Category Archives: Crisis

Administration Considers Reopening Economy, Over Health Experts’ Objections

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The president is questioning whether stay-at-home orders have gone too far. But relaxing them could significantly increase the death toll from the coronavirus, health officials warn.

As the United States entered Week 2 of trying to contain the spread of the coronavirus by shuttering large swaths of the economy, President Trump, Wall Street executives and many conservative economists began questioning whether the government had gone too far and should instead lift restrictions that are already inflicting deep pain on workers and businesses.

Consensus continues to grow among government leaders and health officials that the best way to defeat the virus is to order nonessential businesses to close and residents to confine themselves at home. Britain, after initially resisting such measures, essentially locked down its economy on Monday, as did the governors of Virginia, Michigan and Oregon. More than 100 million Americans will soon be subject to stay-at-home orders.

Relaxing those restrictions could significantly increase the death toll from the virus, public health officials warn. Many economists say there is no positive trade-off — resuming normal activity prematurely would only strain hospitals and result in even more deaths, while exacerbating a recession that has most likely already arrived.

The economic shutdown is causing damage that is only beginning to appear in official data. Morgan Stanley researchers said on Monday that they now expected the economy to shrink by an annualized rate of 30 percent in the second quarter of this year, and the unemployment rate to jump to nearly 13 percent. Both would be records, in modern economic statistics.

Officials have said the federal government’s initial 15-day period for social distancing is vital to slowing the spread of the virus, which has already infected more than 40,000 people in the United States. But Mr. Trump and a chorus of conservative voices have begun to suggest that the shock to the economy could hurt the country more than deaths from the virus.

On Monday, Mr. Trump said his administration would reassess whether to keep the economy shuttered after the initial 15-day period ends next Monday, saying it could extend another week and that certain parts of the country could reopen sooner than others, depending on the extent of infections.

“Our country wasn’t built to be shut down,” Mr. Trump said during a briefing at the White House. “America will, again, and soon, be open for business. Very soon. A lot sooner than three or four months that somebody was suggesting. Lot sooner. We cannot let the cure be worse than the problem itself.”

Similar views are emanating from parts of corporate America, where companies are struggling with a shutdown that has emptied hotels, airplanes, malls and restaurants and sent the stock market tumbling so fast that automatic circuit breakers to halt trading have been tripped repeatedly. Stocks have collapsed about 34 percent since the coronavirus spread globally — the steepest plunge in decades — erasing three years of gains under Mr. Trump.

Lloyd Blankfein, the former chief executive of Goldman Sachs, wrote on Twitter that “crushing the economy” had downsides and suggested that “within a very few weeks let those with a lower risk to the disease return to work.”

Even Gov. Andrew M. Cuomo of New York, whose state has emerged as the epicenter of the outbreak in the United States, has begun publicly floating the notion that, at some point, states will need to restart economic activity and debating how that should unfold.

“You can’t stop the economy forever,” Mr. Cuomo said in a news conference on Monday. “So we have to start to think about does everyone stay out of work? Should young people go back to work sooner? Can we test for those who had the virus, resolved, and are now immune and can they start to go back to work?”

Any push to loosen the new limits on commerce and movement would contradict the consensus advice of public health officials, risking a surge in infections and deaths from the virus. Many economists warn that abruptly reopening the economy could backfire, overwhelming an already stressed health care system, sowing uncertainty among consumers, and ultimately dealing deeper, longer-lasting damage to growth.

The recent rise of cases in Hong Kong, after there had been an easing of the spread of the virus, is something of an object lesson about how ending strict measures too soon can have dangerous consequences. Yet places like China, which took the idea of lockdown to the extreme, have managed to flatten the curve.

“You can’t call off the best weapon we have, which is social isolation, even out of economic desperation, unless you’re willing to be responsible for a mountain of deaths,” said Arthur Caplan, a professor of bioethics at NYU Langone Medical Center. “Thirty days makes more sense than 15 days. Can’t we try to put people’s lives first for at least a month?”

For the last four days, some White House officials, including those working for Vice President Mike Pence, who leads the coronavirus task force, have been raising questions about when the government should start easing restrictions.

Among the options being discussed are narrowing restrictions on economic activity to target specific age groups or locations, as well as increasing the numbers of people who can be together in groups, said one official, who cautioned that the discussions were preliminary.

