President Donald Trump’s February response to the coronavirus pandemic was so botched that the New York Times described it as a “lost month.” Throughout that month, Trump spent much of his time denying that the novel coronavirus was a significant threat to Americans — suggesting the virus would miraculously subside — and his administration failed to scale up the testing and health care capacity needed to confront the challenge ahead.
Now, it looks like April was another lost month. In a viral tweet thread, Jeremy Konyndyk, an expert in disease outbreak preparedness at the Center for Global Development, argued that the federal government wasted April in its response to the coronavirus: Despite some gains in March on health care capacity and testing, the US failed to capitalize on social distancing throughout April to continue scaling up measures and get the coronavirus under control.
Consider testing. Experts widely agree that the US needs at least 500,000 Covid-19 tests a day, on the low end, or even tens of millions, on the high end, to safely end extreme social distancing measures. Throughout March, the US made some progress toward that: It went from a few dozen tests a day to a few hundred to more than 100,000.
In April, that progress seemed to stall out. In the last week of April, the US averaged around 220,000 tests a day — not much of an improvement from the roughly 150,000 a day that it reported during the first few weeks of the month, and far from what experts say is needed to control the outbreak (as South Korea and Germany have).
The result, Konyndyk and other experts warn, is the US still isn’t ready to safely reopen its economy. Confirmed Covid-19 cases and deaths aren’t trending down — with the country reporting around 25,000 to 30,000 new cases each day throughout April and now into May.
US cases, April 1: 25.1k— Jeremy TEST/TRACE/ISOLATE Konyndyk (@JeremyKonyndyk) May 1, 2020
US cases, April 30: 29.5k
We have spent the month of April on a plateau. Daily counts fluctuating between 25-30k, no longer rising but not definitively declining. pic.twitter.com/SgI2aPKqjj
“There’s no definitive downturn,” Konyndyk, who served in President Barack Obama’s administration, told me. “We’re on a plateau.”
No country is escaping — or at least is expected to escape — the coronavirus pandemic unscathed. Besides the US, developed nations like Italy, Spain, and France have also dealt with a frightening number of cases and deaths.
But in Konyndyk’s view, the US is unique among the rest of the developed world in that it has consistently bungled its response even after it became clear that the coronavirus is a real threat. From South Korea to Germany, other countries have taken the steps necessary — scaled-up testing, expanded contact tracing, and built-up health care capacity — as coronavirus began to appear within their borders. The US has taken some steps here and there, but it’s struggled to build an expansive national response.
The difference isn’t that all of these other countries have better public health systems than the US, Konyndyk argued. It’s that their political systems have done a better job, with strong national leadership and coordination. “This is a disease that does not just test your health system,” Konyndyk said. “It tests your political system. It tests the quality and competence of your governance.”
Konyndyk spoke in greater detail about the Trump administration’s response to the coronavirus pandemic. Our conversation is below, edited for length and clarity.
Why do you say the federal government wasted April?
The federal government has not done a great deal to get the country ready to exit the lockdown. The lockdown is not meant to be a permanent state of affairs; it’s intended to be a giant pause button that buys you time to get ready for the next phase. That’s why I see a really striking parallel between February and April.
In February, the main thing that the federal government was doing was the travel bans. The public health literature on travel bans says they are at best a delaying tactic, but they are defensible if they’re used to buy extra time to prepare.
We didn’t. In February, infamously, the Trump administration was not using that month to prepare. They were not signaling the hospital system to get ready. They were not reinforcing our supplies of PPE [personal protective equipment]. They were not scaling up nationwide testing. All those things they began doing in the middle of March, they should have been starting the moment they put those travel bans in place in February.
In the month of March, the federal government started to do some things. They began to scale up testing, with a major increase in the number of tests throughout the month. They began to get FEMA [the Federal Emergency Management Agency] into the game. They began doing work on PPE, although that’s been highly fraught. By the end of March, almost the whole country had put stay-at-home orders in place, had put social distancing, physical distancing measures in place. We actually made headway in March.
But April, we didn’t. You see that in the case numbers: They’ve been basically flat the month of April. According to Johns Hopkins, on April 1 the [daily] case level was 25,100, and on April 30 it was 29,500. Throughout the month, they got as low as 22,000 one day; they got as high as 36,000 one day. Without the outliers, [the case level] was hanging between 25,000 and a little over 30,000 new cases every day.
There’s no definitive downturn. We’re on a plateau. Social distancing stopped the growth of transmission, but it didn’t drive it down.
The hope had been that once this came into place, it would begin driving transmissions down. That’s what we saw in China. That’s what we saw in Italy. That’s what we’ve seen in Spain.
What should the US have been doing in April that it didn’t do?
We should have been laying the groundwork for going from being stuck to actually suppressing cases, and laying the groundwork for an ability to lift the [stay-at-home] orders in a safe way.
There’s a ton of consensus in the public health community around what needs to happen. It’s practitioners, policymakers, scientists. You’ve got Trump’s former FDA commissioner and someone like myself, who served in the Obama administration and is pretty progressive in my political views. It’s not a political or partisan thing.
We need to test much more widely. We need to scale up contact tracing. We need to protect the most vulnerable populations. We need enhanced surveillance so we can actually see what this virus is doing. And we need to reinforce the hospital system.
