A Reluctant Retreat To Reality
When the coronavirus first invaded our country in late January, President Trump proclaimed that it was not a threat to Americans and that it would soon be gone. This was not entirely wishful thinking as the United States had been successful in defeating all of the other viruses that had developed in the far east and made their way into this country. It may have just slipped his mind that he had disbanded the pandemic advisory team within his National Security Council and trashed the pandemic response plan left to him by the Bush and Obama administrations. He may have also forgotten, if he ever knew, that the Strategic National Stockpile of medical supplies had become depleted and that the order for additional ventilators negotiated by the Obama administration had never been placed.
Certainly, these lapses of memory were understandable when you consider that the President’s mind was already focused (to the extent that the President is even able to focus on any subject for more than a few minutes) on his re-election in the Fall; and a thriving economy and stock market would be the keys to his victory. By early March, however, the virus was still around and had already found its way into the bodies of a few thousand Americans. It was the World Health Organization’s declaration on March 11th that our entire planet was now faced with a pandemic that seems to have captured his attention. We know that the President was aware of the W.H.O.’s declaration because he immediately announced that he knew we were faced with a pandemic before the W.H.O. had come to that conclusion.
About this same time, his advisers were showing him projections prepared by the Institute for Health Metrics and Evaluation (“IHME”) which predicted that, in the absence of intervention, virus casualties could total somewhere between 1 and 2 million Americans. Only by taking active measures to lockdown the economy, like those being employed by Spain and Italy, could American deaths be held to under 100,000 during the “first wave” of the virus which was projected to end around August 1st. Of course, shutting down the economy was not what he wanted to hear because that was the to be the path to his victory in the Fall.
Thus, it was with great reluctance that he even consented to the publication of guidelines formulated by the CDC for stemming the spread of the virus which was then well on its way to overwhelming hospital facilities in New York and New Jersey. For the President, a federal mandate closing non-essential businesses was out of the question. Even a gently-worded recommendation to that effect was problematic as it could trigger a slow-down in economic growth and spook the stock market.
To counter these possibilities, the President embarked upon what has been characterized as a campaign of “Happy Talk.” In his newly established daily press briefings he assured Americans that it would only be necessary to take these actions for a couple of weeks even though the IHME projections guiding his administration were premised on the assumptions that all states would impose restrictions on personal and business activities by the end of March and that they would remain in effect through the end of May. When the spread of the virus continued unabated through the end of March, the President conceded that these restrictions would have to remain in effect through the end of April. Nevertheless, at his press briefings, he went out of his way to minimize the threat posed by the virus and contradict his health experts if they indicated otherwise. He also continuously assured Americans that the virus would soon just go away, much like the way Mary Poppins magically departed when the wind changed. While Dr. Fauci tried to diplomatically explain that the virus would set its own time-table, Vice President Pence echoed the President’s fantasy that the threat posed by the virus would soon pass and that Americans would be able to reunite on the beaches by Memorial Day.
As predicted by the IHME, the daily number of new virus cases peaked in mid-April and slowly started to decline. From the President’s perspective, the worst was behind us and it was now time to revive the nation’s economy. This thought was resisted by his public health experts who warned that the downward trend in new confirmed cases would only continue so long as certain conditions were met. To that end, the CDC drafted a set of criteria and suggestions for states to use in determining when and how to lift their restrictions on personal and non-essential business activities. The administration’s first reaction was that the CDC’s document should never see the light of day; and when the states began to ask for guidance, the administration relented and allowed a somewhat watered-down document be published, again in the form of “suggested guidelines.”
The President, bent on an early resumption of economic activity and reminded that he did not have the power to order the states to lift their restrictions, embarked on a campaign to both encourage and coerce them to do so. When the states began to comply starting in late April, the IHME promptly changed its projected number of first wave deaths from its then low of 65,000 to 130,000. The President, being a man who has built his entire life around perceptions, quickly realized that a public perception of increasing deaths could be just as injurious to increasing economic activity as an actual increase of deaths. He, therefore, caused the IHME projections to be removed from the CDC’s website and engaged the ever-compliant Kevin Hassett and Deborah Birx to create an alternative set of projections showing that virus deaths would continue to recede to zero by the end of May. Problem solved---at least for the moment.
Although by mid-May most states had begun to restart their economies, they followed the plans adopted by European countries and did so in slow and measured steps with the result that the number of daily new confirmed cases of the virus continued their gradual decline well into the month of June. By mid-June, however, the tide of new cases began to grow again, principally fueled by the large public gatherings that had taken place over the Memorial Day weekend. By then, however, virtually every state had lifted at least some of its restrictions on social and business activities and many were already into their third stage of doing so.
Having successfully engineered the reopening of the nation’s economy, the President chose to discontinue his daily virus briefings. His suggestion that COVID-19 patients be treated with cleaning disinfectants and the occasional conflicting remarks by his medical experts may have also played a part in that decision. This meant that the states were not receiving expert guidance which might have alerted them to the dangers that lay ahead. Instead, they continued to receive assurances from the Trump administration that the country was safely on course to an economic recovery. Thus, they may not have focused on two critical facts: (1) there is a significant period (up to two weeks) between the time a person becomes infected by the virus and the time he or she experiences symptoms; and (2) a significant portion of those who are infected by the virus experience few, if any, symptoms but are still capable of transmitting it. These were the two very factors that had led to the rapid spread of the virus in New York and New Jersey in March and April and were now starting to take their toll in a dozen or more states across the south and in the west.