Health officials inside the administration have mostly opposed that idea, including Dr. Anthony S. Fauci, an infectious diseases expert and a member of the White House coronavirus task force, who has said in interviews that he believes it will be “at least” several more weeks until people can start going about their lives in a more normal fashion.

Dr. Deborah L. Birx, the White House coronavirus response coordinator, said the United States had learned from other countries like China and South Korea, which were able to control the spread of the virus through strict measures and widespread testing.

“Those were eight- to 10-week curves,” she said on Monday, adding that “each state and each hot spot in the United States is going to be its own curve because the seeds came in at different times.”

Dr. Birx added that the response “has to be very tailored geographically and it may have to be tailored by age group, really understanding who’s at the greatest risk and understanding how to protect them.”

Other advisers, including members of Mr. Trump’s economic team, have said repeatedly in recent months that the virus does not itself pose an extraordinary threat to Americans’ lives or the economy, likening it to a common flu season. Some advisers believe the White House overreacted to criticism of Mr. Trump’s muted actions to deal with the emerging pandemic and gave health experts too large a sway in policymaking.

On Monday, Mr. Trump echoed those concerns, saying that things like the flu or car accidents posed as much of a threat to Americans as the coronavirus and that the response to those was far less draconian.

“We have a very active flu season, more active than most. It’s looking like it’s heading to 50,000 or more deaths,” he said, adding: “That’s a lot. And you look at automobile accidents, which are far greater than any numbers we’re talking about. That doesn’t mean we’re going to tell everybody no more driving of cars. So we have to do things to get our country open.”

Mr. Trump has watched as a record economic expansion and booming stock market that served as the basis of his re-election campaign evaporated in a matter of weeks. The president became engaged with the discussion on Sunday evening, after watching television reports and hearing from various business officials and outside advisers who were agitating for an end to the shutdown.

Casey Mulligan, a University of Chicago professor who served as chief economist for Mr. Trump’s Council of Economic Advisers, said on Monday that efforts to shut down economic activity to slow the virus would be more damaging than doing nothing at all. He suggested a middle ground, one that weighs the costs and benefits of saving additional lives.

“It’s a little bit like, when you discover sex can be dangerous, you don’t come out and say, there should be no more sex,” Mr. Mulligan said. “You should give people guidance on how to have sex less dangerously.”

Many other economists say the restrictions in activity now are helping the economy in the long run, by beginning to suppress the infection rate.

“The idea that there’s a trade-off between health and economics right now is likely badly mistaken,” said Jason Furman of Harvard University, a former chairman of the Council of Economic Advisers under President Barack Obama. “The thing damaging our economy is a virus. Everyone who is trying to stop that virus is working to limit the damage it does to our economy and help our eventual rebound. The choice may well be taking pretty extreme steps now or taking very extreme steps later.”

Mr. Furman and other economists have pushed Mr. Trump and Congress to ease the economic pain by offering trillions of dollars in government assistance to affected workers and businesses. As lawmakers tried to negotiate an agreement on such a bill Monday, an influential business lobbying group, the U.S. Chamber of Commerce, said it supported restrictions on the economy to slow the virus.

“Our view is, when it comes to how you contain the virus, you do everything the public health professionals say to contain the virus,” said Neil Bradley, the chamber’s executive vice president and chief policy officer.

The president’s suggestion that the response may be an overreaction plays into doubts already held by some Americans suffering the economic consequences. Among the self-quarantined, some have questioned the purpose of isolating themselves if the virus is already circulating widely. Students sent home from college have wondered whether they are more likely to infect higher-risk older adults at home.

Dan Patrick, Texas’ lieutenant governor, said Monday on Fox News that he was in the “high-risk pool” but would be willing to risk his life to preserve the country for his children and grandchildren.

“We are going to be in a total collapse, recession, depression, collapse in our society,” said Mr. Patrick, who turns 70 next week. “If this goes on another several months, there won’t be any jobs to come back to for many people.”

But public health officials stress that there would be consequences to ending the measures too quickly. In a tweet on Monday morning, Thomas P. Bossert, the former homeland security adviser who for weeks has been vocal about the need for the U.S. government to take stricter measures, said: “Sadly, the numbers now suggest the U.S. is poised to take the lead in #coronavirus cases. It’s reasonable to plan for the US to top the list of countries with the most cases in approximately 1 week. This does NOT make social intervention futile. It makes it imperative!”

