The crisis that shocked the world: America’s response to the coronavirus



Tulip, 40, had seen her country fail to control the novel coronavirus. She had seen Texas ease restrictions even as case counts and hospitalizations soared. She had seen fellow citizens refuse to wear masks or engage in social distancing.

“I feel like her death was a hundred percent preventable. I’m angry at the Trump administration. I’m angry with the state of our politics. I’m angry at the people who even now refuse to wear masks,” she said.

Six months after the coronavirus appeared in America, the nation has failed spectacularly to contain it. The country’s ineffective response has shocked observers around the planet.

The United States may be heading toward a new spasm of wrenching economic shutdowns or to another massive spike in preventable deaths from covid-19 — or both.

How the world’s richest country got into this dismal situation is a complicated tale that exposes the flaws and fissures in a nation long proud of its ability to meet cataclysmic challenges.

The fumbling of the virus was not a fluke: The American coronavirus fiasco has exposed the country’s incoherent leadership, self-defeating political polarization, a lack of investment in public health, and persistent socioeconomic and racial inequities that have left millions of people vulnerable to disease and death.

In this big, sprawling, demographically and culturally diverse nation, the decentralized political structures gave birth to patchwork policies that don’t make sense when applied to a virus that ignores state boundaries and city limits.

While other countries endured some of the same setbacks, few have suffered from all of them simultaneously and catastrophically. If there was a mistake to be made in this pandemic, America has made it.

The single biggest miscalculation was rushing to reopen the economy while the virus was still spreading at high rates through much of the country, experts say. The only way to reopen safely, epidemiologists said as far back as early April, was to “crush the curve” — to drive down the rate of viral transmission to the point that new infections were few and far between.

Many countries did just that. The United States did not follow the expert advice. Now, the curve is crushing America.

“We didn’t have the stick-to-itiveness, the determination, to carry through what we started in March, April and May, and now the virus is taking advantage of that,” National Institutes of Health Director Francis Collins said.

“If we’d had really strong guidance from local, state and national leaders, maybe we could have sustained the determination to get the curve all the way down to zero,” he said. “Now, we’re on the upswing, and I don’t quite see the top of the upswing yet.”

America, the outlier

Other countries have managed to avoid the kind of dramatic viral resurgence that is happening in America. Spain, Italy, Germany and France — all devastated by the virus months ago — drove coronavirus cases and deaths to relatively low levels. The United Kingdom has been an outlier in Europe, with one of the highest per capita death tolls in the world, but after suppressing transmission, it has not seen a major rebound.

And in Asia, the picture is radically different. In Taiwan, baseball fans sit in the stands and watch their teams play. Japan has had fewer than 1,000 deaths from covid-19, the illness caused by the coronavirus. South Korea has had fewer than 300. Vietnam has recorded no deaths from the virus.

The death rate from covid-19 in the United States looks like that of countries with vastly lower wealth, health-care resources and technological infrastructure.

America’s mishandling of the pandemic has defied most experts’ predictions. In October, not long before the novel coronavirus began sickening people in China, a comprehensive review ranked the pandemic preparedness of 195 countries. The project — called the Global Health Security Index and spearheaded by the Johns Hopkins Center for Health Security and the Nuclear Threat Initiative — assigned scores to countries as a way to warn them of the rising threat of infectious-disease outbreaks.

With a score of 83.5 out of 100, the United States ranked No. 1.

How did the nation get caught so flat-footed? By not really trying, said Beth Cameron, who helped lead the project for the Nuclear Threat Initiative.

The federal government punted the coronavirus response to the states, counties and cities, said Cameron, who was senior director for global health security and biodefense on the White House National Security Council and helped write a pandemic response plan under President Barack Obama. The team Cameron led was disbanded after Donald Trump took office. The White House says positions on the disbanded team were absorbed into another office.

