Trump’s Mismanagement of the Covid-19 Crisis: South Korea Shows What Would Have Been Possible

Source:  David Leonhardt, Newsletter of April 13, 2020, The New York Times

I normally only include charts I have developed myself in this blog, but the chart above, from David Leonhardt of the New York Times, is particularly striking.  It comes from his newsletter of April 13, and shows the daily number of deaths (on a seven-day moving average) per 10 million people, from February 19 to now in the US and in South Korea.

It shows what the US could have achieved had the Trump administration managed this crisis as well as South Korea has.  And one cannot argue that South Korea is a rich country with resources that the US does not have – GDP per capita in the US is double that of South Korea.  Nor is it because of travel bans.  Trump repeatedly asserts that the crisis would have been far greater in the US had he not had the singular wisdom to impose a ban on travel (by non-US citizens) from China on February 2 (and from Europe and other countries later).  But the only travel ban South Korea has imposed has been travel from Hubei Province in China.  And South Korea has far more contact with China, from both business and personal travel and trade in goods, than the US has.  Yet despite this, the deaths from Covid-19 have been far fewer in South Korea than in the US even after scaling for population.

And it is not only South Korea that has demonstrated competence in the management of the Covid-19 virus.  Death rates in other countries of East Asia, all similarly heavily exposed to China, have been even lower than that of South Korea.  In terms of the cumulative number of deaths from Covid-19 since the crisis began (as of April 13), there have been 4 deaths per million of population in South Korea, but just 2 per million in Singapore, 1 per million in Japan, 0.5 per million in Hong Kong, and 0.3 per million in Taiwan.  For the US, in contrast, the total is 71 per million.  (Reminder:  The chart above tracks deaths per day, not the cumulative total, and shows the figures per 10 million of population.)

This also shows that Trump’s repeated assertion that the deaths suffered in the US were inevitable – that nothing more could have been done – is simply nonsense.  Sadly, it is deadly nonsense.  South Korea shows what could have been done.  Travel bans were not important.  Rather, it was the basic public health measures of large-scale testing, identifying those with the virus or who may have been exposed to the virus, quarantining or isolating those exposed (including self-isolating, along with self-monitoring and regular reporting), and then treating in hospitals those who developed severe symptoms.

None of this is new to public health professionals.  And the US has excellent public health professionals.  What was different in the US was Trump, who refused to listen to them and indeed treated many of those in government as enemies to be attacked (as those with expertise were seen as members of the “deep state”).

The US had prepared plans on what to do should an infectious disease such as Covid-19 threaten.  There was, for example, a major effort to develop such plans in 2006/2007, towards the end of the Bush administration.  The work included running exercises similar to war-games of various scenarios (“table-top” exercises), to see how officials would respond and what the likely outcomes then would be.  These plans were further developed during Obama’s two terms in office.  But the Trump administration then ignored this previous preparation, and indeed took pride in dismantling important elements of it.

Dr. James Lawler, now an infectious disease doctor at the University of Nebraska but then serving in the Bush White House, participated in the 2006/2007 task force.  Over the weekend, the New York Times released a trove of over 80 pages of emails (obtained through a Freedom of Information Act request) of late-January to mid-March from Dr. Lawler and other experts, in and out of government, discussing how to address the crisis.  Particularly telling is a March 12 email from Dr. Lawler in which he said:

“We are making every misstep initially made in the table-tops at the outset of pandemic planning in 2006.  We had systematically addressed all of these and had a plan that would work – and has worked in Hong Kong/Singapore.  We have thrown 15 years of institutional learning out the window …”

Throwing those 15 years of institutional learning out the window has had deadly consequences.

The Rapid Growth in Deaths from Covid-19: The Role of Politics

Deaths from Covid-19 have been growing at an extremely rapid rate.  The chart above shows what those rates have been in the month of March, averaged over seven day periods to smooth out day-to-day fluctuations.  The figures are for the daily rate of growth over the seven day period ending on the date indicated.  The curves start in the first period when there were at least 10 cases, which was on March 3 for the US as a whole.  Hence the first growth rate shown is for the one week period of March 3 to 10.  As I will discuss below, the chart has not only the growth rates for the US as a whole but also for the set of states that Trump won in 2016 and for the set that Clinton won.  They show an obvious pattern.

