Operation reopen America: are we about to witness
a second historic failure of leadership from Trump?
Without mass testing, contact tracing, and protective
equipment for health workers – all in critically short supply – the president’s
plan could be disastrous
by Ed
Pilkington and Dominic Rushe in New York
Sat 18 Apr
2020 11.00 BSTLast modified on Sat 18 Apr 2020 21.37 BST
On Thursday
evening, Donald Trump took to the dais in the White House press briefing room
and declared that he was leading America in a “historic battle against the
invisible enemy” that amounted to the “greatest national mobilisation since
world war two”.
Warming to
his theme, the US president said the country was now ready to move to the next
phase in the war against coronavirus. It was time, he said, “to open up.
America wants to be open, and Americans want to be open”.
Unveiling
new guidelines for the loosening of the lockdown, he committed his
administration to a “science-based reopening”. He added: “We are starting our
life again, we are starting rejuvenation of our economy again, in a safe and
structured and very responsible fashion.”
Beyond the
cloistered confines of the White House an alternative interpretation of events
was gathering force. On a day in which the US suffered its highest death toll
from Covid-19, with a total of more than 680,000 confirmed cases and 34,000
deaths, public health experts were scrutinising the president’s new guidelines
and coming to rather different conclusions.
“This isn’t
a plan, it’s barely a PowerPoint,” spluttered Ron Klain on Twitter. Klain, the
US government’s Ebola tsar during the last health crisis to test the White
House, in 2014, said the proposals contained “no provision to ramp up testing,
no standard on levels of disease before opening, no protections for workers or
customers”.
•••
On 28 March
the Guardian exposed the missing six weeks lost as a result of Trump’s
dithering and downplaying of the crisis when the virus first struck. Jeremy
Konyndyk, another central figure in the US battle against Ebola, told the
Guardian that the Trump administration’s initial response was “one of the
greatest failures of basic governance and leadership in modern times”.
Now that
the US is contemplating a shift into the second phase of the crisis – a
tentative reopening of the economy – scientists and public health officials are
agreed that three pillars need to be put into place to manage the transition
safely. They are: mass testing to identify those who are infected, contact
tracing to isolate other people who may have caught Covid-19 from them, and
personal protective equipment (PPE) to shield frontline healthcare workers from
any flare-up.
A chorus of
expert voices has also begun to be heard warning that those three essential
pillars remain in critically short supply throughout the US. Less than a month
after the Guardian’s exploration of the missing six weeks, the chilling
recognition is dawning that the country is heading for a second massive failure
of governance under Trump, this time on an even bigger scale.
Unless
testing capability is dramatically ramped up and a giant army of health workers
assembled to trace the contacts of those infected – right now – the
consequences could be devastating.
Senior
Advisor to the President Jared Kushner (3rd L) looks on as President Donald
Trump holds a meeting with healthcare executives in the Cabinet Room of the
White House April 14, 2020 in Washington, D.C. Earlier in the day Trump met
with people who had recovered from the coronavirus. During the April 13
Coronavirus Task Force briefing, Trump said the president had “total authority”
to reopen the U.S. economy.
“I’m
fearful,” said Dr Tom Frieden, the former director of the US Centers for
Disease Control and Prevention (CDC). “Testing remains scarce in many parts of
the country and it’s slow to scale up – we are weeks if not months away from
having enough test capacity.”
Frieden,
who now heads the global health initiative Resolve to Save Lives, told the
Guardian in an interview conducted shortly before Trump released the new
reopening guidelines that time was being wasted. The federal government’s
misplaced insistence in February that its China travel ban would be enough to
make the virus go away had “lost precious weeks” in tackling the first wave of
coronavirus.
We wasted
February, and I’m worried we’re about to waste April too
Jeremy Konyndyk, key figure in Ebola fight
Now, as the
US contemplates reopening, Frieden said he was afraid a repeat performance was
imminent.
“I fear
there’s an analogous mistaken belief that sheltering in place will make this
virus go away, that we can then choose a date and all come out. It’s not about
the date, it’s about data and building a national response at scale.”
