Trump’s defense of his mishandling of the COVID-19 crisis falls apart

It’s not often that one of the world’s leading medical journals delivers a damning indictment of an American president, but that is what The Lancet has done in an editorial. COVID-19 in the USA: a question of time:

With more than 600,000 confirmed cases and close to 27,000 deaths, the USA has become the current centre of the global coronavirus disease 2019 (COVID-19) pandemic. Fewer than 3 months have elapsed since the first severe acute respiratory syndrome coronavirus 2 infection in Washington State was confirmed by the US Centers for Disease Control and Prevention (CDC). Initially appearing slow moving and constrained in contrast to the scale of outbreaks in China and Italy, COVID-19 has given way to a nationwide public health catastrophe. For the first time in US history, a disaster declaration has been put in place for all 50 states and most US territories, and 95% of Americans are at least temporarily under some form of stay at home order. The increasing gravity of the situation in the USA has drawn public health and infectious disease experts, policy makers, and partisans across state and federal government into a fitful clash for control and direction of the COVID-19 response. Putting the USA at odds with the international community and global pandemic strategy efforts, President Trump announced his intention to withdraw funding from WHO (about 22% of its budget). Caught amid the chaos are the American people grappling with the fear of a deadly and poorly understood virus, conflicting messaging around their protection and safety, fear of financial fallout, absence of a cohesive national strategy, and volatile, incompetent leadership.

As Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has suggested, sluggish decision making by the federal government at the outset of the COVID-19 crisis lost precious time: had “you started mitigation earlier, you could have saved lives”. It was not until late February, 2020, after local transmission of COVID-19 was established in additional clusters in Oregon and New York states, that the CDC updated guidance to authorise testing for individuals who had not travelled recently, substantially widening the scope of cases that could be detected. During the brief window when containment of the virus might have been a possibility, the CDC retained control of all testing, preventing external academic and commercial test development, and processing only about 100 samples per day. The US Food and Drug Administration has also created barriers through its requisite approval scheme for all diagnostics. Even with the slow scale-up of testing, private facilities and laboratories tasked with processing samples have been severely overwhelmed with thousands of backlogged cases. Point-of-care and clinic testing for active infections is still pressing, especially in regions where outbreaks are predicted to occur, but there must now be a shift in urgency to develop and expand testing capacity for previous COVID-19 infections.

Testing might rely on the ability to innovate, but simple and effective prophylaxis against COVID-19 has been hampered and delayed by Trump’s prevarication. Dynamic models predicting the rates of mortality and hospital admission, such as the IHME COVID-19 projections as well as previous pandemic preparedness plans, have been available to help states get ready for surge responses, through increasing the number of hospital beds and ventilators available. Yet shortages and inadequate personal protective equipment have and continue to put front-line health-care workers at great risk. After sparring with governors over access to the Strategic National Stockpile, Trump has not invoked the Defense Production Act, ordering private businesses to manufacture needed goods, leaving states, philanthropists, and health-care advocacy groups to source equipment, often directly competing with the federal government for goods. Anticipating a protracted fight against COVID-19 that could involve multiple waves of outbreak, reinforcing that availability and equitable distribution of essential medical supplies should be the priority of existing federal agencies.

In hard-hit states such as New York, although hundreds of COVID-19 deaths are still occurring daily, hospital admissions appear to have plateaued. Credit might be due to effective physical distancing measures that limit community mobility. But progress in preventing the spread of COVID-19 has come with economic havoc—at least 17 million Americans are unemployed, a number that could ultimately surpass the Great Depression, and take years to correct. A new impasse is forming around the Trump administration’s eagerness to boost the economy by lifting restrictions, just as mitigation efforts by the states are yielding results. The degree to which the USA stalled in taking aggressive action to curtail the spread of COVID-19 is directly the product of an administration marked by consistently poor timing, intent on making decisions in favour of economic interests instead of those that are guided by science and to protect health. The rush to reopen the country puts dollars over deaths.

Aaron Blake at the Washington Post has published a timeline of events which presents damning evidence of Trump’s criminal negligence to support the indictment. 2 months in the dark: the increasingly damning timeline of Trump’s coronavirus response (excerpts):

Below is a timeline of all the reported warning signs, with some of Trump’s public actions and comments interspersed. Much of it is based upon two investigative pieces published by The Washington Post on March 20 and April 4.

Note: If this Times of Israel report is accurate (and I have not seen this verified by other sources), the US Intelligence Community became aware of an “emerging disease” in the second week of November. The Trump administration “did not deem it of interest” but intelligence officials shared a classified report with NATO and Israel.

Dec. 31: The Centers for Disease Control and Prevention learn of a cluster of cases in China.

Jan. 1: The CDC begins developing reports for the Department of Health and Human Services about the situation.

