Trump’s Covid-19 disaster will likely get worse before Biden takes office

Biden’s victory comes too late to stop a Covid-19 surge this fall and winter.

The week before Election Day, Brown University School of Public Health dean Ashish Jha told me something that still haunts me: “In two weeks, [Biden and his team] are going to have no more power to turn the pandemic around than they do today.”

It’s true. President-Elect Joe Biden has defeated President Donald Trump, but his inauguration isn’t until January 20, 2021. Until then, there are no signs that Trump will give up any levers of power early — if anything, the opposite is true, as Trump now contests the election results. So Trump’s failed response to Covid-19 will continue, unchecked, over the next couple of months.

The US’s coronavirus epidemic is already among the worst in the world, with a death toll from Covid-19 that now stands above 230,000. It’s fall, and winter is coming, both bringing several issues that could make America’s outbreak even worse: Schools will continue to reopen, the cold will push people into poorly ventilated indoor spaces in which the virus can spread more easily, the holidays will bring families together in potential superspreading events, and a possible flu season could further strain health care systems.

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Trump could, of course, prepare the country for all of this. But he’s spent the past several months actively downplaying the coronavirus — deliberately so, as he told journalist Bob Woodward. He rejected or undermined proven policies, from social distancing to masking to testing and tracing.

And now Trump no longer has to worry about the politics around his response. He’ll instead be able to spend the next few months carrying out the response he truly believes in without any risk that it could cost him the election. (Though with Trump, it’s also true politics never seemed to restrain him much to begin with.)

To put it another way, Trump’s loss may unchain Scott Atlas, the controversial adviser Trump has leaned on to justify a hands-off approach to the coronavirus. Atlas has spoken favorably of a “herd immunity” strategy — which experts widely reject because it would likely lead to a catastrophic death toll, but which Trump and Atlas see favorably as a way to avoid measures that can hinder the economy in the short term.

If states follow that lead, America’s already soaring Covid-19 cases and deaths will get even worse.

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All of this will boost the need for comprehensive action starting from Biden’s first day in the Oval Office.

That begins with implementing the policies proven to combat Covid-19, including measures that encourage and enable social distancing to slow overall spread, get people to wear masks to protect themselves and others, and widely deploy testing and tracing to detect new outbreaks and contain them. It also requires empowering science — something that Trump has worked against as he’s contradicted expert advice, including from federal public health agencies. And Biden has to prepare the country for a vaccine, which requires not just finding a safe, effective vaccine but also mounting a vast distribution effort to get doses to hundreds of millions of Americans.

Biden, for his part, has already promised to do all of this.

But doing some of it will require Congress, which could pass economic stimulus to ease the pain of and therefore enable further social distancing, incentivize states to mandate masks, and direct more funding to vaccine efforts. With Democrats’ chances of winning the Senate now looking worse, it’s unclear how much of these measures Congress — and therefore Biden — will get done.

If done correctly, a rigorous federal response could help turn America’s Covid-19 epidemic around. Quick, decisive action can’t completely fix what Trump has done and the US has gone through so far — those 230,000-plus deaths are with us forever — but it can help.

For now, though, Jha’s point rings true: America will have to wait until Biden actually has power. And that leaves plenty of time for things to keep getting worse.

America’s Covid-19 epidemic is out of control

The US is already in a bad spot with Covid-19. Its death rate so far is within the top four for developed nations and more than five times the death rate of the median developed country. If the US had the same death rate as Canada, over 140,000 more Americans would likely be alive today.

And just like they are in much of Europe, Covid-19 cases are now rapidly increasing in the US — recently hitting more than 100,000 confirmed cases in one day for the first time.

The rise in the US and Europe doesn’t mean this was all inevitable. As Jha told me, “The truth is there’s lots of countries that have controlled it.” Among the countries that have performed much better than the US: Australia, Canada, Germany, Japan, New Zealand, South Korea, and Vietnam.