Mr. Trump’s interest in potentially easing some of the restrictions met with pushback from one of his close allies, Senator Lindsey Graham, Republican of South Carolina, who himself self-quarantined after a potential exposure. “President Trump’s best decision was stopping travel from China early on,” Mr. Graham tweeted on Monday. “I hope we will not undercut that decision by suggesting we back off aggressive containment policies within the United States.”

Health officials remain largely united in defense of sustaining the restrictions.

“There is a way to think through how and when to start reopening our economy and society, and it’s important to get this right,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention.

Dr. Tom Inglesby, the director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, pointed to the experience of countries like Italy, which did not institute aggressive measures to stop the spread of the virus and saw infection rates and deaths soar as a result.

The United States will need “a couple weeks” to see positive effects from its measures, Dr. Inglesby said, and abandoning them would mean “patients will get sick in extraordinary numbers all over the country, far beyond what the U.S. health care system will bear.”

 

 

 

 

“We’re looking at a tsunami”

Posted on by • Posted in Childcare, Coronavirus, Crisis, Crisis Management, Cybersecurity, Health System, Healthcare Providers, Home Care, Home Health, Hospital, Hospital Industry, Infection Control, Infectious Virus, Intensive Care (ICU), Leadership, Nurses, Paid Time Off (PTO), Pandemic, Talent Management • Leave a comment

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Yesterday we spoke with a senior healthcare executive leading the COVID-19 response for a regional health system on the West Coast. Their area is now experiencing exponential growth of new cases, with the number of local diagnoses doubling every couple of days. In all likelihood, they’re less than two weeks from having the number of cases seen in harder-hit areas like San Francisco, Seattle and New York City. She said the “anticipation of what is about to happen” is the scariest part of the around-the-clock work they are doing to prepare.

But that two-week lead time has given them precious time to organize, and she generously shared key elements of their action plan. Their preparation work—surely similar to what hundreds of health systems around the country are doing—impressed us not only with its breadth, depth and comprehensiveness, but also the level of energy and confidence conveyed by the hundreds of actions and decisions, large and small, the system is making every day. Here are some of their important learnings so far:

  1. Even though the surge of patients has yet to begin, staff are “worried and scared”. They are concerned about PPE shortages and personal safety and stressed at home with schools and daycare closed. Detailed and regular communication is more critical than ever—and they’re trying to answer every inbound concern or question from associates directly. They are funding and expanding childcare options for staff, through partnerships with community organizations and daily stipends for home-based care.
  2. As the system works through worst-case scenario planning, they anticipate the need for critical care nurses, respiratory therapists, and emergency physicians will be the worst bottlenecks, and they are working to cross-train adjacent clinicians and build new staffing models to increase capacity. While most providers are deeply dedicated to providing care for COVID-19 patients, a small number have already “called off” and refused to report—creating unanticipated questions around how to manage these difficult situations.
  1. As they prepare to implement new surge staffing models, the system is now navigating through a period of downtime. With elective procedures cancelled and some ambulatory sites closed, they currently need fewer nurses and clinical staff than a month ago, and are creating policies, like allowing staff to go negative into PTO, to maintain income while they wait for the surge. Staff who must work in-person are working variable shifts to reduce crowding. They are also working to credential nurses and staff furloughed from local ambulatory surgery centers, so they have them ready to deploy when needed.
  1. IT staff are working nonstop to quickly make it possible for all eligible employees to work remotely, and to enable staff to safely gain access to the system’s intranet while guarding against new cybersecurity threats. The system is training and enabling hundreds of doctors to deliver care virtually, including affiliated independents.
  1. Guidelines for coronavirus patient management and recommended PPE practices change daily; it’s a full-time job for clinical leaders to keep up. Doctors are eager to try novel and creative treatments for very sick patients. (For instance, one doctor is developing a 3-D printed device that will allow one ventilator to be used for four patients simultaneously.) This eagerness to “do something” is understandable but creates a bit of chaos as leaders work to create policies around how to best manage patients.
  1. While leaders communicate with other health systems and local and state authorities daily, the vast majority of decisions are made internally, on the fly. For instance, the system is connecting with now-empty local hotels and universities to provide options for low-acuity patient capacity, but leaders hope that parallel efforts at other organizations can be brought together into a more unified regional response. For now, however, coordination would likely create unacceptable delays.
  1. Long-term health and stamina of staff is top among the system’s concerns. “If I borrow worry from the future”, this leader said, “I am worried that we are facing years-long trauma, both emotional and financial, and I’m not sure how we will sort it out”. For now, efforts to support staff and provide moments of relief and joy, are critical, and very appreciated by front-line team members.

