Group items tagged

A dark portrait of a vulnerable homeland – impotent against Islamic State militants, susceptible against undocumented refugees and isolated in a world of fraying alliances –

military strikes against ISIS targets should be less concerned about “civilian casualties.”

Ted Cru

the disastrous war McCain celebrated, should be blamed on President Obama’s foreign policy.

The one reaction nearly every Republican candidate agreed on is a refusal to accept Syrian refugees – as if the real lesson of the Paris attacks is feeling less sympathy for ISIS’s victims

the Republican’s rush toward “stop letting in refugees” is reminiscent of “the ‘travel ban now or we all die of Ebola’ fad of last year.”

But there’s also the unnerving track record of many Republican officials – including would-be presidents – who seem to fall to pieces every time there’s a crisis

The GOP’s responses to Friday night’s bloodshed was a discouraging reminder of a party that still doesn’t know what to do or say when mature leadership is required

Researchers believe the incubation period before symptoms is roughly five days on average. In studying the pattern of illness, epidemiologists have made the dismaying discovery that people start shedding the virus — potentially making others sick — in advance of symptoms.

The bulldozer nature of coronavirus means widespread severe illnesses and deaths from covid-19 can happen with terrifying speed.

a large percentage of the world’s population, potentially billions of people, could become infected within the next couple of years. Frantic efforts to develop a safe and effective vaccine are likely to take a year or more.

covid-19 may be many times as lethal for an infected person as seasonal flu.

the virus has a gift for stealth transmission. It seeds itself in communities far and wide,

But on Jan. 23, China imposed extreme travel restrictions and soon put hundreds of millions of people into some form of lockdown as authorities aggressively limited social contact. The R0 plummeted below 1, and the epidemic has been throttled in China, at least for now.

R0, pronounced “R naught.” That is the average number of new infections generated by each infected person.

he R0 is not an intrinsic feature of the virus. It can be lowered through containment, mitigation and ultimately “herd immunity,”

In the early days in China, before the government imposed extreme travel restrictions in Wuhan and nearby areas, and before everyone realized exactly how bad the epidemic might be, the R0 was 2.38, according to a study published in the journal Science. That is a highly contagious disease.

The pandemic appears to be largely driven by direct, human-to-human transmission. That is why public health officials have told people to engage in social distancing

its ability to spread depends also on the vulnerability of the human population, including the density of the community.

Without a vaccine or a drug to stop infections, the best hope is to break the chain of transmission one infection at a time

“Social distancing is building speed bumps so that we can slow the spread of the virus. We have to respect the speed bumps,”

the efficacy of social distancing “is the million-dollar question right now.”

She compared the current public measures to what happened during the 1918 influenza pandemic that killed an estimated 675,000 people in the United States, and in which some cities were more careful than others about enforcing social distancing.

“The USA is currently in a natural experiment of sorts, which each state implementing their own version of social distancing,” she said. “We will be able to compare the efficacy of these various public health policies, but not until more time has passed.”

Not only must people limit their direct contact, they need to limit the amount that their paths overlap, because the virus can linger on surfaces.

The virus degrades outside a host because of exposure to moisture and sunlight, or from drying out

in pristine laboratory conditions, some SARS-CoV-2 particles can remain potentially viable on metal or plastic for up to three days.

Absent hard data, limiting contact with shared surfaces, such as door handles or checkout machines, and frequent hand-washing is highly advisable.

people have some innate, mechanical defenses against viruses just like they do against pollen and dust, Taubenberger noted. Cells in the respiratory tract have tiny hairlike projections, called cilia, that move mucus toward the throat in a manner that helps clear invasive particles. This is not our body’s first viral rodeo.

The plan was published Sunday by the American Enterprise Institute. Its lead author — Scott Gottlieb, former Food and Drug Administration commissioner in the Trump administration

“The goal is to outline a plan that will allow a gradual return to a more normal way of life without increasing the risk” that the epidemic will resurge.

Most economists and health experts say there is no way to restart the economy without addressing the underlying problem of the coronavirus. As long as the pandemic continues to spread, the markets will be in turmoil and any businesses will struggle to stay open, they say.

instead of giving false reassurances and deadlines, the White House should tell people the hard truth about the current situation and a coherent strategy they can work toward. “The social distancing, being stuck at home, the deaths we’re going to be seeing. People want to know what it’s for. That there’s a plan.”

the road map Gottlieb’s group outlined stresses the need to move away from the current decentralized system and “toward more coordinated execution of response.”

The plan divides coming months into four phases and sets “triggers” for states to move from one phase to the next.

The latest proposal is a 19-page plan with a step-by-step timeline, with clear benchmarks states and regions would need to meet to safely move forward to the next step

With most of the nation now in phase one of the epidemic, the goal should be a sharp increase in hospital critical care beds and an increase of testing to 750,000 people a week to track the epidemic — a number Gottlieb said could be achieved in the next week or two.

For a state to move to phase two, it should see a sustained reduction in new cases for at least 14 days, and its hospitals need to be able to provide care without being overwhelmed.

“The reason we set it at 14 days is that’s the incubation period of the virus,” said Rivers of Johns Hopkins. “That way you know the downward trend is certain and not because of a holiday or blip or some other delay in reported cases.”

States that have moved into phase two would begin gradually lifting social distancing measures and opening schools and businesses, while increasing surveillance.

The key goals thereafter would be accelerating the development of new treatments and deploying tests to determine who has recovered from infection with some immunity and could rejoin the workforce.

Phase 3 occurs when the nation has a vaccine or drugs to treat covid-19 in place and the government launches mass vaccinations

For weeks, World Health Organization officials have stressed such lockdowns are only helpful for slowing down the virus and buying time to deploy more targeted and comprehensive measures, which the U.S. has not yet done.

Trump has repeatedly returned to strategies of bans and movement restriction

Phase 4 involves rebuilding the nation’s capacity to deal with the next pandemic by building up its scientific and public health infrastructure.

Mike Ryan, WHO head of emergency programs, recently urged countries to focus on finding and isolating infected people and their contacts. “It’s not just about physical distancing, it’s not just about locking down,”

Many experts’ recent proposals for a U.S. strategy have similar stressed the importance of large-scale contact tracing — because it was a cornerstone for successful efforts like South Korea and Singapore.

as countries have shown success with it against this coronavirus, that thinking has changed.

such contact tracing is “impractical now in many places but more practical once case numbers have been reduced and testing scaled up” and “could alleviate the need for stringent social distancing to maintain control of the epidemic.”

Rapidly building up that capacity — either with community volunteers or short-term hires — will be crucial in coming months, said Rivers of Johns Hopkins. “If you build capacity up and bring cases down, it starts looking a lot more possible.”