By this time the Republican Party was essentially married to the President’s wishful thinking that the virus would soon disappear. Even though epidemiologists were still warning that new case numbers would soon be rising and that they would be followed by rising hospitalizations and deaths. there were still encouraging signs. Important strides were being made in the development of vaccines, those contracting the virus were much younger than those who had previously succumbed to it and the medical profession had gained a better understanding of the virus and were having greater success in treating COVID-19 patients. Moreover, the President was politicizing the pandemic as a means of keeping Republican governors moving forward with their re-opening programs. He made it known that he considered wearing a mask was a sign that you did not subscribe to his assessment that the virus was being defeated. He also emphasized in his daily tweets that the economy was growing and jobless numbers were falling. That “V-shaped” recovery that the President had been predicting was underway and with it Republicans would do well in the Fall elections.
Then, toward the end of June, reality began to reassert itself. New case numbers started to rise all across the Sunbelt and hospitalizations were nearing capacity. Medical supplies began to run out and hospital staffs became pressed to handle the influx of new patients. By early-July, several hospitals in Florida, Alabama, Texas, Arizona and California found that all of their ICU beds were occupied and, even if more could be found, they did not have the staffs to service them. At first, the pleas for re-imposing restrictions on social and non-essential business activities came from doctors and nurses, then from public health administrators and then mayors. By mid-July over 20 governors had decided to pause their plans to lift remaining restrictions on businesses and public gatherings and by the third week in July a handful had ordered bars to be closed.
Still most Republican governors continued to resist calls for imposing more stringent restrictions so as not to scuttle the reopening of the nation’s economy. Then Dr. Redfield, the Director of the CDC, showed them a way out of their dilemma when he stated that if everyone simply wore a mask, the virus could be contained in one to two months. This would allow them to comply with the President’s insistence that they continue with their efforts to reopen their economies while at the same time placate the pleas of public health administrators and mayors to take action that would relieve the then untenable situations in their hospitals. Almost immediately the governors of 28 states issued orders requiring that masks be worn in all public spaces in which social distancing was not possible and a few others authorized local governments to impose such restrictions. Even the President, who for weeks had treated not wearing a mask as a badge of loyalty, began to publicly expressed his support for wearing a mask in public. A notable dissenter was Governor Kemp of Georgia who not only declined to take such action, but issued an order prohibiting local governments from doing so, an action which precipitated lawsuits by mayors of the State’s largest cities.
The problem is that these measures are almost inevitably going to be too little, too late. That’s because if everyone immediately complied with these new restrictions, it would not have an immediate effect upon curbing the increase in infections and preventing hospitals from becoming overwhelmed. Flattening the curve of new cases is similar to changing the direction of an aircraft carrier. There is a distinct lag time between when the action is taken and when the intended results are realized. That lag time could easily be between two to three weeks. In the interim, hospitals will continue to be overrun with COVID-19 patients and many patients would die simply from a want of medical attention.
The more serious issue, however, is that Dr. Redfield’s prescription is not even likely to be effective. Like the IHME original projections, which were premised on the assumption that social and business restrictions remained in place for two months, Dr. Redfield’s advice was premised on all Americans wearing masks for one to two months. That is a condition that simply cannot and will not be satisfied. First, there are not enough law enforcement officials to enforce such requirements; and even if there were, they would undoubtedly consider that there are better ways for them to spend their time. To have any chance of being effective, mask requirements must be made the responsibility of the owners of facilities to assure compliance. Thus, any business or facility owner not enforcing the mask requirement would be subject to having his/her facility closed.
Secondly, there are simply too many Americans who will still refuse to comply. Many will choose to be guided by the initial advice of the President’s Coronavirus Taskforce that wearing masks is not an effective means of stopping the spread of the virus. There are also those who are so impressed with the President and will follow his example and assume that his current statements to wear a mask are simply a half-hearted efforts to appear “politically correct.” (Yes, I understand that it is hard to believe that anyone would think that the President would even try to be politically correct; but remember that Hydroxychloroquine sales are still booming.) There are also a significant number of libertarians who simply refuse to abide by governmental restrictions that constrict their actions. Perhaps the largest group that will not go along with wearing a mask in public are those who feel that such restrictions are singularly for their own benefit and simply don’t feel threatened by the virus because of their youth or physical condition.
For the foregoing reasons, Dr. Redfield’s least painful suggestion for containing the virus is not going to work. This, in effect, is the conclusion of over 100 medical experts from colleges and universities all across the country who co-signed a letter addressed to “America’s decision makers” urging them to immediately shut down the nation’s economy and start over; only this time “do it right.” They counsel that “reopening before suppressing the virus isn’t going to help the economy” which can only be achieved by first addressing the pandemic itself. In this connection they recommend that non-essential businesses be closed, restaurant service should be limited to take-out, Individuals should stay at home except to purchase food and medicines and to exercise, and masks should be mandatory in all situations where there is interaction with others. Extensive testing should be employed to determine whether and the extent to which the spread of the disease has been slowed to the point that new infections can be traced. At that point, contact tracing and quarantining can be used to prevent a further resurgence of the virus as the economy is slowly and methodically reopened.
The sad thing is that the President only believes what he wants to believe. He heard and disregarded this same advice before when New York was experiencing 10,000 new cases a day. With the election less than 100 days away, it seems unlikely that he would adopt a plan of action that would place the nation’s economy in a coma all the way to election day even though we now have three states (Florida, California and Texas) recording 10,000 or more new cases each day. Thus, he will stick with Dr. Redfield’s advice and embark on a new chapter of wishful thinking causing the nation to waste more time without effectively dealing with a problem that other countries with more effective leadership have managed to overcome. Thus, unless Republican governors turn on the President (the subject of a future article), we can look forward to a continuing, if not a growing, onslaught of virus cases that will claim more deaths while encumbering the nation’s efforts to resuscitate its economy.