The New York Times - USA (2020-10-25)

4 SR THE NEW YORK TIMES, SUNDAY, OCTOBER 25, 2020

O

NE of the mostlethal leadership

failures in modern times un-

folded in South Africa in the

early 2000s as AIDS spread

there under President Thabo Mbeki.

Mbeki scorned science, embraced con-

spiracy theories, dithered as the disease

spread and rejected lifesaving treat-

ments. His denialism cost about 330,000

lives, a Harvard study found.

None of us who wrote about that deba-

cle ever dreamed that something similar

might unfold in the United States. But to-

day, health experts regularly cite Presi-

dent Trump as an American Mbeki.“We’re

unfortunately in the same place,” said

Anne Rimoin, an epidemiologist at

U.C.L.A. “Mbeki surrounded himself with

sycophants and cost his country hundreds

of thousands of lives by ignoring science,

and we’re suffering the same fate.”

One role of journalism is to establish ac-

countability, and that’s particularly im-

portant before an election. Trump says he

deserves an A-plus for his “phenomenal

job” handling the coronavirus, but history

is likely to be a far harsher judge.

“I see it as a colossal failure of leader-

ship,” said Larry Brilliant, a veteran epi-

demiologist who helped eliminate small-

pox in the 1970s. “Of the more than

200,000 people who have died as of today, I

don’t think that 50,000 would have died if it

hadn’t been for the incompetence.”

There’s plenty of blame to go around, in-

volving Democrats as well as Republi-

cans, but Trump in particular “recklessly

squandered lives,” in the words of an un-

usual editorial this month in the New Eng-

land Journal of Medicine. Death certifi-

cates may record the coronavirus as the

cause of death, but in a larger sense vast

numbers of Americans died because their

government was incompetent.

As many Americans are dying every 10

days of Covid-19 as U.S. troops died in 19

years of war in Iraq and Afghanistan. The

economists David Cutler and Lawrence

Summers estimate that the cost of the

pandemic in the United States will be $16

trillion, or about $125,000 per American

household — far more than the median

family’s net worth. Then there’s an im-

measurable cost in soft power as America

is humbled before the world.

“It’s really sad to see the U.S. presiden-

cy fall from being the champion of global

health to being the laughingstock of the

world,” said Devi Sridhar, an American

who is a professor of global health at the

University of Edinburgh. “It was a trage-

dy of history that Donald Trump was pres-

ident when this hit.”

The United States has made other terri-

ble mistakes over the decades, including

the Iraq war and the war on drugs. But in

terms of destruction of American lives,

treasure and well-being, this pandemic

may be its greatest failure of governance

since the Vietnam War.

AMERICA WAS THE LEADER IN PANDEMIC

PREPAREDNESS.

The paradox is that a year ago, the United

States seemed particularly well posi-

tioned to handle this kind of crisis. A 324-

page study by Johns Hopkins found last

October that the United States was the

country the best prepared for a pandemic.

Credit for that goes to President George

W. Bush, who in 2005 read an advance

copy of “The Great Influenza,” a history of

the 1918 flu pandemic. Shaken, Bush

pushed aides to develop a strategy to pre-

pare for another great contagion, and the

result was an excellent 396-page playbook

for managing such a health crisis.

The Obama administration updated

this playbook and in the presidential tran-

sition in 2016, Obama aides cautioned the

Trump administration that one of the big

risks to national security was a contagion.

Private experts repeated similar warn-

ings. “Of all the things that could kill 10

million people or more, by far the most

likely is an epidemic,” Bill Gates warned in

2015.

Trump has accused the Obama admin-

istration of depleting stockpiles of medical

supplies so that “the cupboard was bare.”

It’s true that the Obama administration

did not do enough to refill the national

stockpile with N95 masks, but Republi-

cans in Congress wouldn’t provide even

the modest sums that Obama requested

for replenishment. And the Trump admin-

istration itself did nothing in its first three

years to rebuild stockpiles.

We in the media also blew it: We didn’t

do enough to warn about the risks of pan-

demics.

Trump argues that no one could have

anticipated the pandemic, but it’s what

Bush warned about, what Obama aides

tried to tell their successors about, and

what Joe Biden referred to in a blunt tweet

in October 2019 lamenting Trump’s cuts to

health security programs and adding:

“We are not prepared for a pandemic.”

THE FIRST ALARM BELLS FROM WUHAN

When the health commission of Wuhan,

China, announced on Dec. 31 that it had

identified 27 cases of a puzzling pneumo-

nia, Taiwan acted with lightning speed.

Concerned that this might be an outbreak

of SARS, Taiwan dispatched health in-

spectors to board flights arriving from

Wuhan and screen passengers before al-

lowing them to disembark. Anyone show-

ing signs of ill health was quarantined.

If either China or the rest of the world

had shown the same urgency, the pan-

demic might never have happened.

In the United States, the Centers for

Disease Control and Prevention issued a

notice about the Wuhan outbreak on Jan.

1, but not much else happened for a time.

