vox--2020-09-09--How Trump let Covid-19 win

How Trump let Covid-19 win

As America , and even his own administration , woke up to the threat of Covid-19 , President Donald Trump still didn ’ t seem to get it .
Within weeks of suggesting that people social distance in mid-March , the president went on national TV to argue that the US could reopen by Easter Sunday in April .
“ You ’ ll have packed churches all over our country , ” Trump said in March .
“ I think it ’ ll be a beautiful time.
” The US wasn ’ t able to fully and safely reopen in @ @ @ @ @ @ @ to fully and safely reopen in September .
The virus rages on , affecting every aspect of American life , from the economy to education to entertainment .
Nearly 190,000 Americans are dead .
Schools are closing down again after botched attempts to reopen , with outbreaks in universities and K-12 settings .
America now has one of the worst ongoing epidemics in the world , with the most daily new deaths among developed nations .
Before fall arrived , in-person teaching was back in parts of Europe , fans returned to baseball @ @ @ @ @ @ @ and dine-in reservations jumped to previous years ’ levels in Germany — while many states in the US had to scale back their already limited reopenings as the disease continues to spread .
The Easter episode , experts said , exemplified the magical thinking that has animated Trump ’ s response to the Covid-19 pandemic before and after the novel coronavirus reached the US .
It ’ s a problem that ’ s continued through September — with Trump and those under him recently denying the existence of a resurgence in Covid-19 , @ @ @ @ @ @ @ of more tests .
With every day , week , and month that the Trump administration has tried to spin a positive story , it ’ s also resisted stronger action , allowing the epidemic to drag on .
A pandemic was always likely to be a challenge for the US , given the country ’ s large size , fragmented federalist system , and libertarian streak .
The public health system was already underfunded and underprepared for a major disease outbreak before Trump .
Yet many other developed countries dealt with these @ @ @ @ @ @ @ systems are notoriously underfunded worldwide .
Australia , Canada , and Germany , among others , also have federalist systems of government , individualistic societies , or both .
Instead , experts said , it ’ s Trump ’ s leadership , or lack thereof , that really sets the US apart .
Before Covid-19 , Trump and his administration undermined preparedness — eliminating a White House office set up by the previous administration to combat pandemics , making cuts across other key parts of the federal government , and proposing further cuts @ @ @ @ @ @ @ downplayed the threat , suggesting it would soon disappear “ like a miracle.
” The Centers for Disease Control and Prevention ( CDC ) took weeks to fix botched tests , and the administration actively abdicated control of issues to local , state , and private actors .
“ There was a failure to realize what an efficiently spreading respiratory virus for which we have no vaccine and no antiviral meant , ” Amesh Adalja , a senior scholar at the Johns Hopkins Center for Health Security , told me .
“ From @ @ @ @ @ @ @ set a tone that reverberated from the highest levels of government to what the average person believes about the virus.
” Several developed countries — including Belgium , France , Italy , and Spain — were caught off-guard by the pandemic and were hit hard early , suffering massive early outbreaks with enormous death tolls .
But most developed countries took these crises seriously : adopting lengthy and strict lockdowns , widespread testing and contact tracing , masking mandates , and consistent public messaging about the virus .
( Though Spain and France @ @ @ @ @ @ @ because they prematurely relaxed social distancing measures . )
America did not take the steps necessary , even after an outbreak spiraled out of control in New York .
Now the US has about seven times the Covid-19 deaths as the median developed country , ranking in the bottom 20 percent for coronavirus deaths among wealthy nations .
Tens of thousands of lives have been needlessly lost as a result : If America had the same death rate as , for example , Canada , 100,000 more Americans would likely be alive today @ @ @ @ @ @ @ been president , if John McCain had been president , if Mitt Romney had been president , this would have looked very different , ” Ashish Jha , the faculty director of the Harvard Global Health Institute , told me , emphasizing the failure to act after Covid-19 hit the US hard was a phenomenon driven by Trump .
Experts worry that things will again get worse : Colder weather is coming , forcing people back into risky indoor environments .
So are holiday celebrations , when families and friends will gather from @ @ @ @ @ @ @ looms .
And Trump , experts lamented , is still not ready to do much , if anything , about it .
The White House disputes the criticisms .
Spokesperson Sarah Matthews claimed Trump “ has led an historic , whole-of-America coronavirus response ” that followed experts ’ advice , boosted testing rates , delivered equipment to health care workers , and remains focused on expediting a vaccine .
The US wasn ’ t prepared for a pandemic — and Trump made it worse During the 2014 Ebola outbreak , President Barack Obama @ @ @ @ @ @ @ wasn ’ t prepared for a pandemic .
Jeremy Konyndyk , who served in the Obama administration ’ s Ebola response , said he “ came away from that experience just completely horrified at how unready we would be for something more dangerous than Ebola , ” which has a high fatality rate but did not spread easily in the US and other developed nations .
The Obama administration responded by setting up the White House National Security Council ’ s Directorate for Global Health Security and Biodefense , which was meant to @ @ @ @ @ @ @ CDC to the Department of Health and Human Services to the Pentagon , involved in contagion response .
But when John Bolton became Trump ’ s national security adviser in 2018 , he moved to disband the office .
In April 2018 , Bolton fired Tom Bossert , then the homeland security adviser , who , the Washington Post reported , “ had called for a comprehensive biodefense strategy against pandemics and biological attacks.
” Then in May , Bolton let go the head of pandemic response , Rear Adm. Timothy Ziemer , @ @ @ @ @ @ @ .
Bolton claimed that the cuts were needed to streamline the National Security Council , and the team was never replaced .
In the months before the coronavirus arrived , the Trump administration also cut a public health position meant to detect outbreaks in China and another program , called Predict , that tracked emerging pathogens around the globe , including coronaviruses .
And Trump has repeatedly called for further cuts to the CDC and National Institutes of Health , both on the front lines of the federal response to disease outbreaks ; @ @ @ @ @ @ @ after the pandemic began , though Congress has largely rejected the proposals .
The Trump administration pushed for the cuts despite multiple , clear warnings that the US was not prepared for a pandemic .
A 2019 ranking of countries ’ disaster preparedness from the Johns Hopkins Center for Health Security and Nuclear Threat Initiative had the US at the top of the list , but still warned that “ no country is fully prepared for epidemics or pandemics.
” A federal simulation prior to the Covid-19 pandemic also predicted problems the US @ @ @ @ @ @ @ coordination and communication to shortages in personal protective equipment for health care workers .
Bill Gates , who ’ s dedicated much of his Microsoft fortune to fighting infectious diseases , warned in 2017 , “ The impact of a huge epidemic , like a flu epidemic , would be phenomenal because all the supply chains would break down .
There ’ d be a lot of panic .
Many of our systems would be overloaded.
” Gates told the Washington Post in 2018 he had raised his concerns in meetings with Trump @ @ @ @ @ @ @ s now clear , didn ’ t listen .
There are limitations to better preparedness , too .
“ If you take what assets the United States had and you use them poorly the way we did , it doesn ’ t matter what the report says , ” Adalja said , referring to the 2019 ranking .
“ If you don ’ t have the leadership to execute , then it makes no difference.
” On February 25 , Nancy Messonnier , director of the CDC ’ s National Center for Immunization @ @ @ @ @ @ @ Americans should prepare for community spread of the coronavirus , social distancing , and the possibility that “ disruption to everyday life might be severe.
” Six months later , Messonnier ’ s comments seem prescient .
But soon after the briefing , she was pushed out of the spotlight — though she ’ s still on the job , her press appearances have been limited — reportedly because her negative outlook angered Trump .
( Messonnier didn ’ t respond to a request for comment . )
The CDC as a whole @ @ @ @ @ @ @ her .
The agency is supposed to play a leading role in America ’ s fight against pandemics , but it ’ s invisible in press briefings led by Trump , Vice President Mike Pence , advisers , and health officials like Anthony Fauci and Deborah Birx who are not part of the organization .
CDC Director Robert Redfield acknowledged as much : “ You may see [ the CDC ] as invisible on the nightly news , but it ’ s sure not invisible in terms of operationalizing this response.
” University @ @ @ @ @ @ @ it in blunter terms , telling me the US has “ benched one of the greatest fighting forces against infectious diseases ever created.
” Meanwhile , the president downplayed the virus .
The day after Messonnier ’ s warning , Trump said that “ you have 15 people [ with the coronavirus ] , and the 15 within a couple of days is going to be down to close to zero.
” This type of magical thinking appears to have driven Trump ’ s response to Covid-19 from the start , from his @ @ @ @ @ @ @ proclamation that the country would reopen by Easter .
This was deliberate .