We left this conversation emotionally overwhelmed ourselves, and with a huge sense of gratitude for clinicians and health system leaders. Americans can take comfort in the amount of work that is taking place even before critical patients begin to appear—and that doctors, nurses and hospitals are truly dedicated to providing us the best possible care under circumstances they have never faced before. If you know about creative approaches or new ideas organizations are putting in place to contend with the current situation, please let us know. We’re eager to share great ideas!

 

 

 

How the coronavirus pandemic differs from the flu

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Incubation Period, Infection Control, Infectious Virus, Influenza, Mortality, Pandemic, Vaccine, World Health Organization (WHO) • Leave a comment

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The COVID-19 pandemic is caused by a virus humans haven’t encountered before — meaning our bodies have no built-in immunity to it and researchers are frantically working to learn more about it.

Why it matters: While there are important lessons to be learned from other pandemic flus and even seasonal flu outbreaks, the coronavirus pandemic is new and not exactly comparable, making predictions, policies and treatments all the more difficult.

The latest: The coronavirus is spreading throughout the U.S., with at least 35,224 confirmed cases and 471 deaths early Monday morning, per Johns Hopkins’ Center for Systems Science and Engineering.

  • Meanwhile, the Centers for Disease Control and Prevention estimates the 2019-2020 seasonal flu has caused at least 38 million illnesses, 390,000 hospitalizations and 23,000 deaths so far this season.

What they’re saying: Anthony Fauci, who’s served as director of the National Institute of Allergy and Infectious Diseases since 1984, told a JAMA podcast he’s worked on multiple infectious disease crises “but nothing of the magnitude of this.”

  • One of the problems, he said, is that without strong containment and mitigation efforts, it hits society and its health care system “all of a sudden — boom! It starts to skyrocket.”
  • The World Health Organization on Friday warned against dismissing the coronavirus as just a bad outbreak of the flu, saying overwhelmed health systems are “collapsing” around the world.
  • “This is not normal. This isn’t just a bad flu season,” WHO’s Mike Ryan said.

While both seasonal flu and COVID-19 cause similar respiratory illnesses, there are key differences between the viruses.

  • Influenza has an incubation period of roughly 2-3 days, whereas the coronavirus incubates longer (5-6 days on average) before symptoms appear, possibly allowing more people to unknowingly spread the virus.
  • On average, 1.3 people catch the flu from an infected person versus 2-3 for the coronavirus.
  • There’s a flu vaccine and multiple effective treatments, so many exposed to the flu will have lessened symptoms. There’s no vaccine or treatment yet approved for COVID-19.
  • Children appear to be more susceptible to severe complications from this seasonal flu than from COVID-19, with the CDC reporting the highest number of influenza-associated deaths (149) at this point in the season, with the exception of the 2009 flu pandemic.
  • But, the overall mortality rate for COVID-19 is between 10 and 40 times higher than the average 0.1% mortality rate for the seasonal flu.

The U.S. can learn from both Asia and Europe, which experienced cases of COVID-19 earlier than the U.S., Julie Fischer of Georgetown University’s Center for Global Health Science and Security tells Axios.

  • China is providing data showing what measures are working better than others, and is conducting treatment tests on patients, which will be valuable, she said.
  • In South Korea, robust diagnostic testing using creative measures like drive-thrus combined with strong health care followup shows the importance of isolating the right people early enough to limit the spread, Fischer says.
  • Italy tried to do a widespread but unfocused social distancing. There’s been some success in stemming the outbreak in certain areas that tested a large number of people, tracing and quarantining those who have been in contact with positive cases. But, it wasn’t early enough or sufficiently extensive, and many parts of Italy are now overwhelmed.

Longer term lessons can be drawn from prior pandemics, like the Spanish flu of 1918, Fischer says.

