There Is Still No Plan

Trump seems content to have an excuse for losing the election, rather than trying to beat coronavirus and have a chance at winning it. Photo: Bloomberg via Getty Images

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There is still no plan for the end of the coronavirus crisis, for all intents and purposes.

A month ago, on April 5, I wrote that, weeks into what was initially intended to be a short lockdown, there was no clear vision of an endgame from the White House. In theory, the lockdowns were designed to slow the spread of the disease to give us time to catch up and prepare for what would happen when restrictions were relaxed. In the month since, we’ve had a lot more action at the state and local level, though that action has moved in different directions at once — Los Angeles rolling out free universal testing and Massachusetts building out a contact-tracing army while Texas reopens dangerously close to its own peak and Georgia leans into its own coronavirus surge. That disarray is because, in the White House and throughout the federal government, there is still nothing like a vision or concerted effort to coordinate a national response. On Tuesday, it was even reported that the president was disbanding the coronavirus task force, though on Wednesday the president somewhat walked that back on Twitter in a thread that was really more a self-congratulations on a job very well done. Thursday, the Associated Press reported that guidelines prepared by the CDC to inform state and local officials in managing their own re-openings were abruptly shelved, with agency scientists told the plan “would never see the light of day.”

So, how well have we done? Well, abysmally. Aside from flattening the curve in critical places enough to ease the burden on the health-care system, the country has accomplished essentially none of the necessary preparatory work required to safely begin to reopen and return to some semblance of normal life.

That is true by nearly every metric, but let’s begin with testing, the most fundamental. On March 30, when lockdowns were under way in the vast majority of American states, 117,450 COVID-19 tests were conducted nationally, according to The Atlantic’s “Covid Tracking Project.” On April 30, a month later, it was 229,599. Testing capacity had only doubled during a month of lockdown designed, presumably, to buy time to mount a sufficient response. In the two weeks prior to lockdown, the capacity had grown about 15-fold — up from 7,658 tests on March 15. Proportionally, then, the country made considerably less progress during lockdown than it had before; even in raw numbers, testing capacity had grown only about as much during lockdown as it had in those two weeks before.

How many tests would we need to be able to safely open up, as we are already beginning to anyway? Estimates vary, but one lower-end projection, from Harvard, puts the number at 500,000 to 700,000 tests every day — two to three times the capacity we have today. Another estimate comes from economist Paul Romer: more than 20 million each week
or 3 million every day. And a third, from one of the leading “road maps,” produced by the Safra Center, also at Harvard, calls for 5 million tests daily by June and 20 million every day before proceeding to full reopening. Five million is 25 times what we are doing now; 20 million is nearly a hundred times more.

Romer has sold his proposal as easier than the others because it does not depend on contact tracing — large numbers of public-health officials responding to each positive case like detectives, making contact with all those people the new patient recently encountered, and advising them to be tested, quarantine, or both. But the even higher testing target put forward by the Safra Center uses both — testing and contact tracers.

How many of those would we need? Last week, a group of powerful former federal public-health officials (including Scott Gottlieb, once Trump’s FDA commissioner, and Andy Slavitt, once Obama’s head of Medicare and Medicaid) called for around 180,000 of them; other proposals range from 100,000 to 300,000. In response, NPR conducted a nationwide survey and found 7,602 currently working across 41 states. Surge plans would bring that total to 36,587 — barely a sixth of the estimated need.

When the White House first released its guidelines for “opening up America again,” on April 15, it suggested that reopening would only be advisable following a “downward trajectory of documented cases within a 14-day period.” That is not the case for the U.S. as a whole: On May 6, there were 23,841 new cases reported; on April 28, there were 22,541 new cases reported; on April 23, the number of new cases reported was just 17,588.

And while some of those new cases reflect the expansion of testing capacity, the death totals are far less ambiguous. On May 6, there were 2,144 deaths from COVID-19 nationally; on April 28, it was 1,369; on April 23, it was 1,721. On May 4, the same day that the University of Washington’s unreliable but influential IHME model literally doubled its projections for death totals by August 4, a leaked report from the CDC suggested that, rather than moving in the right direction, the death totals were likely to get considerably worse very fast — with an average of about 3,000 deaths (and 200,000 new cases) a day as soon as June 1.

But it is worth looking even closer at that leaked report, because the much-talked-about headline numbers did not communicate all that well just how dire the near future depicted by the model really was. The median projection — 3,000 deaths a day, as soon as the end of this month — is quite horrific, a 50 percent increase above our current peak. But for the lifetime of the model’s projections, no single day of data came anywhere close to as low as the median prediction. For the last two weeks, with the country’s infection and death rates shaped profoundly by social distancing and shelter-at-home orders, the results have fallen at or above the model’s 75th-percentile projection. That percentile, on June 1, yields a projection of more than 7,500 deaths every day. For most of the lifetime of the model, when the data reflected fewer lockdowns and less social distancing — that is, when it reflected conditions more like the ones we are going to see more of going forward — daily deaths fell at or above the 97th-percentile projection. For June 1, that projection is for 15,000 deaths every day. If that rate held for a month, it would produce 750,000 deaths just in June. And though the leaked projections end June 1, the model shows no sign of flattening then, which means, as far as the CDC is concerned, not only could the totals grow as the summer goes on but they could accelerate.

