. And that means that even other agencies end up not putting as much attention and energy on it. So I think this has been a longstanding problem of the White House.”

Trump, for his part, has defended his record, arguing, “I’m a businessperson. I don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.”

But experts argue that’s not how pandemic preparedness should work. “You build a fire department ahead of time,” Tom Inglesby, director of the Johns Hopkins Center for Health Security, told the Washington Post. “You don’t wait for a fire.”

The administration has been slow to react

Even after it became clear that the coronavirus outbreak was becoming a global threat in January, the Trump administration has been very slow to prepare and react. The common refrain among experts is that other countries’ actions, such as China’s draconian measures, gave the US a bit of time to do something, but the federal government has failed to get even the basics right in that allotted time.

That begins, first and foremost, with testing. But as report after report has confirmed, the US is doing a very bad job in this area — falling behind its developed peers in Europe and Asia. On social media, doctors regularly complain that they can’t obtain tests for patients even if the patients display symptoms.

 Christina Animashaun/Vox

Not all of this is necessarily the Trump administration’s fault. When the CDC rolled out its tests, a component in them turned out to be faulty. That was unfortunate, but it put a big spotlight on the CDC’s decision to use its own test kit instead of test kits other countries have used, reportedly in an effort to create a more accurate test. Since then, as Olga Khazan explained at the Atlantic, the Trump administration has consistently failed to make things better, with reports of infighting making it harder for the administration to get its act together.

But this is exactly the kind of situation that proper preparedness, well, prepares federal agencies for. If the Trump administration had prioritized outbreak prevention before the coronavirus pandemic, it might have used the time prior to Covid-19 — or even January and February, when the global threat was increasingly clear — to establish contingencies in case something went wrong.

“These kinds of things are what you prepare for, why you do preparedness planning, so this kind of thing doesn’t happen,” Kates said. “Right now everyone’s playing catch-up to try to address these gaps, and every day matters. A good preparedness plan would be addressing that from the outset.”

This is, after all, something the federal government has done before for outbreaks, from H1N1 to Zika. A big difference from then to now is Trump is in charge.

 Andrew Theodorakis/Getty Images
A lab technician begins semi-automated testing for COVID-19 at Northwell Health Labs in Lake Success, New York on March 11, 2020.

Recognizing the criticisms, the Trump administration has promised to try to boost testing output, including a partnership with the private sector. But whether that actually leads to significant changes remains to be seen.

One of the problems is Trump has consistently downplayed the coronavirus, comparing it to the common flu and claiming that his administration is doing a “GREAT job” and keeping things under control. Even on Friday, when announcing his administration’s goal to get 5 million test kits out, Trump said, “I doubt we’ll need anywhere near that.”

Some of that may be political. Politico reporter Dan Diamond told NPR host Terry Gross that, based on his own reporting, Trump “did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear — the lower the numbers on coronavirus, the better for the president, the better for his potential re-election this fall.”

Some of it could also be a result of too much optimism. Trump in February said of the coronavirus, “One day it’s like a miracle, it will disappear.” (As of March 13, the US has nearly 2,000 confirmed cases, up from fewer than 100 at the beginning of the month, according to Johns Hopkins University.)

The administration more broadly seems to have underestimated the threat, requesting $2.5 billion in emergency funding for the crisis — a fraction of what both Democrats and Republicans said is necessary and ultimately passed.

Trump has taken some steps as the pandemic has worsened

What Trump has done is focus on travel restrictions, first against China and most recently against most of Europe. While this likely bought the US a little time with China, the Trump administration didn’t use that time properly.

And in the case of Europe, the restrictions will likely do little to nothing. There’s one simple reason for that, Kates told me: “The virus is already here.” Since the coronavirus is already spreading within communities, the concern is no longer the virus coming in from outside the US.

 NurPhoto via Getty Images
Travellers at the Schiphol Airport in Amsterdam on March 13, 2020. President Trump announced a travel ban from European countries, which doesn’t address the spread of disease within the US.