The basic components of a sustainable suppression strategy are pretty universally agreed upon at this point. They mirror what’s been successful in other countries. They mirror what’s been successful in South Korea, Hong Kong, and Taiwan.
There’s no indication we’re making headway on that in a serious way.
You tweeted that if we have another month like April, we’ll have another month with a death toll that’s equivalent to all American casualties in the Vietnam War. And even if you look at less grave impacts, the lack of action means people will have to social distance for longer. It seems like everything negative we associate with this pandemic is going to stay the same or get worse the longer we keep having these lost months.
Absolutely. This is what’s so confounding about the federal position right now: What needs to happen is very clear.
But what we need is federal leadership; it requires the federal government to take ownership of some of these problems. Testing is not going to be resolved until the federal government takes ownership of expanding it; as long as they keep kicking it to the states, we will remain stuck. Contact tracing is going to be difficult to scale up at a national level without a consistent federal approach. The bottlenecks on PPE aren’t going to be fixed without federal leadership.
The federal government wants to shift all the political responsibility on the states. If something is going wrong, blame the governor. But they still want to take the credit for getting the win.
I was struck by this “blueprint” the Trump administration put out, which basically said states and the private sector will have to solve every problem and the federal government will play a supplementary role — a “supplier of last resort.”
But if Maryland sees a swab factory in Maine become the bottleneck for testing, what can Maryland do? That seems to be the problem here. That’s why you need federal leadership.
That’s exactly right. There’s a reason why when we go to war, we don’t go to war with each governor running their own brigades. We go to war with a unified military. If we’re going to say that this is like a war — and I think that’s a fair analogy for what we’re up against — we need the federal government for this just as much as we need it for any other war.
There are really important, substantive reasons for that. The federal government has much more buying power than the individual state has. The federal government has the leverage to solve problems across and between states.
Take contact tracing. You have to have a contact tracing network that can cross state lines, because people cross state lines, the disease crosses state lines. If this is all being run by individual state departments of health that are relatively siloed from each other, you don’t get that kind of connectivity.
But we have a federal CDC for a reason. We have FEMA for a reason. If they weren’t relevant, they wouldn’t exist.
There’s this great quote from Abraham Lincoln to Gen. George McClellan during the Civil War. McClellan was proving tepid about actually fighting the Confederates. Lincoln said, “If General McClellan does not want to use the army, I would like to borrow it.”
If President Trump doesn’t want to use the federal government, he should let someone else borrow it — because there is a lot of capability there that’s simply not being used.
I wanted to focus on this point a bit. To some degree, this pandemic would be bad no matter what. Many countries have underinvested in public health. Many countries have seen cases and deaths. Even those that haven’t, they face a threat from Covid-19.
But part of what you’re talking about here is that the US and this administration have done particularly badly compared to other countries.
Well, let’s start with the fact that clearly we are doing worse than just about everyone else.
The only places that got this right from the beginning are South Korea, Hong Kong, Taiwan, and Vietnam. You could argue Singapore, although recent developments there have called that into question. These were countries that right from the beginning took it seriously. It’s no coincidence that these were all countries that experienced SARS, MERS, or other novel coronavirus outbreaks. They saw cases, but they didn’t have their health-care systems overwhelmed, because they acted very early. That’s the best tier of countries.
Then you have the next tier of countries, which bungled it initially but then got on top of it. I would put China in that category, but also Germany. Initially, they had a pretty significant acceleration of transmission, and they didn’t do enough to prepare. But once it became clear how bad it was, they swung into very serious action. They had a peak that’s higher than it should have been, but once it arrived, they at least did what was necessary — and they’ve been able to get their numbers way down now from the peak that they experienced.
Then you have countries like the US, which is the third category. Not only did we fail to prepare initially, but then we have mismanaged the response once we began responding. We were late, slow, and unprepared, and then we executed poorly once we began acting.
That’s what really sets the US apart.
The countries that have done well have done well not just because of their stronger public health systems but also because their political systems performed better.
That’s the critical variable here: This is a disease that does not just test your health system. It tests your political system. It tests the quality and competence of your governance.
Looking forward, how do we make sure May is not a repeat of February or April?
I can answer that in a technical way by laying out the strategic elements that we need to be executing on. But the gap we face right now is not a failure to know what to do. It’s a failure of the political will to do it. That’s the hardest thing to generate.
The way we avoid May being like April is we get serious about national-level contact tracing, we have the federal government get serious about PPE production and using the DPA [Defense Production Act] to go big on PPE production, and we have the federal government going big on strengthening the supply chain for testing supplies. All those things are absolutely things that need to happen, and would have a helpful impact.
But they all require the political will by the president to have the federal government own those problems. And that seems to the one red line.
I don’t know how we do that. Do we have Congress force his hand? Do we have governors band together and demand that he do it? The only way he’s going to do it is if he’s forced to.
To your point, the approaches you listed are things you and other experts were telling people in February and early March. It’s not stuff we just figured out in late April or May.
That’s right. That’s what’s so infuriating. We have a clearer idea now of what we need to do than a month ago or two months ago, but we knew the broad strokes.
As little as I expected from this administration, I expected that they would have this sorted out by now. And they don’t.
The fundamental issue here is we have an incompetently managed federal response — and that is unlikely to change.