The data come from the set assembled by The New York Times, based on a compilation of state and local reports.  The Times updates these figures daily, and has made them available through the GitHub site.  And it provides a summary report on these figures, with a map, at least daily.

I emphasize that the figures are of daily growth rates, even though they are calculated over one week periods.  And they are huge.  For the US as a whole, that rate was just over 28% a day for the seven day period ending March 30.  It is difficult to get one’s head around such a rapid rate of growth, but a few figures can be illustrative.  In the New York Times database, 3,066 Americans had died of Covid-19 as of March 30.  If the 28% rate of growth were maintained, then the entire population of the US (330 million) would be dead by May 16.  For many reasons, that will not happen.  The entire population would have been infected well before (if there was nothing to limit the spread) and it is fatal for perhaps 1% of those infected.  And the 99% infected who do not die develop an immunity, where once they recover they cannot spread the virus to others.  For this reason as well, 100% of those not previously exposed will not catch the virus.  Rather, it will be some lower share, as the spread becomes less and less likely as an increasing share of the population develops an immunity.  This is also the reason why mass vaccination programs are effective in stopping the spread of a virus (including to those not able to receive a vaccination, such as very young children or those with compromised immune systems).

So that 28% daily rate of growth has to come down, preferably by policy rather than by running out of people to infect.  And there has been a small reduction in the last two days (the seven day periods ending March 29 and March 30), with the rate falling modestly to 28% from a 30% rate that had ruled since the seven day period ending March 22.  But it has much farther to go to get to zero.

The recent modest dip might be an initial sign that the social distancing measures that began to be put in place around parts of the nation by March 16 are having a positive effect (and where many individuals, including myself, started social distancing some time before).  It is believed that it takes about 4 to 7 days after being infected before one shows any symptoms, and then, in those cases where the symptoms are severe and require hospitalization (about 20% of the total), another several days to two weeks before it becomes critical for those where it will prove fatal.  Hence one might be starting to see the impacts of the policies about now.

But the social distancing measures implemented varied widely across the US.  They were strict and early in some locales, and advisory only and relatively late in other locales.  Sadly, Trump injected a political element into this.  Trump belittled the seriousness of Covid-19 until well into March, even calling Covid-19 a “hoax” conjured up by the Democrats while insisting the virus soon would go away.  And even since mid-March Trump has been inconsistent, saying on some days that it needs to be taken seriously and on others that it was not a big deal.  Fox News and radio hosts of the extreme right such as Rush Limbaugh also belittled the seriousness of the virus.

It is therefore understandable that Trump supporters and those who follow such outlets for what they consider the news, have not shown as much of a willingness to implement the social distancing measures that are at this point the only way to reduce the spread of the virus.  And it shows in the death figures.  The red curve in the chart at the top of this post shows the daily growth rates of fatalities from this virus in those states that voted for Trump in the 2016 election.  While the spread of the virus in these states, many of which are relatively rural, started later than in the states that voted for Clinton, their fatalities from the virus have since grown at a substantially faster pace.

The pace of growth in the states that voted for Clinton has also been heavily influenced by the rapid spread of the virus in New York.  As of March 30, more than half (57%) of the fatalities in the Clinton states was due to the fatalities in New York alone.  And New York is a special case.  With its dense population in New York City, where a high proportion use a crowded subway system or buses to commute to work, with the work then often in tall office buildings requiring long rides in what are often crowded elevators, it should not be surprising that a virus that goes person to person could spread rapidly.

Excluding New York, the rate of increase in the other states that voted for Clinton (the curve in green in the chart above) is more modest.  The rates are also then even more substantially lower than those in the Trump-voting states.

But any of these growth rates are still incredibly high, and must be brought down to zero quickly.  That will require clear, sustained, and scientifically sound policy, from the top.  But Trump has not been providing this.

The Democratic Primaries Thus Far: Bernie Sanders’ Vote Numbers

A.  Introduction

One of the main arguments Bernie Sanders has made for why he should be the nominee of the Democratic Party to run against Trump is that he would spur a much higher turnout, especially of young voters who would not otherwise go to the polls (with those young voters favoring him).  But this has not turned out to be the case in the Democratic primaries held thus far.  While turnout has gone up substantially, Sanders has not been receiving an exceptionally high share of that increased turnout.  And even Sanders has now acknowledged that a higher number of younger voters that he argued would go to the polls to vote for him have not materialized.