In China, President Xi Jinping issued or-

ders on Jan. 7 for handling the coronavi-

rus, but they were inadequate. If, at that

time or soon after, Xi had ordered a more

modest version of the Wuhan lockdown

that was to come, it is possible that the vi-

rus could have been stifled before it

spread around the globe.

Instead, Wuhan held a banquet for

40,000 people on Jan. 18, and by the time

the lockdown was ordered on Jan. 23,

some five million people had already left

Wuhan for the Chinese New Year. In hind-

sight, two points seem clear: First, China

initially covered up the scale of the out-

break. Second, even so, the United States

and other countries had enough informa-

tion to act as Taiwan did. The first two

countries to impose travel restrictions on

China were North Korea and the Marshall

Islands, neither of which had inside infor-

mation.

That first half of January represents a

huge missed opportunity for the world. If

the United States, the World Health Orga-

nization and the world media had raised

enough questions and pressed China, then

perhaps the Chinese central government

would have intervened in Wuhan earlier.

And if Wuhan had been locked down just

two weeks earlier, it’s conceivable that

this entire global catastrophe could have

been averted.

THE DEFIANCE OF SCIENCE

Perhaps the original sin of America’s re-

sponse to the coronavirus came with the

bungling of testing.

Without testing, health officials fight an

opponent while blindfolded. They don’t

know where the virus lurks, and they can’t

isolate those infected or trace their con-

tacts.

But the C.D.C. devised a faulty test, and

turf wars in the federal government pre-

vented the use of other tests. South Korea,

Germany and other countries quickly de-

veloped tests that did work, and these

were distributed around the world. Sierra

Leone in West Africa had effective tests

before the United States did.

Trump supporters note, correctly, that

within the United States, the states with

the highest mortality rates have been

Democrat-led: New Jersey has had the

most deaths per capita, followed by New

York. It’s true that local politicians, Demo-

crats and Republicans alike, made disas-

trous decisions, as when Mayor Bill de

Blasio of New York City urged people in

March to “get out on the town despite co-

ronavirus.” But local officials erred in part

because of the failure of testing: Without

tests, they didn’t know what they faced.

It’s unfair to blame the testing catastro-

phe entirely on Trump, for the failures un-

folded several paygrades below him.

Partly that’s because Trump appointees,

like Robert Redfield, director of the C.D.C.,

simply aren’t the A team.

In any case, presidents set priorities for

lower officials. If Trump had pushed aides

as hard to get accurate tests as he pushed

to repel refugees and migrants, then

America almost certainly would have had

an effective test by the beginning of Feb-

ruary and tens of thousands of lives would

have been saved.

Still, testing isn’t essential if a country

gets backup steps right. Japan is a densely

populated country that did not test much

and yet has only 2 percent as many deaths

per capita as the United States. One rea-

son is that Japanese have long embraced

face masks, which Dr. Redfield has noted

can be at least as effective as a vaccine in

fighting the pandemic. A country doesn’t

have to do everything, if it does some

things right.

Yet in retrospect, Trump did almost ev-

erything wrong. He discouraged mask

wearing. The administration never rolled

out contact tracing, missed opportunities

to isolate the infected and exposed, didn’t

adequately protect nursing homes, issued

advice that confused the issues more than

clarified them, and handed responsibil-

ities to states and localities that were un-

prepared to act. Trump did do a good job of

accelerating a vaccine, but that won’t help

significantly until next year.

Trump’s missteps arose in part because

he channeled an anti-intellectual current

that runs deep in the United States, as he

sidelined scientific experts and responded

to the virus with optimism apparently

meant to bolster the financial markets.

“It’s going to disappear,” Trump said on

Feb. 27. “One day — it’s like a miracle — it

will disappear.”

The false reassurances and dithering

were deadly. One study found that if the

United States had simply imposed the

same lockdowns just two weeks earlier, 83

percent of the deaths in the early months

could have been prevented.

A basic principle of public health is the

primacy of accurate communications of

the best science. Chancellor Angela

Merkel of Germany, who holds a doctorate

in physics, is the global champion of that

approach. Trump was the opposite, sow-

ing confusion and conspiracy theories; a

Cornell study found that “the President of

the United States was likely the largest

driver of the Covid-19 misinformation.”

Instead of listening to top government

scientists, Trump marginalized and derid-

ed them, while elevating charlatans: One

senior health department official, Michael

Caputo, who had no background in health,

was ousted only after he denounced gov-

ernment scientists for “sedition” and ad-

vised Trump supporters, “If you carry

guns, buy ammunition.”

Trump recruited as a Covid-19 adviser a

regular guest on Fox News, Dr. Scott At-

las, who is not a specialist on infectious

diseases but a radiologist who is an expert

on magnetic resonance imaging. You

wouldn’t want an epidemiologist review-

ing your M.R.I. scans, and it’s equally odd

to have a radiologist managing a pan-

demic.

A conservative commentariat echoed

Trump in downplaying the virus and de-

riding efforts to stay safe. Brit Hume of

Fox News mocked Joe Biden for wearing a

large mask, and the right-wing website

RedState denounced “the public health

Gestapo” and called Dr. Anthony Fauci a

“mask Nazi.” A University of Chicago

study found that watching the Sean Han-

nity program correlated to less social dis-

tancing, so watching Fox News may well

have been lethal to some of its fans.