  • Comparing Philadelphia’s response with that of St. Louis is quite striking, Fischer says. Philadelphia decided to hold a 200,000-person parade to boost morale — but this led to widespread infections. In contrast, St. Louis rapidly battened down the hatches and reported a smaller epidemic.
  • Another lesson from the Spanish flu was that closing schools early on was “one of the most beneficial” non-pharmaceutical interventions.

The bottom line: “This is not an ‘abandon all hope, ye who enter here,’ scenario,” Fischer says. “We can focus our strategy and become much more aggressive” in diagnostics testing and social distancing measures until scientists make advancements on vaccines and treatments.

 

 

We may need retired doctors and nurses

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Hospitals are asking retired doctors and nurses to come back and help with operations as they prepare for a rush of severe coronavirus cases, Axios’ Bob Herman reports.

The bottom line: Retired clinicians likely won’t be placed in intensive care units or coronavirus testing stations, because older adults are at higher risk of falling ill and dying from the virus. But they could help stabilize hospitals that will need as many hands on deck as possible over the coming months.

Where it stands: The Association of American Medical Colleges floated this idea last week with hospitals and federal agencies.

  • “The question is: How can we bring people up to speed and bring them in?” said Janis Orlowski, a physician and executive at the AAMC. “They will … [likely] backfill in areas where it’s not direct patient care.”

What they’re saying: Some retired clinicians are willing to take on other necessary care, while residents and other doctors funnel into coronavirus cases.

By the numbers: 41% of doctors are 55 or older, according to American Medical Association data provided to Axios, and 38% of nurses are 55 or older.

 

 

 

Hospital leaders plead for financial help, warn of closures, missing payroll

Posted on by • Posted in American Hospital Association (AHA), Cash, Cash Reserves, Coronavirus, Credit Ratings, Creditors, Crisis, Crisis Management, Financially Distressed, Health Policy, Health System, Hospital, Hospital Bankruptcy, Hospital Closure, Hospital Industry, Infection Control, Infectious Virus, Net Income, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, Pandemic • Leave a comment

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Hospital executives from across the country sounded the alarm Saturday about the dire need for federal financial aid as their cash on hand continues to erode amid the coronavirus pandemic.

“We’ll exhaust all avenues to make payroll in the next few weeks,” Scott Graham, CEO of Three Rivers and North Valley Hospitals in rural Washington said of Three Rivers during a call with reporters Saturday morning.

The American Hospital Association is urging lawmakers on Capitol Hill to consider deploying at least $100 billion to aid hospitals fight against the outbreak of the novel coronavirus. The relief package would fund medical personnel, supplies and infrastructure, and expenses related to COVID-19, Rick Pollack, CEO of AHA, told reporters.

Without a relief package, Pollack warned it “could mean that many hospitals won’t survive.” The pleas came as Congress debates a stimulus package this weekend.

American life has ground to halt as experts urge the public to distance themselves from others in an attempt to slow the spread of the virus. Many states closed bars and restaurants with virtually all group events canceled. Likewise, hospitals have been asked — or required in some locales — to halt all elective procedures to free up resources for an expected surge of patients.

But hospitals rely on those typically lucrative procedures to drive revenue. Some hospitals are starting to wonder how they’ll keep the lights on after facing the reality of canceled procedures and the need to increase staff and supplies to combat the pathogen.

On top of that, hospitals are unable to get much needed supplies as some vendors are requiring payment on delivery, funds they do not have.

There is no time to waste, hospital leaders warned, citing less than two weeks cash on hand.

“We need to get this done now,” Pollack said of an emergency funding package from the federal government.

Despite the dire financial strain, hospitals are still preparing to increase capacity to meet a surge in demand. It’s unclear whether they will be reimbursed for all expenses related to increasing the amount of beds, capacity and supplies.

Some areas were already facing a shortage of nurses and physicians before the outbreak and anticipate that to become worse.

“In spite of our existing financial challenges, we are planning to increase capacity because that is what we must do,” LaRay Brown, CEO of One Brooklyn Health System in New York, said Saturday. One Brooklyn​ operates three hospitals, nursing homes and community health centers in New York, serving about 2 million.

Brown said all hospitals in New York were asked Friday by state health officials to submit plans for the upping of capacity by 50% of existing bed count.