Many proposals tackle the problem of the tanking economy.

Gottlieb-Johns Hopkins plan, for example, calls for widespread use of blood tests to identify people who have had the infection and now are immune — called serology testing

People who are immune could return to work, or take on high-risk roles in the health care system and help people, especially the elderly, who are still quarantined at home.

Such serology tests have not been deployed before like this on such a large scale

during Ebola outbreaks in Africa, survivors were often the ones who provided care, watched over the children of sick patients and buried the dead.

One challenge unaddressed by most proposals and op-eds, however, is how to get such detailed plans adopted by the White House, whose response has weighed down by infighting and unclear leadership ping-ponging in recent weeks among Trump, Pence and health advisers like Anthony S. Fauci and Deborah Birx and others.

Health officials and scientists involved in the federal response, especially from the Centers for Disease Control and Prevention, have fought to be heard while straining to avoid offending Trump, who bristles at being publicly contradicted, undercut or overshadowed by praise for ideas or people beside himself, according to people who spoke on the condition of anonymity about sensitive deliberations.

On Thursday, Trump unveiled a plan of his own, though scarce in detail. He said he planned to help communities ease their restrictions and reopen for business by using on “robust” surveillance and categorizing counties across America into three “risk levels” — low, medium and high. More details are likely in coming days, White House officials said.

I don't think that we are ready this time, but hopefully with our collective efforts we can be more ready next time," said Guang-Zhong Yang, founding editor of Science Robotics, one of the authors of the editorial and dean of the Institute of Medical Robotics at Shanghai Jiao Tong University.

It's one of many examples showing how robots could prevent human contact from spreading the virus.

Yang, who did not test positive for the virus, said some developed robotic technologies are already helping, like robots being used for disinfecting hospitals and surfaces like plastic, metal and glass where the virus can live for up to 72 hours.

And roboticists are realizing that some of the simplest tasks, which carry risk during pandemics, could be assumed by robots.

The authors of the editorial, consisting of robotics experts across the globe, identified key areas where robots could lend assistance that would remove humans from harm's way during a pandemic.

This includes disease prevention, diagnosis and screening, patient care and disease management.

Remote presence robots could also stand in the place of someone in a meeting, basically providing their presence through a video screen.

The pandemic is also highlighting a need for assistance and social robots to help those at home, especially the elderly.

Yang's work primarily focuses on surgical robots, which can be operated remotely. He thinks they could be used to help clinicians who are treating contagious patients in crowded ICU wards.

Roboticists don't want to see us in this situation again -- realizing the resources we need in the middle of a problem with limited methods of action.

Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.

etween 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected.

So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.

The current best estimate is that around 1% of those infected will die.

Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread

Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.

Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene

Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.

I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.

just as nations have insisted on building their own drones, their own stealth fighters and their own cyberweapons, they do not want to be beholden to a foreign power for access to the drugs that are needed in a crisis.

they do not say how, or more important, when. And many analysts recall what happened during the swine flu epidemic in 2009, when a company in Australia that was among the first to develop a single-dose vaccine was required to satisfy demand in Australia before fulfilling export orders to the United States and elsewhere.

“I would encourage everyone not to get into this trap of saying we have to get everything into our countries now and close the borders,” said Severin Schwan, the chief executive of the Swiss pharmaceutical company Roche. “It would be completely wrong to fall into nationalist behavior that would actually disrupt supply chains and be detrimental to people around the world.”

a vaccine remains at least 12 to 18 months away, both American officials and the leaders of major pharmaceutical companies say.

“Vaccines are injected into healthy people, so we need to ensure safety,” a process that takes time,

China has made clear it is looking for a national champion — an equivalent to the role that Huawei, a Chinese telecommunications giant, plays in the race to build 5G networks around the world. If the Huawei pattern holds, China could make deals to increase its influence over poorer or less developed countries, which might otherwise might not get affordable access to a vaccine.

There are already signs that China is using the moment for geopolitical advantage, delivering help to countries that once would have looked to Europe or the United States. Its decision to ship diagnostic kits to the Philippines, an ally of the United States, and to help Serbia was a leading indicator of what may come with drugs and vaccines, when they are available.

In the aftermath of the Ebola plague that flared across West Africa from 2014 to 2016, Norway, Britain and other mostly European countries as well as the Bill and Melinda Gates Foundation began contributing millions of dollars to a multinational organization, the Coalition for Epidemic Preparedness Initiatives, to fund vaccine research.

All of its funding agreements included provisions for equal access to assure that “appropriate vaccines are first available to populations when and where they are needed to end an outbreak or curtail an epidemic, regardless of ability to pay,” the organization said in a statement.

In the past two months, the coalition has funded research into eight of the most promising candidates to block the coronavirus — including CureVac, the Germany company.

Of course, presidents can and do marginally affect markets, especially Trump. His trade war was a negative for the markets; his corporate tax cut was a booster, at least for a blip. His shaky, chaotic response to the coronavirus probably contributed to the ongoing, huge sell-off. None of this contradicts the foolishness of linking your performance to a metric far outside of your control.

Does it matter to the bigger picture if Trump claims credit and gets blame for market swings?

think it does, and that Trump’s market fetish is a microcosm of a dynamic for which we’re paying a heavy price. It’s the replacement of any shred of concern for the quality of governance with vicious, partisan 24/7 politics

Trump’s stock market focus is a symptom of the broader problem with conservatives who, since Ronald Reagan, have defined governing as tax cuts for their donor base, deregulating industry, and the use of racial divisions and other types of identity politics to split the electorate.

When governance is replaced with this sort of self-dealing, government itself becomes incapable of heeding the many warnings that pandemic preparedness was essential

Instead, Trump shut down the Obama-era office set up after the Ebola epidemic. Its mission was “to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic.”

More broadly, when governance is disparaged and ignored, government is incapable of dealing with climate change, inequality, poverty or any of the challenges private markets cannot and will not take on

before the coronavirus pandemic, the ineptitude of team Trump wasn’t so clearly and dramatically tested.

If there’s a silver lining to the coronavirus, it is this. People — more pointedly, voters — need to understand in their guts that good governance isn’t just an essential function in a $22 trillion, globalized economy. It’s sometimes a matter of life and death.

But the pandemic has revealed a dearth of reliable data about the key parts of the nation’s health-care system now under assault. That leaves decision-makers operating in the dark

Given the limitations, The Washington Post assembled data to analyze the availability of the critical-care resources needed to treat severely ill patients who require extended hospitalization. The Post conducted a stress test of sorts on available resources, which revealed a patchwork of possible preparedness shortcomings in cities and towns where the full force of the virus has yet to hit and where people may not be following isolation and social distancing orders.

