Blog IV: COVID-19 in the U.S.: the situation (part A)

The first confirmed case of COVID-19 in the U.S. has been identified in the state of Washington on the 20th of January of this year, when a 35-year-old who had travelled back from Wuhan, five days before. The coronavirus has since January 31 officially been identified as a ‘public health emergency’ and since March 13 a ‘national emergency’. The White House Coronavirus Task Force was set up on January 29, that’s been led by Vice President Mike Pence since February 26. This same day, not a coincidence, the first case of community spread(1) was documented. Since March 27, the U.S. has been the country with the largest number of known cases of coronavirus globally. Since then, as of May 4 1,188,826 cases and 68,606 deaths have been counted. 

Number of coronavirus cases U.S. over time

Source: Worldometer (2)

Epicenter of the coronavirus clearly lies in the State of New York, accounting for a total of 323,883 coronavirus cases and 24,648 deaths. According to the John Hopkins Coronavirus Resource Center, on May 3rd, New York City counted 18,752 deaths, only a little less than the Netherlands, Germany and Belgium combined (accounting for 19,712 deaths). Countrywide, the northeastern part of the country (New York, New Jersey, Massachusetts, Rhode Island, Connecticut) has been hit hardest so far, based on the amount of cases per capita. The image below shows, however, that there are multiple regions across the country that experience high numbers of confirmed cases when controlled for by their populations.

Covid-19 - Confirmed by Population

Source: John Hopkins Coronavirus Resource Center (3)

Recent simulations on how the coronavirus could spread the next five years by Public Health researchers from Harvard University have found that prolonged and intermittent social distancing might be necessary into 2022, unless a vaccine becomes widely available or critical care capacity is increased significantly. They do note more research needs to be done on the influence of the different seasons on the way the virus spreads, how long immunity to the new COVID-19 lasts, and “if exposure to coronaviruses that cause mild illnesses offer any protection against the virus that causes COVID-19.” (4)

Social distancing, face masks & stay-at-home orders

Since March 16, the White House recommended ‘social distancing’ guidelines. It took until April 3 before Trump communicated that the White House was recommending citizens to wear nonmedical cloth masks. Surrounding (and sometimes preceding) this federal recommendation, a part of the local (cities of New York and Los Angeles) and state officials (Pennsylvania, Colorado, Maryland, Rhode Island) started to encourage their residents to wear non-medical cloth face coverings in public. Other states, such as Connecticut and Massachusetts, extended their stay-at-home orders. Virginia has the longest lockdown of all states, lasting through June 10. Then, other states (among which the larger state of Texas and many southern states) have already been easing their stay-at-home orders since the end of April, and some states (North Dakota, South Dakota, Iowa and Arkansas) never adopted a stay-at-home order in the first place.

U.S. stay-at-home orders per state (May 1st)

Source: Business Insider (5)

Furthermore, the gravity of the situation is not just felt by the states but even more by its people. Unemployment has been soaring in the six weeks since the start of the state lockdowns, as illustrated by the more than 30 million claims for unemployment benefits. Many states across the country have been experiencing protests because of the economic downside the lockdowns are causing. 

Strategic National Stockpile

A problem to cope with the pandemic lies in the country’s terrible state of the Strategic National Stockpile, the government’s emergency reserve of supplies like ventilators and masks. As the outbreak accelerated the U.S. found out only a fraction of the needed emergency supplies were in stock. Trump’s administration has allocated $16 billion towards the production of respirators, masks and other equipment in the national stockpile. At the start of April, the U.S. was producing around 50 million of N95 masks each month, while the Department of Health and Human Services estimated 300 million were needed on a monthly basis. Since most of the masks are made in China, and the Chinese government hasn’t allowed for many of them to leave Chinese soil, this exposed a weak link in the U.S. coronavirus response. 

Testing

Another problem is the U.S. testing capacity. Delays in the widespread rollout of tests, as well as faulty test kits, have hindered U.S. public-health authorities to adequately determine how many citizens have been infected by the coronavirus. This means that people with relatively mild symptoms that have not been hospitalized, as well as close friends and families of confirmed cases, cannot be tested. Dr. Anthony Fauci stated that the U.S. needs to significantly increase the “number of tests and the capacity to actually perform them.” Meanwhile, Trump and fellow Republicans have been praising the country’s testing numbers. For comparison, South Korea and the U.S. noted their first corona case on the same day. On March 8, South Korea’s total number of tests done per million citizens was 700 times the U.S. (only 5 tests per million people, according to the CDC). 