Brown anticipates receiving some support from the state of New York but seemed wary of the state’s future financial footing as it battles the pathogen as well, and with a weakened tax base as businesses have shuttered.

“This is why I’m on this call,” Brown said. “We need immediate cash relief from the federal government.”

 

 

 

To solve the economic crisis, we will have to solve the health-care crisis

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In Washington, the focus has now turned to the economic response to the coronavirus pandemic, with experts and politicians proposing their preferred policy tools — ranging from tax cuts to corporate bailouts to direct payments of cash. Each is worth debating, but the focus is misplaced. This is not an economic crisis; it is a health-care crisis.

The distinction may sound academic. But understanding it is actually vital to designing the policies that should follow.

In an economic crisis, you could imagine a situation in which people lose their jobs and are unable to spend money. That’s called a demand shock, which is what happened during the global financial crisis of 2008. Or producers could raise prices (for various reasons), making it harder to buy their goods. That’s a supply shock, and it describes the oil crises of 1973 and 1979. But what is happening now cannot be addressed primarily by economic responses, because we are witnessing the suspension of economics itself.

Today, even if you have money, increasingly you cannot go into a shop, restaurant, theater, sports arena or mall because those places are closed. If you own a factory that hasn’t already closed for health reasons, you may still have to shut it down because you can’t get key components from suppliers or you can’t find enough stores open to sell your goods.

In these conditions, cash to consumers cannot jump-start consumption. Relief to producers will not jump-start production. This problem is on a level different and far greater than the recession of 2008 or the aftermath of 9/11. If it were to go on for months, it could look worse than the Great Depression.

This is not an argument against any of the economic measures being proposed. People need to be able to eat, buy medicine and pay their bills. New York Times columnist Andrew Ross Sorkin has canvassed experts and concluded that the best approach would be a zero-interest “bridge loan” to all businesses and self-employed people as long as they keep most of their workers on staff. It is probably the right course of action, massively expensive but cheaper than a full-blown Great Depression.

But even that might not work if we do not recognize that first and foremost the United States faces a health crisis. And that crisis is not being solved. China is now reporting no new domestic infections. South Korea, Taiwan and Singapore have also made progress in “flattening the curve” — the phrase of the year — because they have prioritized dealing with the health-care crisis over enacting a grand economic stimulus.

The United States is still dangerously behind the curve. A headline in Thursday’s Wall Street Journal is, “Coronavirus Testing Chaos Across America.” The article details how the country still has “a chaotic patchwork of testing sites,” with testing proceeding “far slower than experts say is necessary, in part due to a slow federal response.” The U.S. testing rate remains shockingly low, well behind the rates of most other rich countries and far behind those of the Asian countries that are handling this crisis best. Across the United States, hospitals are warning of a dire shortage of beds, medical equipment and supplies. And the worst is yet to come. With infections doubling every two to three days, the U.S. health-care system will face what New York Gov. Andrew Cuomo correctly described as a “tsunami.”

The Trump administration is still acting slowly and fitfully. Experts predicted weeks ago that cities would need thousands more hospital beds, and yet the Navy is still performing maintenance on two hospital ships and figuring out staffing. The president says he will invoke “defense production” powers only if necessary. What is he waiting for? He should direct firms to start production of all key medical equipment in short supply. The armed forces should be deployed immediately to set up field testing and hospital sites. Hotels and convention centers should be turned into hospitals. The federal government should announce a Manhattan Project-style public-private partnership to find and produce a vaccine. After decades of attacks on government, federal agencies are understaffed, underfunded and ill-equipped to handle a crisis of this magnitude. They need help, and fast.

And here’s another idea: President Trump could forge an international effort to unite the world against this common threat. If the United States, China and the European Union worked together, prospects for success — on a vaccine, for example — would be greater. China in particular produces most of the supplies and medical ingredients the world needs. Trump should remove all of his self-defeating tariffs so that American consumers don’t have to pay more for these goods and China can ramp up production. This is a war, and in a war you try to find allies rather than create enemies.

 

 

Pandemic Provides Defining Moment for Government Leaders

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Governors and mayors don’t run for office with the intention of managing emergencies. But when a crisis strikes, they become the public face of government response and need to be ready to communicate accurately and calmly.

Mike DeWine didn’t pull any punches.

