The United States has just 4% of the world’s population but over 25% of its confirmed COVID‑19 cases and deaths. With arguably the most advanced healthcare research and top hospitals and doctors, it seems difficult to fathom. What the hell went wrong?

Two friends (neither of them are Trump apologists) could not convincingly list the major ways in which this country and its leader, Trump, screwed up. So I asked others:

One friend came up with this list of 14 points regarding Trump’s failures:

1. He didn’t follow the procedures laid out in the pandemic plan the Obama administration left for him.
2. He had too many exceptions to the China travel ban.
3. He didn’t implement a European travel ban and that was where most of the NY cases that spread across the country came from.
4. He didn’t invoke the war powers act  to manufacture PPE or ventilators or  tests, which forced states to bid against each other and foreign governments, drove up prices and resulted in unnecessary shortages.
5. He has prioritized financial aid to large companies over aid to states and localities.
6. He stockpiled supplies at the federal level, bidding against states, without a cogent plan for distributing them to the states as needed and reportedly sending them to whomever spoke to or flattered him or Kushner.
7. He didn’t mandate masks and repeatedly said and demonstrated that they aren’t important, instead holding rallies, and time and again appearing in televised press conferences with others in a manner that flouts social distancing and mask wearing.
8. He didn’t allow scientists to speak at his televised daily briefings and instead spread misinformation about the severity of the pandemic and “how well” we’re doing.
9. He minimized the importance of and sought to reduce testing and tracking.
10. He implicitly and explicitly threatened scientists who tried to level with the public by expressing or implying by leak or tweet the vulnerability of their positions to his whims (Fauci) or by exiling them to travel for information sessions (Birx) which has most likely restricted the flow of accurate information to the public.
11. He recommended hydroxychloroquine and suggested treatment by light and cleansers such Clorox.
12. He pressured the FDA to authorize the use of convalescent blood plasma, skipping trials and full analysis of data. 
13. He recommended schools and the economy open universally instead of setting federal standards for the number of cases or other criteria required to do so. (And I believe he has threatened to reduce or eliminate federal aid to school districts that don’t fully offer in-person school regardless of their numbers.)
14. He calls it the China flu, endangering Asian Americans.

Here is another list largely based on an excellent article by Ed Yong in the Atlantic.