As Trump later acknowledged in recorded interviews with journalist Bob Woodward , he knew that the coronavirus was “ deadly stuff , ” airborne , more dangerous than the flu , and could afflict both the young and old .
Yet he deliberately downplayed the threat : “ I wanted to always play it down , ” he told Woodward on March 19 .
“ I still like playing it down , because I don ’ t want to create @ @ @ @ @ @ @ he believes in the power of positive thinking .
“ I ’ ve been given a lot of credit for positive thinking , ” he told Axios reporter Jonathan Swan during a wide-ranging discussion about Covid-19 in July .
“ But I also think about downside , because only a fool doesn ’ t. ” Pressed further , he added , “ I think you have to have a positive outlook .
Otherwise , you have nothing.
” The concern , experts said , is the signal this messaging sends .
It tells @ @ @ @ @ @ @ isn ’ t a priority , and things are fine as they are .
And it suggests to the public that the virus is under control , so they don ’ t have to make annoying , uncomfortable changes to their lives , from physical distancing to wearing masks .
It creates the perfect conditions for a slow and inadequate response .
The CDC botched the initial test kits it sent out , and it took weeks to fix the errors .
The Food and Drug Administration ( FDA ) also took weeks @ @ @ @ @ @ @ .
As supply problems came up with testing kits , swabs , reagents , machines , and more , the Trump administration resisted taking significant action — claiming it ’ s up to local , state , and private actors to solve the problems and that the federal government is merely a “ supplier of last resort.
” South Korea , which has been widely praised for its response to coronavirus , tested more than 66,000 people within a week of the first community transmission within its borders .
By comparison , the @ @ @ @ @ @ @ that many tests — in a country with more than six times the population .
Asked about testing problems in March , Trump responded , “ I don ’ t take responsibility at all.
” In June , Trump claimed that “ testing is a double-edged sword , ” adding that “ when you do testing to that extent , you ’ re going to find more people — you ’ re going to find more cases .
So I said to my people , ‘ Slow the testing down , please.
’ @ @ @ @ @ @ @ few thought possible in the wealthiest , most powerful nation on earth .
“ We all kind of knew if a biological event hit during this administration , it wasn ’ t going to be good , ” Saskia Popescu , an infectious disease epidemiologist , told me .
“ But I don ’ t think anyone ever anticipated it could be this bad.
” Trump also consistently undermined the advice of experts , including those in his administration .
When the CDC released reopening guidelines , Trump effectively told states to ignore @ @ @ @ @ @ @ “ LIBERATE ” their economies .
When the CDC recommended masks for public use , Trump described masking as a personal choice , refused to wear one in public for months , and even suggested that people wear masks to spite him .
( He ’ s changed his tone recently . )
While federal agencies and researchers work diligently to find effective treatments for Covid-19 , Trump has promoted unproven and even dangerous approaches , at one point advocating for injecting bleach .
The most aggressive steps Trump took to halt the @ @ @ @ @ @ @ Europe imposed in February and March , respectively — were likely too limited and too late .
And to the extent these measures bought time , it wasn ’ t properly used .
The federal government is the only entity that can solve many of the problems the country is facing .
If testing supply shortfalls in Maine are slowing down testing in Arizona or Florida , the federal government has the resources and the legal jurisdiction to quickly act .
Local or state offices looking for advice on how to react to @ @ @ @ @ @ @ the federal government for guidance .
But the inaction , contradictions , and counterproductive messaging created a vacuum in federal leadership .
In the months after Trump ’ s prediction that coronavirus cases would go down to zero , confirmed cases in the US grew to more than 160,000 .
As of September 9 , they stand at more than 6.3 million .
Months into the pandemic , Trump has continued to flail After the initial wave of coronavirus cases began to subside in April , the White House stopped its daily press @ @ @ @ @ @ @ , Trump ’ s tweets and public appearances focused on Black Lives Matter protests and the 2020 election — part of what Politico reporter Dan Diamond described , based on discussions with administration officials , as an “ apparent eagerness to change the subject.
” Then another wave of coronavirus infections hit beginning in June , peaking with more than 70,000 daily new cases , a new high , and more than 1,000 daily deaths .
America ’ s response to the initial rise of infections was slow and inadequate .
But other @ @ @ @ @ @ @ arrival of a disease brand new to humans .
The second surge , experts said , was when the scope of Trump ’ s failure became more apparent .
By pushing states to open prematurely , failing to set up national infrastructure for testing and tracing , and downplaying masks , Trump put many states under enormous pressure to reopen before the virus was under control nationwide .
Many quickly did — and over time suffered the consequences .
Rather than create a new strategy , Trump and his administration returned to magical @ @ @ @ @ @ @ White House ’ s coronavirus task force , wrote an op-ed titled “ There Isn ’ t a Coronavirus ‘ Second Wave ’ ” in mid-June , as cases started to increase again .
Internally , some of Trump ’ s experts seemed to believe this ; Birx , once a widely respected infectious disease expert , reportedly told the president and White House staff that the US was likely following the path of Italy : Cases hit a huge high but would steadily decline .
Trump trotted out optimistic , but misleading @ @ @ @ @ @ @ Axios reporter Jonathan Swan in July that the US was doing well because it had few deaths relative to the number of cases .
When Swan , clearly baffled , clarified he was asking about deaths as a proportion of population — a standard metric for an epidemic ’ s deadliness — Trump said , “ You can ’ t do that.
” He gave no further explanation .
Seemingly believing its coronavirus mission accomplished , the Trump administration , the New York Times reported , moved to relinquish responsibility for the pandemic @ @ @ @ @ @ @ — in what the Times called “ perhaps one of the greatest failures of presidential leadership in generations.
” “ The biggest problem in the US response is there is not a US response , ” Konyndyk , now a senior policy fellow at the Center for Global Development , told me .
“ There is a New York response .
There ’ s a Florida response .
There ’ s a Montana response .
There ’ s a California response .
There ’ s a Michigan response .
There ’ s a @ @ @ @ @ @ @ a US response.
” When the coronavirus first hit the US , the country struggled with testing enough people , contact tracing , getting the public to follow recommendations such as physical distancing and masking , delivering enough equipment for health care workers , and hospital capacity .
In the second wave , these problems have by and large repeated themselves .
Consider testing : It has significantly improved , but some parts of the country have reported weeks-long delays in getting test results , and the percentage of tests coming back positive @ @ @ @ @ @ @ in most states — a sign of insufficient testing .
The system once again appeared to collapse under the weight of too much demand , while the federal government failed to solve continuing problems with supply chains .
Months after Congress approved billions of dollars in spending to deal with testing problems , the Trump administration has not spent much of it .
Some of Trump ’ s people even seemed to listen to his calls to slow down testing : On August 24 , the CDC updated its guidelines to recommend , @ @ @ @ @ @ @ tested .
It suggested people exposed to others with Covid-19 don ’ t necessarily have to get tested — in a move that experts have called “ dangerous ” and “ irresponsible.
” Mask-wearing also remains polarized .
While surveys show that the vast majority of Americans have worn masks in the past week , there ’ s a strong partisan divide .
According to Gallup ’ s surveys , 99 percent of Democrats say they ’ ve gone out with a mask in the previous week , compared to 80 percent of @ @ @ @ @ @ @ , the New York Times estimated that the percentage of people using masks in public can fall to as low as 20 , 10 , or the single digits — even in some communities that have been hit hard .
Anti-mask protests have popped up around the country .
Testing and mask-wearing are two of the strongest weapons against Covid-19 .
Testing , paired with contact tracing , lets officials track the scale of an outbreak , isolate those who are sick , quarantine their contacts , and deploy community-wide efforts as necessary @ @ @ @ @ @ @ demonstrated in Germany , New Zealand , and South Korea , among others .
There ’ s also growing scientific evidence supporting widespread and even mandated mask use , with experts citing it as crucial to the success of nations like Japan and Slovakia in containing the virus .
It ’ s not that other developed nations did everything perfectly .
New Zealand has contained Covid-19 without widespread masking , and Japan has done so without widespread testing .
But both took at least one aggressive action the US hasn ’ t .
@ @ @ @ @ @ @ many countries , the thing that distinguishes the countries doing well is they took something seriously , ” Kirsten Bibbins-Domingo , an epidemiologist at the University of California San Francisco , told me .
One explanation for the shortfalls in the US response is Trump ’ s obsession with getting America , particularly the economy , back to normal in the short term , seemingly before Election Day this November .
It ’ s why he ’ s called on governors to “ LIBERATE ” states .
It ’ s why he ’ @ @ @ @ @ @ @ can ’ t be worse than the problem itself.
” It ’ s one reason , perhaps , he resisted embracing even very minor lifestyle changes such as wearing a mask .
The reality is that life will only get closer to normal once the virus is suppressed .