“I just never expected that we would have such a lack of federal leadership, and it’s been deliberate,” she said. “In a national emergency that is a pandemic, spreading between states, federal leadership is essential. And if there was any doubt about that, we ran that experiment from March and April until now. It failed. So we have to run a different experiment.”

A nation of individuals

Somehow, this highly mobile virus keeps sneaking up on communities, seeding itself extensively before people detect the breadth and intensity of the attack. That happened catastrophically in New York City early in the pandemic. The new outbreaks have been largely in the South and West.

This month, Roy Ramos, a reporter for WPLG-TV in Miami, noticed he had a cough. He and his wife, the station’s evening news anchor, Nicole Perez, went to get tested for the coronavirus. Positive — both of them. Soon, another anchor and the station’s chief meteorologist had tested positive, too.

As of July 14, 10 station employees had tested positive, including some who hadn’t even been in the office or in contact with their co-workers. The virus was everywhere in South Florida, which is now reeling from the pathogen’s assault.

“This is not a political message, but a personal one,” Perez’s co-anchor, Calvin Hughes, told viewers. “Please, please wear a mask.”

In the minds of many Americans, the coronavirus crisis that was so alarming in March and April lost its fearsomeness in May and June, when people tried to resume something approximating a normal life. The shutdowns had been miserable, but they’d been effective.

The success of the shutdowns meant that many Americans didn’t know anyone personally sickened by the virus. In places with low transmission, the crisis seemed far away.

“We just let our guard down,” Ohio Gov. Mike DeWine (R) said in an interview Friday. “Some people when they heard, ‘Hey, Ohio’s open,’ what they mentally processed is, ‘It’s safe. We can go out and do whatever we want to. It’s back to normal.’ ”

In the past two months, the virus has been smoldering in his state, the governor said, and “now we start to see some flames.” He fears Ohio could soon have the kind of runaway transmission afflicting Florida.

“Florida a month ago is where Ohio is today. If we don’t want to be Florida, we’ve got to change what we’re doing. Everybody’s got to mask up,” the governor said.

He and others cite human nature as a problem with containing the virus. Human brains simply aren’t wired to emphasize the importance of doing things, like wearing masks, that protect others but offer no immediate payoff, said Paul Slovic, a University of Oregon psychologist.

“You don’t get rewarded for putting on a mask,” Slovic said. “You don’t see who you’ve protected from harm, but you do feel an immediate discomfort.”

Protecting one life — or even one small puppy — generates a major emotional response that can prompt action, Slovic has found. But as the number of individuals involved increases — say, to the 137,000-plus deaths caused by the coronavirus — people grow inured to the loss, less prone to take action.

That makes public messaging especially essential, experts say. But the messaging in the United States has been all over the place. Even the scientists have struggled: They were wobbly on the effectiveness of masks before eventually embracing them.

Kristin Urquiza, 39, said she tried warning her father, Mark — a lifelong Republican — against going out and risking infection. In their home state of Arizona, as leaders including Gov. Doug Ducey (R) sprinted to reopen in May and June, Urquiza could tell she was losing the argument.

“When the president, the governor and people on cable news are all saying one thing, how do you compete with that?” she said. “He would push back. ‘I hear what you’re saying, but why would the governor say it’s safe to go out if it’s not true?’ ”

“He was a huge supporter of Trump and Arizona governor Ducey. He believed what they said. And they betrayed him,” she said in an interview.

When there’s no cavalry to send

Even before the pandemic hit, local public health agencies had been decimated by years of staffing and budget cuts.

They had lost almost a quarter of their overall workforce since 2008 — a cut of almost 60,000 workers, according to national associations of health officials. The agencies’ main source of federal funding — the Centers for Disease Control and Prevention’s emergency preparedness budget — had been cut 30 percent since 2003.

Public health is an enterprise with an intrinsic problem: People can’t see sicknesses avoided or deaths averted.

“You don’t see the results. It’s a dog that doesn’t bark,” said David Himmelstein, professor of public health and health policy at the CUNY School of Public Health.

