Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.
For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.
On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.
Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.
Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”
The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.
In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.
Diminished role
When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.
As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.
The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.
The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.
But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.
“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”
What does it mean for the world?
The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.
Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.
This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.
The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources.But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.
This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.
It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.
What happens next?
Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.
In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.
COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.
Both President Trump’s advisers and operatives laboring to defeat him increasingly agree on one thing: The best way for him to regain his political footing is to wrest control of the novel coronavirus.
In the six months since the deadly contagion was first reported in the United States, Trump has demanded the economy reopen and children return to school, all while scrambling to salvage his reelection campaign.
But allies and opponents agree he has failed at the one task that could help him achieve all his goals — confronting the pandemic with a clear strategy and consistent leadership.
Trump’s shortcomings have perplexed even some of his most loyal allies, who increasingly have wondered why the president has not at least pantomimed a sense of command over the crisis or conveyed compassion for the millions of Americans hurt by it.
People close to Trump, many speaking on the condition of anonymity to share candid discussions and impressions, say the president’s inability to wholly address the crisis is due to his almost pathological unwillingness to admit error; a positive feedback loop of overly rosy assessments and data from advisers and Fox News; and a penchant for magical thinking that prevented him from fully engaging with the pandemic.
In recent weeks, with more than 145,000 Americans now dead from the virus, the White House has attempted to overhaul — or at least rejigger — its approach. The administration has revived news briefings led by Trump and presented the president with projections showing how the virus is now decimating Republican states full of his voters. Officials have also set up a separate, smaller coronavirus working group led by Deborah Birx, the White House coronavirus response coordinator, along with Trump son-in-law and senior adviser Jared Kushner.
For many, however, the question is why Trump did not adjust sooner, realizing that the path to nearly all his goals — from an economic recovery to an electoral victory in November — runs directly through a healthy nation in control of the virus.
“The irony is that if he’d just performed with minimal competence and just mouthed words about national unity, he actually could be in a pretty strong position right now, where the economy is reopening, where jobs are coming back,” said Ben Rhodes, a deputy national security adviser to former president Barack Obama. “And he just could not do it.”
Many public health experts agree.
“The best thing that we can do to set our economy up for success and rebounding from the last few months is making sure our outbreak is in a good place,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “People are not going to feel comfortable returning to activities in the community — even if it’s allowed from a policy perspective — if they don’t feel the outbreak is under control.”
Some aides and outside advisers have tried to stress to Trump and others in his orbit that before he could move on to reopening the economy and getting the country back to work — and life — he needed to grapple with the reality of the virus.
But until recently, the president was largely unreceptive to that message, they said, not fully grasping the magnitude of the pandemic — and overly preoccupied with his own sense of grievance, beginning many conversations casting himself as the blameless victim of the crisis.
In the past couple of weeks, senior advisers began presenting Trump with maps and data showing spikes in coronavirus cases among “our people” in Republican states, a senior administration official said. They also shared projections predicting that virus surges could soon hit politically important states in the Midwest — including Michigan, Minnesota and Wisconsin, the official said.
This new approach seemed to resonate, as he hewed closely to pre-scripted remarks in a trio of coronavirus briefings last week.
“This could have been stopped. It could have been stopped quickly and easily. But for some reason, it wasn’t, and we’ll figure out what that reason was,” Trump said Thursday, seeming to simultaneously acknowledge his predicament while trying to assign blame elsewhere.
In addition to Birx and Kushner, the new coronavirus group guiding Trump includes Kushner advisers Adam Boehler and Brad Smith, according to two administration officials. Marc Short, chief of staff to Vice President Pence, also attends, along with Alyssa Farah, the White House director of strategic communications, and Stephen Miller, Trump’s senior policy adviser.
The working group’s goal is to meet every day, for no more than 30 minutes. It views its mission as half focused on the government’s response to the pandemic and half focused on the White House’s public message, the officials said.
White House spokeswoman Sarah Matthews defended the president’s handling of the crisis, saying he acted “early and decisively.”
“The president has also led an historic, whole-of-America coronavirus response — resulting in 100,000 ventilators procured, sourcing critical PPE for our front-line heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world,” Matthews said in an email statement. “His message has been consistent and his strong leadership will continue as we safely reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate.”
For some, however, the additional effort is too little and far too late.
“This is a situation where if Trump did his job and put in the work to combat the health crisis, it would solve the economic crisis, and it’s an instance where the correct governing move is also the correct political move, and Trump is doing the opposite,” said Josh Schwerin, a senior strategist for Priorities USA, a super PAC supporting former vice president Joe Biden, the presumptive Democratic nominee.
Other anti-Trump operatives agree, saying he could make up lost ground and make his race with Biden far more competitive with a simple course correction.
“He’s staring in the mirror at night: That’s who can fix his political problem,” said John Weaver, one of the Republican strategists leading the Lincoln Project, a group known for its anti-Trump ads.
One of Trump’s biggest obstacles is his refusal to take responsibility and admit error.
In mid-March, as many of the nation’s businesses were shuttering early in the pandemic, Trump proclaimed in the Rose Garden, “I don’t take responsibility at all.” Those six words have neatly summed up Trump’s approach not only to the pandemic, but also to many of the other crises he has faced during his presidency.
“His operating style is to double- and triple-down on positions and to never, ever admit he’s wrong about anything,” said Anthony Scaramucci, a longtime Trump associate who briefly served as White House communications director and is now a critic of the president. “His 50-year track record is to bulldog through whatever he’s doing, whether it’s Atlantic City, which was a failure, or the Plaza Hotel, which was a failure, or Eastern Airlines, which was a failure. He can never just say, ‘I got it wrong and let’s try over again.’ ”
Another self-imposed hurdle for Trump has been his reliance on a positive feedback loop. Rather than sit for briefings by infectious-disease director Anthony S. Fauci and other medical experts, the president consumes much of his information about the virus from Fox News and other conservative media sources, where his on-air boosters put a positive spin on developments.