That ’ s what ’ s working for other countries that are more earnestly reopening , from Taiwan to Germany .
It ’ s what a preliminary study on the 1918 flu found , as US cities that emerged economically stronger back then took @ @ @ @ @ @ @ the short term but better kept infections and deaths down overall .
“ Dead people don ’ t shop , ” Jade Pagkas-Bather , an infectious diseases expert and doctor at the University of Chicago , told me .
“ They can ’ t stimulate economies.
” The window to avert further catastrophe may be closing As cases and deaths have climbed , and as the November election nears , Trump has once again tried to spring back into action .
He ’ s brought back his coronavirus press conferences .
He ’ @ @ @ @ @ @ @ suggesting that it ’ s Americans ’ patriotic duty to wear one ( although not always doing so himself ) .
But he still seems resistant to focusing too much on the issue , recently changing the subject to former Vice President Joe Biden ’ s supposed plans to destroy the “ Suburban Lifestyle Dream.
” He continues to downplay the crisis , saying on July 28 , as daily Covid-19 deaths once again topped 1,000 , “ It is what it is.
” His Republican convention continued to downplay the risks of @ @ @ @ @ @ @ in fighting the virus .
So while combating Covid-19 aligns with Trump ’ s political incentives ( it remains Americans ’ top priority ) , he and his administration continue to flounder .
And White House officials stand by their response so far , continually pushing blame to local and state governments .
“ There ’ s no national plan to combat the worst pandemic that we ’ ve seen in a century , ” Jen Kates , director of global health and HIV policy at the Kaiser Family Foundation , told me @ @ @ @ @ @ @ calmed now , although cases across the US have so far flattened out at a much higher level than they were in the previous wave .
That ’ s likely a result of cities , counties , states , and the public taking action as the federal government doesn ’ t .
Experts now worry that the country could be setting itself up for another wave of Covid-19 .
Schools reopening across the country could create new vectors of transmission .
The winter will force many Americans indoors to avoid the cold , @ @ @ @ @ @ @ can hinder the spread of the disease .
Families and friends will come together from across the country to celebrate the holidays , creating new possibilities for superspreading events .
And in the background , another flu season looms — which could limit health care capacity further just as Covid-19 cases spike .
“ The virus spreads when a large number of people gather indoors , ” Jha said .
“ That ’ s going to happen more in December than it did in July — and July was a pretty awful month.
@ @ @ @ @ @ @ might not get so bad .
Since so many people in the US have gotten sick , that could offer some element of population immunity in some places as long as people continue social distancing and masking .
After seeing two large waves of the coronavirus across the country , the public could act cautiously and slow the disease , even if local , state , and federal governments don ’ t .
Social distancing due to Covid-19 could keep the spread of the flu down too ( which seemed to happen in @ @ @ @ @ @ @ federal government could do much more to push the nation in the right direction .
Experts have urged the federal government to provide clear , consistent guidance and deploy stronger policies , encouraging people to take Covid-19 as a serious threat — now , not later .
“ I ’ m really concerned that the window might be closing , ” Kates said .
Without that federal action , the US could remain stuck in a cycle of ups and downs with Covid-19 , forcing the public to double down on social distancing @ @ @ @ @ @ @ .
As cases and deaths continue to climb , the country will become even more of an outlier as the rest of the developed world inches back to normal .
And the “ beautiful time ” Trump imagined for Easter will remain out of reach .
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As America, and even his own administration, woke up to the threat of Covid-19, President Donald Trump still didn’t seem to get it. Within weeks of suggesting that people social distance in mid-March, the president went on national TV to argue that the US could reopen by Easter Sunday in April. “You’ll have packed churches all over our country,” Trump said in March. “I think it’ll be a beautiful time.”
The US wasn’t able to fully and safely reopen in April. It isn’t able to fully and safely reopen in September.
The virus rages on, affecting every aspect of American life, from the economy to education to entertainment. More than 200,000 Americans are confirmed dead. Many schools are closing down again after botched attempts to reopen — with outbreaks in universities and K-12 settings. America now has one of the worst ongoing epidemics in the world, with the second most daily new Covid-19 deaths among developed nations, surpassed only by Spain.
America does not have the most Covid-19 deaths per capita of any rich country, but it’s doing worse than most. The US reports about seven times the Covid-19 deaths as the median developed country, ranking in the bottom 20 percent for coronavirus deaths among wealthy nations. Tens of thousands of lives have been needlessly lost as a result: If America had the same death rate as, for example, Canada, about 120,000 more Americans would likely be alive today.
The Easter episode, experts said, exemplified the magical thinking that has animated Trump’s response to the Covid-19 pandemic before and after the novel coronavirus reached the US. It’s a problem that’s continued through September — with Trump and those under him flat-out denying the existence of a resurgence in Covid-19, falsely claiming rising cases were a result of more tests. With every day, week, and month that the Trump administration has tried to spin a positive story, it’s also resisted stronger action, allowing the epidemic to drag on.
A pandemic was always likely to be a challenge for the US, given the country’s large size, fragmented federalist system, and libertarian streak. The public health system was already underfunded and underprepared for a major disease outbreak before Trump.
Yet many other developed countries dealt with these kinds of problems too. Public health systems are notoriously underfunded worldwide. Australia, Canada, and Germany, among others, also have federalist systems of government, individualistic societies, or both — and they’ve all fared much better.
Instead, experts said, it’s Trump’s leadership, or lack thereof, that really sets the US apart. Before Covid-19, Trump and his administration undermined preparedness — eliminating a White House office set up by the previous administration to combat pandemics, making cuts across other key parts of the federal government, and proposing further cuts.
Once the coronavirus arrived, Trump downplayed the threat, suggesting that it would soon disappear “like a miracle.” The Centers for Disease Control and Prevention (CDC) took weeks to fix botched tests, and the administration actively abdicated control of issues to local, state, and private actors.
“There was a failure to realize what an efficiently spreading respiratory virus for which we have no vaccine and no antiviral meant,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “From the very beginning, that minimization … set a tone that reverberated from the highest levels of government to what the average person believes about the virus.”
Several developed countries — including Belgium, France, Italy, and Spain — were caught off-guard by the pandemic and were hit hard early, suffering massive early outbreaks with enormous death tolls. But most developed countries took these crises seriously: adopting lengthy and strict lockdowns, widespread testing and contact tracing, masking mandates, and consistent public messaging about the virus. (Though parts of Europe are now seeing second waves, seemingly because they prematurely relaxed social distancing measures.)
America did not take the steps necessary, even after an outbreak spiraled out of control in New York. So the US suffered a wave of huge cases over the summer that other developed nations generally avoided, leading to new and continued surges in both cases and deaths. And while other developed countries have seen spikes in cases as fall neared, America also has seen cases start to rise once again.
“If George W. Bush had been president, if John McCain had been president, if Mitt Romney had been president, this would have looked very different,” Ashish Jha, dean of the Brown University School of Public Health, told me, emphasizing the failure to act after Covid-19 hit the US hard was a phenomenon driven by Trump.
Experts worry that things will again get worse: Colder weather is coming, forcing people back into risky indoor environments. So are holiday celebrations, when families and friends will gather from across the country. Another flu season looms. And Trump, experts lamented, is still not ready to do much, if anything, about it.
The White House disputes the criticisms. Spokesperson Sarah Matthews claimed Trump “has led an historic, whole-of-America coronavirus response” that followed experts’ advice, boosted testing rates, delivered equipment to health care workers, and remains focused on expediting a vaccine.
She added, “This strong leadership will continue.”
The US wasn’t prepared for a pandemic — and Trump made it worse
During the 2014 Ebola outbreak, President Barack Obama’s administration realized that the US wasn’t prepared for a pandemic. Jeremy Konyndyk, who served in the Obama administration’s Ebola response, said he “came away from that experience just completely horrified at how unready we would be for something more dangerous than Ebola,” which has a high fatality rate but did not spread easily in the US and other developed nations.
The Obama administration responded by setting up the White House National Security Council’s Directorate for Global Health Security and Biodefense, which was meant to coordinate the many agencies, from the CDC to the Department of Health and Human Services to the Pentagon, involved in contagion response.
But when John Bolton became Trump’s national security adviser in 2018, he moved to disband the office. In April 2018, Bolton fired Tom Bossert, then the homeland security adviser, who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then in May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and dismantled his global health security team. Bolton claimed that the cuts were needed to streamline the National Security Council, and the team was never replaced.
In the months before the coronavirus arrived, the Trump administration also cut a public health position meant to detect outbreaks in China and another program, called Predict, that tracked emerging pathogens around the globe, including coronaviruses. And Trump has repeatedly called for further cuts to the CDC and National Institutes of Health, both on the front lines of the federal response to disease outbreaks; the administration stood by the proposed cuts after the pandemic began, though Congress has largely rejected the proposals.