ECHOES OF THE SOVIET UNION

Americans have often pointed to the Sovi-

et Union as a place where ideology

trumped science, with disastrous results.

Stalin backed Trofim Lysenko, an agricul-

tural pseudoscientist who was an ardent

Communist but scorned genetics — and

whose zealous incompetence helped

cause famines in the Soviet Union. Later,

in the 1980s, Soviet leaders were troubled

by data showing falling life expectancy —

so they banned the publication of mortal-

ity statistics. It was in the same spirit that

Trump opposed testing for the coronavi-

rus in the hope of holding down the num-

ber of reported cases.

Of course, science sometimes gets it

wrong. Many experts opposed closing

borders, while Trump’s move to limit trav-

el from China now appears sound — al-

though 45 countries imposed such travel

restrictions before the United States.

Likewise, Fauci said on March 9: “If

you’re a healthy, young person, if you want

to go on a cruise ship, go on a cruise ship.”

Inevitably, science errs, then self-cor-

rects. But Trump was not self-correcting.

Most striking, Trump still has never de-

veloped a comprehensive plan to fight

Covid-19. His “strategy” was to downplay

the virus and resist business closures, in

an effort to keep the economy roaring —

his best argument for re-election.

This failed. The best way to protect the

economy was to control the virus, not to

ignore it, and the spread of Covid-19

caused economic dislocations that devas-

tated even homes where no one was in-

fected. Eight million Americans have

slipped into poverty since May, a Colum-

bia University study found, and about one

in seven households with children have

reported to the census that they didn’t

have enough food to eat in the last seven

days. More than 40 percent of adults re-

ported in June that they were struggling

with mental health, and 13 percent have

begun or increased substance abuse, a

C.D.C. study found. More than one-quar-

ter of young adults said they have seri-

ously contemplated suicide. Diane Reyn-

olds, who runs an excellent addiction pro-

gram called Provoking Hope, estimates

that relapses have increased 50 percent

during the pandemic.

So in what may be the richest country in

history, political malpractice has resulted

in a pandemic of infectious disease fol-

lowed by pandemics of poverty, mental ill-

ness, addiction and hunger.

The rejection of science has also exacer-

bated polarization and tribalism. As I

write this, I’m on our family farm in rural

Oregon. Trump is popular in this area, and

his contempt for science has contributed

to a dangerous unraveling, even talk of

civil war. An old school friend shared this

conspiracy theory on Facebook:

Create a VIRUS to scare people. Place

them in quarantine. Count the number of

dead every second of every day in every

news headline. Close all businesses....

Mask people. Dehumanize them. Close

temples and churches.... Empty the pris-

ons because of the virus and fill the streets

with criminals. Send in Antifa to vandal-

ize property as if they are freedom fight-

ers. Undermine the law. Loot.... And, in

an election year, have Democrats blame

all of it on the President. If you love Amer-

ica, our Constitution, and the Rule of Law,

get ready to fight for them.

Mismanagement of the virus has not

only sickened millions of Americans but

has also poisoned our body politic.

TAKING A THREAT SERIOUSLY

A pandemic is a huge challenge for any

country. Spain and Brazil have had more

deaths per capita than the United States,

and Europe now has slightly more new in-

fections per capita than the United States.

Still, it’s not reassuring for the country

that a year ago was considered best pre-

pared for a pandemic to hear: We’re not

quite as bad as Brazil!

In World War II, American soldiers died

at a rate of 9,200 a month, less than one-

third the pace of deaths from this pan-

demic, but the United States responded

with a massive mobilization. By 1945, a

Ford assembly line was turning out a B-24

bomber every hour. Today we can’t even

churn out enough face masks; a poll of

nurses in late July and early August found

that one-third lacked enough N95 masks.

Trump and his allies have even argued

against mobilization. “Don’t be afraid of

Covid,” Trump tweeted this month. “Don’t

let it dominate your life.” Attorney Gen-

eral William Barr compared stay-at-home

orders to slavery.

Instead of leading a war against the vi-

rus, Trump organized a surrender. He

even held a super-spreader event at the

White House, for Judge Amy Coney Bar-

rett. That’s why the White House recently

had more new cases of Covid-19 than New

Zealand, Taiwan and Vietnam combined.

It didn’t have to be this way. If the U.S.

had worked harder and held the per capita

mortality rate down to the level of, say,

Germany, we could have saved more than

170,000 lives. And if the U.S. had re-

sponded urgently enough to achieve Tai-

wan’s death rate, fewer than 100 Ameri-

cans would have died from the virus.

“It is a slaughter,” Dr. William Foege, a

legendary epidemiologist who once ran

the C.D.C., wrote to Dr. Redfield. Dr. Foege

predicted that public health textbooks

would study America’s response to

Covid-19 not as a model of A-plus work but

as an example of what not to do.

NICHOLAS KRISTOF

‘A Colossal Failure of Leadership’

MAX LOEFFLER

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