So what has been going on?  To summarize what will be discussed in more detail below, in the primaries held thus far the share of the votes going to Sanders has gone down compared to what he received in the same primary states in the 2016 elections.  But the share going to Sanders and Elizabeth Warren combined has been similar (indeed almost identical overall) to what Sanders received in 2016, when it was essentially only him running against Hillary Clinton.  Similarly, the share going to Joe Biden, Amy Klobuchar, Pete Buttigieg, and Michael Bloomberg has been similar to the share that had gone to Clinton.  This very much looks like a case of Democratic Party primary voters with a separation between those who hold the more extreme liberal views of Sanders and Warren, and those with the more moderate views of Biden, Klobuchar, Buttigieg, and Bloomberg (although it is not really correct to view them as moderates – the positions they hold are all well to the left of the positions that were held by Obama when he served as president).  Primary turnout has gone up, but with similar shares as before of voters in those two channels in that increased turnout.

Pundit commentary, at least until recently, has not focused on this.  Rather, in the Democratic primaries and caucuses held in February before South Carolina (i.e. following the contests in Iowa, New Hampshire, and especially Nevada), all attention was on Sanders winning the vote count (modestly in Iowa and New Hampshire, more significantly in Nevada).  It was not on what the outcomes might be telling us on the broader issue of who will, in the end, amass the delegates needed ultimately to win the Democratic nomination.  Sanders was deemed the “front-runner”.

And then all were surprised when the vote in the South Carolina primary appeared to be so different.  However, if a comparison had been made to the results of the 2016 primary in that state one would have seen important similarities.

This has now become more clear with the results from the Super Tuesday primaries.  Turnout (in all but one of the states) has gone up, and sometimes quite substantially.  The Democratic base is clearly energized.  But the higher turnout was not of voters disproportionately supporting Sanders.  Indeed, the share voting for Sanders has gone down compared to the share that voted for him in 2016.  Rather, across the states with primaries held thus far, the share going now to Sanders and Warren together is very close to what Sanders had received before, and the share going to Biden, et. al., was similarly close to what Clinton had received before.  Thus the higher turnout was composed of similar shares of voters in the two groups.

There were of course differences in several of the individual states.  For the analysis here I looked at the ten states who held primaries and not caucuses (vote counts in caucuses are different, with far lower participation), did so in both 2016 and 2020, and held their primaries in each of those years on Super Tuesday (March 1 in 2016, March 3 in 2020) or before.  Thus this excluded states like Colorado and Minnesota (which held caucuses in 2016), or had primaries (or caucuses) after Super Tuesday in 2016.  The most important, and largest, state thus excluded is California, which held its primary on June 7 in 2016.  I will discuss separately the special case of California.

The overall results for those ten states are summarized in the chart at the top of this post.  But rather than discuss that one first, it is perhaps better to examine the cases in a few of the states individually, before looking at the overall totals across the ten states.  The vote numbers are all as reported in the New York Times, at this post for 2016, or at this post for 2020.  The 2020 results are all as shown as of about 2:00 pm on Wednesday, March 4.  At that point, almost all were either complete (with 100% of precincts reporting) or close to it (with 99% or more in two cases, one at 97.0%, one at 93.8%, and one at 93.4%).  There will be some differences, but small, as they get to 100% of precincts reporting, and as mail-in ballots are fully counted (rules vary by state).  However, these will likely not affect the shares to any significant degree, which are the focus of the analysis here.  And while it will not change the shares, I did scale up to 100% the figures for the cases where fewer than 100% of the precincts had reported, in order to estimate what the total votes (and hence change in turnout) will be and to add up the figures consistently across the states.

B.  Individual States

The South Carolina primary, which was critical for Biden, shows well what the pattern has been.  The key results are summarized in this chart:

Sanders received only 26% of the vote in this primary in 2016, losing badly to Clinton who received 73% of the vote.  And that share of Sanders went down to 20% this year, even though there was a 46% increase in turnout.  But Sanders plus Warren together received 27% of the vote, almost the same as what Sanders received in 2016.  Despite an increase in turnout of close to half, the share going to the extreme liberal candidates remained about the same – not more, not less.