Jan. 3: A Chinese official officially informs CDC Director Robert Redfield of the outbreak of a respiratory illness in the city of Wuhan. Redfield later relays the information to HHS Secretary Alex Azar, and Azar informs the White House National Security Council.

Early January: Intelligence officials begin offering ominous, classified warnings about the virus to Trump in the President’s Daily Brief. The warnings will persist into February.

Early January: In a report to the director of National Intelligence, a State Department epidemiologist warns that the virus is likely to spread across the globe and could result in a pandemic, and the Defense Intelligence Agency’s National Center for Medical Intelligence comes to the same conclusion, per the New York Times.

Jan. 8: The CDC issues its first public warning about the outbreak in China, saying that it is monitoring the situation and that people should take precautions when traveling to Wuhan.

Mid-January: Assistant HHS Secretary for Preparedness and Response Robert Kadlec instructs subordinates to make contingency plans for using the Defense Production Act, which allows the federal government to compel the production of certain materials in a crisis.

Jan. 17: The CDC begins monitoring major airports for passengers arriving from China.

Jan. 18: Azar, who had been trying to speak to Trump about the virus, is finally able to meet with him. Before Azar can begin talking about the virus, though, Trump interjects to ask him about a federal crackdown on vaping.

Jan. 20: Chinese President Xi Jinping says the virus “must be taken seriously,” and Chinese officials confirm the virus can be transmitted via human-to-human contact.

Jan. 21: The first case of the coronavirus is confirmed in the United States, in Seattle.

Jan. 22: Trump makes his first comments about the coronavirus, saying he is not concerned about a pandemic: “No. Not at all. And we have it totally under control. … It’s going to be just fine.”

Jan. 23: Chinese officials take the drastic step of shutting down Wuhan. “That was like, whoa,” a senior U.S. official involved in White House meetings later told The Post. “That was when the Richter scale hit 8.”

Jan. 24: A study published by the Lancet suggests the virus may be carried by people without symptoms.

Jan. 26: Chinese health officials say the virus is infectious before symptoms show. “From observations, the virus is capable of transmission even during incubation period,” China Health Minister Ma Xiaowei says. “There are hidden carriers.”

Jan. 27: Concerned White House aides meet with then-acting chief of staff Mick Mulvaney to get senior officials to pay more attention to the issue. Joe Grogan, the head of the White House Domestic Policy Council, argues it could cost Trump his reelection and says the virus is likely to dominate life in the United States for many months.

Jan. 28: Carter Mecher, a senior medical adviser at the Department of Veterans Affairs, writes to colleagues in the administration: “I’m seeing comments from people asking why WHO [World Health Organization] and CDC seem to be downplaying this.” He adds that “no matter how I look at this, it looks [to] be bad. If we assume the same case ascertainment rate as the spring wave of 2009 H1N1 [swine flu], this looks nearly as transmissible as flu (but with a longer incubation period and greater Ro). The projected size of the outbreak already seems hard to believe, but when I think of the actions being taken across China that are reminiscent of 1918 Philadelphia [during the influenza epidemic], perhaps those numbers are correct. And if we accept that level of transmissibility, the [case fatality rate] is approaching the range of a severe flu pandemic.”

Jan. 29: A Navarro memo warns of 500,000 or more American deaths and says it is “unlikely the introduction of the coronavirus into the U.S. population in significant numbers will mimic a ‘seasonal flu’ event with relatively low contagion and mortality rates.”

Jan. 29: The White House announces the formation of a coronavirus task force, led by Vice President Pence.

Jan. 30: China expands the lockdown beyond Wuhan to the entire province of Hubei, as the WHO declares a global health emergency.

Jan. 30: Azar warns Trump about the possibility of a pandemic and that China isn’t being transparent, according to the Times. But Trump dismisses Azar as an alarmist.

Jan. 30: A German study published in the New England Journal of Medicinesays the virus can be transmitted by asymptomatic individuals.

Jan. 30: Commerce Secretary Wilbur Ross says, “I don’t want to talk about a victory lap over a very unfortunate, very malignant disease,” but he suggests it might give companies pause about sending their production overseas. “So I think it will help to accelerate the return of jobs to North America.”

Jan. 30: Trump says of the threat: “We think it’s going to have a very good ending for it. So that I can assure you.”

Jan. 31: Trump announces travel restrictions from China after three major airlines announced they had halted flights. The restrictions take effect Feb. 2.

Some time in January: The National Security Council’s biodefense experts begin urging officials to look at what it would take to quarantine a city the size of Chicago, per the Times.

Early February: Other White House officials, including deputy national security adviser Matthew Pottinger, join Grogan in calling for a more forceful response. Grogan expresses worry that there aren’t enough tests. Pottinger pushes for expanding the travel ban to countries such as Italy and earns the support of Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. but the plan is resisted by Treasury Secretary Steven Mnuchin, who cites economic concerns.

Feb. 5: Trump’s impeachment trial ends with his acquittal by the Senate.