In a series
of tweets posted in reaction to the new White House guidelines, Konyndyk echoed
the anxiety about more lost weeks. He said the Trump administration had “wasted
February, and the White House guidance on ‘opening up’ leaves me worried that we’re
about to waste April too”.
Konyndyk
said that for states to reopen before they were ready “would be a disaster.
It’s no great insight to say we need more testing, tracing, PPE [protective
gear for health workers] – it’s been obvious for a month and a half. But each
of those face huge bottlenecks and the document doesn’t acknowledge them, much
less propose how to resolve them.”
Trump,
launching the new reopening guidelines on Thursday, insisted that the US was in
“excellent shape” on testing. “We have great tests. We have done more testing
now than any country, in the world, by far.”
Trump says we have the best testing, but the
US is in the last percentage of tests administered to its population
Michael
Greenberger, University of Maryland
The US has
so far tested about 3.3 million people, about 1% of its population. Per capita,
that is small compared with several countries including Germany and South
Korea. Iceland has tested people at 10 times the US rate.
“Testing
has been an unnecessary disaster,” said Michael Greenberger, director of the
University of Maryland Center for Health and Homeland Security. “Trump says we
have the best testing, but the US is in the last percentage of tests
administered to its population.”
Not one of
the 50 states is currently in a position to carry out tracking of Covid-19
infections on the scale needed, whatever Trump said about their readiness to
reopen. Many states, including the hardest hit, New York, are still
experiencing testing shortages, 12 weeks after the first US case was recorded.
Individual
states continue to have to compete for critical supplies against each other,
and against the federal government, driving up prices. Components including
nasal swabs, reagents and RNA extraction kits are running short.
Daily
testing has flattened out and is now hovering around 150,000 tests a day –
vastly below the level that would be needed to detect localized pockets of
disease as the economy reopens. Most alarmingly, the number of tests carried
out by commercial labs has actually plummeted in recent days due to shortages
in test samples, leaving the labs sitting idle.
At the
White House briefing, Trump insisted that the phenomenon of the idle labs was a
“great thing”, a sign that states were finding local solutions and an
“affirmation that testing is growing at a historic rate”.
All of
these impediments have put the US on the back foot as it seeks to pull off the
daunting feat of getting back to work without risking a renewed surge of
contagion.
“We have
had cases circulating in communities undetected for several weeks, and because
of the delay in the roll-out of testing we never had the chance to be on top of
it,” said Anita Cicero. She is joint author of one of the most definitive
scientific plans for reopening the US, produced by a team from the Center for
Health Security at Johns Hopkins University.
“That means
it’s going to require much more ubiquitous testing,” she said.
Estimates
vary on how much testing will be needed, but they are all substantially greater
than present provision. Even at the lower end, as posited by the former
commissioner of the US Food and Drug Administration Scott Gottlieb, some 2m to
3m tests a day are recommended – up to three times the current level.
Harvard’s
Safra Center for Ethics argues that is too few. It calls for tens of millions
of tests every day, way beyond existing capacity.
The states are
not islands. Their borders are not closed
Anita Cicero, Johns Hopkins University
As the
Johns Hopkins plan makes clear, diagnostic testing is only the start. It must
be combined with relentless detective work, called “contact tracing”, to track
down anyone who has come into contact with an infected person and who may need
quarantining to stop the virus spreading again.
The Johns
Hopkins plan envisages a nationwide army of 100,000 contact tracers. “That
might sound eye-popping, but it’s reasonable and may be a low estimate,” Cicero
said, pointing out that in Wuhan, China, the authorities employed a workforce
three times the size per capita.
With
contact tracing, too, there is no sign that Trump recognizes the urgency of the
moment. Frieden told the Guardian that many states were already struggling to
ramp up contact tracing to a level that would support reopening. Health
departments are overwhelmed, and some have “trouble even conceiving the scale
of operations they are going to need”, he said.