More than half of the nation’s population lives in areas that are less prepared than New York City, where in early April officials scrambled to add more ICU beds and find extra ventilators amid a surge of covid-19 patients.

To compare available resources across the country, The Post examined a year-long scenario in which the coronavirus would sicken 20 percent of U.S. adults, and about 20 percent of those infected would require hospitalization

Under that scenario, about 11 million adults would need hospitalization for nearly two weeks, and almost 2.5 million would require intensive care.

This level of hospitalization is considered by Harvard researchers to be a conservative outcome for the pandemic, while others have described it as severe.

about 76 million people, or 30 percent of the nation’s adult population, live in areas where the number of available ICU beds would not be enough to satisfy the demand of virus patients. The scenario for ventilator availability is even more dire: Nearly half of the adult population lives in regions where the demand would exceed the supply.

We need to know where our weapons are. We need to coordinate all of that,” said Retsef Levi, a Massachusetts Institute of Technology professor leading a health-care data initiative called the COVID-19 Policy Alliance. “This is a war.”

Kahn likened the task of evaluating the current readiness of the U.S. health-care system to peering into a dark room.

“We’re outside of it, and we’re all looking through different keyholes and seeing different aspects of it,” he said. “But there’s no way to just open the door and turn on the lights, because of how fragmented the data are. And that is a really, really depressing thing at all times, let alone during a pandemic, that we don’t have an ability to look at these things.”

Bergamo, as the ground zero of the Italian outbreak, was beset by ICU bed and ventilator shortages. “We think Italy may be the most comparable area to the United States, at this point, for a variety of reasons,” Vice President Pence said April 1 in a CNN interview.

The MIT research group, the COVID-19 Policy Alliance, has mapped high-risk areas in the United States where sudden spikes could inundate hospitals as the surge in northern Italy did.

In their U.S. analysis, MIT researchers considered several risk factors, including elderly population, high blood pressure and obesity.

The takeaway, the researchers said, is that across the nation, “micro-geographies” of individual Zip codes or small towns have the potential to generate surges of covid-19 patients that could overwhelm even the most-prepared hospitals.

Levi said nursing home populations should be prioritized for virus testing across the country, because outbreaks in such close quarters can rapidly sicken dozens of people, who then flood into area hospitals.

By The Post’s analysis, the general Seattle region would need all of its available ICU beds — plus a 15 percent increase — to handle an outbreak in which 20 percent of the population is infected with the coronavirus and 20 percent of those people need hospitalization. But the demand for ICU beds could be lower because the curve of infections in Washington appears to be flattening, according to officials.

The Society of Critical Care Medicine estimates that there are nearly 29,000 critical-care specialized physicians like Johnson who are trained to work in ICUs in the United States. Yet about half of all acute-care hospitals have no specialists dedicated to their ICUs. Because of the demands of treating covid-19 patients, the lack of dedicated physicians “will be strongly felt” through a lack of high-quality care, the society said in a statement.

The society also projects that the nurses, respiratory therapists and physician assistants specially qualified to work with ICU patients may be in short supply as patient demand increases and the ranks of medical workers are thinned by illness and quarantine.

what has the hospital been doing as a prevention epicenter in the four years between the Ebola epidemic and the emergence of the coronavirus pandemic?

“Drilling and preparing for it,” said Jorge Salinas, an infectious-disease physician working on the effort. “You may be preparing and training for 10 years and nothing happens. But if you don’t do that, when these pandemics do occur, you will not be prepared.”

Salinas said the pandemic has exposed the long-standing flaws in the nation’s “individualistic” health-care system, where hospitals look out for themselves. Electronic health-monitoring systems vary hospital to hospital. Supply tallies are kept in-house and generally not shared. To counter this in Iowa, he said, all hospitals have begun sharing daily information with state officials.

“The name of the game is solidarity,” Salinas said. “If we try to be individualists, we will fail.”

When his hospital asked for volunteers for a study of an emerging Covid-19 therapy, Dr. Planer was among the first to sign up. His blood carries an especially valuable quantity of antibodies, Dr. Donato said.

While there is no evidence that convalescent-plasma treatments can help with Covid-19, the technique has been used to fight other viruses, including Ebola, influenza and severe acute respiratory syndrome, or SARS.

Enthusiasm for the potential treatment grew after a paper published in the Journal of the American Medical Association on March 27 suggested that a small study of five critically ill patients in China had shown promising results.

The National Covid-19 Convalescent Plasma Project is a related effort that began several weeks ago as a clearinghouse for information and a way to match willing plasma donors with hospitals and doctors authorized to perform infusions.

In addition to being healthy and showing no signs of infection after testing positive for the virus, potential donors must satisfy all other requirements for giving blood.

we see the classic “Confucian values” (or “Asian values”) argument that has historically been deployed to explain everything from the economic success of East Asian nations to the prevalence of authoritarian single-party rule in Asia, and even, most recently, China’s supposed edge in AI research.

So, yeah, kudos to Taiwan for keeping its people safe, but here in America we’re going to do what we always do in a crisis—line up at a gun store and accuse the opposing political party of acting in bad faith. Not for us, those Asian values.

But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons

Taiwan’s self-confidence and collective solidarity trace back to its triumphal self-liberation from its own authoritarian past, its ability to thrive in the shadow of a massive, hostile neighbor that refuses to recognize its right to chart its own path, and its track record of learning from existential threats.

There is no doubt that in January it would have been difficult for the US to duplicate Taiwan’s containment strategy, but that’s not because Americans are inherently more ornery than Taiwanese

It’s because the United States has a miserable record when it comes to learning from its own mistakes and suffers from a debilitating lack of faith in the notion that the government can solve problems—something that dates at least as far back as the moment in 1986 when Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’”

The Taiwan-US comparison is the opposite of a clash of civilizations; instead, it’s a deathly showdown between competence and incompetence.

To be fair, there are some cultural aspects of East Asian societies that may work in Taiwan’s favor

There is undeniably a long tradition in East Asia of elevating scholars and experts to the highest levels of government,

The country’s president Tsai Ingwen, boasts a PhD from the London School of Economics, and the vice president, Chen Chien-jen, is a highly regarded epidemiologist

The threat of SARS put Taiwan on high alert for future outbreaks, while the past record of success at meeting such challenges seems to have encouraged the public to accept socially intrusive technological interventions.

First, and most important was Taiwan’s experience battling the SARS outbreak in 2003, followed by the swine flu in 2009

“Taiwan actually has a functioning democratic government, run by sensible, well-educated people—the USA? Not so much.”)