“What this outbreak gives you is the same problem for every country around the world,” Clare Wenham, a global health policy expert at the London School of Economics and Political Science, said. “So you can really see the impact of different policies that were launched.” The US’s performance “is a testament to failures of the Trump administration.”

The evidence backs several approaches to dealing with Covid-19: social distancing, aggressive testing and tracing, and widespread masking. But Trump has rejected all these approaches — demanding that states open up early and quickly, punting testing and tracing programs down to local and state governments, as well as mocking and questioning masks.

Meanwhile, the public, along with local and state leaders, has collectively become more complacent and fatigued with the pandemic. That’s led to more and more people going out, with each interaction carrying a chance of spreading the coronavirus.

This has continued despite relatively widespread inaction and apathy already leading to outbreak after outbreak in the US. As Jha has told me, “I, at this point, feel like I clearly no longer understand why our country can’t learn its lessons and why we keep repeating the same mistakes.”

As temperatures have gotten colder, particularly in northern parts of the US, people have flocked more to risky indoor spaces like bars and restaurants. In these places, people are close together for long periods; they can’t wear masks as they eat or drink; the air can’t dilute the virus like it can outdoors; and alcohol could lead people to drop their guards further. Each of these factors helps the virus spread further.

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Schools have also reopened since the late summer — with colleges and universities in particular seeing big outbreaks, not only as students go back to class but also as they hit bars and restaurants, party in dorms, and hang out with their peers, friends, fraternities, and sororities.

With winter coming, all of this could get even worse. More schools will reopen. It’ll get colder in more parts of the US. Thanksgiving, Christmas, and New Year’s will bring friends and families together, including from hot spots at colleges and universities. Hospitals and other parts of the health care system may have trouble treating a bigger surge of Covid-19 patients if a flu season appears, too, potentially leading to worse outcomes across the board.

What’s particularly problematic for the US, though, is that the country is starting from such a high baseline of cases. As RTI International epidemiologist Pia MacDonald has repeatedly emphasized to me, “We never got to low enough levels [of Covid-19] to start with in most places.” The threat of exponential growth from such a point could lead to a level of spread that no country has ever seen before — not even in the spring, when the coronavirus first hit the US and Europe.

“The next number in the fall is likely going to shoot way up,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy, previously told me. “Likely well beyond 65,000, 70,000,” the summer’s previous peak. “I think this fall is going to be the biggest spike of all.”

Trump’s response to the coronavirus could get even worse

Trump could, in theory, at any moment shift course and try to take the threat of Covid-19 more seriously.

Eight months into the pandemic, though, that seems very unlikely. Even after he got sick with Covid-19, Trump continued to downplay the threat of the virus: As he left the hospital, he tweeted, “Don’t be afraid of Covid. Don’t let it dominate your life.” He continued to push a false sense of normalcy in the weeks leading up to the election.

One possibility that experts worry about: As bad as Trump has been, maybe he was partially restrained by the election. If he really believes what he was preaching, he could now do even more to discourage social distancing, masking, testing, and tracing.

“What is the Trump team, once they have lost, going to do over the next two, three months? Because they’re going to have the reins of federal power,” Jha said. “It’s going to be a very tough two, three months.” Citing his conversations with White House staff, he added, “There are a lot of people in the White House task force who are already very worried about this.”

Consider what Trump and his people were already doing behind the scenes. One of Atlas’s first actions when he joined Trump’s team was, reportedly, to push for less testing, out of fear that exposing more asymptomatic cases could lead more people to quarantine and more businesses to close down. With Atlas’s support, the Centers for Disease Control and Prevention also briefly recommended less testing, especially for asymptomatic people.

Trump, who has a tendency to say the quiet part out loud, has repeatedly suggested this is what he always wanted. He said he told his people to “slow the testing down please,” since more tests revealed more cases and, in his view, could make the US look bad.