The Trump administration pushed for the cuts despite multiple, clear warnings that the US was not prepared for a pandemic. A 2019 ranking of countries’ disaster preparedness from the Johns Hopkins Center for Health Security and Nuclear Threat Initiative had the US at the top of the list, but still warned that “no country is fully prepared for epidemics or pandemics.”
A federal simulation prior to the Covid-19 pandemic also predicted problems the US eventually faced, from a collapse in coordination and communication to shortages in personal protective equipment for health care workers.
Bill Gates, who’s dedicated much of his Microsoft fortune to fighting infectious diseases, warned in 2017, “The impact of a huge epidemic, like a flu epidemic, would be phenomenal because all the supply chains would break down. There’d be a lot of panic. Many of our systems would be overloaded.”
Gates told the Washington Post in 2018 he had raised his concerns in meetings with Trump. But the president, it’s now clear, didn’t listen.
There are limitations to better preparedness, too. “If you take what assets the United States had and you use them poorly the way we did, it doesn’t matter what the report says,” Adalja said, referring to the 2019 ranking. “If you don’t have the leadership to execute, then it makes no difference.”
As Covid-19 spread, Trump downplayed the threat
On February 25, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters that Americans should prepare for community spread of the coronavirus, social distancing, and the possibility that “disruption to everyday life might be severe.”
Six months later, Messonnier’s comments seem prescient. But soon after the briefing, she was pushed out of the spotlight — though she’s still on the job, her press appearances have been limited — reportedly because her negative outlook angered Trump. (Messonnier didn’t respond to a request for comment.)
The CDC as a whole has been pushed to the sidelines with her. The agency is supposed to play a leading role in America’s fight against pandemics, but it’s invisible in press briefings led by Trump, Vice President Mike Pence, advisers, and health officials like Anthony Fauci and Deborah Birx who are not part of the organization. CDC Director Robert Redfield acknowledged as much: “You may see [the CDC] as invisible on the nightly news, but it’s sure not invisible in terms of operationalizing this response.”
University of Michigan medical historian Howard Markel put it in blunter terms, telling me the US has “benched one of the greatest fighting forces against infectious diseases ever created.”
Meanwhile, the president downplayed the virus. The day after Messonnier’s warning, Trump said that “you have 15 people [with the coronavirus], and the 15 within a couple of days is going to be down to close to zero.” This type of magical thinking appears to have driven Trump’s response to Covid-19 from the start, from his conviction that cases would disappear to his proclamation that the country would reopen by Easter.
This was deliberate. As Trump later acknowledged in recorded interviews with journalist Bob Woodward, he knew that the coronavirus was “deadly stuff,” airborne, more dangerous than the flu, and could afflict both the young and old. Yet he deliberately downplayed the threat: “I wanted to always play it down,” he told Woodward on March 19. “I still like playing it down, because I don’t want to create a panic.”
Trump has long said he believes in the power of positive thinking. “I’ve been given a lot of credit for positive thinking,” he told Axios reporter Jonathan Swan during a wide-ranging discussion about Covid-19 in July. “But I also think about downside, because only a fool doesn’t.” Pressed further, he added, “I think you have to have a positive outlook. Otherwise, you have nothing.”
.@jonathanvswan: “Oh, you’re doing death as a proportion of cases. I’m talking about death as a proportion of population. That’s where the U.S. is really bad. Much worse than South Korea, Germany, etc.”@realdonaldtrump: “You can’t do that.”
Swan: “Why can’t I do that?” pic.twitter.com/MStySfkV39 — Axios (@axios) August 4, 2020
The concern, experts said, is the signal this messaging sends. It tells the staffers under Trump that this issue isn’t a priority, and things are fine as they are. And it suggests to the public that the virus is under control, so they don’t have to make annoying, uncomfortable changes to their lives, from physical distancing to wearing masks.
It creates the perfect conditions for a slow and inadequate response.
The CDC botched the initial test kits it sent out, and it took weeks to fix the errors. The Food and Drug Administration (FDA) also took weeks to approve other tests from private labs. As supply problems came up with testing kits, swabs, reagents, machines, and more, the Trump administration resisted taking significant action — claiming it’s up to local, state, and private actors to solve the problems and that the federal government is merely a “supplier of last resort.”
South Korea, which has been widely praised for its response to coronavirus, tested more than 66,000 people within a week of the first community transmission within its borders. By comparison, the US took roughly three weeks to complete that many tests — in a country with more than six times the population.
Asked about testing problems in March, Trump responded, “I don’t take responsibility at all.” In June, Trump claimed that “testing is a double-edged sword,” adding that “when you do testing to that extent, you’re going to find more people — you’re going to find more cases. So I said to my people, ‘Slow the testing down, please.’”
The testing shortfall was a problem few thought possible in the wealthiest, most powerful nation on earth. “We all kind of knew if a biological event hit during this administration, it wasn’t going to be good,” Saskia Popescu, an infectious disease epidemiologist, told me. “But I don’t think anyone ever anticipated it could be this bad.”
Trump also consistently undermined the advice of experts, including those in his administration. When the CDC released reopening guidelines, Trump effectively told states to ignore the guidance and reopen prematurely — to “LIBERATE” their economies. When the CDC recommended masks for public use, Trump described masking as a personal choice, refused to wear one in public for months, and even suggested that people wear masks to spite him. While federal agencies and researchers work diligently to find effective treatments for Covid-19, Trump has promoted unproven and even dangerous approaches, at one point advocating for injecting bleach. Trump’s allies have even held up CDC studies that could contradict the president’s overly optimistic outlook.
The most aggressive steps Trump took to halt the virus — travel restrictions on China and Europe imposed in February and March, respectively — were likely too limited and too late. And to the extent these measures bought time, it wasn’t properly used.
The federal government is the only entity that can solve many of the problems the country is facing. If testing supply shortfalls in Maine are slowing down testing in Arizona or Florida, the federal government has the resources and the legal jurisdiction to quickly act. Local or state offices looking for advice on how to react to a national crisis will typically turn to the federal government for guidance.
But the inaction, contradictions, and counterproductive messaging created a vacuum in federal leadership.
In the months after Trump’s prediction that coronavirus cases would go down to zero, confirmed cases in the US grew to more than 160,000. As of September 22, they stand at more than 6.8 million.
Months into the pandemic, Trump has continued to flail
After the initial wave of coronavirus cases began to subside in April, the White House stopped its daily press briefings on the topic. By June, Trump’s tweets and public appearances focused on Black Lives Matter protests and the 2020 election — part of what Politico reporter Dan Diamond described, based on discussions with administration officials, as an “apparent eagerness to change the subject.”
Then another wave of coronavirus infections hit beginning in June, peaking with more than 70,000 daily new cases, a new high, and more than 1,000 daily deaths.
America’s response to the initial rise of infections was slow and inadequate. But other developed countries also struggled with the sudden arrival of a disease brand new to humans. The second surge, experts said, was when the scope of Trump’s failure became more apparent.
By pushing states to open prematurely, failing to set up national infrastructure for testing and tracing, and downplaying masks, Trump put many states under enormous pressure to reopen before the virus was under control nationwide. Many quickly did — and over time suffered the consequences.
Rather than create a new strategy, Trump and his administration returned to magical thinking. Pence, head of the White House’s coronavirus task force, wrote an op-ed titled “There Isn’t a Coronavirus ‘Second Wave’” in mid-June, as cases started to increase again. Internally, some of Trump’s experts seemed to believe this; Birx, once a widely respected infectious disease expert, reportedly told the president and White House staff that the US was likely following the path of Italy: Cases hit a huge high but would steadily decline.
Trump trotted out optimistic, but misleading, claims and statistics. He told Axios reporter Jonathan Swan in July that the US was doing well because it had few deaths relative to the number of cases. When Swan, clearly baffled, clarified he was asking about deaths as a proportion of population — a standard metric for an epidemic’s deadliness — Trump said, “You can’t do that.” He gave no further explanation.
Seemingly believing its coronavirus mission accomplished, the Trump administration, the New York Times reported, moved to relinquish responsibility for the pandemic and leave the response to the states — in what the Times called “perhaps one of the greatest failures of presidential leadership in generations.”
“The biggest problem in the US response is there is not a US response,” Konyndyk, now a senior policy fellow at the Center for Global Development, told me. “There is a New York response. There’s a Florida response. There’s a Montana response. There’s a California response. There’s a Michigan response. There’s a Georgia response. But there is not a US response.”
When the coronavirus first hit the US, the country struggled with testing enough people, contact tracing, getting the public to follow recommendations such as physical distancing and masking, delivering enough equipment for health care workers, and hospital capacity. In the second wave, these problems have by and large repeated themselves.