Taiwan’s commitment to transparency has also been critical

In the United States, the Trump administration ordered federal health authorities to treat high-level discussions on the coronavirus as classified material.

In Taiwan, the government has gone to great lengths to keep citizens well informed on every aspect of the outbreak, including daily press conferences and an active presence on social media

“Do not forget that Taiwan has been under China’s threat constantly,” wrote Wang Cheng-hua, a professor of art history at Princeton, “which has raised social consciousness about collective action. When the collective will supports government, then all of the strict measures implemented by the government make sense.”

Over the past quarter-century, Taiwan’s government has nurtured public trust by its actions and its transparency.

The democracy activists who risked their lives and careers during the island nation’s martial law era were not renowned for their willingness to accept government orders or preach Confucian social harmony

some of the current willingness to trust what the government is telling the people is the direct “result of having experienced the transition from an authoritarian government that lied all the time, to a democratic government and robust political dialogue that forced people to be able to evaluate information.”

Because of the opposition of the People’s Republic of China, Taiwan is not a member of the United Nations or the World Health Organization

“The reality of being isolated from global organizations,” wrote Tung, “also makes Taiwanese very aware of the publicity of its success in handling a crisis like this. The more coverage from foreign media, the more people feel confident in government policy and social mobilization.”

Given what we know about Taiwan’s hard-won historical experience, could the US have implemented a similar model?

The answer, sadly, seems to be no

it would be impossible for the US to successfully integrate a health care database with customs and travel records because there is no national health care database in the United States. “The US health care system is fragmented, making it difficult to organize, integrate, and assess data coming in from its various government and private-sector parts,”

more tellingly, continued Fidler, “the manner in which the United States has responded to Covid-19 demonstrates that the United States did not learn the lessons from past outbreaks and is struggling to cobble together a semblance of a strategy. ”

There’s where the contrast between the United States and Taiwan becomes most salient. The US is not only bad at the act of government but has actively been getting worse.

But Taiwan’s own success at building a functional democracy is probably the most potent rebuke to the Asian values thesis.

But over that same period, powerful political and economic interests in the US have dedicated themselves to undermining faith in government action, in favor of deregulated markets that have no capacity to react intelligently or proactively to existential threats.

And instead of learning from history, US leaders actively ignore it, a truth for which there could be no better symbolic proof than the Trump administration’s dismantling of the National Security Council pandemic office created by the Obama administration in the wake of the Ebola outbreak

Finally, instead of seeking to keep the public informed to the best of our ability, some of our political leaders and media institutions have gone out of their way to muddy the waters.

In Taiwan, one early government response to the Covid-19 outbreak was to institute a fine of $100,000 for the act of spreading fake news about the epidemic.

In the US the most popular television news network in the country routinely downplayed or misrepresented the threat of the coronavirus, until the severity of the outbreak became too large to ignore.

If there is any silver lining here, it’s that the disaster now upon us is of such immense scope that it could finally expose the folly of the structural forces that have been wreaking sustained havoc on American governmental institutions

So maybe we are finally about to learn that competence matters, that educated leaders are a virtue, and that telling the truth is a responsibility

Americans might have to learn this the hard way, like we did in Hong Kong and Singapore.”

We’re about to find out how hard it’s going to be. But will we learn?

On the present trajectory, it will kill, by late April, more Americans than Vietnam. Having earlier promised that casualties could be held near zero, Trump now claims he will have done a “very good job” if the toll is held below 200,000 dead.

The United States is on trajectory to suffer more sickness, more dying, and more economic harm from this virus than any other comparably developed country.

The loss of stockpiled respirators to breakage because the federal government let maintenance contracts lapse in 2018 is Trump’s fault. The failure to store sufficient protective medical gear in the national arsenal is Trump’s fault

That states are bidding against other states for equipment, paying many multiples of the precrisis price for ventilators, is Trump’s fault. Air travelers summoned home and forced to stand for hours in dense airport crowds alongside infected people? That was Trump’s fault too

Trump failed. He is failing. He will continue to fail. And Americans are paying for his failures.

The lying about the coronavirus by hosts on Fox News and conservative talk radio is Trump’s fault: They did it to protect him

The false hope of instant cures and nonexistent vaccines is Trump’s fault, because he told those lies to cover up his failure to act in time.

The severity of the economic crisis is Trump’s fault; things would have been less bad if he had acted faster instead of sending out his chief economic adviser and his son Eric to assure Americans that the first stock-market dips were buying opportunities.

The fact that so many key government jobs were either empty or filled by mediocrities? Trump’s fault. The insertion of Trump’s arrogant and incompetent son-in-law as commander in chief of the national medical supply chain? Trump’s fault.

sooner or later, every president must face a supreme test, a test that cannot be evaded by blather and bluff and bullying.

Ten weeks of insisting that the coronavirus is a harmless flu that would miraculously go away on its own? Trump’s fault again. The refusal of red-state governors to act promptly, the failure to close Florida and Gulf Coast beaches until late March? That fault is more widely shared, but again, responsibility rests with Trump: He could have stopped it, and he did not.

Those lost weeks also put the United States—and thus the world—on the path to an economic collapse steeper than any in recent memory.

It’s a good guess that the unemployment rate had reached 13 percent by April 3. It may peak at 20 percent, perhaps even higher, and threatens to stay at Great Depression–like levels at least into 2021, maybe longer.

This country—buffered by oceans from the epicenter of the global outbreak, in East Asia; blessed with the most advanced medical technology on Earth; endowed with agencies and personnel devoted to responding to pandemics—could have and should have suffered less than nations nearer to China

Through the early weeks of the pandemic, when so much death and suffering could still have been prevented or mitigated, Trump joined passivity to fantasy. In those crucial early days, Trump made two big wagers. He bet that the virus could somehow be prevented from entering the United States by travel restrictions. And he bet that, to the extent that the virus had already entered the United States, it would burn off as the weather warmed.

If Trump truly was so trustingly ignorant as late as January 22, the fault was again his own. The Trump administration had cut U.S. public-health staff operating inside China by two-thirds, from 47 in January 2017 to 14 by 2019, an important reason it found itself dependent on less-accurate information from the World Health Organization. In July 2019, the Trump administration defunded the position that embedded an epidemiologist inside China’s own disease-control administration, again obstructing the flow of information to the United States.

Yet even if Trump did not know what was happening, other Americans did. On January 27, former Vice President Joe Biden sounded the alarm about a global pandemic in an op-ed in USA Today.

Because Trump puts so much emphasis on this point, it’s important to stress that none of this is true. Trump did not close the borders early—in fact, he did not truly close them at all.

