Tag Archives: Trump

Trump’s Incompetent Management of the Covid-19 Pandemic: The Consequences for Health

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Trump and his administration have utterly mismanaged the Covid-19 pandemic.  The direct result of this ineptitude has been tens of thousands more Americans dying (already) than would have been the case had the US managed the pandemic as well as any of the developed countries of the Asia and Pacific region.  The difference is not small.  This is also not a calculation comparing what the US did to what theoretically might have been possible.  Rather, it is a comparison to what these seven countries actually achieved, facing the same virus as the US.

The chart above shows the cumulative number of deaths from Covid-19 for the US and for seven Asian/Pacific countries between March 1 and April 25, with the numbers all scaled, for comparability, to what they would have been at the US population level.  The data comes from that assembled on an on-going basis by Johns Hopkins University, where a description is available here, and the country data itself available here.  The country population figures to work out the rates per million are those reported by the UN.

US deaths from the virus totaled 53,755 as of April 25.  The figures for each of the seven Asian/Pacific countries are, at this scale, all scrunched up at the bottom of the chart and are almost indistinguishable.  Each and every one has done far better than the US.

Focusing on the figures for April 25 only, one has:

The highest number of deaths among the seven Asian/Pacific countries (when scaled to the US population) would have been South Korea at 1,562.  That is 97% less than the US had.  The levels at all the other countries would have been even lower.  The least would have been Taiwan, with just 83 deaths from the virus (99.8% less than the US), despite far closer links to China.  Not re-scaled for population, the number of deaths so far in South Korea have totaled 242.  In Taiwan, there have been only 6.

US fatalities from Covid-19 have also just passed another significant milestone.  As of April 25 they now exceed the total number of US deaths in combat during World War I:

The figures for combat deaths are all from the Department of Veteran Affairs.  The total number of deaths from Covid-19 surpassed the number of combat deaths during the entire period of the Vietnam War on April 22, and passed the number of combat deaths during the Korean War on April 16.  And Covid-19 deaths of course continue to rise.  Over the most recent week, the daily increase averaged 2,156.

Yet Trump continues to assert that he and his administration have done a superb job of managing this crisis.  If there are any issues, he has at various times asserted the blame is with China, the Chinese President Xi Jinping (whom he, at other times, lauded), the WHO, Obama, Hillary Clinton, Democratic mayors, Democratic governors, Democrats in Congress and the Senate, Democrats more generally, the news media, government civil servants (the “deep state”), and others.

But not himself.  What can he be faulted for?  David Frum (a longtime self-described “conservative Republican” who served as a speechwriter for George W. Bush, but who is now very much a critic of Trump) puts it well in an April 7 article in The Atlantic.  I will quote it at length:

“That the pandemic occurred is not Trump’s fault. The utter unpreparedness of the United States for a pandemic is Trump’s fault. The loss of stockpiled respirators to breakage because the federal government let maintenance contracts lapse in 2018 is Trump’s fault. The failure to store sufficient protective medical gear in the national arsenal is Trump’s fault. That states are bidding against other states for equipment, paying many multiples of the precrisis price for ventilators, is Trump’s fault. Air travelers summoned home and forced to stand for hours in dense airport crowds alongside infected people? That was Trump’s fault too. Ten weeks of insisting that the coronavirus is a harmless flu that would miraculously go away on its own? Trump’s fault again. The refusal of red-state governors to act promptly, the failure to close Florida and Gulf Coast beaches until late March? That fault is more widely shared, but again, responsibility rests with Trump: He could have stopped it, and he did not.

The lying about the coronavirus by hosts on Fox News and conservative talk radio is Trump’s fault: They did it to protect him. The false hope of instant cures and nonexistent vaccines is Trump’s fault, because he told those lies to cover up his failure to act in time. The severity of the economic crisis is Trump’s fault; things would have been less bad if he had acted faster instead of sending out his chief economic adviser and his son Eric to assure Americans that the first stock-market dips were buying opportunities. The firing of a Navy captain for speaking truthfully about the virus’s threat to his crew? Trump’s fault. The fact that so many key government jobs were either empty or filled by mediocrities? Trump’s fault. The insertion of Trump’s arrogant and incompetent son-in-law as commander in chief of the national medical supply chain? Trump’s fault.

For three years, Trump has blathered and bluffed and bullied his way through an office for which he is utterly inadequate. But sooner or later, every president must face a supreme test, a test that cannot be evaded by blather and bluff and bullying. That test has overwhelmed Trump.”

Since April 7 one could add much more to this list, most recently Trump’s comments at his April 23 press briefing on the possible curative effects of injecting disinfectants into the body.  Health professionals around the country scrambled to warn the public not to do this – it could be deadly – and Trump is responsible for this confusion.  Or the ousting in the last week of Dr. Rick Bright, a highly respected medical researcher with a career on vaccine development, who as the head of BARDA (the Biomedical Advanced Research and Development Authority) had a lead role in the urgent development of a vaccine for Covid-19.  The ousting of such an official in the middle of a pandemic is astonishing for any reason.  Dr. Bright, in a statement issued through his lawyers, said it was because he had resisted administration pressure to promote the anti-malarial drugs chloroquine and hydroxychloroquine that Trump had repeatedly touted, even though there was no good evidence of their efficacy.  Indeed, a recent study found that hydroxychloroquine significantly increased the number of deaths of Covid-19 patients compared to those given the usual care.

Trump, however, is unwilling to take responsibility for these repeated failures.  In a March 13 press briefing he famously said “I don’t take responsibility at all” (where this was with specific reference to the lack of adequate testing in the US for a critical two months).  Rather, it was someone else’s fault.

Leadership requires taking responsibility.  Successful presidents do.

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

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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

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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.