the national interest

The Hospital Deluge Is Coming. Washington Has Done Almost Nothing to Prepare.

Donald Trump Photo: Drew Angerer/Getty Images

President Trump has won glowing plaudits for changing the tone of his press conferences from completely unhinged to partially hinged, and reducing his rate of massive Orwellian lies to one or two per appearance. But as the president manages to stumble over a bar set at ground level in his televised communications, the government’s actual performance is a different matter altogether. Even catastrophically failed government enterprises usually manage to project an air of competence. And a growing body of reporting suggests the government has done shockingly little to prepare for the coming public-health crisis.

The most efficient first step would have been to prevent the coronavirus pandemic from spreading in the first place. As many reports have widely documented, that first step never took place because the Centers for Disease Control and Prevention failed to deploy an effective coronavirus test. “This is such a rapidly moving infection that losing a few days is bad, and losing a couple of weeks is terrible,” Ashish Jha, director of the Harvard Global Health Institute, tells Bloomberg News. “Losing 2 months is close to disastrous, and that’s what we did.”

The loss of those two months deprived the government of any chance to prevent the pandemic from sweeping across the entire country. Officials have been forced into reaction mode, deploying blunt measures of closing public spaces to try to slow down the spread. Even so, it is highly likely that, within a few weeks, the number of infected patients will exceed the capacity of the hospital system to treat them.

Washington has had weeks and weeks to prepare for this surge. The three most obvious and foreseeable shortages are hospital beds, respirator masks to protect medical staff, and ventilators (the machines that are needed to pump air into the lungs of patients with the most serious coronavirus symptoms).

You would think the government would have spent the last two months scrambling to produce more of all three. There is no evidence this has happened, and a great deal of evidence it has not.

Begin with the ventilator machines. Jonathan Cohn consulted with a dozen engineers, executives, and physicians about what’s being done to produce a surge of equipment. You might expect an effort equivalent to the frantic production of ships, tanks, and planes following Pearl Harbor. The sources explain to Cohn what sorts of things would have to happen to produce the ventilator surge — regulators would have to fast-track approval of new production facilities, and arrange planes to fly in supplies. That is not happening.

Several members of Congress sent the White House a letter pleading with the president to use the Defense Production Act to expedite production. A reporter asked Trump yesterday if he had done this. Here was his reply:

Well, we’re able to do that if we have to. Right now, we haven’t had to, but it’s certainly ready. If I want it, we can do it very quickly. We’ve studied it very closely over two weeks ago, actually. We’ll make that decision pretty quickly if we need it. We hope we don’t need it. It’s a big step.

“It’s a big step.” They are days away from having potentially thousands of Americans dying, and Trump still hasn’t decided if he’s ready to take the step to ramp up the machines that will be needed to keep them alive.

At his daily press briefing Wednesday, Trump said he would invoke the Defense Production Act. Later in the day, he insisted he would only reserve it in the future, in case it’s needed:

Trump is describing the need to ramp up production of equipment for a pandemic that is going to flood hospitals within days as a “worst case scenario in the future,” requiring no current action. Does he understand how the timing of this works?

What about getting more respirator masks and hospital beds? The New York Times has an even more harrowing overview of the federal response — or, more accurately, nonresponse. Governors are begging Trump to send more masks for their hospitals, which have desperate shortages. So far they’ve got nothing of value:

Oregon sent a letter to Vice President Mike Pence on March 3 asking for 400,000 N95 masks. For days, it got no response, and only by March 14 received its first shipment, of 36,800 masks. But there was a problem. Most of the equipment they got was well past the expiration date and so “wouldn’t be suitable for surgical settings,” the state said.

New York City also put in a request for more than 2 million masks and only received 76,000; all were expired, said Deanne Criswell, New York City’s emergency management commissioner.

Experts have proposed preparing the Army to set up mobile hospitals to treat overflow patients — something the Army has done before. A spokesperson reported to the Times that the Army has not been given any orders to prepare for such an eventuality:

“The U.S. Army Corps of Engineers is prepared to assist the nation in a time of crisis to the very best of its capabilities, and we are postured to lean forward when an official request is received through the Department of Defense,” Raini W. Brunson, an Army Corps spokeswoman said in a statement. “However, at this time, we have not been assigned a mission.”

They have not been assigned a mission.

What about the Federal Emergency Management Agency, which also has relevant expertise setting up medical facilities during emergencies? “FEMA officials said the Department of Health and Human Services remains in charge of the federal response,” reports the Times, “and it too is waiting for orders from the agency before it moves to ramp up assistance.”

Trump spent weeks publicly downplaying the coronavirus as an overhyped flu, and then treating it as nothing more than a distraction spooking the stock market. Only in recent days has he made a show of acknowledging the virus as a serious health threat. Watching this, we might have clung to the wan hope that his abdication was merely a surface display of incompetence, and that below his level, the government was still functioning. The evidence before us suggests the government actually followed his lead, following the complacent signals he sent — or, at least, has simply floundered for lack of any direction from the top. The closer you look at the inner workings of Trump’s coronavirus response, the worse it gets.

This post has been updated.

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Washington Has Done Nothing to Prepare for Coronavirus Surge