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Trump administration’s lack of a unified coronavirus strategy

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Post time 2020-4-26 19:12:05 | Show all posts |Read mode
Trump administration’s lack of a unified coronavirus strategy will cost lives say a dozen experts

April 3, 2020, 4:01 PM +07
By Ken Dilanian and Dan De Luce
WASHINGTON — The Trump administration's decision to let states chart their own responses to the coronavirus crisis rather than impose a national strategy will cost thousands of lives and is likely to result in an open-ended outbreak rolling across the country, a dozen public health experts told NBC News.
The only way to win what President Donald Trump has called a war against an "invisible enemy" is to establish a unified federal command, the experts insist — something Trump has yet to do. So far, the federal government hasn't leveraged all its authority and influence to dramatically expand testing and tracing measures, ensure a sufficient supply of crucial medical equipment or require residents of all 50 states to stay at home.
Each day that passes without such a national strategy, the experts say, will raise the ultimate U.S. death toll from COVID-19, the disease associated with the virus. Right now, there aren't enough tests and gear as states compete with one another to buy them on the open market. And there is very little ability to trace who has the virus and where it is spreading.
"This is a problem that we should be dealing with over the entire nation," said William Haseltine, a biologist famed for his work on HIV and AIDS. "This is a national problem — it needs a national response."
Without such a national plan of action carried out on a scale akin to the country's mobilization during World War II, the experts say, some hospitals will continue to suffer shortages and the U.S. will lack the data needed to have a clear picture of where COVID-19 has spread, making it much harder to get the virus under control.
The Trump administration has declined to nationalize the medical logistics system and hasn't executed a national testing strategy. Although the president likely lacks the legal authority to impose a national stay-at-home order, he has declined to urge each governor to do so. Seven states haven't imposed one, including Texas.
The results are clear: Governors and doctors report critical shortages of gear, it remains very difficult to get tested for the virus, and some Americans still aren't heeding guidance to keep away from others.
"This is not a partisan issue," said Kenneth Bernard, a retired Navy rear admiral and biosecurity expert who served in the administrations of Presidents Bill Clinton and George W. Bush. "There needs to be a central command presence on this. There needs to be a person who can act as a focal point for tests, personal protective equipment and countermeasures — acquisition and distribution. Right now, it's too fragmented and fractured, and that's counterproductive, because the states are competing against the federal government for the same sources of materials."
Trump continues to assert that the federal government's role is supporting states, not leading.
"Massive amounts of medical supplies, even hospitals and medical centers, are being delivered directly to states and hospitals by the Federal Government," he tweeted Thursday. "Some have insatiable appetites & are never satisfied (politics?). Remember, we are a backup for them."
Massive amounts of medical supplies, even hospitals and medical centers, are being delivered directly to states and hospitals by the Federal Government. Some have insatiable appetites & are never satisfied (politics?). Remember, we are a backup for them. The complainers should...
— Donald J. Trump (@realDonaldTrump) April 2, 2020
The decentralized approach is in stark contrast to South Korea's actions. South Korea contained the outbreak by quickly implementing an aggressive national program of social distancing, testing and monitoring. Until testing is dramatically ramped up in the U.S., it will be extremely risky to go back to normal life, experts say. As of April 2, there have been a total of 1.2 million tests nationwide, according to the COVID Tracking Project, a fraction of what experts say is needeThis report is based on interviews with and analyses from prominent public health experts and former senior U.S. officials who oversaw efforts to combat infectious diseases in administrations from both parties. These experts say a consensus has emerged in the public health field about what the federal government needs to do take control of the epidemic. The framework is based in part on similar efforts by other governments — including South Korea's and Singapore's — that appear to have "flattened the curve" of the virus for now.
Full coverage of the coronavirus outbreak
On Wednesday, an editorial in the New England Journal of Medicine exhorted the president to establish a unified effort.
"The president says we are at war with the coronavirus," wrote Dr. Harvey Fineberg, president of the Institute of Medicine at Harvard University's School of Public Health. "It's a war we should fight to win."
As of now, that isn't happening, said Laurie Garrett, a public health expert and author of "The Coming Plague" and other books that warned of the growing danger posed by pandemics.
"In every way, in every aspect of the American outbreak or epidemic, what we lack is a strategic approach, so we're utterly responsive," she said. "The virus is beating us. It's emerging and surprising us. We don't know where it is. We don't know where it's going. We don't know how it's spreading. We don't have interventions that follow a strategy."
After initially having downplayed the severity of the coronavirus outbreak during a crucial February period of missed opportunities, Trump in recent weeks has ramped up the federal response. But when asked about the federal role, Trump and his advisers have described it as one of supporting the states.
On Wednesday, Surgeon General Jerome Adams said on NBC's "TODAY" that White House coronavirus guidelines should be interpreted as a national stay-at-home order. But he also declined to demand that each governor follow it.
"We live in a nation that has a system of federalism, and the governors get to make the decision," Adams said.
That philosophy has hampered the nation's response to the pandemic in three crucial areas, experts say.
Poor grades for social distancing
A majority of the U.S. population is staying at home, and that drastic change in behavior appears to be slowing the spread of the virus, the experts say.
But a handful of states have resisted statewide directives, even though cities in some of those states have imposed their own. Florida's governor issued a stay-at-home order Wednesday after days of pressure — and college students congregated for spring break on Florida's beaches and then returned to their homes all around the nation.
As of Thursday, Arkansas, Iowa, Nebraska, North Dakota and South Dakota had no known orders in place. In Texas, Pennsylvania and Alabama, some cities have imposed their own restrictions, but there is no statewide rule.
Unacast, which tracks the movements of vast numbers of people via cellphone location data, has created a social distancing scoreboard, grading states on the extent to which residents are staying apart, based on changes from previous movement patterns. Fourteen states got C's, another 14 got D's and one, Wyoming, got an F.
When it comes to social distancing, delay means death, said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, which has created a model the government is using.
The model predicts around 80,000 deaths if every state adopts social distancing until June 1, but each day that doesn't happen increases the death toll, he said.

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