Consider one example from last week. About 6:15 a.m. that Tuesday on “Fox & Friends,” co-host Steve Doocy told viewers, “There is a lot of good news out there regarding the development of vaccines and therapeutics.” The president appears to have been watching because, 16 minutes later, he tweeted from his iPhone, “Tremendous progress being made on Vaccines and Therapeutics!!!”
It is not just pro-Trump media figures feeding Trump positive information. White House staffers have long made upbeat assessments and projections in an effort to satisfy the president. This, in turn, makes Trump further distrustful of the presentations of scientists and reports in the mainstream news media, according to his advisers and other people familiar with the president’s approach.
This dynamic was on display during an in-depth interview with “Fox News Sunday” anchor Chris Wallace that aired July 19. After the president claimed the United States had one of the lowest coronavirus mortality rates in the world, Wallace interjected to fact-check him: “It’s not true, sir.”
Agitated by Wallace’s persistence, Trump turned off-camera to call for White House press secretary Kayleigh McEnany. “Can you please get me the mortality rates?” he asked. Turning to Wallace, he said, “Kayleigh’s right here. I heard we have one of the lowest, maybe the lowest mortality rate anywhere in the world.”
Trump, relying on cherry-picked White House data, insisted that the United States was “number one low mortality fatality rates.”
Fox then interrupted the taped interview to air a voice-over from Wallace explaining that the White House chart showed Italy and Spain doing worse than the United States but countries like Brazil and South Korea doing better — and other countries that are doing better, including Russia, were not included on the White House chart. By contrast, worldwide data compiled by Johns Hopkins University shows the U.S. mortality rate is far from the lowest.
Trump is also predisposed to magical thinking — an unerring belief, at an almost elemental level, that he can will his goals into existence, through sheer force of personality, according to outside advisers and former White House officials.
The trait is one he shares with his late father and family patriarch, Fred Trump. In her best-selling memoir, “Too Much and Never Enough,” the president’s niece, Mary L. Trump, writes that Fred Trump was instantly taken by the “shallow message of self-sufficiency” he encountered in Norman Vincent Peale’s 1952 bestseller, “The Power of Positive Thinking.”
Some close to the president say that when Trump claims, as he did twice last week, that the virus will simply “disappear,” there is a part of him that actually believes the assessment, making him more reluctant to take the practical steps required to combat the pandemic.
Until recently, Trump also refused to fully engage with the magnitude of the crisis. After appointing Pence head of the coronavirus task force, the president gradually stopped attending task force briefings and was lulled into a false sense of assurance that the group had the virus under control, according to one person familiar with the dynamic.
Trump also maintained such a sense of grievance — about how the virus was personally hurting him, his presidency and his reelection prospects — that aides recount spending valuable time listening to his gripes, rather than focusing on crafting a national strategy to fight the pandemic.
Nonetheless, some White House aides insist the president has always been focused on aggressively responding to the virus. And some advisers are still optimistic that if Trump — who trails Biden in national polls — can sustain at least a modicum of self-discipline and demonstrate real focus on the pandemic, he can still prevail on Election Day.
Others are less certain, including critics who say Trump squandered an obvious solution — good governance and leadership — as the simplest means of achieving his other goals.
“There is quite a high likelihood where people look back and think between February and April was when Trump burned down his own presidency, and he can’t recover from it,” Rhodes said. “The decisions he made then ensured he’d be in his endless cycle of covid spikes and economic disruption because he couldn’t exhibit any medium- or long-term thinking.”
From lockdowns to testing, we showed people around the world the facts and figures on how the U.S. has handled the pandemic.
The United States leads the world in Covid-19 deaths, nearing 150,000 lost lives. The unemployment figures brought on by the pandemic are mind-boggling. The Trump administration’s slow and haphazard response has been widely criticized. But what does it look like to young people around the world, whose governments moved quickly and aggressively to contain the coronavirus?
We wanted to know, so we reached out to quite a few and showed them charts, facts, photos and videos illustrating the U.S. response. Spoiler: They were not impressed.
Many advanced economies, from Germany to Singapore, directly supplemented salaries to save jobs. Other nations with fewer resources started mass testing at the first sign of an outbreak. Many countries mandated universal lockdowns — and successfully flattened the curve. In some parts of Europe, you could be fined for straying too far from your home. And Vietnam, a nation of 95 million people, has not seen a single Covid-19 death.
This Opinion video is a follow-up to a popular video we produced last year, which asked young Europeans to respond to American policies such as health care and parental leave. Many comments suggested we produce a sequel. Well, here it is — the Covid-19 edition.
Coronavirus deaths are again on the rise in the U.S., with all three of the nation’s largest states setting new highs for daily death tolls Thursday following weeks of record increases in new cases and hospitalizations, even as President Donald Trump and other conservatives have touted death statistics as a sign the U.S. is handling the pandemic well.
KEY FACTS
California, Texas and Florida all reported new record daily highs for deaths Thursday.
Californiareported 149 deaths, while Florida reported 120 and Texasset a new record for the third-straight day, with 105.
Deaths are rising rapidly in Texas, with the 105 deaths breaking Wednesday’s record of 98, which shattered the record of 60 that was set on Tuesday.
Coronavirus deaths in the U.S. declined from early May through mid-June, but have picked up recently, and are now pacing at just under 1,000 per day.
The rise is being driven by record new death tolls in the nation’s largest states—the same states that have in large part contributed to the U.S.’s record rise in new cases recently.
Experts have said that deaths lag behind increases in cases and hospitalizations, with former FDA Commissioner Scott Gottlieb saying in an interview Sunday that “the total number of deaths is going to start going up again.”