Trump’s actions did little to stop the spread of the virus. The ban applied only to foreign nationals who had been in China during the previous 14 days, and included 11 categories of exceptions. Since the restrictions took effect, nearly 40,000 passengers have entered the United States from China, subjected to inconsistent screenings, The New York Times reported.

At a House hearing on February 5, a few days after the restrictions went into effect, Ron Klain—who led the Obama administration’s efforts against the Ebola outbreak—condemned the Trump policy as a “travel Band-Aid, not a travel ban.”

The president’s top priority through February 2020 was to exact retribution from truth-tellers in the impeachment fight.

Intentionally or not, Trump’s campaign of payback against his perceived enemies in the impeachment battle sent a warning to public-health officials: Keep your mouth shut

Throughout the crisis, the top priority of the president, and of everyone who works for the president, has been the protection of his ego

Denial became the unofficial policy of the administration through the month of February, and as a result, that of the administration’s surrogates and propagandists.

That same day, Secretary of State Mike Pompeo scolded a House committee for daring to ask him about the coronavirus. “We agreed that I’d come today to talk about Iran, and the first question today is not about Iran.”

The president’s lies must not be contradicted. And because the president’s lies change constantly, it’s impossible to predict what might contradict him.

During the pandemic, this psychological deformity has mutated into a deadly strategic vulnerability for the United States.

For three-quarters of his presidency, Trump has taken credit for the economic expansion that began under President Barack Obama in 2010. That expansion accelerated in 2014, just in time to deliver real prosperity over the past three years

The harm done by Trump’s own initiatives, and especially his trade wars, was masked by that continued growth.

The economy Trump inherited became his all-purpose answer to his critics. Did he break laws, corrupt the Treasury, appoint cronies, and tell lies? So what? Unemployment was down, the stock market up.

On February 28, very few Americans had heard of an estimated death toll of 35,000 to 40,000, but Trump had heard it. And his answer to that estimate was: “So far, we have lost nobody.” He conceded, “It doesn’t mean we won’t.” But he returned to his happy talk. “We are totally prepared.” And as always, it was the media's fault. “You hear 35 and 40,000 people and we’ve lost nobody and you wonder, the press is in hysteria mode.”

on February 28, it was still not too late to arrange an orderly distribution of medical supplies to the states, not too late to coordinate with U.S. allies, not too late to close the Florida beaches before spring break, not too late to bring passengers home from cruise lines, not too late to ensure that state unemployment-insurance offices were staffed and ready, not too late for local governments to get funds to food banks, not too late to begin social distancing fast and early

Stay-at-home orders could have been put into effect on March 1, not in late March and early April.

So much time had been wasted by the end of February. So many opportunities had been squandered. But even then, the shock could have been limited. Instead, Trump and his inner circle plunged deeper into two weeks of lies and denial, both about the disease and about the economy.

Kudlow repeated his advice that it was a good time to buy stocks on CNBC on March 6 after another bad week for the financial markets. As late as March 9, Trump was still arguing that the coronavirus would be no worse than the seasonal flu.

The overwhelmed president responded by doing what comes most naturally to him at moments of trouble: He shifted the blame to others.

Trump’s instinct to dodge and blame had devastating consequences for Americans. Every governor and mayor who needed the federal government to take action, every science and medical adviser who hoped to prevent Trump from doing something stupid or crazy, had to reckon with Trump’s psychic needs as their single biggest problem.

Governors got the message too. “If they don’t treat you right, I don’t call,” Trump explained at a White House press briefing on March 27. The federal response has been dogged by suspicions of favoritism for political and personal allies of Trump. The District of Columbia has seen its requests denied, while Florida gets everything it asks for.

The Trump administration is allocating some supplies through the Federal Emergency Management Agency, but has made the deliberate choice to allow large volumes of crucial supplies to continue to be distributed by commercial firms to their clients. That has left state governments bidding against one another, as if the 1787 Constitution had never been signed, and we have no national government.

Around the world, allies are registering that in an emergency, when it matters most, the United States has utterly failed to lead

s the pandemic kills, as the economic depression tightens its grip, Donald Trump has consistently put his own needs first. Right now, when his only care should be to beat the pandemic, Trump is renegotiating his debts with his bankers and lease payments with Palm Beach County.

He has never tried to be president of the whole United States, but at most 46 percent of it, to the extent that serving even the 46 percent has been consistent with his supreme concerns: stealing, loafing, and whining.

Now he is not even serving the 46 percent. The people most victimized by his lies and fantasies are the people who trusted him, the more conservative Americans who harmed themselves to prove their loyalty to Trump.

Governments often fail. From Pearl Harbor to the financial crisis of 2008, you can itemize a long list of missed warnings and overlooked dangers that cost lives and inflicted hardship. But in the past, Americans could at least expect public spirit and civic concern from their presidents.

Trump has mouthed the slogan “America first,” but he has never acted on it. It has always been “Trump first.” His business first. His excuses first. His pathetic vanity first.

rump has taken millions in payments from the Treasury. He has taken millions in payments from U.S. businesses and foreign governments. He has taken millions in payments from the Republican Party and his own inaugural committee. He has taken so much that does not belong to him, that was unethical and even illegal for him to take. But responsibility? No, he will not take that.

Yet responsibility falls upon Trump, whether he takes it or not. No matter how much he deflects and insults and snivels and whines, this American catastrophe is on his hands and on his head.

The danger is that richer nations will buy up the supply for their own use or prevent exports of vaccines developed within their borders as countries scramble to protect their citizens or stockpile for future outbreaks

Another concern is that manufacturers might restrict sales to the highest bidder.

the Coalition for Epidemic Preparedness Innovations is trying to expedite the development of vaccines

The coalition has kick-started the development of at least nine coronavirus vaccines but needs to raise $2 billion to help up to three of these candidates make it through the regulatory and quality requirements and to complete efficacy trials. The world would then need to ensure funds to guarantee manufacturing capacity for global production to make billions of doses available within the next 18 to 24 months.

it is encouraging that the health ministers of the Group of 20 wealthy nations called for accelerating the development, manufacturing and equitable distribution of vaccines against the coronavirus at its April 19 meeting and that last Friday, more than 15 heads of state, the president of the European Union, the director general of the World Health Organization and leaders of other international institutions committed to join together to do the same.

to keep the global population safe, it must be done. Innovative financing mechanisms exist that can translate long-term government commitments into immediate funding by issuing bonds on capital markets. The Ebola vaccine we have today was made possible by such an approach.

Estimates put the cost of Covid-19 to the global economy at up to $2 trillion this year.

