How America's decimated pandemic response capabilities led to one of the worst coronavirus outbreaks in the world

Donald Trump arms crossed

REUTERS/Al Drago

President Donald Trump

  • The US is the global epicenter of the novel coronavirus pandemic.
  • The story of how the country got here was set in motion years ago, when the Trump administration began weakening the very agencies responsible for handling such an outbreak.
  • The result was a beleaguered public health system scrambling to come to grips with a looming crisis, and a disastrous failure to conduct early, rigorous testing.
  • The US response was further hobbled by a lack of interagency communication and ineffective leadership from top brass.
  • Meanwhile, the president spent the critical early weeks of the crisis downplaying its severity and claiming it was a "hoax" to hurt his reelection chances, even as his own intelligence officials briefed him daily about an impending pandemic.
  • Visit Business Insider's homepage for more stories.

On January 20, a 35-year-old man in Washington state who had recently traveled to Wuhan, China, became the first case of the novel coronavirus in the US. 

"We have it totally under control," President Donald Trump said in an interview with CNBC two days later. "It's one person coming in from China. We have it under control. It's going to be just fine."Advertisement

By February 10, the US had recorded 12 confirmed cases, but Trump assured the public that the country was "in great shape" and that the virus would "go away" by April. On February 29, the US announced its first death tied to COVID-19; on March 11, the same day the World Health Organization declared a pandemic, there were 1,000 US cases and 28 deaths.

It's now April, and the US leads the rest of the world in confirmed cases. "China warned Italy," Fred Milgrim, an emergency room physician in Queens, wrote in The Atlantic last week. "Italy warned us. We didn't listen."

 
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The Trump Administration helped hamstring the country's public health agencies

The story of how the US - the world's richest country and home to some of its most brilliant scientific minds - became the global epicenter of the crisis was set in motion years ago.

In 2018, the newly minted Trump administration was intent on distinguishing itself from its predecessor by trimming bureaucracy and what Trump characterized as "waste, fraud, and abuse" across the government. But some of the agencies that took the biggest hit were those tasked with responding to public health crises. In May of that year, the National Security Council's pandemic response team was disbanded amid a reorganization of the NSC under then-national security adviser John Bolton. One month earlier, Bolton forced out Tom Bossert, the White House homeland security adviser who had called for a robust strategy against pandemics and bioweapons attacks.Advertisement

Rear Adm. Timothy Ziemer, who would have overseen the US's response to the coronavirus pandemic in his previous role as head of the pandemic response team, also abruptly left the Trump administration after the unit was disbanded. The group, called the Global Health Security and Biodefense unit, was created under the Obama administration in 2015 following the Ebola outbreak.

The Trump administration also eliminated the US government's $30 million Complex Crises Fund, which consisted of emergency response money that the secretary of state could use to deploy disease experts and others in a crisis.

More recently, it ended a pandemic research program aimed at training scientists in China and other countries to detect and prepare for a threat like the coronavirus, the Los Angeles Times reported. The US Agency for International Development (USAID) launched the initiative, called PREDICT, in 2009; it worked with 60 different foreign laboratories, including the lab in Wuhan that identified the coronavirus that causes COVID-19.Advertisement

The program shut down in September when it ran out of funding - about two months before the novel coronavirus began surging through China.

The administration has continued targeting the nation's health and science agencies for budget reductions, even in the face of a rapidly escalating pandemic. According to the 2021 fiscal year budget proposal the White House sent to Congress in February, the administration has requested an almost 10% cut to the Department of Health and Human Services (HHS) and a 16% cut to the Centers for Disease Control and Prevention (CDC). 

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Coronavirus New York City

REUTERS/Carlo Allegri

A man is wheeled into an ambulance during the outbreak of coronavirus disease (COVID-19), in the Manhattan borough of New York City, New York, U.S., March 27, 2020.

Once the virus gained a stronger foothold in the US, the administration was still slow to act. In early February, HHS Secretary Alex Azar asked the White House to allocate $2 billion to replenish the national emergency stockpile of medical equipment, The Washington Post reported. The White House agreed to just a quarter of that.

Meanwhile, The New York Times reported on Wednesday that the Trump administration allowed a contract with a company maintaining the government's stockpile of emergency, life-saving medical devices to expire last summer. A contract dispute meant a new firm didn't begin its work until late January, when the US coronavirus outbreak was well underway.

The US outbreak was exacerbated after the country botched its early response 

The New York Times reported recently that in the nascent days of the outbreak, leaders on the federal coronavirus task force assured their peers that the CDC had developed a diagnostic testing model that would be quickly rolled out as a first step to contain the virus.Advertisement

But that large-scale testing didn't happen as planned, The Times reported, because of a series of bureaucratic and regulatory flaws at the US agencies responsible for handling the crisis. For one, top officials seemingly failed to grasp the seriousness of scientists' warnings about the virus's spread in China.

Some of the tests the CDC distributed to state labs also turned out to be flawed, and more than half of the labs received inconclusive results. A problem with one ingredient in the test kits resulted in further distribution delays.And when it surfaced that there were significant problems with the CDC's initial screening test, director Robert R. Redfield promised a speedy solution but failed to deliver on it for weeks. In February, only three out of 100 public-health labs were equipped to test for the virus, according to Politico.Advertisement

coronavirus doctors new york

Misha Friedman/Getty Images

Doctors test hospital staff for coronavirus at St. Barnabas hospital in the Bronx on March 24, 2020.

The CDC also imposed strict guidelines on who could get tested for the virus, The Times reported, and dragged its feet on doing "community-based surveillance," making it impossible for federal and local officials to track the early spread of the disease. Meanwhile, the Food and Drug Administration's regulations hamstrung medical centers and private companies from developing and implementing their own diagnostic tests in emergency situations.