At a news conference on Thursday, the Ohio governor announced he was ordering that K-12 schools shut down until April 3 and banning most gatherings of 100 people or more. Ohio had only five confirmed coronavirus cases at that point, but DeWine’s health director Amy Acton, standing by the governor’s side, said they suspected that well over 100,000 state residents were already infected — a number expected to double every five days.

DeWine made it clear that his state, like others, faces massive challenges. In response, he offered resolve but not sugar-coated optimism. “This is temporary. We will get back to normal in Ohio. It won’t happen overnight,” DeWine said. “We must treat this like what it is, and that is a crisis.”

Around the country, other governors and mayors have been offering similar messages. Many are out in front, holding news conferences on a daily basis. Maryland Gov. Larry Hogan announced Thursday that he was putting his lieutenant governor in charge of most state operations so he could devote his full attention to the coronavirus crisis. Michigan Gov. Gretchen Whitmer held a news conference just before midnight on Thursday to announce a statewide school closure.

“Crises and disasters are what separates legislators from executives,” says Jared Leopold, a former communications director for the Democratic Governors Association. “For those executives who face a major disaster, crisis management becomes their defining legacy, whether they like it or not. Nothing else matters.”

Executives become the public face of the government’s response. Whether it’s natural disasters, mass shootings or a pandemic, their role is not only to share information, but to convey the sense that someone is in charge and has a plan that will see the city, state or nation through the worst of times. “That’s what the governor has to do in this situation,” says Bob Taft, a former Ohio governor.

“He’s been very visible, very prompt and as much ahead of the curve as possible in terms of taking decisive action,” Taft says of DeWine. “He’s also putting out good information and he’s obviously listening to the public health experts and the knowledgeable staff on his team.”

There are plenty of examples of politicians winning either acclaim or scorn for their handling of emergency situations. Sen. Joe Manchin’s enduring popularity in West Virginia — he’s the only Democrat still capable of winning statewide election in that increasingly red state — is rooted in his handling of the Sago Mine explosion as governor back in 2006. A year earlier, Mississippi Gov. Haley Barbour won applause for his handling of Hurricane Katrina, while Louisiana Gov. Kathleen Blanco was widely criticized and decided not to run for re-election.

“Do it right, and you’ll be remembered as a leader for decades,” Leopold says. “Do it wrong, and you’ll be voted out of office.”

No One Signs Up for This

Politicians campaign on issues such as taxes and education. No one pledges to provide stalwart leadership if and when there’s a crisis. It doesn’t seem relevant until it happens. But, once elected, they end up being judged by how they respond to the worst challenges.

“People watch very carefully what leaders do during these situations,” says Jay Nixon, who coped with a deadly tornado in Joplin and the Ferguson shooting, along with other challenges, during his tenure as Missouri governor.

Leaders need a plan, Nixon says. It may change daily or even hourly, but having a plan gives them, their teams and the public some sense of where they’re going. They also need to convey information in a reassuring and convincing way. “You have to have a clear source of information that’s not only accurate, but one that people trust,” Nixon says. “Leaders need to remain calm and normal.”

When new governors are elected, they’re often warned by sitting governors they’ll likely need to respond to disaster in some form or other. Taft, who was in office during the 2001 terrorist attacks, said that event opened up governors’ eyes to all manner of contingencies.

“Of course, all governors expect to have to weather emergencies,” he says. “That was something new and different — like today, a whole new set of threats.”

Governors are well-equipped to respond. There’s a whole structured apparatus, whether it’s called an emergency operations center or something else, that offers them plans, a command structure and communications tools to deal with unexpected tragedies.

If you’re a governor, you’re likely to be faced with a flood or a tornado or some other event with devastating consequences you must respond to. No matter their other priorities, they’re always ready to go on an emergency footing.

“To me, governors and states are always well-prepared, because in effect they’re always training for it,” says Scott Pattison, former executive director of the National Governors Association. “Whatever one says about a particular governor, they know that’s the expected role and they step right into it and rise to the occasion.”

The All-Dominant Issue

When executives aren’t seen as responding swiftly and competently, it can imperil both their re-election chances and their broader agendas. It’s a well-established part of political folklore that mayors lose their jobs when cities don’t dig out promptly following snowstorms. “We’ve probably spent as much time on snow as we have on the budget,” Massachusetts Gov. Charlie Baker said not long after taking office in 2015.