If we can advance the mass distribution of an effective vaccine or vaccines by as little as two weeks, not only would we would save countless lives, but the effort would almost pay for itself by getting the world back to work.

until now, the planet’s natural defense systems were better at fighting them off.

Today, climate warming is demolishing those defense systems, driving a catastrophic loss in biodiversity that, when coupled with reckless deforestation and aggressive conversion of wildland for economic development, pushes farms and people closer to the wild and opens the gates for the spread of disease.

ignoring how climate and rapid land development were putting disease-carrying animals in a squeeze was akin to playing Russian roulette.

the virus is believed to have originated with the horseshoe bat, part of a genus that’s been roaming the forests of the planet for 40 million years and thrives in the remote jungles of south China, even that remains uncertain.

China for years and warning that swift climate and environmental change there — in both loss of biodiversity and encroachment by civilization — was going to help new viruses jump to people.

. Roughly 60% of new pathogens come from animals — including those pressured by diversity loss — and roughly one-third of those can be directly attributed to changes in human land use, meaning deforestation, the introduction of farming, development or resource extraction in otherwise natural settings

Vector-borne diseases — those carried by insects like mosquitoes and ticks and transferred in the blood of infected people — are also on the rise as warming weather and erratic precipitation vastly expand the geographic regions vulnerable to contagion.

Climate is even bringing old viruses back from the dead, thawing zombie contagions like the anthrax released from a frozen reindeer in 2016, which can come down from the arctic and haunt us from the past.

It is demonstrating in real time the enormous and undeniable power that nature has over civilization and even over its politics.

it also makes clear that climate policy today is indivisible from efforts to prevent new infectious outbreaks, or, as Bernstein put it, the notion that climate and health and environmental policy might not be related is “a ​dangerous delusion.”

The warming of the climate is one of the principal drivers of the greatest — and fastest — loss of species diversity in the history of the planet, as shifting climate patterns force species to change habitats, push them into new regions or threaten their food and water supplies

What’s known as biodiversity is critical because the natural variety of plants and animals lends each species greater resiliency against threat and together offers a delicately balanced safety net for natural systems

As diversity wanes, the balance is upset, and remaining species are both more vulnerable to human influences and, according to a landmark 2010 study in the journal Nature, more likely to pass along powerful pathogens.

even incremental and seemingly manageable injuries to local environments — say, the construction of a livestock farm adjacent to stressed natural forest — can add up to outsized consequences.

Coronaviruses like COVID-19 aren’t likely to be carried by insects — they don’t leave enough infected virus cells in the blood. But one in five other viruses transmitted from animals to people are vector-borne

the number of species on the planet has already dropped by 20% and that more than a million animal and plant species now face extinction.

Americans have been experiencing this phenomenon directly in recent years as migratory birds have become less diverse and the threat posed by West Nile encephalitis has spread. It turns out that the birds that host the disease happen to also be the tough ones that prevail amid a thinned population

as larger mammals suffer declines at the hands of hunters or loggers or shifting climate patterns, smaller species, including bats, rats and other rodents, are thriving, either because they are more resilient to the degraded environment or they are able to live better among people.

It is these small animals, the ones that manage to find food in garbage cans or build nests in the eaves of buildings, that are proving most adaptable to human interference and also happen to spread disease.

Warmer temperatures and higher rainfall associated with climate change — coupled with the loss of predators — are bound to make the rodent problem worse, with calamitous implications.

As much as weather changes can drive changes in species, so does altering the landscape for new farms and new cities. In fact, researchers attribute a full 30% of emerging contagion to what they call “land use change.”

As the global population surges to 10 billion over the next 35 years, and the capacity to farm food is stressed further again by the warming climate, the demand for land will only get more intense.

Already, more than one-third of the planet’s land surface, and three-quarters of all of its fresh water, go toward the cultivation of crops and raising of livestock. These are the places where infectious diseases spread most often.

The U.S. Centers for Disease Control and Prevention says that fully three-quarters of all new viruses have emerged from animals

Almost every major epidemic we know of over the past couple of decades — SARS, COVID-19, Ebola and Nipah virus — jumped to people from wildlife enduring extreme climate and habitat strain, and still, “we’re naive to them,” she said. “That puts us in a dangerous place.”

A 2008 study in the journal Nature found nearly one-third of emerging infectious diseases over the past 10 years were vector-borne, and that the jumps matched unusual changes in the climate

Ticks and mosquitoes now thrive in places they’d never ventured before. As tropical species move northward, they are bringing dangerous pathogens with them.

by 2050, disease-carrying mosquitoes will ultimately reach 500 million more people than they do today, including some 55 million more Americans.

In 2013, dengue fever — an affliction affecting nearly 400 million people a year, but normally associated with the poorest regions of Africa — was transmitted locally in New York for the first time.

“The long-term risk from dengue may be much higher than COVID,

only 15% of the planet’s forests remain intact. The rest have been cut down, degraded or fragmented to the point that they disrupt the natural ecosystems that depend on them.

it’s only a matter of time before other exotic animal-driven pathogens are driven from the forests of the global tropics to the United States or Canada or Europe because of the warming climate.

it will also shape how easily we get sick. According to a 2013 study in the journal PLOS Currents Influenza, warm winters were predictors of the most severe flu seasons in the following year

Even harsh swings from hot to cold, or sudden storms — exactly the kinds of climate-induced patterns we’re already seeing — make people more likely to get sick.

The chance of a flu epidemic in America’s most populated cities will increase by as much as 50% this century, and flu-related deaths in Europe could also jump by 50%.

Slow action on climate has made dramatic warming and large-scale environmental changes inevitable, he said, “and I think that increases in disease are going to come along with it.”

By late 2018, epidemiologists there were bracing for what they call “spillover,” or the failure to keep a virus locally contained as it jumped from the bats and villages of Yunnan into the wider world.

In late 2018, the Trump administration, as part of a sweeping effort to bring U.S. programs in China to a halt, abruptly shut down the research — and its efforts to intercept the spread of a new novel coronavirus along with it. “We got a cease and desist,” said Dennis Carroll, who founded the PREDICT program and has been instrumental in global work to address the risks from emerging viruses. By late 2019, USAID had cut the program’s global funding.

The loss is immense. The researchers believed they were on the cusp of a breakthrough, racing to sequence the genes of the coronaviruses they’d extracted from the horseshoe bat and to begin work on vaccines.

They’d campaigned for years for policymakers to fully consider what they’d learned about how land development and climate changes were driving the spread of disease, and they thought their research could literally provide governments a map to the hot spots most likely to spawn the next pandemic.