Feb. 5: Sen. Chris Murphy (D-Conn.) says that a briefing shows the administration isn’t taking the virus seriously enough and says it isn’t heeding calls for emergency funding. “Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.”

Feb. 7: Secretary of State Mike Pompeo says the United States has donated nearly 18 tons of medical supplies to China.

Feb. 10: Trump says, “I think the virus is going to be — it’s going to be fine.”

Feb. 14: A memo is drafted by health officials and the National Security Council about the potential need for “quarantine and isolation measures to combat the virus,” per the Times, but a scheduled meeting to brief Trump on the plan is later canceled.

Feb. 19: Trump says: “I think it’s going to work out fine. I think when we get into April, in the warmer weather, that has a very negative effect on that and that type of a virus. So let’s see what happens, but I think it’s going to work out fine.”

Feb. 21: The White House coronavirus task force conducts a mock response to a pandemic and concludes that mass social distancing will be needed, per the Times.

Feb. 23: Another Navarro memo warns of an “increasing probability of a full-blown COVID-19 pandemic that could infect as many as 100 million Americans, with a loss of life of as many as 1-2 million souls.”

Feb. 23: Italy begins to see evidence of a major outbreak in the Lombardy region.

Feb. 24: As Iran becomes a hot spot, WHO Director General Tedros Adhanom Ghebreyesus warns of a possible pandemic. “There is a lot of speculation about whether this increase means that this epidemic has now become a pandemic,” he says.

Feb. 24: Trump says: “The Coronavirus is very much under control in the USA. … Stock Market starting to look very good to me!”

Feb. 25: The Army’s National Center for Medical Intelligence raises its warning that the coronavirus would become a pandemic within 30 days from WATCHCON 2 — a probable crisis — to WATCHCON 1 — an imminent one, according to Newsweek. The news is reportedly shared with the Joint Chiefs of Staff two days later.

Feb. 25: Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, warns publicly about the inevitable spread of the virus and says “we need to be preparing for significant disruption in our lives.” Trump complains to Azar that Messonnier’s comments are spooking the stock market.

Feb. 26: Trump says, “When you have 15 people — and the 15 within a couple of days is going to be down to close to zero — that’s a pretty good job we’ve done.”

Feb. 27: Senate Intelligence Committee Chairman Richard Burr (R-N.C.), who had received briefings on the threat, tells a private luncheon that the coronavirus is “much more aggressive in its transmission than anything that we have seen in recent history” and “is probably more akin to the 1918 [influenza] pandemic,” in which 50 million or more people died worldwide.

Feb. 27: Azar tells the House Ways and Means Committee, “The immediate risk to the public remains low.” He adds: “It will look and feel to the American people more like a severe flu season in terms of the interventions and approaches you will see.”

Feb. 28: Mecher emails again, saying, “[W]e have a relatively narrow window” to respond with non-drug interventions, referring to data from the 1918 flu outbreak. He adds: “And we are flying blind.”

Feb. 28: Trump says: “It’s going to disappear. One day, it’s like a miracle, it will disappear.”

Feb. 29: The United States records its first coronavirus death and announces new travel restrictions for Iran, Italy and South Korea.

Feb. 29: Fauci tells the “Today” show, “There’s no need to change anything that you’re doing on a day-by-day basis. Right now the risk is still low, but this could change.”

March 1: Mecher writes that the United States “should have pulled all the triggers for NPIs [non-pharmaceutical interventions] by now.”

March 2: Trump presses pharmaceutical executives on the timeline for a vaccine, suggesting it could come earlier than anticipated. They repeatedly correct him, saying, testing will require a year or more — as Fauci had previously told Trump.

March 3: The CDC lifts restrictions on coronavirus testing.

March 6: Trump wrongly claims during a tour of the CDC that “anybody that wants a test can get a test.”

March 10: Trump says: “Just stay calm. It will go away.”

March 11: The White House suspends travel from most European countries, as the WHO declares a global pandemic.

March 11: Trump says, “I think we’re going to get through it very well.”

March 13: Trump declares a national emergency.

March 16: Trump for the first time publicly reflects on the gravity of he situation. Asked about his repeated comments saying the situation was “under control,” he says: “If you’re talking about the virus, no, that’s not under control for any place in the world. … I was talking about what we’re doing is under control, but I’m not talking about the virus.”

This does not even begin to address Trump’s subsequent attempts to reopen the economy too soon against all medical advice by Easter Sunday, and then by May 1. He knows that this will result in a surge of new infections and a second wave that could be worse than the first.

On Tuesday, His own CDC director warned a second wave of coronavirus is likely to be even more devastating this fall because it is likely to coincide with the start of flu season. Yet Trump and his Republican allies persist.

This is criminal negligence happening right before your eyes during the “Daily Trump Show.” It’s all on videotape evidence for the jury to review.