Faced with
a wide gap between nationwide demand for testing and contact tracing and
insufficient supply, Trump has flip-flopped in his positions. He began by
insisting that he had “absolute authority” to overrule the states in deciding
when to reopen, a posture widely denounced as king-like and anti-American.
On Thursday
he effected an about-turn and passed the buck to the 50 states. “You are going
to call your own shots,” he told governors on a call on Thursday.
Trump’s
sudden switch to offloading federal responsibility to the 50 states has
prompted questions about his motive. Current and former senior officials in the
Trump administration told the Washington Post that he wanted to “shield himself
from blame should there be new outbreaks after states reopen”.
The U.S.
Capitol stands at dusk in Washington, D.C., U.S., on Thursday, April 16, 2020.
President Donald Trump threatened Wednesday to try to force both houses of
Congress to adjourn -- an unprecedented move that would likely raise a
constitutional challenge -- so that he can make appointments to government jobs
without Senate approval.
The former
head of Medicare and Medicaid from 2015 to 2017, Andy Slavitt, commented on
Twitter that the White House guidelines were sending a clear message to the
states: “Your state didn’t open, that’s on your governor. Your state opened and
people died, that’s on your governor.”
Trump
attempted to sell the idea of devolving responsibility by presenting his vision
of America as a “beautiful puzzle”. He said: “I call it a beautiful puzzle. You
have 50 pieces. All very different. But when it’s done … a very beautiful
picture.”
A
“beautiful puzzle” may be an appealing concept to the incumbent of the Oval
Office in an election year. But it fits uncomfortably with a virus that is
highly contagious, relatively deadly, and dismissive of state boundaries.
“The states
are not islands, their borders are not closed and they do not have water around
them,” Cicero said. “So it will be a bumpy road going forward in terms of
managing the virus.”
States
still held in the grip of the contagion, such as New York, are finding it
difficult to accept the idea that the buck stops with them in a country with
the most powerful national government on Earth. New York’s governor, Andrew
Cuomo, has repeatedly called on the Trump administration to do more to help.
“I
understand that the federal government’s not eager to get involved in testing.
But the plain reality here is we have to do it in partnership,” he said on
Thursday.
At Trump’s
disposal is the formidable wartime power of the Defense Production Act, which
allows the administration to order corporations to redirect their efforts to
the cause of fighting Covid-19. So far the president has deployed this
capability only sparingly.
I’m moved and
crushed by what’s happening in New York right now
Tom Frieden, former CDC head
The
president said there were 29 states which are in “extremely good shape” and
could reopen soon, some “literally tomorrow”. He declined to name them, though
it has been reported that several Republican governors are champing at the bit
to loosen lockdowns.
Florida,
Texas, Alabama and Mississippi are at the head of the line, according to Axios.
Florida began to reopen its beaches on Friday, a controversial move given that
the late closure of its beaches during spring break helped spread Covid-19
across the US.
The danger
of Trump’s “beautiful puzzle” approach is illustrated by New York City, where
the death toll is heartwrenching. The probable tally of deaths from Covid-19 in
the city now stands at more than 11,000 – more than double the normal monthly
loss of life from all other causes.
People
wearing protective masks walk next to Myrtle Ave. in the Bushwick neighborhood
of Brooklyn on April 2, 2020 in New York City. Currently, over 92,000 people in
New York state have tested positive for COVID-19.
“I’m moved
and crushed by what’s happening in New York right now,” said Frieden, who until
2009 was the city’s health commissioner.
About
10,000 New Yorkers a day are currently being tested for coronavirus. Mark
Levine, chair of New York City council’s health committee, told the Guardian
that the frequency would need to be stepped up twentyfold were the city to have
a fighting chance at reopening.
Yet even
now New York is just days away from running out of testing kits.
Levine said
he worries that the window for federal action is rapidly closing. “Trump has
the authority to order manufacturers to retool to produce test kits. Unless the
White House issues the order immediately, we are going to be out of time.”
Sem comentários:
Enviar um comentário