They also hoped the genetic material they’d collected could lead to a vaccine not just for one lethal variation of COVID, but perhaps — like a missile defense shield for the biosphere — to address a whole family of viruses at once

Carroll said knowledge of the virus genomes had the potential “to totally transform how we think about future biomedical interventions before there’s an emergence.

PREDICT’s staff and advisers have pushed the U.S. government to consider how welding public health policy with environmental and climate science could help stem the spread of contagions.

Since Donald Trump was elected, the group hasn’t been invited back.

What Daszak really wants — in addition to restored funding to continue his work — is the public and leaders to understand that it’s human behavior driving the rise in disease, just as it drives the climate crisis

“We turn a blind eye to the fact that our behavior is driving this,” he said. “We get cheap goods through Walmart, and then we pay for it forever through the rise in pandemics. It’s upside down.”

Still, to call it a pandemic felt momentous and weighty.

A couple of days later, WHO adopted the same language.

WHO had been sounding the alarm steadily for nearly six weeks, since January 30, 2020, when the director general, Tedros Adhanom Ghebreyesus, declared the situation a "public health emergency of international concern" -- the highest level of health alert under international law. The definition is "an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response."

While every country has responded to the emerging threat in its own way, some countries took the early warnings more seriously, she said.

"It wasn't about rich or poor countries. It was about experience. It was about those countries that knew the threat that this was; they heeded our warnings," said Van Kerkhove. That experience came from dealing with previous infectious outbreaks, such as SARS, MERS and Ebola. And those countries quickly implemented strong public health measures, mobilized community health workers, contact tracers and lab technicians. Van Kerkhove points to places like South Korea, Japan and Nigeria -- all of which managed to keep transmission of this novel virus relatively under control.

The US has more than 29 million total reported cases and more than half a million deaths. South Korea? Fewer than 100,000 cases and less than 2,000 deaths. You can't dismiss that as the US having a higher population than South Korea, because when you look at the per capita deaths per 100,000 population, the US has more than 161 compared with South Korea's 3.2.

How did they do it? By being strategic and leveraging the tools they had at their disposal, Van Kerkhove said. "They looked at the situation that they were in. They enhanced their cluster investigation. ... They ramped up their screening capacity, their testing capacity. They used quarantine effectively and they brought that outbreak under control. But at one point in time, it seemed almost impossible -- and they turned it around," she said.

But that's changing, thanks to COVAX, a global initiative that promotes equitable access for developing nations to Covid-19 vaccines. Led by the WHO and other organizations, COVAX delivered 20 million vaccine doses to 20 countries last week during the first week of distribution, according to WHO Director-General Tedros. An additional 14.4 million vaccine doses are slated to go out this week to an another 31 countries.

"I have glimmers of hope in many countries around the world," Van Kerkhove said, pointing to places such as Australia, New Zealand, China and Japan. "I see societies that are opened up. I see sporting events that are happening. I see a resilient community that is living their life, that has driven transmission down in some situations to zero."

The result was a perfect storm: A U.S. government not well prepared for a pandemic, run by a president who was slow to act after his intelligence community and public health advisers were warning about the dangers.

U.S. government over 20 years of successive administrations and Congresses failed to heed the warnings by taking basic steps that would have made it easier to quickly respond to a fast spreading and lethal pathogen. They didn't set up and fund a large volunteer medical reserve corps, for example, or build surplus hospital capacity, or create a system to quickly produce and deploy virus tests.

elected officials from both parties have never fully geared up for the biological threat, former officials and public health experts told NBC News. Each new White House deprioritized the issue, only to elevate it later after some defining event led to a presidential revelation. They then belatedly scrambled to respond with ambitious plans and initiatives, which faded after a few years.

"Here's the problem: In 10 years, if there's no pandemic, then everybody starts getting a bit relaxed," said Michael Leavitt, a former Utah governor who served as secretary of Health and Human Services in the Bush administration.

officials deserved "at least a B-plus," and Mount Sinai virologist Peter Palese called the overall response "excellent." Republicans in Congress praised the CDC for developing a vaccine in six months.

But after 9/11 and the subsequent anthrax attacks, the newly created Department of Homeland Security hired Bernard back, with added staff, to run a bio-preparedness unit.

After Bush read a book about the 1918 influenza pandemic in 2005, he forced his administration to double down on pandemic preparation, replenishing the stockpile and creating an early warning system.

When President George W. Bush took office in 2001, Bernard wrote a transition memo. He soon learned the Bush team had eliminated his job as White House biodefense czar.

When Ebola erupted in Africa in 2014, Obama brought in an outsider, Ron Klain, to run the federal response. The effort was widely praised, as was Obama's response to the 2016 Zika virus outbreak. But afterward, the Obama administration failed to fully replenish the federal stockpiles, according to research by ProPublica and USA Today.

Under Obama and a mostly Republican-controlled Congress, public health spending declined. Per capita public health spending, adjusted for inflation, rose from $39 in 1960 to $281 in 2008, and fell by 9.3 percent from 2008 to 2016, according to a 2016 study published in the American Journal of Public Health. It has fallen further under the Trump administration, records show.

During the transition from Obama to Trump, Obama officials conducted a tabletop exercise based on a pandemic with incoming Trump aides. But in his second year as president, Trump fired his top official in charge of pandemic response, Tom Bossert, and did not replace him. Trump then allowed his national security adviser to disband the NSC's global health unit. As a result, when alerts about coronavirus began to emanate from the intelligence and public health communities, there was no senior official in the White House to coordinate a response.

"Every administration has at some point in time gotten religion and realized there is a program and dusted it off and used it," Clarke told NBC News."Except this one."

"The disease-causing microbes of the planet," wrote Garrett, "far from having been defeated, [are] posing ever greater threats to humanity."

The exercise predicted many of the problems besetting the coronavirus response – confused lines of authority, shortages of medical gear, controversies over social distancing.

They failed to set up a system that would insure the rapid deployment of tests for a novel virus. And they failed to replenish a federal stockpile that hospital officials say is both insufficiently stocked and rife with defective gear.

Those failures — and the late start on gear purchases by the Trump administration — have severely hampered the U.S. response to coronavirus, said Scott Gottlieb, who ran the FDA from 2017 to 2019.

"In no way, shape or form can anyone say that we weren't warned, that the information wasn't available and shared with them," he said. "We've known about the risk of pandemics, and war gamed them literally going back some 30 years."

Alejandro Mayorkas, who was a deputy secretary in the Department of Homeland Security during the Obama administration, is the first Latino and immigrant nominated as DHS secretary

Mayorkas was born in Havana, Cuba, and his family fled as political refugees to Miami.

he worked on the development and implementation of the Deferred Action for Childhood Arrivals program and headed the department's response to the Ebola and Zika health crises.