In the meantime, the U.S. has significantly ramped up its testing numbers and is currently executing the highest number of tests worldwide. To draw a fairer comparison, the U.S., on May 4th, accounting for 21,742 tests per million people, was still behind Italy on the number of tests per million people. The Netherlands, meanwhile, has only done 13,184 tests per million people. For now, it’s fair to say that the Dutch numbers look worse than the U.S. numbers. Besides saying that a) the data collection methods (among them, number of executed tests) differ a lot among countries worldwide and b) the Netherlands shows in every aspect it has advanced further in the process (U.S. right in the middle and the Dutch numbers seem to be dropping), I won’t get much into this country comparison now. 

Coronavirus country comparison (May 4th)

Source: Worldometer (7)

A Rockefeller Foundation report sketched the following perspective: a) in order to reopen parts of the economy, within the next two months testing capacity needs to be expanded to 3 million tests per week; and b) in order to reopen the rest of the economy, in the next six months, further expansion of testing capacity by 30 million tests per week is needed. Another report from Harvard University, states that the U.S. a) needs to execute at least 5 million tests per day by early June to start reopening; and b) needs 20 million tests per day to fully reopen and mobilize the economy (ideally by late July). Although the recommended numbers from the two reports are very far apart, the current number of 200 thousands tests per day shows there’s in both cases a significant gap to close. Experts argue that, with the current lack of testing capabilities, social distancing guidelines cannot be lifted and the U.S. economy cannot be reopened safely as long as this is the case. 

White House v. Congress: ill-preparedness and slow response

It has been argued that both the White House and Congress can be held responsible for the ill-preparedness of the U.S.. Trump’s administration decided to close down the pandemic response team (PRT) in 2018. It needs to be stated, though, that some of the PRT’s initial members have been assigned to responding to pandemics through other teams. Congress, for its part, has steadily underfunded key health agencies, each year providing them less money than the experts asked for. 

Furthermore, assessing the situation preceding the mass outbreak in the U.S., both Trump’s administration and Congress have misjudged the gravity of the situation. Both the White House and Congress, despite warnings from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), didn’t respond adequately to the slowly approaching pandemic. 

First of all, the administration shouldn’t have downplayed the virus and should have asked for higher amounts of money (and earlier in the trajectory) to fight the virus. In hindsight, the White House declining a February 5 emergency fund offer from Congress to fight the coronavirus was a mistake. 

Congress, in turn, came across both partisan and legal hurdles, The latter, among them adjusting minimal quality guidelines for personal protective equipment (PPE), prevented them from passing bills earlier on. Concerning the nowadays inevitable partisan issues, an early bipartisan effort in fighting the virus would have been rather helpful towards an early response. Both parties point to other reasons for the lack of such a response. Republicans state, indirectly blaming Democrats, it was unfortunate that Trump’s impeachment trial distracted the parties from the first coronavirus warnings. The Democrats, in turn, argue that Republicans have constantly downplayed the severity of the virus and that the House had only been briefed after the trial anyway. 

Dr. Fauci

Trump’s administration has received a sufficient amount of criticism for the way they responded to the crisis, among them the principal face of the U.S. response to the coronavirus: Dr. Anthony Fauci. He argued that “if you had a process that was ongoing, and you started mitigation earlier, you could have saved lives.” Furthermore, he has been critical of the U.S. testing capabilities. As you can imagine, these haven’t been the only opinions Trump didn’t share. Trump even retweeted a tweet that ended with “Time to #FireFauci”. Dr. Fauci, however, is a popular figure with support among both parties. The White House, so far, has been quick to deny any rumors about firing Fauci. They did block him from testifying on the coronavirus response before the House Appropriations Committee.

Dr. Anthony Fauci and Donald Trump during one of the daily coronavirus briefings

Trump’s coronavirus communication

Since the outbreak of the virus in China and the first case in the U.S., President Trump has had different types of reactions to the coronavirus. This is not weird when one thinks of the fast-changing character of the virus and the many interests leaders need to protect during such a crisis. In general terms, it’s a delicate balance between protecting your citizens and not panicking them at the same time. These were the categories of reactions Trump has had towards the coronavirus and the dates he expressed some of those reactions: 

• Downplaying virus: It’s going to go away when the weather gets warmer (February 10). It’s going to disappear like a miracle (February 28). Numbers are lower in the U.S. than anywhere else (beginning of March). “We’re all going to be great.” (March 15)
• Responding ‘great’! “We have it all under control” (January 22). Vaccines and therapies will be ready soon (start of March). “We’re responding with great speed and professionalism” (March 11). 
• Not to blame: “I don’t take responsibility at all” (13th of March). “It came up so suddenly” (16th of March).
• Scapegoating: “Democratic hoax” (February 28). “WHO failed in its basic duty” (April 15). “They (other countries) should have told us earlier” (April 17). “If China has been knowingly responsible, there should be consequences” (April 19).  