Andy Beshear was sworn in as Kentucky’s governor four months ago. Lately, he has been holding daily news conferences to provide updates on caseloads and policy changes. In recent days, he has called for schools to close for two weeks, for church services to be held virtually and for the state’s 200 senior centers to shut down in-person activities. “Let me say once again: We’re going to get through this,” he said on Friday.

People are not looking for uplift, but rather find confidence in knowing that there’s someone in charge offering a serious, smart response, says George C. Edwards III, a political scientist at Texas A&M University. “You get credibility from two things — one, from recognizing the problem as it is, and two, from acting,” he says.

One of Winston Churchill’s most famous wartime speeches begins, “The news from France is very bad.” When asked about the death toll on Sept. 11, 2001, Rudy Giuliani, then New York City’s mayor, said, “The number of casualties will be more than any of us can bear, ultimately.”

“People want reassurance and so (politicians) give it,” Edwards says. “They want to know it’s going to work out. At the same time, what’s critical is credibility, showing you have a firm handle on the crisis.”

No More Rallying Around the Leader

“During crises, people turn to the government for leadership, including what actions to take and how to return to stability,” according to a 2018 communication study. “Leaders are responsible for and expected to minimize the impact of crises, enhance crisis management capacity and coordinate crisis management efforts.”

In Kentucky, Beshear has won praise, so far, for sharing information personally and presenting the advice and counsel offered by public health and safety experts. “Party’s aside (he’s not mine) Beshear has done an excellent job with all this,” Samuel Keathley, a resident of Martin, Ky., tweeted on Thursday. “He’s never seemed panicked; he’s also never made it seem like nothing. He sounds and acts like a leader.”

The 2001 terrorist attacks offer one of the most dramatic examples of a politician winning acclaim for response to a crisis. Within 10 days, President George W. Bush’s approval ratings had jumped from 51 percent to 90 percent, according to Gallup.

“Presidents must take charge of crises right away,” says Matthew Eshbaugh-Soha, who chairs the political science department at the University of North Texas. “If presidents do well, the American people will respond with support.”

That hasn’t happened for President Trump. For weeks, Trump has sought to downplay the crisis, offering optimistic assessments that contradict warnings from federal public health officials. His speech from the Oval Office on Wednesday was hastily written and included a number of factual errors regarding policy positions that had to be quickly walked back by the administration.

“He’s not telling the truth and he is not trusted in that sense,” says Nixon, the former Missouri governor. “He doesn’t have a plan and he seems to be in a completely reactive mode.”

In general, Trump’s style is combative. His presidency has been disruptive, not designed to offer calming reassurance. His supporters have loved him for it, but there are more Americans, as measured by polls, that went into the coronavirus period already distrusting him.

“Trump has a very dedicated base who are absolutely steadfast, but he’s got an even larger opposition coalition that is equally steadfast,” says Edwards, the Texas A&M presidential scholar. “If you already hate him, you’re much less likely to be reassured.”

At the same time, the news media also has a problem when it comes to trust. That’s something predating Trump, but which he has encouraged with his frequent complaints about “fake news.” On Thursday, Megyn Kelly, a former news anchor and correspondent for NBC and Fox News, tweeted that while she didn’t believe Trump was a credible source, “we can’t trust the media to tell us the truth without inflaming it to hurt Trump.”

On Thursday, the city of Murfreesboro, Tenn., posted a statement on its website advising residents not to turn to media outlets for coronavirus information: “Unfortunately, today’s media know that negative or overtly controversial stories receive more attention and thereby generate traffic to their publications, broadcasts and websites.”

That assertion has since been deleted, but it spoke to the polarization that continues even in a country beset by crisis.

According to an ABC News/Ipsos poll released Friday, 47 percent of Democrats are “very concerned” about catching coronavirus, while only 15 percent of Republicans share that level of concern. Just 17 percent of Democrats say they are not concerned about being infected, compared with 44 percent of Republicans.

As the virus spreads and more businesses and activities shut down, public opinion will necessarily shift. No one can say how this will play out. No one can predict the ultimate costs in terms of health and mortality.

“It may take an event of this magnitude to shake people on both sides of the political equation,” Nixon says. “This may be that moment where, as a country, both Democrats and Republicans realized that there are some things that should be analyzed separately from political partisanship.”