Consider testing: It has significantly improved, but some parts of the country have reported weeks-long delays in getting test results, and the percentage of tests coming back positive has risen above the recommended 5 percent in most states — a sign of insufficient testing. The system once again appeared to collapse under the weight of too much demand, while the federal government failed to solve continuing problems with supply chains. Months after Congress approved billions of dollars in spending to deal with testing problems, the Trump administration has not spent much of it.
Some of Trump’s people seemed to listen to his calls to slow down testing: On August 24, the CDC updated its guidelines to suggest people exposed to others with Covid-19 don’t necessarily have to get tested — a move for effectively less testing that experts described as “dangerous” and “irresponsible.” Only after weeks of criticism did the CDC back down and, on September 18, once again call for testing people without symptoms.
Mask-wearing also remains polarized. While surveys show that the vast majority of Americans have worn masks in the past week, there’s a strong partisan divide. According to Gallup’s surveys, 99 percent of Democrats say they’ve gone out with a mask in the previous week, compared to 80 percent of Republicans. Leveraging surveys on mask use, the New York Times estimated that the percentage of people using masks in public can fall to as low as 20, 10, or the single digits — even in some communities that have been hit hard. Anti-mask protests have popped up around the country.
Testing and mask-wearing are two of the strongest weapons against Covid-19. Testing, paired with contact tracing, lets officials track the scale of an outbreak, isolate those who are sick, quarantine their contacts, and deploy community-wide efforts as necessary to contain the disease — as successfully demonstrated in Germany, New Zealand, and South Korea, among others. There’s also growing scientific evidence supporting widespread and even mandated mask use, with experts citing it as crucial to the success of nations like Japan and Slovakia in containing the virus.
It’s not that other developed nations did everything perfectly. New Zealand has contained Covid-19 without widespread masking, and Japan has done so without widespread testing. But both took at least one aggressive action the US hasn’t. “While there’s variation across many countries, the thing that distinguishes the countries doing well is they took something seriously,” Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco, told me.
One explanation for the shortfalls in the US response is Trump’s obsession with getting America, particularly the economy, back to normal in the short term, seemingly before Election Day this November. It’s why he’s called on governors to “LIBERATE” states. It’s why he’s repeatedly said that “the Cure can’t be worse than the problem itself.” It’s one reason, perhaps, he resisted embracing even very minor lifestyle changes such as wearing a mask.
The reality is that life will only get closer to normal once the virus is suppressed. That’s what’s working for other countries that are more earnestly reopening, from Taiwan to Germany. It’s what a preliminary study on the 1918 flu found, as US cities that emerged economically stronger back then took more aggressive action that hindered economies in the short term but better kept infections and deaths down overall.
“Dead people don’t shop,” Jade Pagkas-Bather, an infectious diseases expert and doctor at the University of Chicago, told me. “They can’t stimulate economies.”
The window to avert further catastrophe may be closing
As cases and deaths climbed over the summer, and as the November election neared, Trump at times appeared to spring back into action — bringing back coronavirus press conferences and briefly changing his tone on masks (before going back to mocking them).
But Trump still seems resistant to focusing too much on the issue. He’s tried to change the subject to former Vice President Joe Biden’s supposed plans to destroy the “Suburban Lifestyle Dream.” He’s continued to downplay the crisis, saying on July 28, as daily Covid-19 deaths once again topped 1,000, “It is what it is.” His Republican convention continued to diminish the risks of Covid-19 and exaggerate Trump’s successes in fighting the virus. At a campaign rally in Ohio on September 21, Trump claimed the virus “affects virtually nobody.”
So while combating Covid-19 aligns with Trump’s political incentives (it remains Americans’ top priority), he and his administration continue to flounder. And White House officials stand by their response so far, continually pushing blame to local and state governments.
“There’s no national plan to combat the worst pandemic that we’ve seen in a century,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me.
The summer surge of Covid-19 has calmed now, although cases across the US flattened out at a much higher level than they were in the spring, likely a result of cities, counties, states, and the public taking action as the federal government didn’t. Still, cases have started to pick back up again.
Experts now worry that the country could be setting itself up for another wave of Covid-19. Schools reopening across the country could create new vectors of transmission. The winter will force many Americans indoors to avoid the cold, while being outdoors in the open air can hinder the spread of the disease. Families and friends will come together from across the country to celebrate the holidays, creating new possibilities for superspreading events. And in the background, another flu season looms — which could limit health care capacity further just as Covid-19 cases spike.
“The virus spreads when a large number of people gather indoors,” Jha said. “That’s going to happen more in December than it did in July — and July was a pretty awful month.”
There are reasons to believe it might not get so bad. Since so many people in the US have gotten sick, that could offer some element of population immunity in some places as long as people continue social distancing and masking. After seeing two large waves of the coronavirus across the country, the public could act cautiously and slow the disease, even if local, state, and federal governments don’t. Social distancing due to Covid-19 could keep the spread of the flu down too (which seemed to happen in the Southern Hemisphere).
But the federal government could do much more to push the nation in the right direction. Experts have urged the federal government to provide clear, consistent guidance and deploy stronger policies, encouraging people to take Covid-19 as a serious threat — now, not later.
“I’m really concerned that the window might be closing,” Kates said.
Without that federal action, the US could remain stuck in a cycle of ups and downs with Covid-19, forcing the public to double down on social distancing and other measures with each new wave. As cases and deaths continue to climb, America will become even more of an outlier as much of the developed world inches back to normal. And the “beautiful time” Trump imagined for Easter will remain out of reach.


vox--2020-09-09--The Kardashian-Jenners don’t need reality TV to sell themselves anymore

After 13 years , Keeping Up With the Kardashians is coming to an end .
The show that made household names out of Kim Kardashian West and her extended family will air its 20th and final season in 2021 , the Kardashian-Jenner clan announced on Tuesday , September 8 .
“ Without Keeping Up With the Kardashians , I wouldn ’ t be where I am today , ” Kardashian West wrote on social media .
“ I am so incredibly grateful to everyone who has watched and supported me and my family these past 14 incredible years .
This @ @ @ @ @ @ @ I will be forever in debt to everyone who played a role in shaping our careers and changing our lives forever.
” Kardashian West isn ’ t wrong : Keeping Up With the Kardashians did launch her career when it premiered on E !
in 2007 .
It ’ s what helped her pivot away from her early semi-fame as Paris Hilton ’ s closet organizer and the girl whose sex tape leaked and toward the kind of celebrity who shows up on the cover of Vogue .
It also made her sisters @ @ @ @ @ @ @ Kardashian-Jenner media empire .
But at this point , it ’ s also clear that the Kardashians have outgrown their reality show platform .
For 13 years , Keeping up With the Kardashians has operated less as the center of the family business and more as an advertisement for the family ’ s many operations .
And now , the Kardashian-Jenners have hit a point where they no longer need that ad .
Earlier this year , Kardashian West sold a stake in her cosmetics company KKW Beauty to Coty for $ 200 @ @ @ @ @ @ @ her net worth at $ 900 million .
In addition to KKW Beauty , Kardashian West also has her own fragrance line , shapewear line , and a mobile game called Kim Kardashian : Hollywood , with accompanying Kimoji .
Her sisters all have similar product lines : Kylie ’ s lip kits , Khloe ’ s Good American jeans , and Kourtney ’ s Poosh , for starters .
( Poosh is a lifestyle brand . )
Then there are the one-off deals , the sponsored posts for laxatives and tooth whiteners @ @ @ @ @ @ @ social media platforms for what family matriarch Kris Jenner says are six-figure fees .
( Kendall Jenner was reportedly paid $ 250,000 to promote the infamous Fyre Fest . )
The Kardashian business strategy is to leverage the family celebrity and all the attention that comes with it to sell to brands .
And when Keeping up With the Kardashians launched in 2007 , it was the architect of the family ’ s fame .
It was how they sold stuff .
As Amy Chozick wrote in the New York Times in 2019 @ @ @ @ @ @ @ news cycle , which drives interest in the TV show , which then helps to publicize an ever-increasing number of sponsorships and branded products.
” But in 2020 , Keeping Up With the Kardashians isn ’ t where the serious numbers are anymore .
When the most recent season aired in April , it captured fewer than a million viewers an episode .
And this was despite premiering during quarantine , when Americans were desperate for distractions .
Instead , the attention the Kardashians capture and sell comes to them on social media @ @ @ @ @ @ @ Instagram .
Kendall has 139 million .
Kylie has 195 million .
With those kind of numbers , who needs television ?
Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
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After 13 years, Keeping Up With the Kardashians is coming to an end. The show that made household names out of Kim Kardashian West and her extended family will air its 20th and final season in 2021, the Kardashian-Jenner clan announced on Tuesday, September 8.