What can we learn from these categories of reactions and their dates? 1. From early on in the process, he has been using them interchangeably. 2. He has downplayed the virus until he arrived at a point that he really couldn’t anymore. 3. He decides to blame ‘outside parties’ as soon as he receives criticism himself. 

Finally, it took him until March 30 to tell the nation it had to prepare itself for “hard days.” The New York Times published an article on April 26 that analyzed the 260,000 words Trump used during his daily briefings since March 9 (the day the coronavirus outbreak led to widespread disruptions in daily life). They found that, rather than unifying the country by speaking words of empathy, “by far the most recurring utterances from Mr. Trump in the briefings are self-congratulations...., which are often predicated on exaggerations and falsehoods.”  (8)

So far, Trump himself has suggested multiple remedies to cure the coronavirus. On April 7, he suggested that an anti-malaria drug was worth a try. Recently, he communicated on the possibility of injecting disinfectants like Lysol or ultraviolet light to clean the inside of your body and get rid of corona: “And then I see the disinfectant, where it knocks it out in a minute, one minute. And is there a way we can do something like that by injection inside or almost a cleaning, because, you see, it gets in the lungs and it does a tremendous number.” 

The poison control centers in, at least the states of New York. Michigan, Illinois and Maryland, were experiencing spikes in calls for people exposed to household cleaning products. In the state of New York, at least 30 people ingested or injected themselves with bleach, Lysol or other household cleaning products. Being confronted with the call spikes, Trump played ignorant and responded: “I can’t imagine why”, claiming that he was at the same time being sarcastic towards reporters and asking his medical advisers to look into the impact of sunlight rays on corona. 

Summarizing Trump’s communication so far, as (Republican) Maryland Governor Larry Hogan put it: “..unfortunately, some of the messaging has not been great."

Trump’s measures

So far, his track record on communication has been far from flawless. What do his actions in the form of measures tell us? 

One of the first things Trump did, on January 31, was restrict entry for travelers from China. As of the 16th of March, a large part of Europe (Schengen area plus UK and Ireland) has also been issued a travel ban to the U.S.. 

After the Dow Jones Industrial average dropped more than 1,000 points as a consequence of Covid-19, Trump requested $1.25 billion in emergency funding to adequately respond to the coronavirus, plus the ability to use another $535 million in emergency funds already appropriated. At this stage, the White House expected to “allocate at least $2.5 billion in total resources.” Most of this predicted budget would receive its money from budgets that had yet been allocated to different government agencies. 

Then, on March 6, Trump signed a bill that was passed by the House of Representatives to support the immediate health response to the coronavirus pandemic. Trump declaring the coronavirus a national emergency means that the US states and territories have access to $50 billion in funding. This allows for waivers for hospitals and doctors in their response to the virus.

On March 27, the largest bill in U.S. history, accounting for $2.2 trillion, was passed by the House and Senate, and subsequently signed by Trump. The bill supports, albeit caveats and limitations apply to individuals, individuals up to $1,200 per individual and $500 per child for households earning up to $150,000 a year. The healthcare industry has had access to $180 billion, whereas small businesses have gotten access to $377 billion in loans that can be forgiven. Corporations, state and local governments received access to $454 billion. 

Then, on the 14th of April, Trump announced he was cutting funds to the WHO. He blamed them for not objectively assessing the gravity of the situation in China and believing China’s officials too easily: According to Trump, WHO missed the opportunity to contain the outbreak at its source and prevent a higher number of deaths.  

On the 22nd of April, he signed an executive order to suspend immigration into the US for 60 days. Trump couldn’t put the opportunity aside to rally his blue-collar supporters by tweeting that besides the corona attack, there was “the need to protect the jobs of our GREAT American citizens.” During April 22nd’s coronavirus press briefing, he communicated that the order would guarantee that jobs and healthcare resources would be available for U.S. people and not “to be replaced by new immigrant labor flown in from abroad.” 

Foreign blame game: another China-U.S. trade war looming

At first, Trump let other officials within his administration play the direct blame game with China, staying out of it himself. Instead, he criticized China indirectly by blaming the WHO for its poor response, and had actually been praising President Xi directly for his efforts to fight the coronavirus. 