KEY BACKGROUND
Coronavirus deaths reached a peak nationally in April through early May with over 2,000 a day on many days, largely driven by the severe outbreak in New York. Now the pandemic has eased in the Northeast while states in the South and West are the new national epicenters for coronavirus.
CHIEF CRITICS
Trump and Republican politicians had used the decline in deaths and a decrease in mortality rates to argue that the U.S. response to coronavirus has worked. However, there has also been a massive increase in testing, meaning that many less severe cases are now being identified.
BIG NUMBER
4.3%. According to Johns Hopkins University, that’s what the current mortality rate is among confirmed coronavirus cases in the U.S., a number that’s continually dropped as testing has increased. However, health experts like Dr. Anthony Fauci said early on in the pandemic that they believe the actual mortality rate is around 1%, which is still at least 10 times the lethality of the seasonal flu. And Gottlieb noted that even if the reported death rate continues to drop, if there is an increase in infections, the amount of deaths will ultimately rise, as well.
CRITICAL QUOTE
“It’s a false narrative to take comfort in a lower rate of death,” Fauci said on Tuesday, adding “There’s so many other things that are very dangerous and bad about this virus, don’t get yourself into false complacency.”
A pandemic would normally be a time when public health expertise and data are in urgent demand — yet President Trump and his administration have been going all out to undermine them.
Why it matters: There’s a new example almost every day of this administration trying to marginalize the experts and data that most administrations lean on and defer to in the middle of a global crisis.
Here’s how it has been happening just in the past few weeks:
The administration has repeatedly undermined the Centers for Disease Control and Prevention. Most recently, Trump has criticized the CDC’s school reopening guidelines, Education Secretary Betsy DeVos declared that “kids need to be in school,” and the administration has reportedly ordered hospitals to bypass the CDC in reporting coronavirus patient information.
It has repeatedly undermined Anthony Fauci. Trump distanced himself on Wednesday from an op-ed attack by White House trade adviser Peter Navarro, but longtime Trump aide Dan Scavino also called the infectious diseases specialist “Dr. Faucet” in a Facebook post accusing him of leaking his disagreements. And the White House gave a opposition research-style list of the times Fauci “has been wrong” to the Washington Post and other media outlets.
Trump himself undermined public health experts generally with his retweet of former game show host Chuck Woolery’s “everyone is lying” tweet — which blamed “The CDC, Media, Democrats, our Doctors, not all but most, that we are told to trust.”
Trump has made numerous statements suggesting, over and over again, that we wouldn’t have as many COVID cases if we just tested less. (From his Tuesday press conference at the White House: “If we did half the testing we would have half the cases.”)
The impact: The result is that the CDC — which is supposed to be the go-to agency in a public health crisis — is distracted by constant public critiques from the highest levels. And Fauci, “America’s Doctor,” is the subject of yet another round of stories about whether Trump is freezing him out.
“The way to make Americans safer is to build on, not bypass, our public health system,” Tom Frieden, a former CDC director under Barack Obama, said in a statement to Axios about the efforts to sideline the agency.
“Unfortunately, as with mask-up recommendations and schools reopening guidance, the administration has chosen to sideline and undermine our nation’s premier disease fighting agency in the middle of the worst pandemic in 100 years,” Frieden said.
And Fauci, in an interview with The Atlantic, said of the efforts to discredit him: “Ultimately, it hurts the president to do that … It doesn’t do anything but reflect poorly on them.”
The other side: The White House insists there’s no problem. “President Trump has always acted on the science and valued the input of public health experts throughout this crisis,” said White House deputy press secretary Sarah Matthews.
Trump campaign communications director Tim Murtaugh closed ranks with the experts as well. “President Trump has said repeatedly that he has a strong relationship with Dr. Fauci, and Dr. Fauci has always said that the President listens to his advice,” he said.
And Department of Health and Human Services spokesman Michael Caputo declared that “the scientists and doctors speak openly, they are listened to closely, and their advice and counsel helps guide the response.”
“Frankly, when it comes to this tempest in a teapot over Dr. Fauci, I blame the media and their unending search for a ‘Resistance’ hero, for turning half a century of a brilliant scientist’s hard work into a clickbait headline that helps reporters undermine the president’s coronavirus response,” Caputo said.
Between the lines: Murtaugh deflected several times when asked whether there was a deliberate strategy to marginalize the CDC and the experts: “The President and the White House have consistently advised Americans to follow CDC guidelines. The President also believes we can open schools safely on time and that we must do so.”
However, one administration official said there were parts of the CDC school reopening guidelines that were impractical, and noted that kids can also suffer long-term harm by staying out of school too long.
Our thought bubble, by Axios White House reporter Alayna Treene: The responses make it clear that the White House and the Trump campaign don’t want to advance the narrative that they’re deliberately battling with America’s health experts, or that there’s any kind of strategy behind it.
The bottom line: When the history of this pandemic is written, it will show that the public health experts who were trying to fight it also had to deal with political fights that made their jobs harder.
Tensions between the White House and Anthony Fauci, the government’s top infectious diseases expert, are spilling into the open as officials openly attack the doctor for his public health advice during the coronavirus pandemic.
Fauci’s advice has often run contrary to President Trump’s views, and the attacks on Fauci have begun to look like a traditional negative political campaign against an opponent. Yet this time, the opponent is a public health expert and career civil servant working within the administration.
Dan Scavino, deputy chief of staff for communications, shared a cartoon on his Facebook page late Sunday that depicted Fauci as a faucet flushing the U.S. economy down the drain with overzealous health guidance to slow the spread of the pandemic.
The cartoon, which shows Fauci declaring schools should remain closed and calling for “indefinite lockdowns,” did not accurately portray what Fauci has advised in public.
Adm. Brett Giroir, the administration’s testing czar, downplayed any riff within the White House coronavirus task force before offering some criticism of Fauci.