One saw the same in Virginia:

Here turnout rose by close to 70%.  And the Sanders share fell again, from 35% in 2016 to 23% in 2020.  But Sanders and Warren together received 34%, very close to what Sanders had received before.  Despite the far higher turnout, the shares were close to unchanged (taking Sanders and Warren together).

As noted above, there were a total of ten states where one could make such a comparison.  I won’t go through them all, and there were individual exceptions.  One noteworthy case was that of New Hampshire, the state with the first primary (Iowa is a caucus):

Bernie Sanders did exceptionally well in that primary in 2016, receiving 60% of the vote, against Hillary Clinton’s 38% (with other candidates receiving the rest).  Sanders won again in 2020, but this time with only 25.7% of the vote (with Pete Buttigieg in second place at 24.4%).  But while the pundits focused on Sanders winning that primary again, I did not see mentioned that despite an increase in turnout (of a not insignificant 18%), the absolute number of votes Sanders received fell in half (falling from 151,584 in 2016, to just 76,234 in 2020).  And even if one adds in the votes that Warren received, the total still came only to 103,711, with a share of 35%.

There were two other states where Sanders and Warren together did significantly worse than Sanders alone in 2020.  One was in Sanders’ home state of Vermont, where Sanders received 86% of the vote in 2016 while Sanders and Warren together received just 63% in 2020 (despite a 17% increase in turnout).  The other was Oklahoma, where Sanders received 52% of the vote in 2016 while Sanders and Warren together received just 39% in 2020 (and is the one state where turnout fell – by 7%).

These states were offset by Texas, where Sanders received 33% of the vote in 2016 (and 30% in 2020), but where Sanders and Warren together received 41% (with turnout rising 47%).  In the other states, the shares of Sanders in 2016 and Sanders plus Warren together in 2020 were pretty much the same.  Especially similar was the case of Massachusetts (the home state of Warren):  Sanders received 48.7% of the vote in 2016, while Sanders plus Warren received 48.3% in 2020.

California is also a special case, but an important one.  In 2016, the California primary was held on June 7, close to the end of the primary season.  Close to 5.1 million voted in the Democratic primary in that year, and Sanders won 45.7% of the vote.  As I write this (in the evening of Friday, March 6, and based on what is shown on the New York Times website), California has posted results for only 89% of the precincts.  Why this is less than 100% three days after the primary is not clear to me.  California also accepts mail-in ballots that were mailed on election day or before, and the state allows up to a month for these to come in.

But based on what has been reported as of now, Sanders plus Warren together received 45.9% of the votes, almost exactly the same as the 45.7% Sanders received in 2016.  But there was a big change in turnout, likely tied to the different election date.  While 5.1 million voted in 2016, the total votes recorded as of today is just 3.3 million.  While this will go up as all the mail-in ballots are counted (and as full reports are provided on all of the precincts), it will certainly not go up to anywhere close to the 5.1 million of 2016.

C.  The Ten States as a Whole

The chart at the top of this post reflects the figures added up across all of the ten states.  And one finds that as with most of the states (where the few exceptions basically offset each other), the share of the vote Sanders and Warren together received in 2020 (38%) was very close to what Sanders alone received in 2016 (39%).  The share of Sanders alone went down, with this offset almost exactly by the share Warren received.  And this was despite a substantial increase in turnout – of 34% across the ten states as a group.

In terms of what has been called the “more moderate” wing, the share across the ten states of those voting for Clinton in 2016 was 59%.  The share going to Biden plus Klobuchar plus Buttigieg plus Bloomberg in 2020 was 58%.  Again almost the same.

With turnout up by a third, the Democratic primary electorate appears to be energized.  There are real concerns about Trump, and what he has done to our country.  But the higher turnout is not because Sanders is pulling in a large number of new voters who will vote for him and him only.  Rather, the split in the new voters between those voting for Sanders or Warren on one side, or for Biden, Klobuchar, Buttigieg, or Bloomberg on the other side, is very close to the split between Sanders and Clinton voters in 2016.

With the withdrawal in the past week of all of the major remaining candidates other than Sanders and Biden, we will now see whether this pattern continues.  It is now basically a two-person race, and the results should be clear to all.