However, since his administration has received more and more criticism, it seems like he has decided to distract the attention by going after China himself through the claim that he has seen evidence the coronavirus was created in a Wuhan lab theory (and not on a Wuhan market). Pence communicated Trump’s policy plans most clearly: “I fully expect that the President will consider a range of options to ensure that those who were not forthcoming with the American people, be that in China or in the World Health Organization, are held to account." White House officials have already revealed the administration’s desire to choose between a variety of measures, including the creation of new trade policies, canceling U.S. debt obligations to China or sanctions. Economists warn that provoking China by threatening with another tariff war, in those times, is far from a wise thing to do, potentially transforming a deep recession into a full-scale depression. 

Trump’s administration has tasked the U.S. intelligence community with finding out if the virus indeed originated in a Chinese lab. So far, no evidence has been found that is the case. However, on May 2nd, Fox News reporter John Roberts claimed that a senior intelligence source told him that “there is agreement among most of the 17 Intelligence agencies that COVID-19 originated in the Wuhan lab.” He ended the tweet by stating that they don’t believe releasing the virus was a deliberate choice, it merely being a mistake. 

Current domestic situation: reopening the economy v. public health

Already on March 24, Trump expressed the wish that the country would open back up by Easter (April 12). 

Trump sparked commotion among the whole country on April 13, by claiming that he has total authority (during times of emergency) over the decision whether and when states reopen. This was a false claim since the U.S. constitution grants power on public health and safety decisions primarily to state and local officials within their own jurisdictions. Governors from both parties, including Trump loyalists, publicly corrected Trump on his claim. Three days later, the White House corrected Trump’s claims by presenting a plan (coming from the CDC) for a phased approach to reopen states’ economies and putting reopening in governors’ hands. 

A total of 31 states, although adopting different approaches, will have (partially) reopened by the end of this week (week of May 4). Some of those states, anticipating possible bad news, might opt for an extension of the stay-at-home order beyond the end of this week. 

The image above showed, as well, that there are big differences in case and death numbers among states. It can, with a part of society exerting fierce pressure to remobilize the economy, not be called a surprise that governors are deciding to reopen their economy. If it’s a smart move, even with the social distancing guidelines still in place, remains to be seen. Dr. Fauci uttered the prediction that there is “no doubt” more people will become infected with COVID-19 as the country starts reopening. 

Poll: Do you think it’s a good idea or a bad idea to do each of the following without further testing for the coronavirus:

Source: PBS NewsHour/NPR/Marist poll (9)

In practice, the states experience an increasing amount of resistance against the lockdowns.The most extreme case being April 30’s attack of the Michigan state house by armed protesters and militia, coming ahead of a voting whether or not to extend Michigan’s stay-at-home order. On the other hand, April 29’s PBS NewsHour/NPR/Marist poll shows that a large majority of the U.S. people are uncomfortable with reopening the economy. Despite the common crisis the entire U.S. is facing, the health versus economy discussion (and the different magnitude each state experiences concerning the outbreak) seems to be sharpening political divisions among states. 

In the second part of this blog on the coronavirus, I’ll be focusing on the implications the coronavirus has on the presidential race. How are President Trump’s chances affected by the responsibility (of handling the crisis adequately) his administration carries? Meanwhile, how is Biden doing while being unable to hold political rallies to promote his presidentiality? Moreover, I’ll do a little analysis on the relevant parameters that will determine the outcome of the 2020 presidential elections. 

Footnotes/sources:

1. Indicating that a person has coronavirus without being in touch with another infected person or without documented travel to hot spots.
2. https://www.worldometers.info/coronavirus/country/us/
3. https://coronavirus.jhu.edu/us-map 
4. https://thehill.com/changing-america/well-being/prevention-cures/492755-us-may-have-to-keep-some-social-distancing
5. https://www.businessinsider.nl/us-map-stay-at-home-orders-lockdowns-2020-3?international=true&r=US
6. Furthermore, one could argue that the fairest comparison available is by testing either on a per capita basis or by measuring the percentage of positive tests results. A high percentage of the latter option indicates that a country is not just testing its (very) sick people and not missing other cases of infection.
7. ttps://www.worldometers.info/world-population/population-by-country/ & https://www.worldometers.info/coronavirus/#countries
8. https://www.nytimes.com/interactive/2020/04/26/us/politics/trump-coronavirus-briefings-analyzed.html
9. https://www.pbs.org/newshour/politics/despite-widespread-economic-hardship-most-americans-not-ready-to-reopen-poll-says