1. Summary. The richest country in the world still lacks sufficient testing to accurately count its sick citizens and to initiate effective contact tracing. Chronic underfunding of public health neutered the nation’s ability to prevent the pathogen’s spread.
2. We should have seen this coming. In recent decades, epidemics of SARS, MERS, Ebola, H1N1 flu, Zika, and monkeypox showed the havoc that new and reemergent pathogens could wreak. Health experts, business leaders, and even middle schoolers ran simulated exercises to game out the spread of new diseases. Back in 2018 Ed Young warned us in the Atlantic about the fragility of the nation’s health-care system and our poor state of preparation for a pandemic.  COVID‑19 is merely a harbinger of worse plagues to come. The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of us ache to do.
3. Isolationism. Under President Donald Trump, the U.S. has withdrawn from several international partnerships and antagonized its allies. It has a seat on the WHO’s executive board, but left that position empty, only filling it this May, when the pandemic was in full swing. Since 2017, Trump has pulled more than 30 staffers out of the Centers for Disease Control and Prevention’s office in China, who could have warned about the spreading coronavirus. Last July, he defunded an American epidemiologist embedded within China’s CDC. America First was America oblivious.
4. Trump’s dismissal of expertise and evidence. He filled his administration with inexperienced newcomers, while depicting career civil servants as part of a “deep state.” In 2018, he dismantled an office that had been assembled specifically to prepare for nascent pandemics. American intelligence agencies warned about the coronavirus threat in January, but Trump habitually disregards intelligence briefings. The secretary of health and human services, Alex Azar, offered similar counsel, and was ignored.
5. Early missteps. “By early February, we should have triggered a series of actions, precisely zero of which were taken.” Trump could have spent those crucial early weeks mass-producing tests to detect the virus, asking companies to manufacture protective equipment and ventilators. Instead, he focused on the border. Travel bans are woefully inefficient at restricting either travel or viruses. They prompt people to seek indirect routes via third-party countries, or to deliberately hide their symptoms. They are often porous: Trump’s included numerous exceptions,
6. Misleading the public. Genetic evidence shows that the specific viruses that triggered the first big outbreaks, in Washington State, didn’t land until mid-February. The country could have used the time between January and mid-February to prepare. Instead, Trump, assured Americans that “the coronavirus is very much under control,” and “like a miracle, it will disappear.”  On February 26, Trump asserted that cases were “going to be down to close to zero.” Over the next two months, at least 1 million Americans were infected.
7. Testing debacle. The CDC developed and distributed its own diagnostic tests in late January. These proved useless because of a faulty chemical component.  Tests were in such short supply, and the criteria for getting them were so laughably stringent, that by the end of February, tens of thousands of Americans had likely been infected but only hundreds had been tested.  Private labs were strangled by FDA bureaucracy.  It’s hard to overstate how thoroughly the testing debacle incapacitated the U.S. People with debilitating symptoms couldn’t find out what was wrong with them. Health officials couldn’t cut off chains of transmission by identifying people who were sick and asking them to isolate themselves.
8. Superspreader events at indoor gatherings. The odds of catching the virus from an infected person are roughly 19 times higher indoors than in open air. Among crowds clustered in prolonged proximity, the coronavirus ran rampant in the conference rooms of a Boston hotel, the cabins of the Diamond Princess cruise ship, and a church hall in Washington State where a choir practiced for just a few hours.  The hardest hit were prisons and nursing homes: as of mid-June, nursing homes accounted for 40 percent of coronavirus deaths. That includes both residents and staff.  Before the pandemic, three in four nursing homes were understaffed, and four in five had recently been cited for failures in infection control. A Seattle nursing home was one of the first COVID‑19 hot spots, but similar facilities weren’t provided with tests and personal protective equipment. Rather than girding these facilities against the pandemic, the Department of Health and Human Services paused nursing-home inspections in March, passing the buck to the states.
9. No priority for the public healthcare system. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good. “As public health did its job, it became a target” of budget cuts, says Lori Freeman, the CEO of the National Association of County and City Health Officials. Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health.  Underfunded health departments are also struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Since the last recession, in 2009, chronically strapped local health departments have lost 55,000 jobs—a quarter of their workforce.
10. Pandemic preparedness. The US profit-driven healthcare system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.
11. Face masks and PPE fiasco. About half of the world’s face masks, are made in China, some of them in Hubei province. When that region became the pandemic epicenter, the mask supply shriveled just as global demand spiked. The Trump administration turned to the Strategic National Stockpile, only to find that the 100 million respirators and masks that had been dispersed during the 2009 flu pandemic were never replaced. Just 13 million respirators were left. In April, four in five frontline nurses said they didn’t have enough protective equipment. Some solicited donations from the public, or navigated back-alley deals and internet scams. In April, four in five frontline nurses said they didn’t have enough protective equipment. Some solicited donations from the public, or navigated a morass of back-alley deals and internet scams.  The federal government could have mitigated those problems by buying supplies at economies of scale and distributing them according to need. Instead, in March, Trump told America’s governors to “try getting it yourselves.” As usual, health care was a matter of capitalism and connections. In New York, rich hospitals bought their way out of their protective-equipment shortfall, while neighbors in poorer, more diverse parts of the city rationed their supplies.
12. Delayed action led to more deaths. Trump finally declared a national emergency on March 13, and before governors and mayors subsequently issued formal stay-at-home orders, or closed schools, shops, and restaurants. A study showed that the U.S. could have averted 36,000 COVID‑19 deaths if leaders had enacted social-distancing measures just a week earlier.
13. Delayed action led to economic disaster. The indiscriminate lockdown was necessary only because America’s leaders wasted months of prep time. Deploying this blunt policy instrument came at enormous cost. Unemployment rose to 14.7 percent, the highest level since record-keeping began, in 1948. More than 26 million people lost their jobs, a catastrophe in a country that ties health care to employment.
14. The social safety net. The dismantling of America’s social safety net left Black people with less income and higher unemployment. They make up a disproportionate share of the low-paid “essential workers” who were expected to staff grocery stores and warehouses, clean buildings, and deliver mail while the pandemic raged around them. Earning hourly wages without paid sick leave, they couldn’t afford to miss shifts even when symptomatic. They faced risky commutes on crowded public transportation.
15. Distribution of information. Distribution of accurate information is an important defense against an epidemic’s spread. The largely unregulated, social-media-based communications infrastructure almost ensures that misinformation will proliferate fast.  In fact, an infodemic of falsehoods spread alongside the actual virus. For example, in March, a small and severely flawed French study suggested that the antimalarial drug hydroxychloroquine could treat COVID‑19. Published in a minor journal, it likely would have been ignored a decade ago. But in 2020, it wended its way to Donald Trump via a chain of credulity that included Fox News, Elon Musk, and Dr. Oz. Trump spent months touting the drug as a miracle cure despite mounting evidence to the contrary, causing shortages for people who actually needed it to treat lupus and rheumatoid arthritis.
16. Lack of leadership in a pandemic. During a pandemic, leaders must rally the public, tell the truth, and speak clearly and consistently. Instead, Trump repeatedly contradicted public-health experts, his scientific advisers, and himself. He said that “nobody ever thought a thing like [the pandemic] could happen” and also that he “felt it was a pandemic long before it was called a pandemic.”  No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the U.S. had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his unqualified son-in-law; that an armchair polymath would claim to have a “natural ability” at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, “I don’t take any responsibility at all.”  A pandemic demands the coordinated efforts of dozens of agencies. “In the best circumstances, it’s hard to make the bureaucracy move quickly,” per Ron Klain. “It moves if the president stands on a table and says, ‘Move quickly.’ But it really doesn’t move if he’s sitting at his desk saying it’s not a big deal.”
17. Trump has corrupted the CDC.  On February 25, the agency’s respiratory-disease chief, Nancy Messonnier, shocked people by raising the possibility of school closures and saying that “disruption to everyday life might be severe.” Trump was reportedly enraged. In response, he seems to have benched the entire agency. The CDC led the way in every recent domestic disease outbreak and has been the inspiration and template for public-health agencies around the world. But during the three months when some 2 million Americans contracted COVID‑19 and the death toll topped 100,000, the agency didn’t hold a single press conference. Its detailed guidelines on reopening the country were shelved for a month while the White House released its own uselessly vague plan.
18. Trump never rallied the country. Despite declaring himself a “wartime president,” he merely presided over a culture war, turning public health into yet another politicized cage match. Abetted by supporters in the conservative media, he framed measures that protect against the virus, from masks to social distancing, as liberal and anti-American. Armed anti-lockdown protesters demonstrated at government buildings while Trump egged them on, urging them to “LIBERATE” Minnesota, Michigan, and Virginia. Several public-health officials left their jobs over harassment and threats.

Related posts on this blog:

How We Got Here

Covid-19: US-is-only-industrialized-country-without-a-national-policy

Irresponsible!

Changing her mind on Medicare for All

The Scale of Testing Compared to the Scale of the Outbreak

Lee Zeldin Promoting Massive COVID Super-spreader Event

Rampant Asymptomatic COVID-19 in a Homeless Shelter

Ignorance is Not Bliss

Fox News Coverage is Dangerous