Thursday, March 19, 2020

Health Bureaucrats Botched the Response to Coronavirus. Trump Made It Even Worse.

By Peter Suderman - March 19, 2020 at 12:39PM

The single most important failure of the U.S. response to COVID-19, the disease caused by the novel coronavirus, has been the slow rollout of testing. This was an abject failure of bureaucracy. But it was also a failure of presidential leadership. 

The countries that have had the most success in containing the outbreak, such as South Korea and Singapore, have done so through early, rapid, and widespread testing and contact tracing, followed by targeted quarantines. South Korea and the United States discovered initial cases of the coronavirus on the same day in January. Since then, some 290,000 people in South Korea have been tested and new daily cases have fallen from 909 to just 93. Despite a much larger population, the United States, tested just 60,000 people in the same period of time. 

South Korea saw the problem and took steps to stop it. The U.S. was flying blind. 

Much of the failure to make mass testing available lies with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). As a Wall Street Journal report makes clear, the CDC, which managed the development of the initial test kits, botched the job in just about every possible way: The CDC not only produced a faulty test that had to be retracted but adopted narrow testing criteria that meant many people with symptoms simply couldn't be tested. 

Perhaps most disastrously, as The Washington Post reports, federal health agencies initially declined to certify tests produced by private companies that were better suited for rapid mass testing anyway. This is despite the fact that experts, including the former head of the FDA, were publicly recommending that they do so as early as February 2. 

The CDC was following its usual protocols, developing initial diagnostic tests on its own in order to maintain quality control, as it usually does. But that's exactly the problem. 

This was a catastrophe of top-down, slow-moving, centrally managed government bureaucracy, bound by outdated rules and practices, unable to swiftly adapt to an emergency. It will almost certainly cost American lives and livelihoods. The virus has likely already spread far and wide undetected. One reason restrictive social distancing measures have been adopted across the country is that public officials have little visibility into its scale and spread. 

But this was also a failure of political leadership, most notably from President Donald Trump. For weeks, Trump and senior White House officials actively downplayed the threat of the virus. 

As late as February 25, National Economic Council adviser Larry Kudlow was offering assurances that the coronavirus was "contained" and that it was "pretty close to airtight." Trump treated the virus with similar breeziness, suggesting that the virus was "going to disappear" and that while it might get worse, "nobody really knows."   

The stock market, needless to say, does not look very good today. 

As concern grew about the spread of the coronavirus, Trump continued to insist that all was well, telling Americans to remain calm. "Anyone who wants a test can get a test," he falsely claimed early in March. (Two weeks later, it remains difficult to get tested in many parts of the country.) Trump emphasized that confirmed case counts in the U.S. were low—which was true, but only because testing was so limited. White House officials later had to clarify Trump's statement

The problem here is obvious: Trump, who as the head of the executive branch oversees federal agencies such as the FDA, did not view the virus as a serious problem—and did not want others to view it that way either. That, in turn, translated into a downstream lack of urgency, which meant that critical aspects of the response were not prioritized.  According to The Wall Street Journal, health officials who have examined the testing calamity have concluded that it was a result of both bureaucratic bumbling and a "broader failure of imagination," in which Trump and other administration officials "appeared unable or unwilling to envision a crisis of the scale that has now emerged."

The job of a president is to make decisions, set priorities, and convey clear information to both the public and the staff of the executive branch. This is especially important in a moment of crisis, when the executive is in charge of acting both quickly and with sound judgment. In this outbreak, Trump has failed on every count. Not only did he fail to see the threat even when it was apparent to experts, but he actively undermined preparedness by downplaying its significance far long after the problem was apparent, and by providing false and misleading information as the mitigation effort proceeded. 

Trump has also repeatedly mischaracterized his own administration's responses to the crisis, saying, for example, that his 30-day ban on European travel would include cargo—a mistake he later blamed on the teleprompter. As New York's Jonathan Chait writes, there is now reason to worry that Trump is similarly failing to prepare for the expected wave of hospitalizations as more people become infected, by declining to expand the stock of critical supplies. 

The federal health bureaucracy deserves much of the blame for America's faltering response to the coronavirus outbreak. But the president has made the fiasco worse. 

The bureaucracy reports up to an executive, who is tasked with setting priorities and ensuring performance—and for taking responsibility when there are failures. Instead, Trump has inaccurately blamed the Obama administration for failures that occurred on Trump's watch. (Indeed, under Barack Obama, diagnostic tests for swine flu were designed and approved in less than two weeks.) Asked whether any of this is his fault, the president rejected the idea, saying, "I don't take responsibility at all." Trump's refusal to admit failures makes it more likely that he will repeat them, and that more Americans will pay the price.


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