“Without Keeping Up With the Kardashians, I wouldn’t be where I am today,” Kardashian West wrote on social media. “I am so incredibly grateful to everyone who has watched and supported me and my family these past 14 incredible years. This show made us who we are and I will be forever in debt to everyone who played a role in shaping our careers and changing our lives forever.”
Kardashian West isn’t wrong: Keeping Up With the Kardashians did launch her career when it premiered on E! in 2007. It’s what helped her pivot away from her early semi-fame as Paris Hilton’s closet organizer and the girl whose sex tape leaked and toward the kind of celebrity who shows up on the cover of Vogue. It also made her sisters magazine-cover stars and helped launch the larger Kardashian-Jenner media empire.
But at this point, it’s also clear that the Kardashians have outgrown their reality show platform. For 13 years, Keeping up With the Kardashians has operated less as the center of the family business and more as an advertisement for the family’s many operations. And now, the Kardashian-Jenners have hit a point where they no longer need that ad.
Earlier this year, Kardashian West sold a stake in her cosmetics company KKW Beauty to Coty for $200 million. Forbes estimated the deal put her net worth at $900 million. In addition to KKW Beauty, Kardashian West also has her own fragrance line, shapewear line, and a mobile game called Kim Kardashian: Hollywood, with accompanying Kimoji. Her sisters all have similar product lines: Kylie’s lip kits, Khloe’s Good American jeans, and Kourtney’s Poosh, for starters. (Poosh is a lifestyle brand.)
Then there are the one-off deals, the sponsored posts for laxatives and tooth whiteners the Kardashian kids release on their various social media platforms for what family matriarch Kris Jenner says are six-figure fees. (Kendall Jenner was reportedly paid $250,000 to promote the infamous Fyre Fest.)
The Kardashian business strategy is to leverage the family celebrity and all the attention that comes with it to sell to brands. And when Keeping up With the Kardashians launched in 2007, it was the architect of the family’s fame. It was how they sold stuff. As Amy Chozick wrote in the New York Times in 2019, “Family turmoil feeds the celebrity news cycle, which drives interest in the TV show, which then helps to publicize an ever-increasing number of sponsorships and branded products.”
But in 2020, Keeping Up With the Kardashians isn’t where the serious numbers are anymore. When the most recent season aired in April, it captured fewer than a million viewers an episode. And this was despite premiering during quarantine, when Americans were desperate for distractions.
Instead, the attention the Kardashians capture and sell comes to them on social media. Kim has 188 million followers on Instagram. Kendall has 139 million. Kylie has 195 million.
With those kind of numbers, who needs television?
Contribute today from as little as $3.


vox--2020-09-09--A top Covid-19 vaccine trial is on hold after a patient had health problems. Good.

One of the most promising Covid-19 vaccine candidates , being developed by AstraZeneca and Oxford University , had its Phase 3 trials put on hold after a patient experienced a serious adverse event .
That certainly sounds like bad news for everybody eager to have a vaccine as soon as possible .
But hidden in this development is a kernel of good news , if you can call it that : This is exactly the kind of scientific rigor we want biopharma companies to practice — especially amid fears that the US approval of a Covid-19 vaccine could be compromised @ @ @ @ @ @ @ been one of the most intriguing vaccines in development .
As Bloomberg covered in its profile of the lead scientist , Oxford ’ s Sarah Gilbert , it is distinct from the other leading candidates because it does not need to be stored at nearly as cold a temperature .
Others must be frozen to be transported ; Oxford ’ s need only be chilled .
That could be a serious advantage , considering the existing concerns about how easy it will be to widely distribute any Covid-19 vaccine .
AstraZeneca/Oxford Phase 3 @ @ @ @ @ @ @ August , having already started in the United Kingdom , Brazil and South Africa .
The company planned to enroll 30,000 Americans in its US trials .
Phase 3 trials are the make-or-break moment for any new therapy , large-scale trials to determine whether a drug or vaccine has a meaningful effect and to monitor for any adverse effects in a much larger patient population than the earlier , smaller Phase 1 and Phase 2 trials .
STAT broke the news Tuesday evening that Oxford ’ s Phase 3 trial had been paused @ @ @ @ @ @ @ complication .
A follow-up story from STAT on Thursday conveyed the details of the patient ’ s case : The participant who triggered a global shutdown of AstraZeneca ’ s Phase 3 Covid-19 vaccine trials was a woman in the United Kingdom who experienced neurological symptoms consistent with a rare but serious spinal inflammatory disorder called transverse myelitis , the drug maker ’ s chief executive , Pascal Soriot , said during a private conference call with investors on Wednesday morning .
The woman ’ s diagnosis has not been confirmed yet , @ @ @ @ @ @ @ be discharged from the hospital as early as Wednesday , Soriot said .
The board tasked with overseeing the data and safety components of the AstraZeneca clinical trials confirmed that the participant was injected with the company ’ s Covid-19 vaccine and not a placebo , Soriot said on the conference call , which was set up by the investment bank J.P. Morgan .
STAT also learned that an earlier stoppage in July resulting from another patient ’ s adverse event had turned out to be unrelated to the vaccine : the person @ @ @ @ @ @ @ is a helpful reminder that a patient developing a medical condition while participating in a clinical trial doesn ’ t necessarily mean their diagnosis has any relation to the vaccine being investigated .
However , as Derek Lowe , who covers drug development for Science magazine , explained , there is some reason to worry about what this particular adverse event means for the viability of the Oxford vaccine .
The vaccine uses a live virus , adapted from a virus found in primates , to produce an immune response to Covid-19 .
@ @ @ @ @ @ @ , transverse myelitis , has been associated in the past with an autoimmune response following viral infections .
That link has not been conclusively proven , but it is part of the existing body of research .
“ I think this is indeed an event to be taken seriously , ” Lowe wrote , “ and I think pausing the trial to take stock of what ’ s going on is entirely appropriate.
” That was the consensus of scientists and medical journalists after the Oxford news broke .
With the world desperate @ @ @ @ @ @ @ to see a clinical trial for a promising candidate slowed down .
But such stoppages are not unusual — NIH Director Francis Collins told Congress on Wednesday that it was “ not at all unprecedented ” — and they represent sound scientific method .
“ This type of pause normally happens when there is an unexpected severe adverse event , ” Angela Rasmussen , a Columbia University virologist , wrote on Twitter about the news .
“ It may be unrelated to the vaccine , but the important part is that this is @ @ @ @ @ @ @ a vaccine to the general public.
” And that is really the point .
We want a rigorous process to produce a viable vaccine because , as Vox ’ s Brian Resnick explained , many people are skeptical about whether the approval of a Covid-19 vaccine will be based on good science , given President Trump ’ s very public agitation for a vaccine to be approved as soon as possible .
If too few people take a vaccine because of doubts about the process that produced it , then the pandemic isn @ @ @ @ @ @ @ the FDA puts its stamp of approval on a vaccine .
Drug makers seem cognizant of that risk ; Vox ’ s Umair Irfan covered the hopeful signs that companies won ’ t bow to political pressure by speeding up their clinical review .
This stoppage is more evidence that they will actually live up to those principles .
As AstraZeneca CEO Pascal Soriot told investors , according to STAT : “ A vaccine that nobody wants to take is not very useful.
” Everybody wants a vaccine as soon as possible .
@ @ @ @ @ @ @ So strange as it may seem , the abundance of caution shown by AstraZeneca and Oxford after this adverse event is the kind of response we need to build and preserve public trust in a Covid-19 vaccine .
This story appears in VoxCare , a newsletter from Vox on the latest twists and turns in America ’ s health care debate .
Sign up to get VoxCare in your inbox along with more health care stats and news .
Every day at Vox , we aim to answer your most important questions and @ @ @ @ @ @ @ the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and @ @ @ @ @ @ @ consider making a contribution to Vox today .

One of the most promising Covid-19 vaccine candidates, being developed by AstraZeneca and Oxford University, had its Phase 3 trials put on hold after a patient experienced a serious adverse event. That certainly sounds like bad news for everybody eager to have a vaccine as soon as possible.
But hidden in this development is a kernel of good news, if you can call it that: This is exactly the kind of scientific rigor we want biopharma companies to practice — especially amid fears that the US approval of a Covid-19 vaccine could be compromised by politics.
The Oxford vaccine has been one of the most intriguing vaccines in development. As Bloomberg covered in its profile of the lead scientist, Oxford’s Sarah Gilbert, it is distinct from the other leading candidates because it does not need to be stored at nearly as cold a temperature. Others must be frozen to be transported; Oxford’s need only be chilled. That could be a serious advantage, considering the existing concerns about how easy it will be to widely distribute any Covid-19 vaccine.