Even conservatives have been critical of Trump’s response. The National Review editorial board wrote:

[Trump] resisted making the response to the epidemic a priority for as long as he could — refusing briefings, downplaying the problem, and wasting precious time. He has failed to properly empower his subordinates and refused to trust the information they provided him — often offering up unsubstantiated claims and figures from cable television instead. He has spoken about the crisis in crude political and personal terms. He has stood in the way of public understanding of the plausible course of the epidemic, trafficking instead in dismissive clichés. He has denied his administration’s missteps, making it more difficult to address them.

On Wednesday night, Trump appeared to finally confront the reality of the crisis in a televised statement from the Oval Office — acknowledging that the outbreak is now a pandemic and the damage that concerns about the virus are now doing to the economy.

But even then, he only promised a limited travel ban for most of Europe, which won’t address the spread of the disease within the US, and some economic relief measures. The speech included no new policy proposals for stopping the spread of the disease within the US.

The speech was also riddled with errors, leading the administration and others to later issue several corrections on the extent of the travel restrictions for Europe and exemptions health insurers are making to make coronavirus treatment more accessible.

Jha, for his part, was not allayed by Trump’s speech. “It was a distraction,” he said. “I think it made things significantly worse off. I don’t know any public health officials who felt even an iota of assurance coming out of that conversation.”

After the speech failed to calm the public or markets, Trump on Friday declared a national emergency, which will unlock billions of dollars in disaster aid to help combat the virus. The administration previously declared a public health emergency in January, but that didn’t tap into as much money as the new declaration under the 1988 Stafford Act — which is typically used for natural disasters like hurricanes and tornadoes — will allow.

Other Trump policies could impact the pandemic

In the background of all of this, the Trump administration has continued to push for several policies that, while not obviously related to the coronavirus, experts caution could have a negative impact on the pandemic.

For one, Trump has continued pushing for the repeal of the Affordable Care Act, as well as efforts to reel back Medicaid with work requirements. With the outbreak growing, the US’s lack of universal health care has become an even more obvious problem: If people can’t get testing, they’re obviously less likely to find out they have Covid-19 and take precautions to avoid spreading the virus. If they can’t get treatment in case of complications, they’re more likely to suffer, potentially spread the disease, and die.

 Drew Angerer/Getty Images
The Trump administration has continued to push for policies that could have a negative impact on the epidemic, including repealing the Affordable Care Act and kicking people off food stamps.

The Trump administration seems aware of this problem, working with insurers to eliminate copayments for testing, stop surprise medical billing, and help expand coverage related to the coronavirus. But in many ways, the administration is working against problems that it’s also helping create by pushing to worsen access to health care.

The pandemic is “bringing to the fore the underlying challenges that we have in our health and social support system in the United States,” Kates said.

Another example: The administration has pushed forward on measures that will kick people off food stamps. This will not only lead people to suffer if they lose their jobs as a result of a coronavirus-caused recession, but it could lead to sick people going to work and spreading the disease, because they won’t have a safety net if they don’t bring in a paycheck.

“If you ask people who are very marginal and barely had enough money to put food on the table, if you ask them to not work and therefore not get paid, and choose between that and having to go to work and put themselves or others at risk, that’s a terrible choice,” Jha said. “And a lot of people are going to make ‘the wrong choice,’ and you’d understand why. This is not about just helping people economically; this is about fighting the virus.”

The Trump administration, for its part, appears to understand part of the problem here. Trump has supported House Democrats’ efforts to create an emergency paid leave program and boost food aid, at least for the duration of the Covid-19 outbreak and for the people affected. But his administration has also stuck to its other efforts to kick people off food stamps.

Experts also pointed to the “public charge” rule, which effectively discourages immigrants from seeking public services, including health care, by threatening their immigration status if they are “likely to be a public charge” by relying on those services.

“With an outbreak, that’s a recipe for potential disaster,” Kates argued. “You don’t want individuals to feel frightened about seeking the care that they need because they’re fearful of not being able to stay in the country or with their families. That would threaten the public’s health.”

Even if the administration doesn’t want to permanently back off these policy proposals, it could, Kates said, consider a moratorium. But so far, that’s not happening.

That reflects the lack of priority that the Trump administration has given to the coronavirus pandemic, even as it rapidly worsens. If stopping the pandemic was the top priority, Trump could halt, even just temporarily, policies that could potentially worsen the crisis. But he’s not.

Author: German Lopez

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