Lazy Caturday Reads: Can We Ever Go Back To “Normal?”Posted: April 11, 2020
Over the past week, Trump’s daily “coronavirus briefings” have grown more and more disorganized, nonsensical, and infuriating. It has become very clear that he has deliberately decided to abdicate any efforts to stem the tide of infections, leaving the battle against the virus to state and local governments. He has no plan, no strategy, except to make every effort to force Americans to go back to work even if that means millions of us get infected and hundreds of thousands die.
The Washington Post reports that states, health experts, think tanks, and non-profits are trying to come up with plans, but there’s no sign that Trump would let the federal government follow their recommendations. The plans involve ramping up testing and organizing contact-tracing efforts.
…a collection of governors, former government officials, disease specialists and nonprofits are pursuing a strategy that relies on the three pillars of disease control: Ramp up testing to identify people who are infected. Find everyone they interact with by deploying contact tracing on a scale America has never attempted before. And focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown.
But there is no evidence yet the White House will pursue such a strategy.
Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the U.S. economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak. President Trump has been especially focused on creating a second coronavirus task force aimed at combating the economic ramifications of the virus.
Administration officials, speaking on the condition of anonymity to describe internal deliberations, say the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors — rather than the federal government — to figure out how to move ahead. [emphasis added]
“It’s mind-boggling, actually, the degree of disorganization,” said Tom Frieden, former Centers for Disease Control and Prevention director. The federal government has already squandered February and March, he noted, committing “epic failures” on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication. The next failure is already on its way, Frieden said, because “we’re not doing the things we need to be doing in April.”
At a White House briefing Friday, Trump said he will announce next week the members of his second coronavirus task force, charged with determining when and how to reopen the country. He stressed his desire to get the economy running again as soon as possible but wouldn’t commit to specifics, saying, “The facts are going to determine what I do. But we do want to get the country open. So important.”
It’s obvious to anyone with half a brain what will happen if Trump convinces some states to do what he wants. But The New York Times gained access to a government report that includes projections from DHS and HHS.
The new federal projections, obtained by The New York Times, come from the departments of Homeland Security and Health and Human Services, and outline three possible situations. The first imagines policymakers doing nothing to mitigate the spread of the virus. The second, labeled “steady state,” assumes schools remain closed until summer, 25 percent of Americans telework from home, and some social distancing continues. The third scenario includes a 30-day shelter in place, on top of those “steady state” restrictions.
The government’s conclusions are sobering. Without any mitigation, the death toll from the virus could have reached 300,000. And if the administration lifts the 30-day stay-at-home orders, the death total is estimated to reach 200,000.
The projections foresee a bump in the demand for ventilators 30 days after stay-at-home orders are issued, a major spike in infections about 100 days after, and peaking 150 days after the initial order. (Those timelines assume further shelter-in-place policies are not put in place to reduce future peaks.)
These numbers fueling the projections may already be out of date. Forecasts accepted by the White House that once estimated at least 100,000 deaths in the United States have now been revised to about 60,000, thanks to aggressive social distancing.
Read the full report here: Data and Analytics
The Daily Mail provides a summary of some of the projections with charts here: New federal projections show huge spike in coronavirus infections in the summer if current lockdown and social distancing measures are lifted after planned 30 days.
At Vox, Ezra Klein summarizes the various plans for reopening the economy and makes it clear that we are not going to return to the old “normal” anytime soon–probably never.
Even Trump’s evangelical CDC director says we shouldn’t open up the economy without contact tracing. NPR: CDC Director: ‘Very Aggressive’ Contact Tracing Needed For U.S. To Return To Normal.
CDC Director Robert Redfield spoke with NPR on Thursday, saying that the plan relies on not only ramped-up testing but “very aggressive” contact tracing of those who do test positive for the coronavirus, and a major scale-up of personnel to do the necessary work.
Contact tracing is the process of finding and reaching out to the contacts of someone who tests positive for an infectious pathogen. Those contacts are then quarantined or monitored, and if any of them are also positive, the process is repeated with their contacts, and on and on, until the chain of transmission is halted. It’s a labor-intensive, time-consuming practice that for decades has been a fundamental public health tool for containing infectious diseases….
Redfield said his agency is ramping up America’s capacity to do more contact tracing. “We are going to need a substantial expansion of public health fieldworkers,” he said. This, along with ample testing, is what will be needed “to make sure that when we open up, we open up for good.”
The first step will be to expand testing, especially testing that provides rapid results, so people can get diagnosed quickly. Redfield’s agency has received a lot of criticism for failing to quickly deliver working tests to public health labs. (Redfield defended the CDC on this point, saying that when problems with the initial test were discovered, “we figured it out and corrected it. Somebody might say that’s botched — I don’t think that’s botched.”) Redfield said that now, testing capacity is increasing daily and that he’s encouraged to see that point-of-care tests that give results within minutes are starting to enter the market.
Next, Redfield said, America will need to scale up capacity for tracing the contacts of those who test positive. “It is going to be critical,” he said. “We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission — so it is going to be very aggressive, what I call ‘block and tackle,’ ‘block and tackle.'”