Testing is perhaps the least controversial part of this pandemic, with both Democrats and Republicans supporting it at varying levels across the country. After all, who could object to more data showing the disease’s spread? That Trump managed to make this into an issue speaks to his never-ending drive to “always play [the coronavirus] down,” as he told journalist Bob Woodward.

But unchaining Trump and Atlas from politics could go much further than testing. Both have at different points spoken favorably of a “herd immunity” strategy — one that would aim to get younger, healthier people infected and, hopefully, immune to Covid-19. The idea is this would build up enough immunity that the vast majority of the country could go back to life as normal.

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Experts have widely panned this idea, pointing that it could lead to hundreds of thousands or even millions of Covid-19 deaths as massive segments of the population are infected with the virus and get seriously sick. Sweden, which appeared to try a “herd immunity” strategy while denying it was doing so, suffered one of the highest Covid-19 death rates in the world — even as its neighbors were spared significant outbreaks — before its leaders admitted to a mistake.

If the US followed such an approach, and the Trump administration worked even more against widespread social distancing, masking, testing, and tracing, it could make the country’s Covid-19 disaster even worse.

And even if Trump’s approach doesn’t get worse, the status quo clearly hasn’t been working.

One potential for optimism: Maybe Trump will shift course now that the election is behind him. Maybe he only downplayed the virus as part of his reelection bid, out of a desire to make it seem like things were fine and normal, hoping that would boost voters’ approval of his presidency. So the lack of political incentives could make Trump act more wisely.

But that assumes a level of competence and responsibility that Trump, who got his start in politics by falsely suggesting then-President Barack Obama wasn’t born in the US, has yet to display. And if Trump genuinely believes what he’s been saying for months, things could get much worse.

Biden has to be ready to strike on day one

It will be too late for Biden to do anything about a fall and winter Covid-19 surge in late January. But a Biden administration could take significant steps to put the country on a better path once he takes office. And Biden, as the president-elect, can start putting together a plan and team to accomplish this on day one.

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When I previously asked experts about what Biden should do, they pointed to several ideas:

1) Implement policies that are proven to work: A Biden administration could encourage more social distancing, simultaneously offering financial support to affected people and businesses so they don’t suffer as much and don’t have another incentive to try to go back to normal. It could push, with the bully pulpit and potential funds, states to mandate masks and really enforce those mandates. It could build up a national testing-and-tracing system, fixing supply bottlenecks for widespread tests and putting money into hiring contact tracers. All of these efforts could help suppress the virus.

2) Rebuild trust in scientists: Under Trump, trust in scientific institutions has dwindled. Federal agencies like the Food and Drug Administration and the CDC were previously considered the gold standard in their fields, but now Americans and experts are increasingly questioning just how effective these once-respected institutions are, in large part because they’ve been politically polarized under Trump. By taking steps to ensure Americans that the experts are leading the response and the best science is the guide, Biden could help rebuild some faith in these institutions.

3) Prepare the country for a vaccine: If all goes well, a vaccine will be proven to be safe and effective in clinical trials before Biden takes office. But that’s just the beginning. After that, the vaccine will have to be distributed to every corner of the country so hundreds of millions of Americans can actually get it. It will be a massive operation — one that experts often compare to nationwide wartime efforts — and the federal government will need to lead that operation to ensure it all goes well.

Crucially, much of this, particularly elements that require more money, will require support from Congress. How quickly Congress acts could dictate how quickly Biden does. And with more than 800 Americans dying of Covid-19 a day now and potentially more dying once we’re in the middle of winter, every single day, week, and month will matter.

But if done correctly, this could get the US closer to normal more quickly. “If you do things the right way, you can do them,” Cedric Dark, an emergency medicine physician at the Baylor College of Medicine, previously told me. “If you do them the wrong way, then you’re going to get cases.”

Before that, however, the US will need to get through the fall and much of winter under the same leadership that’s made America’s Covid-19 outbreak one of the worst in the world.