“I respect Dr. Fauci a lot, but Dr. Fauci is not 100 percent right and he also doesn’t necessarily, and he admits that, have the whole national interest in mind,” Giroir told “Meet the Press” on Sunday. “He looks at it from a very narrow public health point of view.”
There have been tensions between Trump and Fauci throughout the pandemic. The president has repeatedly downplayed the severity of the virus, broken with the advice of his own public health experts and painted rosy but at times misleading pictures of the U.S. response. Fauci, who has served four decades in his current post, has offered blunt talk on the dangers of the pandemic that has directly contradicted the president from time to time.
But the latest criticisms mark a shift as the White House has begun publicly undermining one of the leading public health voices in the administration at a time when multiple states are struggling to get new outbreaks under control.
White House trade adviser Peter Navarro, whom the president tapped to manage the use of the Defense Production Act, said he personally proceeds with caution before heeding Fauci’s advice.
Trump said last week that Fauci is a nice man but that he’s “made a lot of mistakes.”
A White House official this weekend sent media outlets a lengthy list of “mistakes” Fauci has made since the pandemic began, like his comment in March that there is no need for people to wear masks.
That comment came before scientists knew people could spread the virus without showing symptoms, and Fauci, the Centers for Disease Control and Prevention (CDC) and other experts now urge people to use face coverings in public.
Public health experts have leaped to Fauci’s defense on Twitter, noting that Fauci is one of the most respected health experts in the world, having worked for six presidents and researched HIV/AIDS, Ebola, Zika and a variety of other infectious diseases.
“When studies show that, opposite from SARS & MERS, COVID19 is most infectious soon after infection & less infectious later, we recognize asymptomatic transmission and importance of masks,” tweeted Tom Frieden, the former director of the CDC.
“That’s called science, not a mistake. The real, deadly mistake is not listening to science.”
Ashish Jha, director of the Harvard Global Health Institute, tweeted, “His track record isn’t perfect. It’s just better than anyone else I know.Sidelining Dr. Fauci makes the federal response worse. And it’s the American people who suffer.”
Polls still show the public trusts Fauci more than Trump for accurate information on the virus, with Democrats more likely than Republicans to believe the infectious diseases expert.
White House press secretary Kayleigh McEnany during a “Fox & Friends” interview Monday insisted Fauci’s recommendations were reaching Trump, while saying he represented only “one viewpoint” among many considered by the president.
“The point of the task force is to be a whole of government look at what is best for this country,” McEnany said when asked about the status of the relationship between Trump and Fauci. “Dr. Fauci is one member of a team, but rest assured, his viewpoint is represented and the information gets to the president through the task force.”
Still, Fauci’s public appearances became few and far between as his dire warnings about the state of the pandemic in the U.S. increasingly clashed from more hopeful messages coming from the White House.
Fauci also told the Financial Times last week that he hadn’t briefed Trump in two months, in which time a growing number of states have experienced significant surges in cases.
Fauci was not present at the White House coronavirus task force media briefing last week, events that have become rarer even as the COVID crisis grows worse.
And while he was a regular on cable news in the early days of the pandemic, his appearances have dwindled, a fact he said last week could be because of his “honesty.”
While Fauci has warned that the U.S. could hit 100,000 new COVID-19 cases per day if steps aren’t taken to alter the trajectory of the outbreaks, Trump has tied the rise in cases to increased testing.
While Fauci attributed outbreaks in some states to reopening too quickly after the spring lockdowns, Trump and his top allies have mostly stood by their decision to push governors to jump over checkpoints set by the White House.
Fauci has refuted the president’s claims that the rise in cases is solely tied to increased testing and that 99 percent of cases are “totally harmless.”
And as Trump touted a falling COVID-19 death rate, which is actually now increasing, Fauci has said the U.S. shouldn’t take comfort in the “false narrative,” noting the disease can cause other severe health outcomes.
Fauci’s warnings grew more urgent last week when he warned that the U.S. is “facing a serious problem” and the pandemic has become politicized.
“And you know from experience historically that when you don’t have unanimity in an approach to something, you’re not as effective in how you handle it,” Fauci said in an interview with FiveThirtyEight. “So I think you’d have to make the assumption that if there wasn’t such divisiveness, that we would have a more coordinated approach.”
The coronavirus is still killing as many as 1,000 Americans per day — but the Trump administration isn’t saying much about it.
It’s been more than a month since the White House halted its daily coronavirus task force briefings. Top officials like infectious disease expert Anthony Fauci have largely disappeared from national television — with Fauci making just four cable TV appearances in May after being a near fixture on Sunday shows across March and April — and are frequently restricted from testifying before Congress. Meanwhile, President Donald Trump is preparing to resume his campaign rallies after a three-month hiatus, an attempted signal to voters that normalcy is returning ahead of November’s election, and that he’s all but put the pandemic behind him.
“We’ve made every decision correctly,” Trump claimed in remarks in the Rose Garden Friday morning. “We may have some embers or some ashes or we may have some flames coming, but we’ll put them out. We’ll stomp them out.”
Inside the White House, top advisers like Jared Kushner privately assured colleagues last month that the outbreak was well in hand — citing data on declines in community spread — and that the long-feared “second wave” may have even been averted, according to three current and former officials.
However, new data from states like Florida and mass protests across the country are renewing concerns about the virus’s spread. Texas, for instance, has reported two straight days of record-breaking coronavirus hospitalizations — highs that come shortly after the state kicked off the third stage of its reopening plan.
Those officials also acknowledge that the Covid-19 task force has scaled back its once-daily internal meetings — the task force now meets twice per week —but insist that the pandemic response remains a priority. One official with direct knowledge of the administration’s strategy cited efforts to scale up testing, accelerate the development of treatments and vaccines and perform other behind-the-scenes work to get ready for a potential fall surge.