Given how laborious contact tracing is, that means bringing on a lot more people to do that work. Since state and local public health departments aren’t likely to have the staff to do this, Redfield suggested, the federal government will need to help. “We have over 600 people in the field right now from CDC in all the states trying to help with this response, but we are going to have to substantially amplify that,” he said.
One more from The Nation by Yale epidemiology expert Gregg Gonsolves: The Science Is Clear on How to Beat This Pandemic. But first Trump, Kushner, and the GOP have to stop playing politics with people’s lives.
There is a quiet bipartisan consensus sweeping Washington, DC. Over the past 10 days, the center-right American Enterprise Institute and the center-left Center for American Progress have each come out with reports detailing the steps we need to take to get on the path to recovery from the coronavirus pandemic in the United States. The road maps are more alike than different, both focused on scaling up coronavirus testing, contact tracing, and isolation of infected individuals in the context of a sustained reduction in cases after a prolonged period of social distancing. While some can quibble with the details, the main architecture of an evidence-based, comprehensive response to Covid-19 has now been put together by Republicans and Democrats in exile in the think tanks of our nation’s capital.
Both plans are based on traditional public health principles. Social distancing has a long history in the mitigation of infectious disease outbreaks reaching back into antiquity. In the modern era, during the influenza pandemic of 1918, cities that implemented such measures had half the number of deaths compared to cities that did not. Current strategies centered around testing, contact tracing, and isolation also have a long history, much of it a variation on what was known as the Leicester method for containing smallpox in the late 19th century. If we could now act utilizing these classic methods, we might see the beginning of the end of this pandemic in our country.
Yet the official US response, led, on alternating days, by Jared Kushner’s team of disruptors or Vice President Mike Pence’s task force, hasn’t coalesced around this vision. In fact, the White House remains in chaos, with no hint of preparing to put such plans in place, which would require enormous new funding to support the industrial production and logistical capacity necessary to get it all online. Meanwhile, like a snake oil salesman touting some magical elixir, President Trump hawks chloroquine, while his would-be boy genius son-in-law claims the Strategic National Stockpile is not for use by the states—although that is, in fact, is exactly what it is for. Instead of trying to head off this lunacy, the White House doubles down, with trade adviser Peter Navarro scolding task force member and infectious disease physician Anthony Fauci for refusing to get with the party line on chloroquine, while Secretary Alex Azar cravenly has the Department of Health and Human Services change the language about the stockpile on his agency’s website to reflect Kushner’s claims.
What a circus; what a show! Except none of this was ever entertaining. And now we’re heading toward disaster for millions of Americans. The failure of the initial response to the outbreak, the failure to get Covid-19 testing online or to scale up production of personal protective equipment and ventilators has been widely reported. But nothing has changed, no lessons have been learned, and no one in the president’s party has pulled the emergency brake on this train speeding 100 miles an hour toward the sharp turn ahead.
I won’t be holding my breath waiting for Trump to support federal funding for these efforts. Will Congress force his hand? What Trump will do is continue his ridiculous “briefings” as long as the cable networks are willing to televise them.
There has never been an American president as spiritually impoverished as Donald Trump. And his spiritual poverty, like an overdrawn checking account that keeps imposing new penalties on a customer already in difficult straits, is draining the last reserves of decency among us at a time when we need it most.
I do not mean that Trump is the least religious among our presidents, though I have no doubt that he is; as the scholar Stephen Knott pointed out, Trump has shown “a complete lack of religious sensibility” unique among American presidents. (Just recently he wished Americans a “Happy Good Friday,” which suggests that he is unaware of the meaning of that day.) Nor do I mean that Trump is the least-moral president we’ve ever had, although again, I am certain that he is. John F. Kennedy was, in theory, a practicing Catholic, but he swam in a pool of barely concealed adultery in the White House. Richard Nixon was a Quaker, but one who attempted to subvert the Constitution. Andrew Johnson showed up pig-drunk to his inauguration. Trump’s manifest and immense moral failures—and the shameless pride he takes in them—make these men seem like amateurs by comparison.
And finally, I do not mean that Trump is the most unstable person ever to occupy the Oval Office, although he is almost certain to win that honor as well. As Peter Wehner has eloquently put it, Trump has an utterly disordered personality. Psychiatrists can’t help but diagnose Trump, even if it’s in defiance of the old Goldwater Rule against such practices. I know mental-health professionals who agree with George Conway and others that Trump is a malignant narcissist.
What I mean instead is that Trump is a spiritual black hole. He has no ability to transcend himself by so much as an emotional nanometer. Even narcissists, we are told by psychologists, have the occasional dark night of the soul. They can recognize how they are perceived by others, and they will at least pretend to seek forgiveness and show contrition as a way of gaining the affection they need. They are capable of infrequent moments of reflection, even if only to adjust strategies for survival.
Trump’s spiritual poverty is beyond all this. He represents the ultimate triumph of a materialist mindset. He has no ability to understand anything that is not an immediate tactile or visual experience, no sense of continuity with other human beings, and no imperatives more important than soothing the barrage of signals emanating from his constantly panicked and confused autonomic system.
I hope everyone is staying home and staying safe. Have a quiet, peaceful weekend.