This is not how the rest of the world is trending. Since the onset of the outbreak in the U.S., we have heard a lot about the contrasting experience in South Korea, which had its first confirmed case on the same day as the U.S. As recently as the end of February, the country had more confirmed cases of COVID-19 than any country in the world outside of China. In April, 85 South Koreans died from the disease; in the U.S., that month, 62,000 Americans died — 85 every single hour, as Derek Thompson has calculated. And much more recently, with many fewer resources, the state of Kerala, in India, has managed to drive all the way to zero its number of cases through an aggressive regime of testing and tracing.

Not everyone has done as well as South Korea and Kerala. But consider this array of disease curves:

Every country in the world has seen steep declines in new cases but the U.S., U.K., and Sweden, which has chosen to skip shelter-in-place guidelines and experience a more severe outbreak by design, in the hopes that the epidemic will pass through the population more quickly. As Ryan Cooper wrote in The Week, at this point, the American response is functionally indistinguishable from Sweden’s: “Trump is pursuing a herd immunity strategy,” as he put it, “whether intentionally or not.” Such a strategy, the epidemiologists Carl T. Bergstrom and Natalie Dean wrote recently in the New York Times, would result in millions of American deaths. That’s millions plural.

Why is the U.S. story so exceptional? As with everything in this pandemic, the story is complicated, and given how many levels of American government and leadership stumbled in their response, and how many nations and international institutions failed in the early stages, we should be careful not to overly attribute final outcomes of the disease to any single political decision or leader. But, in this case, what counts as “overly”? As the pandemic wears on, and even those other countries that had been slow to respond to the crisis turn their own corners, it is increasingly hard to hang our failures on anything but the president’s refusal to lead, and the total vacuum that has opened up at the heart of what should have been the country’s disease response. No clear federal clinical guidelines, no comprehensive national strategy of social distancing or shelter in place, no clearinghouse of best practices about how to avoid spreading the disease. No rapid mass production of PPE or other necessary equipment. And above all no use of federal powers to build out testing or contact-tracing capacity.

All of this could have been kick-started in January, once the possibility the virus might come here first announced itself, and there has been plenty of justified outrage that none of it was. But it also could’ve been kick-started in February, or March, or April. Practically speaking, none of it was, though our politics and news cycles had been entirely eaten up by the pandemic at that point. It is unfortunate but unexceptional that the White House did nothing in January — in this, it was quite like most of its peer countries. What is remarkable and unforgivable is that it did almost nothing to make up for it in the months that followed, doubling down on a policy of indifference whose most aggressive feature was the president’s son-in-law commanding FEMA to seize shipments of critical medical supplies on the way to states and hospitals to redistribute according to unclear criteria. Finally, in the last stimulus bill, some money was allotted for this capacity, but the initiative didn’t come from the executive branch, which spent the time urging states to reopen. The testing will only come slowly, and, in the meantime, as MTA conductor Sujatha Gidla wrote in the Times this week, “essential” workers are being treated as “sacrificial.” On Twitter, Jeet Heer went even further: “I cannot underscore enough that the plan is to make the working class into human sacrifices on the altar of capitalism,” he wrote.

On his blog, press critic Jay Rosen was perhaps even more excoriating. “The plan is to have no plan,” he wrote, “to let daily deaths between one and three thousand become a normal thing, and then to create massive confusion about who is responsible — by telling the governors they’re in charge without doing what only the federal government can do, by fighting with the press when it shows up to be briefed, by fixing blame for the virus on China or some other foreign element, and by ‘flooding the zone with shit,’ Steve Bannon’s phrase for overwhelming the system with disinformation, distraction, and denial, which boosts what economists call ‘search costs’ for reliable intelligence.”

What makes this especially strange is that Trump is an inveterate political animal, obsessed above all else with his own ratings and popularity, and should be able to see, as anyone else regarding the American political landscape can, that his political success depends on getting the disease under control and the economy somewhat back on its feet. But he hasn’t even tried, not even bothering to feel out the options made available to him by the crisis — true wartime power, expanded surveillance capacities, and much more leeway in other areas, should he choose to focus on them. Which is another reminder, if we needed it, that, for all liberals have worried over the president’s authoritarian tendencies the last few years, he has behaved in office much more like the con man he was in business than all the Mussolinis, Erdogans, and Putins he professed to admire in politics. Over the last few years, at every juncture when faced with an opportunity to seize more power, with the possible exception of immigration policy, he has chosen instead to do what he can to avoid responsibility. He is doing that now, with his reelection hanging in the balance — apparently preferring to be able to blame a loss in November on this virus, at the cost of perhaps hundreds of thousands of American lives, than to give himself a chance of winning, and a chance of saving them.

There Is Still No Plan