“The question is, does the water come out of your tap clean? Are the sewer systems being inspected? Are restaurants and food being inspected? Those things, you don’t notice until they fail,” he said.

The country’s electronic disease surveillance systems are “archaic and cumbersome,” said Cathy Slemp, who was recently dismissed as West Virginia’s public health commissioner after the governor blamed her for failing to reclassify certain coronavirus cases as recovered.

“We’re driving a Pinto and want to have a Ferrari,” she said.

The public health challenges are keenly felt in Malheur County, a vast swath of mostly federal rangeland in rural eastern Oregon. About a quarter of its 30,000 residents live in poverty. Teen pregnancy rates are double the statewide rate. There’s one school nurse for 10,000 square miles. Drug use is high.

The first coronavirus case hit March 30, and for more than a month, the county averaged just one to two cases a week. There was resistance to a statewide shutdown in the conservative area, but most people were willing to observe temporary restrictions, said Sarah Poe, director of the county health department.

But after a month or so, residents began to complain of government overreach. Many felt they had to resume working to survive, she said.

“People’s response has been to just take care of themselves, take care of your own business, your own family,” Poe said. “That’s not how this virus works.”

Now, the coronavirus is a full-blown crisis in Malheur County. Cases began soaring three weeks ago, to 15 or 16 a day. As of Friday, the county had 477 cases. The cumulative positive rate since the first case is nearly 16 percent — quadruple the state’s rate.

On Wednesday, facing an accelerating caseload, Malheur County commissioners passed a resolution that goes further than the state’s mask order. It recommends gatherings of no more than 10 people indoors and 25 outdoors, and mask-wearing in groups indoors and out.

“We’re up against just a ton of misinformation,” she said. “What are we fighting here? We are fighting a virus and our goal is to save lives. Let’s not be distracted into fighting other people.”

A turning point

America, experts say, is approaching a tipping point at which its public health systems could become so overwhelmed they begin to collapse. Already, coronavirus test results take so long to come back they are almost useless for anything except as a historical record.

The delays have a cascading effect. Contact tracing is rendered ineffectual. Containing the virus by isolation becomes impossible. And as hospitals fill, the virus’s fatality rate could inch upward because of overtaxed ICU nurses and doctors struggling to care for so many.

But the most dangerous cascading effect could be despair — a loss of hope, along with the resolve to fight the virus, warned Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

“When that happens, you lose the ability to act rationally. You lose the commitment to fight. You lose all chance of beating back the virus,” he said.

Adam Fleming Petty, a writer in Grand Rapids, Mich., said he feels that demoralization acutely — as well as “so much rage” at Trump and other political leaders whose measures did not quell the virus enough to allow many schools to open.

“One thing I told myself was, ‘Okay, as long as school starts back up in the fall, I can do this. I can make it through the summer if I have that goal waiting for me.’ Now, that goal isn’t there anymore,” said Petty, 38, who has been the primary supervisor of two daughters, ages 5 and 7, while his wife works from home. For four months, the family has socialized with only a handful of relatives just a few times.

“This is far from the first time that governmental administrative incompetence has been displayed. But I can’t remember the last time that the consequences of that were so personal,” Petty said.

Governors and local officials across the Sun Belt have announced incremental measures in recent days to halt the viral resurgence. California instituted a statewide mask requirement. Arkansas and Colorado did so Thursday. Arizona allowed local jurisdictions to implement mask mandates as they see fit.

Florida’s governor has resisted weeks of calls to implement such a mandate. Georgia Gov. Brian Kemp (R) announced Wednesday that all local mask mandates in his state are void.

Louisiana and Texas recently shut down bars all over again. Alabama Gov. Kay Ivey (R) announced a statewide mask mandate in recent days as an alternative to closing. West Virginia limited gatherings to 25 people or fewer.