“We’re delivering the supplies and resources that states asked for,” said the official. “This doesn’t need to be the public ‘coronavirus show’ every day anymore.”
“You can’t win,” said a senior administration official. “Some people complained for weeks that ‘we don’t want so much White House involvement,’ and that ‘the President should stop doing daily briefings,’ and then they turn around and complain that there aren’t enough or as many briefings.”
But the White House’s apparent eagerness to change the subject comes as new coronavirus clusters — centered around meatpacking plants, prisons and other facilities — drive spikes in disparate states like Utah and Arkansas. Meanwhile, states and major cities are lifting lockdowns and reopening their economies, prompting public health experts to fret that additional outbreaks are imminent. And several Democratic governors also have defied their own states’ social distancing restrictions to join mass protests over police brutality, where hundreds of thousands of Americans have spilled into the streets, further raising public health risks.
The fear is that all the mixed signals will only confuse people, stoke public skepticism over the health threat and promote the belief the worst is over just as the outbreak enters a dangerous new phase.
“Cases are rising, including from cases in congregate settings,” said Luciana Borio, who led pandemic preparedness for the National Security Council between 2017 and 2019. “We still have a pandemic.”
Nine current and former administration officials, as well as outside experts, further detailed how the White House is steadily ramping down the urgency to fight a threat that continues to sicken more than 100,000 Americans per week and is spiking in more than 20 states.
For instance, the administration in recent days told state health officials that it planned to reorganize its pandemic response, with HHS and its agencies taking over the bulk of the day-to-day responsibilities from the Federal Emergency Management Agency.
“The acuity of the response is not what it was, so they’re trying to go back to a little more of a normal ongoing presence,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials.
The coronavirus task force, which used to send daily updates to state officials, has done so with less regularity over the last several weeks, Plescia said. And the CDC has restructured its daily conference calls with states, moving away from the practice of giving top-down briefings to encouraging state officials to offer updates on what they’re seeing in their parts of the country.
One current and one former FEMA official also said they’re keen to have HHS resume its leadership role in containing the coronavirus so FEMA can make contingencies for a summer of hurricanes, floods and other natural disasters.
“Given the likelihood that we will soon see both hurricanes and coronavirus, HHS should manage the ongoing pandemic response so FEMA can prepare for coming ‘coronacanes,’” Daniel Kaniewski, who served as the top deputy at FEMA through January, wrote last week. “But they need to act soon. Coronacanes are in the forecast.”
Meanwhile, officials in at least 19 states have recorded two-week trends of increasing coronavirus cases, including spikes of more than 200 percent in Arizona and more than 180 percent in Kentucky. Two months after the White House issued so-called gating criteria that it recommended states hit before resuming business and social activities, only a handful of states — like Connecticut, New Jersey, New York and South Dakota — currently meet all of those benchmarks, according to CovidExitStrategy.org.
Officials within Trump’s health department are strategizing over how to convey the current level of risk, given data that Americans have put off emergency care and other potential medical needs, fearful of contracting Covid-19. “Our message now is that people should start returning to their health care providers to get the screenings, vaccines, care, or emergency services that they need,” Laura Trueman, the HHS official in charge of external affairs, wrote in an office-wide email to colleagues and shared with external groups on June 3, which was obtained by POLITICO.
Dan Abel, a longtime Coast Guard vice admiral, also has been installed at HHS with a small team, where he’s coordinating daily Covid-19 calls with HHS Secretary Alex Azar and the department’s division leaders, according to four officials with knowledge of the calls — an arrangement that’s raised some questions.
“Why is a Coast Guard admiral leading meetings between the HHS secretary and his senior staff?” asked one senior official, suggesting it created an unnecessary layer of management.
Meanwhile, the department is steadily turning back to its many pre-Covid-19 priorities. At the Food and Drug Administration, officials are returning to hot-button issues like tobacco and CBD regulations. Some staff in the health department’s emergency response arm are pivoting away from Covid-19 and back toward natural disasters as hurricane season begins.
At the same time, the Centers for Disease Control — traditionally the beating heart of the nation’s infectious disease response — remains largely demoralized and often sidelined in fighting what CDC director Robert Redfield last week acknowledged as the nation’s biggest health challenge in more than a century, and one he said is “moving through our social consciousness, our outward expression, and our grief.” That grim message has conflicted with Trump’s frequent vows of victory over the coronavirus.
“We were able to close our country, save millions of lives, open,” Trump said in Friday’s Rose Garden remarks. “And now the trajectory is great.”
“I fully recognize the anguish our Nation is experiencing & am deeply saddened by the many lives lost to COVID19,” Redfield tweeted just minutes later. “I call upon the American people to remain vigilant in protecting the vulnerable – protect your community, grandparents and loved ones from COVID-19.”
Redfield and other top officials also have spent the past week reckoning with the implications of widespread protests over police brutality, from meeting with staff to discuss longstanding concerns about systemic racism in health care to acknowledging the probability that those protests will spark new outbreaks.
HHS also on Monday sent members of Congress a fact sheet on its response to racial disparities in Covid-19 care — a much scrutinized issue in public health, with African Americans contracting and dying from the virus at much higher rates.
But on Capitol Hill, watchdogs say that fact sheets don’t cut it, and they’re frustrated by the lack of access to experts and insight into how the administration is handling a historic pandemic.
“Some are acting like the battle has been won when in reality it’s just beginning,” said a senior Democratic staffer. “The White House still won’t let task force members testify at hearings in June even though they have disappeared from TV and it’s not clear how often they are meeting.”
Fauci, meanwhile, has continued to issue a string of dire warnings in his lower-profile media appearances and at an industry conference on Tuesday.