AstraZeneca/Oxford Phase 3 trials got underway in the US in August, having already started in the United Kingdom, Brazil and South Africa. The company planned to enroll 30,000 Americans in its US trials. Phase 3 trials are the make-or-break moment for any new therapy, large-scale trials to determine whether a drug or vaccine has a meaningful effect and to monitor for any adverse effects in a much larger patient population than the earlier, smaller Phase 1 and Phase 2 trials.
STAT broke the news Tuesday evening that Oxford’s Phase 3 trial had been paused because of one patient’s medical complication. A follow-up story from STAT on Thursday conveyed the details of the patient’s case:
The participant who triggered a global shutdown of AstraZeneca’s Phase 3 Covid-19 vaccine trials was a woman in the United Kingdom who experienced neurological symptoms consistent with a rare but serious spinal inflammatory disorder called transverse myelitis, the drug maker’s chief executive, Pascal Soriot, said during a private conference call with investors on Wednesday morning. The woman’s diagnosis has not been confirmed yet, but she is improving and will likely be discharged from the hospital as early as Wednesday, Soriot said. The board tasked with overseeing the data and safety components of the AstraZeneca clinical trials confirmed that the participant was injected with the company’s Covid-19 vaccine and not a placebo, Soriot said on the conference call, which was set up by the investment bank J.P. Morgan.
STAT also learned that an earlier stoppage in July resulting from another patient’s adverse event had turned out to be unrelated to the vaccine: the person was diagnosed with multiple sclerosis. It is a helpful reminder that a patient developing a medical condition while participating in a clinical trial doesn’t necessarily mean their diagnosis has any relation to the vaccine being investigated.
However, as Derek Lowe, who covers drug development for Science magazine, explained, there is some reason to worry about what this particular adverse event means for the viability of the Oxford vaccine.
The vaccine uses a live virus, adapted from a virus found in primates, to produce an immune response to Covid-19. The neurological complication experienced by the patient, transverse myelitis, has been associated in the past with an autoimmune response following viral infections. That link has not been conclusively proven, but it is part of the existing body of research.
“I think this is indeed an event to be taken seriously,” Lowe wrote, “and I think pausing the trial to take stock of what’s going on is entirely appropriate.”
That was the consensus of scientists and medical journalists after the Oxford news broke.
With the world desperate for a Covid-19 vaccine, nobody wants to see a clinical trial for a promising candidate slowed down. But such stoppages are not unusual — NIH Director Francis Collins told Congress on Wednesday that it was “not at all unprecedented” — and they represent sound scientific method.
“This type of pause normally happens when there is an unexpected severe adverse event,” Angela Rasmussen, a Columbia University virologist, wrote on Twitter about the news. “It may be unrelated to the vaccine, but the important part is that this is why we do trials before rolling out a vaccine to the general public.”
And that is really the point. We want a rigorous process to produce a viable vaccine because, as Vox’s Brian Resnick explained, many people are skeptical about whether the approval of a Covid-19 vaccine will be based on good science, given President Trump’s very public agitation for a vaccine to be approved as soon as possible. If too few people take a vaccine because of doubts about the process that produced it, then the pandemic isn’t going to end just because the FDA puts its stamp of approval on a vaccine.
Drug makers seem cognizant of that risk; Vox’s Umair Irfan covered the hopeful signs that companies won’t bow to political pressure by speeding up their clinical review. This stoppage is more evidence that they will actually live up to those principles.
As AstraZeneca CEO Pascal Soriot told investors, according to STAT: “A vaccine that nobody wants to take is not very useful.”
Everybody wants a vaccine as soon as possible. But science cannot be rushed. So strange as it may seem, the abundance of caution shown by AstraZeneca and Oxford after this adverse event is the kind of response we need to build and preserve public trust in a Covid-19 vaccine.
This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.


vox--2020-09-09--How bad is your state’s Covid-19 outbreak?

The US is now in the middle of what can only be described as a national Covid-19 epidemic , with cases across the country rising at alarming rates in recent weeks .
Public health experts look at a few markers to determine how bad things are in each state : the number of daily new cases ; the infection rate , which can show how likely the virus is to spread ; the percentage of tests that come back positive , which should be low in a state with sufficient testing ; and the percentage of hospital beds that are @ @ @ @ @ @ @ Vox analysis indicates the vast majority of states report alarming trends across all four benchmarks for coronavirus outbreaks .
Most states still report a high — sometimes very high — number of daily new Covid-19 cases .
Most still have high infection rates .
Most still have test positive rates that are too high , indicating they don ’ t have enough tests to track and contain the scope of their outbreaks .
( The US overall has seen a decrease in new cases in recent weeks , but the numbers are still @ @ @ @ @ @ @ still have hospitals with intensive care units that are too packed .
Across these benchmarks , only two states — Connecticut and Vermont — fare well on all four metrics , meaning their epidemics are relatively under control for now .
Only the Northeast currently seems to be doing better overall after a resurgence of Covid-19 cases .
But that region , particularly New York City , was hit hard by the initial wave of the Covid-19 pandemic , with New York reporting the highest overall death toll for the country so far @ @ @ @ @ @ @ from California to Florida , is the result of the public and its leaders collectively letting their guard down .
States , with the support of President Donald Trump , moved to reopen — often before they saw sizable drops in daily new Covid-19 cases , and at times so quickly they didn ’ t have time to see if each phase of their reopening was leading to too many more cases .
The public embraced the reopenings , going out and often not adhering to recommended precautions like physical distancing and wearing @ @ @ @ @ @ @ mix — of government withdrawal and public complacency — that experts have cited again and again in explaining why states are now seeing a resurgence in Covid-19 cases .
“ It ’ s a situation that didn ’ t have to be , ” Jaime Slaughter-Acey , an epidemiologist at the University of Minnesota , told me .
“ For almost three months , you had opportunities to be proactive with respect to mitigating the Covid-19 pandemic and to help normalize culture to adopt practices that would stem the tide of transmissions as @ @ @ @ @ @ @ .
… It was not prioritized over the economy.
” The effects are felt not just in terms of more infections , critical illnesses , new chronic conditions , and deaths , but in the long-term financial impact as the economy starts shutting down again , people refuse to go out , and businesses resist reopening during a pandemic .
“ Dead people don ’ t shop .
They don ’ t spend money .
They don ’ t invest in things , ” Jade Pagkas-Bather , an infectious diseases expert and doctor @ @ @ @ @ @ @ me .
“ When you fail to invest in the health of your population , then there are longitudinal downstream effects.
” The benchmarks tracked by Vox don ’ t cover every important facet of the pandemic .
They don ’ t show , for instance , how well a state is doing with contact tracing , when “ disease detectives ” track down people who may have been infected and push them to quarantine ; the data for how states are doing on that front is still lacking .
And some measures @ @ @ @ @ @ @ state can safely start to reopen , like whether cases have fallen in the previous two weeks and total tests , are excluded to focus more on the status of each state ’ s current Covid-19 outbreak .
Together , these four benchmarks help give an idea of how each state is doing in its fight against Covid-19 .
Nationwide , it ’ s pretty grim .
1 ) Most states have too many daily new Covid-19 infections What ’ s the goal ?
Fewer than four daily new coronavirus cases per 100,000 @ @ @ @ @ @ @ from the New York Times and the Census Bureau .
Which states meet the goal ?
Connecticut , Maine , Massachusetts , New Hampshire , New Jersey , New York , and Vermont — just seven states .
Why is this important ?
The most straightforward way to measure whether any place is experiencing a big coronavirus outbreak is to look at the number of daily new Covid-19 cases .
There ’ s no widely accepted metric for how many cases , exactly , is too many .
But experts told me that @ @ @ @ @ @ @ per 100,000 is generally a good idea — a level low enough that a state can say it ’ s starting to get significant control over the virus .
A big caveat to this metric : It ’ s only as good as a state ’ s testing .
Cases can only get picked up if states are actually testing people for the virus .
So if a state doesn ’ t have enough tests , it ’ s probably going to miss a lot of cases , and the reported cases won @ @ @ @ @ @ @ That ’ s why it ’ s important not to use this benchmark by itself , but to use it alongside metrics like the test positive rate .
Along those lines , the number of daily new cases may give a delayed snapshot of a Covid-19 outbreak .
If test results take a week to get reported to the state , then the count for daily new cases will really reflect the state of the outbreak for the previous week .
If testing is adequate in a state , though , the toll @ @ @ @ @ @ @ best snapshot of how big a state ’ s Covid-19 outbreak is .
2 ) The coronavirus is spreading too quickly in many states What ’ s the goal ?