In New York, Gov. Andrew M. Cuomo (D) threatened to close restaurants if social distancing is not taken seriously.

“Closing the bars is going to be the equivalent of fixing three of the five screen doors in your submarine,” said Osterholm, who says that places with high levels of transmission need to return to the kind of shutdowns common in March and April.

In a telephone interview, Cuomo said New York officials were caught off guard early in the year because everyone assumed the virus was coming into the West Coast from China. But it had already spread in Europe, and from there to New York.

“We didn’t find out until after the fact. You don’t have the revelation by the academics until mid-March that this was one of the great health blunders of all time,” Cuomo said. “You actually got hit by a bus that came from the other direction.”

He expressed dismay about the national failure to suppress the virus.

“If you could have written a prescription four months ago, a manual — ‘This is what you must do to deal with a virus’ — and if people could just follow the manual, we would be over this, like other countries are over it,” Cuomo said. “I think it exposed a fundamental weakness in this country. We have a divided country.”

New York beat back the virus by closely following the scientific data and being cautious about reopening the economy, Cuomo said. Many places suffering high rates of infections didn’t do that, he said.

“It was science denial meets government incompetence,” he said.

‘The exception and anomaly’

This crisis has been sucked inexorably into the vortex of political polarization.

Trump repeatedly downplayed the viral threat. “You have 15 people, and the 15 within a couple of days is going to be down to close to zero,” he said in late February. On Twitter, he cheered on citizen protests of shutdowns that had been ordered by Democratic governors. He did not wear a mask in public until July 11.

White House spokeswoman Sarah Matthews in a statement defended the administration’s response to the crisis, saying Trump “has led an historic, whole-of-America coronavirus response — resulting in 100,000 ventilators procured, sourcing critical PPE for our frontline heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world. … This strong leadership will continue as we safely reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate.”

A White House official on background defended the president’s support for reopening the economy while the virus was still spreading, citing Trump’s belief that the cure cannot be worse than the disease: “There are consequences to staying closed, including but not limited to missed doctors’ appointments, drug or alcohol misuse, and suicide as a result of the pandemic.”

Future historians will not treat kindly Trump’s efforts to divide and confuse, said James Grossman, executive director of the American Historical Association.

“You look at the Great Depression and how Roosevelt made a concerted effort to unite the country — the fireside chats, the New Deal. That is the instinctive reaction of almost every president in crisis. Even if you don’t succeed, you try to convince people that they’re all in this together,” Grossman said. “This presidency is the exception and anomaly.”

Many Americans now believe the pandemic has been exaggerated, or even fabricated, by scientists and the mainstream news media. The rejection of scientific expertise has flowered into a conspiracy theory holding that the experts are lying as part of a political agenda.

“The most outrageous lies are the ones about Covid 19. Everyone is lying. The CDC, Media, Democrats, our Doctors, not all but most, that we are told to trust,” former “Wheel of Fortune” game show host Chuck Woolery tweeted July 12.

Trump retweeted that. Days later, Woolery revealed his son was sick with the virus, and he has since taken down his Twitter account.

To be an American

As she prepares for a three-day drive across the country — from New York to Texas — to bury her mother, Tulip said she has been thinking a lot about what it means to be American.

She was raised like many Texans, unabashedly proud of her roots and her patriotism. “I grew up a Dallas Cowboys fan. All about the stars and stripes. You know that song ‘Proud to Be an American’? We would literally sing that as kids in elementary school and mean every word.”

Now, she said, she feels betrayed by her country and home state. For the past two weeks, she and her husband have been calling funeral homes in Brownsville, unable to get through because the town has been overwhelmed by the virus.

“I desperately want to believe we as a country can change, that we can recover from where we are now,” she said. “I want to believe that America can get back to who we were, a proud country, one where people can thrive and not suffer.”

Isaac Stanley-Becker contributed to this report.



First Published at www.washingtonpost.com on 2020-07-20 01:30:57

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