“We have something that turned out to be my worst nightmare,” Fauci said in virtual remarks aired at a conference of the biotech industry’s Washington trade group, recounting how quickly the virus spread around the globe, outpacing Ebola and HIV. “And it isn’t over yet.”
The White House has maintained that chief of staff Mark Meadows has needed to clear officials like Fauci to testify, so they can stay focused on other priorities, and a spokesperson insisted that Trump has still prioritized the coronavirus fight even as the White House shifts toward focusing on revitalizing the economy.
Several officials have suggested that the task force’s lower profile has been helpful for the response, especially because the daily Covid-19 press briefings were often hijacked by Trump’s meandering remarks or the day’s other political news.
“In some ways, it actually has been easier to get Covid-related work done,” said one HHS staffer who’s helped support the Covid-19 response. “The task force briefings and the prep sessions for them took up a lot of principals’ time, and staff would sometimes have to crash on putting together materials for them.”
But the white-hot spotlight on the coronavirus also brought urgency and intensity, and the increasingly scattered nature of the current response could present new challenges if there’s an uptick in cases.
“This is when a one-government approach is needed more now than ever,” said Howard Koh, who served as President Barack Obama’s HHS assistant secretary for health. “Get all those people together in one room every day at the highest level and track outcomes and address all the questions and try to maximize coordination as much as possible.”
President Trump said Friday the U.S. would halt its funding of the World Health Organization and pull out of the agency, accusing it of protecting China as the coronavirus pandemic took off. The move has alarmed health experts, who say the decision will undermine efforts to improve the health of people around the world.
In an address in the Rose Garden, Trump said the WHO had not made reforms that he said would have helped the global health agency stop the coronavirus from spreading around the world.
“We will be today terminating our relationship with the World Health Organization and redirecting those funds to other worldwide and deserving urgent global public health needs,” Trump said. “The world needs answers from China on the virus.”
It’s not immediately clear whether the president can fully withdraw U.S. funding for the WHO without an act of Congress, which typically controls all federal government spending. Democratic lawmakers have argued that doing so would be illegal, and House Speaker Nancy Pelosi threatened last month that such a move would be “swiftly challenged.”
The United States has provided roughly 15% of the WHO’s total funding over its current two-year budget period.
The WHO has repeatedly said it was committed to a review of its response, but after the pandemic had ebbed. Last month, Robert Redfield, the director of the Centers for Disease Control and Prevention, also said the “postmortem” on the pandemic should wait until the emergency was over.
As the Trump administration’s response to pandemic has come under greater scrutiny, with testing problems and a lack of coordination in deploying necessary supplies, Trump has sought to cast further blame on China and the WHO for failing to snuff out the spread when the virus was centered in China.
During his remarks, Trump alleged, without evidence, that China pressured WHO to mislead the world about the virus. Experts say that if the U.S. leaves the WHO, the influence of China will only grow.
“The world is now suffering as a result of the malfeasance of the Chinese government,” Trump said. “China’s coverup of the Wuhan virus allowed the disease to spread all over the world, instigating a global pandemic that has cost more than 100,000 American lives, and over a million lives worldwide.” (That last claim is not true; globally, there have been about 360,000 confirmed deaths from Covid-19, the disease caused by the coronavirus.)
When Trump earlier this month threatened to yank U.S. funding in a letter, Tedros Adhanom Ghebreyesus, the WHO director-general, would only say during a media briefing that the agency was reviewing it. But he and other officials stressed that the agency had a small budget — about $2.3 billion every year — relative to the impact the agency had and what it was expected to do.
Mike Ryan, head of the WHO’s emergencies program, said the U.S. funding provided the largest proportion of that program’s budget.
“So my concerns today are both for our program and … working on how we improve our funding base for WHO’s core budget,” Ryan said. “Replacing those life-saving funds for front-line health services to some of the most difficult places in the world — we’ll obviously have to work with other partners to ensure those funds can still flow. So this is going to have major implications for delivering essential health services to some of the most vulnerable people in the world and we trust that other donors will if necessary step in to fill that gap.”
But a Vox analysis suggests that most states haven’t made the preparations needed to contain future waves of the pandemic — putting themselves at risk for a rise in Covid-19 cases and deaths should they continue to reopen.
Experts told me states need three things to be ready to reopen.State leaders, from the governor to the legislature to health departments, need to ensure the SARS-CoV-2 virus is no longer spreading unabated. They need the testing capacity to track and isolate the sick and their contacts. And they need the hospital capacity to handle a potential surge in Covid-19 cases.
More specifically, states should meet at least five basic criteria. They should see a two-week drop in coronavirus cases, indicating that the virus is actually abating. They should have fewer than four daily new cases per 100,000 people per day — to show that cases aren’t just dropping, but also below dangerous levels. They need at least 150 new tests per 100,000 people per day, letting them quickly track and contain outbreaks. They need an overall positive rate for tests below 5 percent — another critical indicator for testing capacity. And states should have more than 40 percent of their ICU beds free to actually treat an influx of people stricken with Covid-19 should it be necessary.
These metrics line up with experts’ recommendations, as well as the various policy plans put out by both independent groups and government officials to deal with the coronavirus.
Meeting these metrics doesn’t mean that a state is ready to reopen its economy — a process that describes a wide range of local and state actions. And failing them doesn’t mean a state is in immediate danger of a coronavirus outbreak if it starts to reopen; with Covid-19, there’s always an element of luck and other factors.
But with these metrics, states can gauge if they have repressed the coronavirus while building the capacity to contain future outbreaks should they come. In other words, the benchmarks show how ready states are for the next phase of the fight.
So far, most states are not there. As of May 27, just three states — Alaska, Kentucky, and New York — met four or five of the goals, which demonstrates strong progress. Thirty states hit two or three of the benchmarks. The other 17, along with Washington, DC, achieved zero or one.
