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 and the protective medical gear for health care workers 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, nor with his mid-March insistence that social distancing measures could be lifted by Easter (he later backpedaled).
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, helps explain why the Trump administration has consistently botched its response to the coronavirus pandemic.
The administration has in recent weeks taken steps to combat criticisms about its slow and muddled response to the coronavirus. Trump has been appearing on TV a lot more, starting with an Oval Office address and recently with daily press briefings. He declared a national emergency, advised Americans to social distance, vowed more testing for patients and medical equipment for health care workers, and promised more economic relief to those affected by the crisis.
But experts say a lot of the damage has been done: The federal government is still only playing catch-up, as thousands of new cases of coronavirus are confirmed and the death toll steadily increases every day.
The first sign of a massive failure came with testing. South Korea, which has been widely praised for its response to coronavirus, tested more than 66,000 people within a week of the first community transmission within its borders. By comparison, the US took roughly three weeks to complete that many tests — in a country that is much more populous and, now, is on track to have a much worse outbreak than South Korea and other nations.
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 into quarantine as well. It’s one of the best tools we have for an outbreak like this.
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, previously 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 last month.
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.”
Even as the Trump administration has tried to escalate its efforts to combat the pandemic, Trump has continued to downplay concerns. Recently, he’s suggested that social distancing measures — asking people to stay home and keep their physical distance from one another — could be lifted within weeks, instead of the months experts say is likely necessary. “What a great timeline that would be,” Trump said.
This kind of downplaying 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.
But in the current pandemic, the approach has left the Trump administration unprepared for the challenge ahead, whether it’s in the failure in testing or the administration’s inability to calm the public and markets as the novel coronavirus spreads. 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 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, that May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and his global health security team. The team, the Directorate for Global Health Security and Biodefense, was never replaced.
At the time, the Trump administration and Bolton argued 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,” Jen 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 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 at the National Institutes of Health, 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 NIH, 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. (But Congress has generally denied such proposals.)
In the months before the coronavirus outbreak, the administration cut a public health position that was meant to help detect disease outbreaks in China, where the pandemic began, Marisa Taylor reported for Reuters.
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 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 time.
That begins, first and foremost, with testing. But as report after report has confirmed, the US has done a bad job in this area — falling behind its developed peers in Europe and Asia. While the US has dramatically scaled up testing in recent weeks, health care workers and patients still complain that they still sometimes can’t obtain tests even when symptoms are present.
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 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’s appearance — 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 that Trump is in charge.
Recognizing the criticisms, the Trump administration has promised to try to boost testing output, including a partnership with the private sector. But while things are improving, the full rollout of tests will likely take weeks — eating up crucial time that could have gone to actually using the tests to stop the spread of the coronavirus.
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 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 25, the US has more than 55,000 confirmed cases, up from fewer than 100 at the beginning of March, according to Johns Hopkins University.)
In mid-March, as Trump more openly acknowledged the threat of coronavirus, he suggested that the country could pull back on social distancing efforts by Easter — in just a couple weeks. When pressed on why he chose that date, he did not cite any evidence or data. Instead, he said that Easter “is a beautiful time. It would be a beautiful timeline.” That timeline did not last long.
Trump has taken some steps as the pandemic has worsened
Trump initially focused his response to coronavirus on travel restrictions, first against China and most recently against 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.
Even conservatives have been critical of Trump’s response. The National Review editorial board wrote earlier this month:
[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.
In the face of all these criticisms, Trump has, at least in public, seemingly taken the crisis more seriously. He held an Oval Office address. He’s led daily press briefings. A White House task force released guidelines advising people to avoid public spaces and larger gatherings. His administration has, in light of declaring a national emergency, promised to take all sorts of actions to shore up coronavirus testing, health care capacity, and a tanking economy.
At the same time, Trump has continued to do things that conflict with what experts are saying. He’s hyped up an anti-malaria drug, chloroquine, that experts say we simply don’t have enough evidence for as an anti-coronavirus treatment. He’s downplayed experts’ warnings that social distancing may be necessary for months, instead suggesting that it may just be weeks. And instead of using press briefings to convey clear, actionable messages and let his own experts speak, Trump often uses his time at the podium to brag about unrelated issues and criticize the media as “fake news.”
Meanwhile, the actual policy response continues lagging behind. Beyond the lack of testing, experts often cite a shortage of medical equipment, such as ventilators, masks, gloves, and goggles. While the administration has said it’s using federal authorities and tapping into its stockpiles to get more of this gear to the places that need it, health care workers on the ground complain that they still don’t have enough — forcing them to reuse possibly contaminated equipment and choose between working in unsafe conditions or not show up to work at all. All of this at a time when the country needs to, according to experts, boost health care capacity.
“Even with the infusion of supplies from the strategic stockpile and other federal resources, there will not be enough medical supplies, including ventilators, to respond to the projected COVID-19 outbreak,” a March 21 letter from the American Medical Association, American Hospital Association, and American Nurses Association stated. “We have heard of health care providers reusing masks or resorting to makeshift alternatives for masks.”
Again, this reflects on the lack of preparedness: A shortage of medical equipment is one of the many problems government simulations and exercises warned about before the current outbreak. But Trump simply didn’t prioritize pandemic preparedness beforehand.
“The US … was not prepared,” Kates said. “A good preparedness plan would have helped address this and had things in place to allow for that increased need to be met.”
But the Trump administration didn’t quickly prioritize such efforts, even after it got warnings in January and February based on how coronavirus cases took off in China.
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 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.
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. He has signed a bill that’s providing economic relief to affected workers and Covid-19 patients — including paid leave, more food aid, and free testing — with more to come.
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 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.