As a result, the US was initially performing fewer than 100 tests per day on average; other countries like South Korea were conducting tens of thousands of tests daily.Advertisement

A host of emails detailed in a recent ProPublica investigation showed that the CDC also lagged behind on updating its testing guidelines, training states on how to use a new digital platform to track and monitor coronavirus cases, and developing a screening process for travelers arriving at US airports.

Taken together, the Times and ProPublica reports paint a damning picture of a beleaguered public health system scrambling to come to grips with the severity of a looming crisis. 

"We're behind the curve, possibly well behind the curve" when it comes to being prepared, Jeremy Konyndyk, who served as the director of office of foreign disaster assistance at USAID during the Obama administration, told Insider.Advertisement

Donald Trump Alex Azar

Reuters

Trump and Health and Human Services Secretary Alex Azar.

"A bad flu season is typically enough to strain US healthcare services to their limit," said Konyndyk, who led the US response to the Ebola outbreak in West Africa and is now a senior policy fellow at the Center for Global Development. "This is a disease that has the potential to be much worse than that."

Intelligence officials warned Trump about an impending pandemic but 'couldn't get him to do anything about it'

As the extent of the virus's spread in China became clearer toward the end of 2019 and at the beginning of this year, US intelligence officials began warning Trump about a pandemic, the Washington Post reported. The president was receiving briefings on the situation as early as January.Advertisement

By the end of January and beginning of February, a majority of the intelligence contained in Trump's daily briefings was about the coronavirus, the report said. At the same time that he was getting those briefings, the president was publicly downplaying the risk of the virus.

"The system was blinking red," one US official with access to the intelligence told The Post. "Donald Trump may not have been expecting this, but a lot of other people in the government were - they just couldn't get him to do anything about it."Some of the warnings came even earlier. Days before Trump's inauguration, Obama administration officials briefed Trump officials on how to respond to a pandemic, Politico reported. The hypothetical scenario Obama officials presented to the incoming administration bore many similarities to the coronavirus outbreak.Advertisement

When asked whether any information from the session made its way to the president-elect, a former senior Trump administration official wasn't sure but said hypotheticals like that were not "the kind of thing that really interested the president very much."

cdc redfield

REUTERS/Joshua Roberts

Director of the Centers for Disease Control and Prevention (CDC) Dr. Robert Redfield.

Politico also reported that the Trump administration declined to use a nearly 70-page pandemic playbook that the NSC's health unit put together under the Obama administration. The document instructed federal officials on how to prepare for many of the same obstacles the Trump administration is now facing, including medical equipment shortages and a lack of coordination.Advertisement

Then, from January to August 2019, the HHS conducted a training simulation about a hypothetical pandemic, caused by a disease that bore striking parallels to the novel coronavirus. 

In the simulation, federal agencies fought over who was in charge, state officials and hospitals couldn't figure out what and how much medical equipment was available, and there was no centralized coordination on state lockdowns and school closings.

The team conducting the simulation put together a draft report laying out the roadblocks they discovered in the exercises, but their warnings went unheeded, according to The New York Times.Advertisement

Trump consistently downplayed the outbreak and attempted to control messaging, further obscuring the depth of the crisis

The president spent the early weeks of the outbreak insisting there was nothing to worry about, and that warnings about a potential pandemic were a "hoax" meant to hurt his re-election bid and tank the stock market.

He appointed loyalists to head up the White House coronavirus task force and instructed some public health officials not to discuss any more matters related to the virus with the public without prior clearance. The president also has a powerful ally in the right-wing media, which has largely echoed his messaging from the start. 

As the number of coronavirus cases in the US began ticking up and the death count increased, Trump acknowledged the problem but assured the public it would go away soon, and the pro-Trump media followed suit.Advertisement

Trump

Jabin Botsford/The Washington Post via Getty Images

"There's this effort here to craft the truth about the disease for political purposes, and certainly partisan media is operating in a similar way to how state media functions in places like China," Stephen Hess, a professor of political science at Transylvania University who is an expert in authoritarianism, told Insider.Trump's attempt to control messaging about the virus mirrors that of Chinese President Xi Jinping when the coronavirus hit China, Hess added.Advertisement

The consequences have been devastating

The result of the US's failure to prevent the crisis: The country is on track to have the worst coronavirus outbreak in the world. Entire cities and states have been placed on lockdown as the economy grinds to a halt. Schools and restaurants have been shuttered, and unemployment claims have shot up to unprecedented levels.

Hospitals are overflowing as healthcare workers race against the clock to save their patients, even as they place themselves at risk because of a dangerous shortage in personal protective equipment (PPE) like masks, gloves, and gowns.

"If this isn't a public health crisis, I don't know what is," a nurse in Detroit told The Daily Beast.Advertisement

Trump

Tom Brenner/Reuters

President Donald Trump walks past Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, as the president arrives for the daily coronavirus response briefing at the White House in Washington, DC, March 31, 2020.

A paramedic described the situation in New York, which is the epicenter of the US outbreak, as a "war zone." An emergency worker in Queens, New York told The New York Times her hospital was using refrigerated trucks to store the bodies of deceased patients because there was no more space in the morgue.

Patrick Marmo, a funeral director in New York, told Insider's Dave Mosher the pandemic is straining his work to a breaking point as well.Advertisement

"I don't know how many more bodies I can take," Marmo said. "No one in the New York City area possibly has enough equipment to care for human remains of this magnitude."

John Haltiwanger and Ashley Collman contributed reporting.

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