Avril Haines is tapped to serve as director of national intelligence, and if confirmed, she would become the first woman to lead the intelligence community.

She previously was deputy national security adviser and deputy director of the CIA, the first woman to hold the position

Additionally, former Secretary of State John Kerry, who led the negotiations over the Paris climate accords, has been named as special presidential envoy for climate to sit on the National Security Council. It will be the first time the NSC has included a member solely devoted to the issue of climate change.

Jake Sullivan, another close Biden aide, has been announced for the position of national security adviser in the new administration.

Sullivan previously was the former vice president's national security adviser and worked at the State Department under Hillary Clinton.

Linda Thomas-Greenfield for the position of U.S. ambassador to the United Nations. The role would mark Thomas-Greenfield's return to public service after retiring from her 35-year career with the Foreign Service in 2017.

Biden is elevating the ambassadorship to a Cabinet-level position. The announcement also puts a Black woman in a highly visible role.

The staffing announcements come after reporting that Biden had selected longtime adviser Antony Blinken for the coveted secretary of state post. Blinken was deputy secretary of state and deputy national security adviser under President Barack Obama.

Four of the six roles require Senate confirmation, with Sullivan's and Kerry's positions not needing such a vote.

"These individuals are equally as experienced and crisis-tested as they are innovative and imaginative," Biden said in a statement.

they also reflect the idea that we cannot meet the profound challenges of this new moment with old thinking and unchanged habits — or without diversity of background and perspective. It's why I've selected them."

And dozens of House Democrats are urging Biden to name their colleague, Rep. Deb Haaland, as interior secretary. She would be the first Native American Cabinet secretary in U.S. history.

It was only in July, when case counts began soaring in a trio of populous, Republican-leaning states — Arizona, Florida and Texas — and polls showed a majority of Americans disapproving of Trump’s handling of the pandemic, that the president and his top aides renewed their public activity related to the virus.

Trump and many of his top aides talk about the virus not as a contagion that must be controlled through social behavior but rather as a plague that eventually will dissipate on its own. Aides view the coronavirus task force — which includes Fauci, Birx and relevant agency heads — as a burden that has to be managed, officials said.

. An internal model by Trump’s Council on Economic Advisers predicts a looming disaster, with the number of infections projected to rise later in August and into September and October in the Midwest and elsewhere, according to people briefed on the data.

As the nation confronts a once­in-a-century health crisis that has killed at least 158,000 people, infected nearly 5 million and devastated the economy, the atmosphere in the White House is as chaotic as at any other time in Trump’s presidency — “an unmitigated disaster,” in the words of a second former senior administration official.

“It’s extraordinary that a country that helped eradicate smallpox, promoted HIV/AIDS treatment worldwide and suppressed Ebola — we were the world’s leader in public health and medicine, and now we can’t even protect our own people from the most devastating epidemic in decades.”

Asked who was to blame for the pandemic’s dark summer turn, Pelosi said, “1600 Pennsylvania Avenue.”“The delay, the denial . . . the hoax that it’s going to go away magically, a miracle is going to happen, we’ll be in church together by Easter, caused death,” Pelosi added.

In Trump’s White House, there is little process that guides decision-making on the pandemic. The president has been focused first and foremost on his reelection chances and reacting to the daily or hourly news cycle as opposed to making long-term strategy, with Meadows and other senior aides indulging his impulses rather than striving to impose discipline.

“He sits in the Oval Office and says, ‘Do this,’ or, ‘Do that,’ and there was always a domino blocker. It was John Bolton or H.R. McMaster on national security or John Kelly. Now there are no domino blockers.”

What’s more, with polls showing Trump’s popularity on the decline and widespread disapproval of his management of the viral outbreak, staffers have concocted a positive feedback loop for the boss. They present him with fawning media commentary and craft charts with statistics that back up the president’s claim that the administration has done a great — even historically excellent — job fighting the virus.

“Everyone is busy trying to create a Potemkin village for him every day. You’re not supposed to see this behavior in liberal democracies that are founded on principles of rule of law. Everyone bends over backwards to create this Potemkin village for him and for his inner circle.”

Although Fauci, Birx and other medical professionals sit on the coronavirus task force, many of the more pressing decisions lately have been made by the smaller group that huddles in the morning and mostly prioritizes politics. The cadre includes Meadows, senior adviser Jared Kushner and strategic communications director Alyssa Farah.

The policy process has fallen apart around Meadows, according to four White House officials, with the chief of staff fixated on preventing leaks and therefore unwilling to expand meetings to include experts or to share documents with senior staffers who had been excluded from discussions.

Luciana Borio, a director for medical and biodefense preparedness at the National Security Council during the first two years of the Trump administration, decried “a response in disarray hampered by a lack of clear, consistent public health-oriented guidance to the public.

“It’s very difficult to know who to trust,” Borio said. “To expect the public to sort out the facts in a time of tremendous stress leads to inconsistent and disparate actions, and that really hurts our collective effort to fight the virus.”

What also has frustrated a number of the president’s allies and former aides is that he simply seems uninterested in asserting full leadership over the crisis, instead deferring to state leaders to make the more difficult decisions while using his presidential bully pulpit to critique their performances.

“A suppression-level effort to shrink and not just mitigate the spread of covid requires a national strategy that includes standards and significant federal funding. Such a strategy is lacking right now.”

The Trump administration has resisted devising a national testing program and instead ceded the task to state governments, even as cases of infection average more than 60,000 a day and some people wait 10 days or longer for test results, delays that render the results essentially useless.

While some states have been able to largely meet the needs of their populations, the federal government is the only entity with the power to coordinate testing across state lines, push and enable manufacturers to increase production of test kits and supplies, surge those supplies as needed and ensure fair payment.

Without federal coordination, states, businesses, hospitals — and soon schools and universities — find themselves competing with each other for limited supplies, often overpaying as a result.

Despite repeated calls to invoke the Defense Production Act to help resolve testing-supply shortages, the administration has resisted doing so. Trump and several White House aides have instead continued to think that it is politically advantageous to cede the issue to the states to avoid taking ownership or blame for the issue, even though testing shortages are largely seen as a federal failure.

“Other countries have taken this virus seriously, trusted their public health officials and scientists, and now they’ve flattened the curve,” he said. “Meanwhile, our situation gets worse and worse every day and some Americans think, ‘Oh, that’s just the way it is.’ But that isn’t how it has to be.

He’s just not oriented towards things that even in the short term look like they’re involving something that’s hard or negative or that involves sacrifice or pain,” a former senior administration official explained. “He is always anxious to get to a place of touting achievements and being the messenger for good news.”