Even the states that have made the most progress aren’t necessarily ready to safely reopen. There’s a big difference between Alaska — which has not suffered from a high number of coronavirus cases — and New York, and no expert would say that all of New York is ready to get back to normal.
Nor do the metrics cover everything that states should do before they can reopen. They don’t show, for example, if states have the capacity to do contact tracing, in which people who came into contact with someone who’s sick with Covid-19 are tracked down by “disease detectives” and quarantined. Contact tracing is key to containing an epidemic, but states don’t track how many contact tracers they’ve hired in a standardized, readily available way.
They also don’t have ready data for health care workers’ access to personal protective equipment, such as masks and gloves — a critical measure of the health care system’s readiness that is difficult to track.
But the map gives an idea of how much progress states have made toward containing the coronavirus and keeping it contained.
States will have to follow these kinds of metrics as they reopen. If the numbers — especially coronavirus cases — go in the wrong direction again, experts said governments should be ready to bring back restrictions. If states move too quickly to reopen or respond too slowly to a turn for the worse, they could see a renewed surge in Covid-19 cases.
“Planning for reclosing is part of planning for reopening,” Mark McClellan, a health policy expert at Duke, told me. “There will be outbreaks, and there will be needs for pauses and going back — hopefully not too much if we do this carefully.”
So this will be a work in progress, at least until we get a Covid-19 vaccine or the pandemic otherwise ends, whether by natural or human means. But the metrics can at least help give states an idea of how far along they are in finally starting to open back up.
Goal 1: A sustained two-week drop in coronavirus cases
What’s the goal? A 10 percent drop in daily new coronavirus cases compared to two weeks ago and a 5 percent drop in cases compared to one week ago, based on data from the New York Times.
Which states meet the goal? Colorado, Connecticut, Delaware, Hawaii, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Missouri, Nebraska, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, and Texas — 17 states in all. Washington, DC, did as well.
Why is this important? Guidance from the White House and several independent groups emphasize that states need to see coronavirus cases drop consistently over two weeks before they can say they’re ready to begin reopening. After all, nothing shows you’re out of an outbreak like a sustained reduction in infections.
“The first and foremost [metric] is you want to have a continued decrease in cases,” Saskia Popescu, an infectious disease epidemiologist, told me. “It’s a huge piece.”
A simple reduction in cases compared to two weeks prior isn’t enough; it has to be a significant drop, and it has to be sustained over the two weeks. So for Vox’s map, states need at least a 10 percent drop in daily new cases compared to two weeks prior and at least a 5 percent drop compared to one week prior.
Reported cases can be a reflection of testing capacity: More testing will pick up more cases, and less testing will pick up fewer. So it’s important that the decrease occur while testing is either growing or already sufficient. And since states have recently boosted their testing abilities, increases in Covid-19 cases can also reflect improvements in testing.
Even after meeting this benchmark, continued caution is warranted. If a state meets the goal of a reduction in cases compared to one and two weeks ago but cases seemed to go up in recent days, then perhaps it’s not time to reopen just yet. “You have to use common sense,” Cyrus Shahpar, a director at the public health policy group Resolve to Save Lives, told me.
For states with small outbreaks, this goal is infeasible. Montana has seen around one to two new Covid-19 cases a day for several weeks. Getting that down to zero would be nice, but the current level of daily new cases isn’t a big threat to the whole state. That’s one reason Vox’s map lets states meet four or five of the five goals — in case they miss one goal that doesn’t make sense for them but hit others.
Still, the two-week reduction in cases is the most cited by experts and proposals to ease social distancing.
Goal 2: A low number of daily new Covid-19 cases
What’s the goal? Fewer than four daily new coronavirus cases per 100,000 people per day, based on data from the New York Times and Census Bureau.
Which states meet the goal? Alaska, Florida, Hawaii, Idaho, Kentucky, Maine, Michigan, Missouri, Montana, Oklahoma, Oregon, South Carolina, Texas, Vermont, Washington, West Virginia, and Wyoming — 17 states.
Why is this important? One of the best ways to know you’re getting away from a disease outbreak is to no longer see a high number of daily new infections. While there’s no universally accepted number, experts said that four daily new coronavirus cases per 100,000 people is a decent ceiling.
“If I go from one to two to three [coronavirus cases a day], it’s different than going from 1,000 to 2,000 to 3,000, even though the percent difference is the same,” Shahpar said. “That’s why you have to take into account the overall level, too.”
This number can balance out the shortcomings in other metrics on this list. For example, New York — which has suffered the worst coronavirus outbreak in the country — has seen its reported daily new coronavirus cases drop for weeks, meeting the goal of a sustained drop in cases. But since that’s coming down from a huge high, even a month of sustained decreases may not be enough. New York has to make sure it falls below a threshold of new cases, too.
At the same time, if your state is now below four daily new cases per 100,000 but it’s seen a recent uptick in cases, that’s a reason for caution. New York, after all, saw just a handful of confirmed coronavirus cases before an exponential explosion of the disease took the state to thousands of new cases a day.
But if your state is below the threshold, it’s in a pretty solid place relative to most other states.
Which states meet the goal? Alaska, Connecticut, Delaware, Georgia, Illinois, Louisiana, Nevada, New Jersey, New Mexico, New York, North Dakota, and Rhode Island — for a total of 12 states.
Why is this important? Since the beginning of the coronavirus pandemic, experts have argued that the US needs the capacity for about 500,000 Covid-19 tests a day. Controlling for population, that adds up to about 150 new tests per 100,000 people per day.
Testing is crucial to getting the coronavirus outbreak under control. When paired withcontact tracing, testing lets officials track the scale of the outbreak, isolate the sick, quarantine those the sick came into contact with, and deploy community-wide efforts as necessary. Testing and tracing are how other countries, like South Korea and Germany, have managed to control their outbreaks and started to reopen their economies.
