THE APOCALYPSE IN SIX EASY STEPS

Nobody knew there would be a pandemic or epidemic of this proportion. 

Nobody has ever seen anything like this before.

—President Donald Trump, 29 March, 2020

Someday – if and when we emerge from our pandemic fallout shelters – diligent journalists will reconstruct in detail Trump’s craven abdications, tantrums, lies, and sundry high crimes and misdemeanors during this crisis.  For now, it is possible to summarize the major factors responsible for the catastrophic meltdown of the federal response in the first three months of the pandemic.

First, there was no continuity of leadership experience from the Obama era or even from the first two years of Trump’s presidency. In the last days of the Obama White House, the President’s homeland security advisor, Lisa Monaco, invited her incoming counterpart, Tom Bossert, to co-organize a large-scale test of the country’s preparedness to deal with a viral pandemic.  She was concerned that all the lessons of the Ebola crisis were passed on to the Trump Cabinet and agency heads. “Crimson Contagion,” which took place just a week before the Inauguration, was coordinated by HHS with the participation of a dozen federal agencies and twelve states. Its storyline supposed that an avian flu outbreak in China was brought back to the United States by tourists.  The exercise revealed innumerable problems arising from the friction of competing agencies and officials as well as the cacophony of demands from governors and mayors.  “But the problems,” according to a New York Times investigation, “were larger than bureaucratic snags.  The United States, the organizers realized, did not have the means to quickly manufacture more essential medical equipment, supplies or medicines, including antiviral medications, needles, syringes, N95 respirators and ventilators, the agency concluded.”  Amongst the participants from the new administration, in addition to Bossert, were Rex Tillerson, John F. Kelly and Rick Perry, all of whom reportedly accepted the lessons of the simulation. The White House did not, and by 2019 all of the leaders who took part in Crimson Contagion, as well as the author of the CEA report, had either resigned or been fired.  The Trump administration is its own fifth column.

Second is the shocking incompetence and poor judgment of the CDC which declined the use of the coronavirus test kit developed for the WHO by a German firm.  It has been the consensus of experts internationally that the immediate response priority in a pandemic is widespread testing, contact tracing and isolation of positive cases. This has been done successfully in South Korea, Germany, Singapore and Taiwan, as well as in China following the fatal mistakes in January that forced the total closure of Wuhan.  All these countries had quickly produced ample stockpiles of WHO-type test kits.  The CDC, on the other hand, opted to design its own test kit which it unveiled on 24 January.  But the third stage component of the test was flawed and gave false results.  The entire month of February was thus wasted while the CDC tinkered with the kit rather than switching to the available WHO design.  (The use of an alternative test kit developed by Stanford scientists at the beginning of the month was blocked by FDA red tape.) “Had the United States,” concluded an investigation by the New York Times, “been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.”

The same disaster may be repeating itself in the case of a blood test for immunity, a procedure that could certify which people can safely return to work.  Germany is preparing to conduct trial tests, hoping it will allow its specialized metallurgical industries to roar back to life and revive its lucrative exports to China.  Other countries in Europe and Asia are not far behind Germany. “The U.S., by comparison,” according to a Los Angeles Times investigation, “hasn’t come up with a coherent plan for large-scale antibody testing, which health experts say could dash chances for a return to public life and leave health officials with few options for managing the pandemic other than severe social restrictions until a vaccine or drug therapy is available.”  Such a delay would have the most dire consequences for an economy already plunging into a 1932-like depression.

Third, the “stay at home” and “social distancing” strategy is a second-best approach made necessary by the failure to implement early testing and detection.  Indeed “flattening the curve” is a poor substitute for preventing its exponential increase in the first place.  As a last resort measure, it requires immediate and comprehensive implementation but Trump fiddled and stalled, leaving it to Democratic governors and mayors to try to put out the fire.  Even as the President was compelled by public opinion to grudgingly approve limited application of urban quarantines and then a widespread shutdown of non-essential workplaces, hardcore red state governors (eight at time of writing) have resisted shut-downs with the same stubborn zeal as their predecessors resisted racial integration.  They have been co-conspirators in a viral spread that is bound to take tens of thousands of lives, especially in the Deep South.

Ground zero for the outbreak in the region was the Mardi Gras at the end of February which attracted a million celebrants.  This was a bit like the masked ball in Poe’s Mask of the Red Death and the dancers were not all wearing red.  According to the Washington Post, “New Orleans Mayor LaToya Cantrell [a Democrat] said canceling or curtailing Mardi Gras was never considered. Federal agencies that are part of planning Mardi Gras every year — including the FBI and Homeland Security — did not raise concerns about the coronavirus, she said. Federal officials who walked the parade route with members of her administration were focused on terrorist attacks.”  Most of the visitors were from other parts of Louisiana and neighboring states and returned home with the virus to seed outbreaks in smaller towns and cities lacking the laboratories, ICU nurses, and ventilators to treat COVID.  The regional medical centers in larger cities like New Orleans, Baton Rouge, and Jackson (MS) that normally play that role are now overwhelmed and unable to accept critical cases from their rural peripheries.

