How the U.S. Response Became a Fiasco

Isabelle Papadimitriou, 64, a respiratory therapist in Dallas, had been treating a surge of patients as the Texas economy reopened. She developed covid-19 symptoms June 27 and tested positive two days later. The disease was swift and brutal. She died the morning of the Fourth of July.

The holiday had always been her daughter’s favorite. Fiana Tulip loved the family cookouts, the fireworks, the feeling of America united. Now, she wonders whether she’ll ever be able to celebrate it again. In mourning, she’s furious.

Tulip, 40, had seen her country fail to control the novel coronavirus. She had seen Texas ease restrictions even as case counts and hospitalizations soared. She had seen fellow citizens refuse to wear masks or engage in social distancing.

“I feel like her death was a hundred percent preventable. I’m angry at the Trump administration. I’m angry with the state of our politics. I’m angry at the people who even now refuse to wear masks,” she said.

Six months after the coronavirus appeared in America, the nation has failed spectacularly to contain it. The country’s ineffective response has shocked observers around the planet.

Many countries have rigorously driven infection rates nearly to zero. In the United States, coronavirus transmission is out of control. The national response is fragmented, shot through with political rancor and culture-war divisiveness. Testing shortcomings that revealed themselves in March have become acute in July, with week-long waits for results leaving the country blind to real-time virus spread and rendering contact tracing nearly irrelevant.

The United States may be heading toward a new spasm of wrenching economic shutdowns or to another massive spike in preventable deaths from covid-19 — or both.

How the world’s richest country got into this dismal situation is a complicated tale that exposes the flaws and fissures in a nation long proud of its ability to meet cataclysmic challenges.

The fumbling of the virus was not a fluke: The American coronavirus fiasco has exposed the country’s incoherent leadership, self-defeating political polarization, a lack of investment in public health, and persistent socioeconomic and racial inequities that have left millions of people vulnerable to disease and death.

In this big, sprawling, demographically and culturally diverse nation, the decentralized political structures gave birth to patchwork policies that don’t make sense when applied to a virus that ignores state boundaries and city limits.

Track the U.S. deaths from the coronavirus

While other countries endured some of the same setbacks, few have suffered from all of them simultaneously and catastrophically. If there was a mistake to be made in this pandemic, America has made it.

The single biggest miscalculation was rushing to reopen the economy while the virus was still spreading at high rates through much of the country, experts say. The only way to reopen safely, epidemiologists said as far back as early April, was to “crush the curve” — to drive down the rate of viral transmission to the point that new infections were few and far between.

Many countries did just that. The United States did not follow the expert advice. Now, the curve is crushing America.

“We didn’t have the stick-to-itiveness, the determination, to carry through what we started in March, April and May, and now the virus is taking advantage of that,” National Institutes of Health Director Francis Collins said.

“If we’d had really strong guidance from local, state and national leaders, maybe we could have sustained the determination to get the curve all the way down to zero,” he said. “Now, we’re on the upswing, and I don’t quite see the top of the upswing yet.”

America, the outlier

Other countries have managed to avoid the kind of dramatic viral resurgence that is happening in America. Spain, Italy, Germany and France — all devastated by the virus months ago — drove coronavirus cases and deaths to relatively low levels. The United Kingdom has been an outlier in Europe, with one of the highest per capita death tolls in the world, but after suppressing transmission, it has not seen a major rebound.

And in Asia, the picture is radically different. In Taiwan, baseball fans sit in the stands and watch their teams play. Japan has had fewer than 1,000 deaths from covid-19, the illness caused by the coronavirus. South Korea has had fewer than 300. Vietnam has recorded no deaths from the virus.

The death rate from covid-19 in the United States looks like that of countries with vastly lower wealth, health-care resources and technological infrastructure.

America’s mishandling of the pandemic has defied most experts’ predictions. In October, not long before the novel coronavirus began sickening people in China, a comprehensive review ranked the pandemic preparedness of 195 countries. The project — called the Global Health Security Index and spearheaded by the Johns Hopkins Center for Health Security and the Nuclear Threat Initiative — assigned scores to countries as a way to warn them of the rising threat of infectious-disease outbreaks.

With a score of 83.5 out of 100, the United States ranked No. 1.

How did the nation get caught so flat-footed? By not really trying, said Beth Cameron, who helped lead the project for the Nuclear Threat Initiative.

The federal government punted the coronavirus response to the states, counties and cities, said Cameron, who was senior director for global health security and biodefense on the White House National Security Council and helped write a pandemic response plan under President Barack Obama. The team Cameron led was disbanded after Donald Trump took office. The White House says positions on the disbanded team were absorbed into another office.

“I just never expected that we would have such a lack of federal leadership, and it’s been deliberate,” she said. “In a national emergency that is a pandemic, spreading between states, federal leadership is essential. And if there was any doubt about that, we ran that experiment from March and April until now. It failed. So we have to run a different experiment.”

A nation of individuals

Somehow, this highly mobile virus keeps sneaking up on communities, seeding itself extensively before people detect the breadth and intensity of the attack. That happened catastrophically in New York City early in the pandemic. The new outbreaks have been largely in the South and West.

This month, Roy Ramos, a reporter for WPLG-TV in Miami, noticed he had a cough. He and his wife, the station’s evening news anchor, Nicole Perez, went to get tested for the coronavirus. Positive — both of them. Soon, another anchor and the station’s chief meteorologist had tested positive, too.