The idea, experts said, is to have enough surveillance to detect embers before they turn into full wildfires.
“States should be shoring up their testing capacity not just for what it looks like right now while everyone’s in their homes, but as people start to move more,” Jen Kates, the director of global health and HIV policy at the Kaiser Family Foundation, told me. “As people start doing more movement, you’ll have to test more, because people are going to come into contact with each other more.”
This goal is supposed to be for diagnostic tests, not antibody tests. Diagnostic tests gauge whether a person has the virus in their system and is, therefore, sick right at the moment of the test. Antibody tests check if someone ever developed antibodies to the virus to see if they had ever been sick in the past. Since diagnostic tests give a more recent gauge of the level of infection, they’re seen as much more reliable for evaluating the current state of the Covid-19 outbreak in a state.
But some states have included antibody tests in their overall counts. Experts said states shouldn’t do this. But since the data they report and the Covid Tracking Project collects is the best testing data we have, it’s hard to tease out how much antibody tests are skewing the total.
In particular, Georgia’s data suggested it met the goal of 150 daily tests per 100,000 people, but the state only started separating antibody tests from its total after the data was collected. Without the antibody tests, Georgia very likely wouldn’t meet the goal.
Some states’ numbers, like Missouri’s, also may appear significantly worse than they should due to recent efforts to decouple diagnostic testing data from antibody testing data, which can temporarily warp the overall test count.
“The virus isn’t going to care whether they were manipulating the numbers or not in order to look more favorable; it’s going to continue to spread,” Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, told me. “It’s better to really understand what’s going on and report that accurately.”
For states honestly reporting these numbers, though, they’re a critical measure of their ability to detect, control, and contain coronavirus outbreaks.
Goal 4: A low test-positive rate
What’s the goal? Below 5 percent of coronavirus tests coming back positive over the past week, based on data from the Covid Tracking Project.
Which states meet the goal? Alaska, California, Florida, Georgia, Hawaii, Kentucky, Louisiana, Maine, Michigan, Montana, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, West Virginia, and Wyoming — for a total of 23 states.
Why is this important? The positive or positivity rate, which tracks how many tests come back positive for Covid-19, is another way to measure testing capacity.
Generally, a higher positive rate suggests there’s not enough testing happening. An area with adequate testing should be testing lots and lots of people, many of whom don’t have the disease or don’t show severe symptoms. The positive testing rate in South Korea, for example, is below 2 percent. High positive rates indicate only people with obvious symptoms are getting tested, so there’s not quite enough testing to match the scope of an outbreak.
The positive rate data is subject to the same limitations as the overall testing data from the Covid Tracking Project. So if a state includes antibody tests in its test count, it could skew the positive rate to look better than it is. States only risk hurting themselves if they do this.
Which states meet the goal? Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming — for a total of 30 states.
Why is this important? If a pandemic hits, the health care system needs to be ready to treat the most severe cases and potentially save lives. That’s the key goal of “flattening the curve” and “raising the line,” in which social distancing helps reduce the spread of the disease so the health care system can maintain and grow its capacity to treat an influx of Covid-19 patients.
“There’s this idea that in six weeks we can open more things,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “But the virus is still there. It’s all about making sure that the case count isn’t too immense for our hospital system to deal with.”
The aim is to avoid the nightmare scenario that Italy went through when it had more Covid-19 cases than its health care system could handle, leading to hospitals turning away even dangerously ill patients.
To gauge this, experts recommended looking at ICU capacity, with states aiming to have less than 60 percent occupancy in their ICUs.
A big limitation in the metric: It’s based on data collected by the Centers for Disease Control and Prevention of only some hospitals in each state. So it might not be fully representative of hospital capacity throughout an entire state. But it’s the best current data available, and it suggests that the majority of states meet that standard.
That’s extremely good news. It shows that America really has flattened the curve, at least for now. But it’s done that so far through extreme social distancing. If the next step is to keep the curve flattened while easing restrictions, that will require meeting the other metrics on this list.
Hitting the benchmarks is the beginning, not the end
Vox’s map is just one way of tracking success against the coronavirus. Other groups have come up with their own measures, including Covid Act Now, Covid Exit Strategy, and Test and Trace. Vox’s model uses more up-to-date data than some of these other examples, while focusing not just on the state of the pandemic but states’ readiness to contain Covid-19 outbreaks in the future.
Very few states hit all the marks recommended by experts. But even those that do shouldn’t consider the pandemic over. They should continue to improve — for example, getting the positive rate below even 1 percent, as in New Zealand — and look at even more granular metrics, such as at the city or county level.
Meeting the benchmarks, however, indicates a state is better equipped to contain future coronavirus outbreaks as it eases previous restrictions.
Experts emphasized that states have to keep hitting all these goals week after week and day after day — Covid-19 cases must remain low, testing ability needs to stay high, and hospital capacity should be good enough for an influx of patients — until the pandemic is truly over, whether thanks to a vaccine or other means. Otherwise, a future wave of coronavirus cases, as seen in past pandemics, could kill many more people.
“You need to have all the metrics met,” Popescu said. “This needs to be a very incremental, slow process to ensure success.”
And if the numbers do start trending in the wrong direction, states should be ready to shut down at least some parts of the economy again. Maybe not as much as before, as we learn which places are truly at risk of increasing spread. But experts caution that future shutdowns will likely be necessary to some extent.
“I do worry we’re going to see surges of cases and hot spots,” Watson said. “We do need to keep pushing on building those capacities. … Otherwise, we’re just rolling the dice on the spread of the virus. It’s better if we have more control of the spread.”
That’s another reason these metrics, along with broader coronavirus surveillance, are so important: They not only help show how far along states are in dealing with their current Covid-19 outbreaks, but will help track progress to stop and prevent future crises as well.
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HENRY KOTULA 