Fourth, all the competent responses in other countries had ample inventories of personal protective gear – N-95 masks, gowns and goggles – available to assure the safety of firefighters, postal workers, bus drivers, and police as well as medical staff.  Especially in East Asia, the world center for the production of such supplies, the use of surgical masks by the general public during flu season is an old custom, and it was an easy step to require that everyone going outside their home wear a mask.   In contrast, the United States provides a catastrophic counter-example. Nothing I think better symbolizes state failure than the fact that on the same day that Trump was making his usual boasts about the country’s unparalleled scientific and technological might, the New York Times devoted a full page to “how to sew your own mask.” Millions of Americans are now doing so, in the absence of products that cost mere pennies to manufacture.   The shortages of N-95 masks, as well as throat swabs and testing reagents, come at an incalculable cost in the wake of the test kit fiasco.  Countries that had all these essentials available not only saved thousands of lives, but were able to safely maintain essential parts of the economy.

Despite the fact that the Korean War-era Defense Production Act is invoked thousands of times each year by the Defense Department to ensure that contractors meet their deadlines, the Trump White House, cheered on by the US Chamber of Commerce, has refused to use it to accelerate the manufacture of these lifeline products. (The revolutionary Halyard Health mask machine meanwhile gathers dust.) This fatal decision to rely on the Presidents’ rapport with corporate leaders rather than nationalize production as in wartime goes hand in hand with the break in precedent of putting Mike Pence and Jared Kushner in charge of the response over continuing the tradition of letting the CDC coordinate the mobilization with the aid of a uniformed logistics expert from the Department of Defense.  The result is Katrina writ a hundred or even a thousand times larger.

Fifth, the now-depleted National Strategic Stockpile was created to allow Washington to directly aid stricken cities and regions in a health emergency. Kushner’s recent assertion that mandate was only to supplement state inventories is a blatant falsehood, designed to pass the buck and rationalize the White House’s refusal to take decisive leadership in addressing all the shortages and production bottlenecks.  Although the Trump administration has been a power grab in almost every sense, it has consistently rejected power’s responsibilities.  Thus the Trump Doctrine: states and cities should forage on their own for ventilators and protective supplies.  As Maryland’s ex-governor Martin O’Malley caustically observed, “that is a Darwinian approach to federalism; that is states’ rights taken to a deadly extreme”

Moreover, Trumps oft-repeated claim that most states had access to abundant medical resources is the opposite of the actual case. Across the country, the 2008 recession had been a bloodbath for local health departments, trimming their workforces by a quarter and closing a dozen major public-health laboratories.  The loss of experienced public health nurses in particular has come back to haunt many localities.  Fiscal austerity also became a pretext for reducing or eliminating states’ own emergency medical stockpiles.  The blame, as the case of California illustrates, falls on both parties. In response to the threatened 2005 avian flu pandemic, Governor Arnold Schwarzenegger and the Democratic leaders of the legislature spent hundreds of millions of dollars to stockpile 2400 portable ventilators, 50 million respirators, and materials to assemble 21,000 additional hospital beds.  They also invested in three state-of-the-art 200-bed mobile hospitals that could be up and running within 72 hours of a disaster.  But Schwarzenegger was succeeded by a notorious penny pincher named Jerry Brown who in 2011 crossed out the annual allocation of $5.8 million to maintain the stockpile.  While the state’s chief medical officer and others wept, the strategic supplies and field hospitals, specifically mandated for viral emergencies like COVID-19, were either given away or sold off.

Six, Trump’s CDC, still reeling from the test kit fiasco, has abdicated a principal role in vaccine development as have Big Pharma and the WHO.  Within the White House, moreover, there has been no visible enthusiasm for the kind of public “moon shot” effort that so many scientists deem necessary. Instead the leadership vacuum has been filled by the Coalition for Epidemic Preparedness Innovation (CEPI), a non-profit headquartered in Oslo that was launched three years ago by the Gates Foundation, the Wellcome Trust, and the governments of Norway, Germany, and Japan.  Led by Richard Hackett, one of the principal authors of the 2005 National Strategy for Pandemic Influenza, the CEPI funnels investment to ambitious startups and small-to-medium-sized firms that it believes have the talent to advance innovations like mRNA technology and now a vaccine for SARS-CoV-2.  The research community it funds has become a hothouse where molecular biologists and biotechnologists, in an ever-expanding global collaboration, are sharing ideas with astonishing speed and openness as they struggle to move candidate antivirals and vaccines to the testing stage.

But CEPI and similar collaborations do not have the funding to accelerate the transition from the laboratory to production line.  A COVID vaccine, it is estimated, would require an investment of at least $2 billion to roll out the tens of millions of vaccinations that are required just to cover the elderly and chronically ill.  In an editorial for Science, Seth Berkley, another longtime crusader for vaccine research, set parameters for what was immediately needed:  “If ever there was a case for a coordinated global vaccine development effort using a ‘big science’ approach, it is now.” Such a viral Manhattan Project would require at least three things: dynamic US-China cooperation such as existed during the Ebola epidemic, direct government funding and production of the vaccine and other life-saving drugs (an idea endorsed by Senator Elizabeth Warren), and world-class scientific leadership at the helm.  From a Trumpian perspective, however, you might call those the “three anathemas.”