As of July 14, 10 station employees had tested positive, including some who hadn’t even been in the office or in contact with their co-workers. The virus was everywhere in South Florida, which is now reeling from the pathogen’s assault.

“This is not a political message, but a personal one,” Perez’s co-anchor, Calvin Hughes, told viewers. “Please, please wear a mask.”

In the minds of many Americans, the coronavirus crisis that was so alarming in March and April lost its fearsomeness in May and June, when people tried to resume something approximating a normal life. The shutdowns had been miserable, but they’d been effective.

The success of the shutdowns meant that many Americans didn’t know anyone personally sickened by the virus. In places with low transmission, the crisis seemed far away.

“We just let our guard down,” Ohio Gov. Mike DeWine (R) said in an interview Friday. “Some people when they heard, ‘Hey, Ohio’s open,’ what they mentally processed is, ‘It’s safe. We can go out and do whatever we want to. It’s back to normal.’ ”

In the past two months, the virus has been smoldering in his state, the governor said, and “now we start to see some flames.” He fears Ohio could soon have the kind of runaway transmission afflicting Florida.

“Florida a month ago is where Ohio is today. If we don’t want to be Florida, we’ve got to change what we’re doing. Everybody’s got to mask up,” the governor said.

He and others cite human nature as a problem with containing the virus. Human brains simply aren’t wired to emphasize the importance of doing things, like wearing masks, that protect others but offer no immediate payoff, said Paul Slovic, a University of Oregon psychologist.

“You don’t get rewarded for putting on a mask,” Slovic said. “You don’t see who you’ve protected from harm, but you do feel an immediate discomfort.”

Protecting one life — or even one small puppy — generates a major emotional response that can prompt action, Slovic has found. But as the number of individuals involved increases — say, to the 137,000-plus deaths caused by the coronavirus — people grow inured to the loss, less prone to take action.

That makes public messaging especially essential, experts say. But the messaging in the United States has been all over the place. Even the scientists have struggled: They were wobbly on the effectiveness of masks before eventually embracing them.

Kristin Urquiza, 39, said she tried warning her father, Mark — a lifelong Republican — against going out and risking infection. In their home state of Arizona, as leaders including Gov. Doug Ducey (R) sprinted to reopen in May and June, Urquiza could tell she was losing the argument.

“When the president, the governor and people on cable news are all saying one thing, how do you compete with that?” she said. “He would push back. ‘I hear what you’re saying, but why would the governor say it’s safe to go out if it’s not true?’ ”

Her father died of the virus June 30. In the obituary she wrote, she lashed out at government leaders.

“He was a huge supporter of Trump and Arizona governor Ducey. He believed what they said. And they betrayed him,” she said in an interview.

When there’s no cavalry to send

Even before the pandemic hit, local public health agencies had been decimated by years of staffing and budget cuts.

They had lost almost a quarter of their overall workforce since 2008 — a cut of almost 60,000 workers, according to national associations of health officials. The agencies’ main source of federal funding — the Centers for Disease Control and Prevention’s emergency preparedness budget — had been cut 30 percent since 2003.

Public health is an enterprise with an intrinsic problem: People can’t see sicknesses avoided or deaths averted.

“You don’t see the results. It’s a dog that doesn’t bark,” said David Himmelstein, professor of public health and health policy at the CUNY School of Public Health.

“The question is, does the water come out of your tap clean? Are the sewer systems being inspected? Are restaurants and food being inspected? Those things, you don’t notice until they fail,” he said.

The country’s electronic disease surveillance systems are “archaic and cumbersome,” said Cathy Slemp, who was recently dismissed as West Virginia’s public health commissioner after the governor blamed her for failing to reclassify certain coronavirus cases as recovered.

“We’re driving a Pinto and want to have a Ferrari,” she said.

The public health challenges are keenly felt in Malheur County, a vast swath of mostly federal rangeland in rural eastern Oregon. About a quarter of its 30,000 residents live in poverty. Teen pregnancy rates are double the statewide rate. There’s one school nurse for 10,000 square miles. Drug use is high.

The first coronavirus case hit March 30, and for more than a month, the county averaged just one to two cases a week. There was resistance to a statewide shutdown in the conservative area, but most people were willing to observe temporary restrictions, said Sarah Poe, director of the county health department.

But after a month or so, residents began to complain of government overreach. Many felt they had to resume working to survive, she said.

“People’s response has been to just take care of themselves, take care of your own business, your own family,” Poe said. “That’s not how this virus works.”

Now, the coronavirus is a full-blown crisis in Malheur County. Cases began soaring three weeks ago, to 15 or 16 a day. As of Friday, the county had 477 cases. The cumulative positive rate since the first case is nearly 16 percent — quadruple the state’s rate.

On Wednesday, facing an accelerating caseload, Malheur County commissioners passed a resolution that goes further than the state’s mask order. It recommends gatherings of no more than 10 people indoors and 25 outdoors, and mask-wearing in groups indoors and out.

But resistance in the county remains high. Poe said she regularly gets hate mail and phone calls accusing her of peddling a hoax.

“We’re up against just a ton of misinformation,” she said. “What are we fighting here? We are fighting a virus and our goal is to save lives. Let’s not be distracted into fighting other people.”

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