An effective reproduction number , or Rt , below 1 , based on data from Rt.live , a site created by two Instagram founders and a data analyst .
Which states meet the goal ?
Arizona , California , Colorado , Connecticut , Georgia , Hawaii , Idaho , Louisiana , Maine , Mississippi , Montana , Nevada , New Mexico , North @ @ @ @ @ @ @ Island , South Carolina , Texas , Vermont , and Wyoming — a total of 21 states .
Washington , DC , did as well .
Why is this important ?
The Rt measures how many people are infected by each person with Covid-19 .
If the Rt is 1 , then an infected person will , on average , spread the coronavirus to one other person .
If it ’ s 2 , then an infected person will spread it to two on average .
And so on .
It ’ s @ @ @ @ @ @ @ how quickly a virus is spreading .
One way to think about it : Unlike the count for daily new cases , this doesn ’ t give you a snapshot of a state ’ s Covid-19 outbreak today , but where the outbreak is heading in the near future .
The goal is to get the Rt below 1 .
If each infection doesn ’ t lead to another , that would over time lead to zero new Covid-19 cases .
The estimated Rt can be very imprecise — with margins of error @ @ @ @ @ @ @ certain in any state if it ’ s really above or below 1 .
Different modelers can also come up with different estimates .
That ’ s , unfortunately , just the reality of using limited data to come up with a rough estimate of a disease ’ s overall spread .
The Rt also reflects an average .
If 10 people are infected with Covid-19 , nine spread it to no one else , and one spreads it to 10 , that adds up to an Rt of 1 .
But it @ @ @ @ @ @ @ whatever reason , can still cause superspreading events — which seem of particular concern with the coronavirus .
Still , the Rt is one of the better measures we have for tracking a pathogen ’ s spread across the whole population .
When paired with the other metrics on this list , it can give us a sense of each state ’ s outbreak now and in the future .
3 ) Most states ’ positive rates for tests are too high What ’ s the goal ?
Below 5 percent of coronavirus @ @ @ @ @ @ @ week , based on data from the Covid Tracking Project .
Which states meet the goal ?
Alaska , California , Connecticut , Delaware , Hawaii , Illinois , Maine , Massachusetts , Michigan , New Hampshire , New Jersey , New Mexico , New York , Ohio , Oregon , Rhode Island , Vermont , Washington , West Virginia , and Wyoming — 20 states .
Washington , DC , did as well .
Why is this important ?
To properly track and contain coronavirus outbreaks , states need to have enough @ @ @ @ @ @ @ proposals for how much testing is needed in the US , from 500,000 a day to tens of millions .
But one way to see if a state is testing enough to match its outbreak is the rate of tests that come back positive .
An area with adequate testing should be testing lots and lots of people , many of whom don ’ t have the disease or don ’ t show severe symptoms .
High positive rates indicate that only people with obvious symptoms are getting tested , so there ’ @ @ @ @ @ @ @ the scope of an outbreak .
The goal for the positive rate is , in an ideal world , zero percent , since that would suggest that Covid-19 is vanquished entirely .
More realistically , in a world going through a big pandemic , the positive rate should be below 5 percent .
But even if a state reaches 5 percent , experts argue it should continue trying to push that number further down , to match nations like Germany , New Zealand , and South Korea that have gotten their positive rates @ @ @ @ @ @ @ , in order to truly get a hold of their outbreaks .
As long as a state is above 5 percent , chances are it ’ s still missing a significant number of Covid-19 cases .
And the higher that number is , the more cases that are very likely getting missed .
So even if your state is reporting a low number of daily new cases , a high positive rate should be a cause for alarm — a sign that there ’ s an outbreak that ’ s only hidden due @ @ @ @ @ @ @ if your state is reporting a high number of daily new cases and a high positive rate , that ’ s all the more reason for concern , suggesting that the epidemic is even worse than the total case count indicates .
4 ) Most states ’ hospitals don ’ t have much space for Covid-19 patients What ’ s the goal ?
Below 60 percent occupancy of ICU beds in hospitals , based on data from the US Department of Health and Human Services .
Which states meet the goal ?
Alaska @ @ @ @ @ @ @ Hawaii , Idaho , Illinois , Indiana , Kansas , Massachusetts , Nebraska , New Hampshire , New Jersey , New Mexico , New York , North Dakota , Oregon , South Dakota , Utah , Vermont , Wisconsin , and Wyoming — 22 states .
Why is this important ?
One thing the world has seen , from China to Italy to New York , is that Covid-19 can very quickly overwhelm hospitals .
The consequences for this are dire : If any place has a big coronavirus outbreak , and there @ @ @ @ @ @ @ hospital to treat patients , that could lead to worse outcomes , including death .
The occupancy rate in states ’ intensive care units helps track how much space hospitals have to deal with more Covid-19 patients .
It also gives a snapshot of just how busy states ’ hospitals are on any given day .
Generally , the goal is to stay below 60 percent occupancy at ICU beds in hospitals .
That ’ s a point when hospitals have enough cushion , experts say , to more effectively treat patients as @ @ @ @ @ @ @ patients should an outbreak get worse .
This is a bit of a lagging indicator for tracking an outbreak .
Since people can take as long as weeks to develop Covid-19 symptoms once they ’ re infected , hospitalizations also take a few weeks to start trending up as cases trend up .
ICU occupancy also isn ’ t the only metric for tracking hospital readiness .
The US Department of Health and Human Services also tracks the percentage of people in inpatient beds who have Covid-19 and the percentage of inpatient beds @ @ @ @ @ @ @ also give a view of how well a state ’ s hospitals are handling a coronavirus outbreak .
Still , for a general idea of how bad a state ’ s Covid-19 outbreak is and how ready the state is to handle a surge in cases , the ICU occupancy rate is a helpful indicator .
If a state ’ s ICUs are overwhelmed , the state is possibly experiencing a big epidemic , or at least not ready for one .
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America’s national Covid-19 epidemic continues, with the US’s daily new cases down from an early January peak but still higher than those of most developed nations — and the country recently surpassing 500,000 deaths due to the disease.
At the state level, things can look even worse than the national picture.
Public health experts look at a few markers to determine how bad things are in each state: the number of daily new cases; the infection rate, which can show how likely the virus is to spread; and the percentage of tests that come back positive, which should be low in a state with sufficient testing. Combined, these three benchmarks can tell you whether or not a state’s coronavirus outbreak is under control.
Vox’s analysis, updated weekly, shows the vast majority of states are reporting alarming trends for coronavirus cases based on these benchmarks. Only one state — Hawaii — fares well on all three metrics, suggesting the vast majority of states don’t have their outbreaks fully under control right now.
The US outbreaks are due to the failure of both the American public and the country’s leaders to take the virus seriously enough; to the extent they did, many let their guard down prematurely. With the support of former President Donald Trump, states moved to reopen — often before seeing sizable drops in daily new Covid-19 cases, and at times so quickly they weren’t able to tell whether each phase of their reopening plan was leading to too many new infections.
The public embraced the reopenings, resuming their usual day-to-day activities and often refusing to adhere to recommended precautions like physical distancing and mask-wearing.
Even as cases began to fall later in the summer, America’s overall caseload remained very high. Yet many states moved to reopen once more, with much of the public embracing the looser restrictions and subsequently going out.
It’s this mix of government withdrawal and public complacency that experts have cited in explaining why states continue to struggle with getting the coronavirus under control.
“It’s a situation that didn’t have to be,” Jaime Slaughter-Acey, an epidemiologist at the University of Minnesota, previously told me, adding, “You had opportunities to be proactive with respect to mitigating the Covid-19 pandemic and to help normalize culture to adopt practices that would stem the tide of transmissions as well as the development of Covid-19 complications. … It was not prioritized over the economy.”
The effects are felt not just in terms of more infections, critical illnesses, new chronic conditions, and deaths, but in the long-term financial impact as the economy struggles, many people still refuse to go out, and businesses resist reopening during a pandemic.
“Dead people don’t shop. They don’t spend money. They don’t invest in things,” Jade Pagkas-Bather, an expert in infectious diseases and a doctor at the University of Chicago, previously told me. “When you fail to invest in the health of your population, then there are longitudinal downstream effects.”
With a Covid-19 vaccination campaign underway, a finish line to this crisis in finally visible. But until America reaches sufficient population protection — and, preferably, herd immunity — every day the coronavirus spreads means more illnesses, hospitalizations, and deaths.
As the country works toward vaccinating everyone, the three benchmarks tracked by Vox give an idea of how each state is doing in its fight against Covid-19 in the meantime. Nationwide, it’s pretty grim.
1) Most states have too many daily new Covid-19 infections
What’s the goal? Fewer than four daily new coronavirus cases per 100,000 people per day, based on data from the Covid Tracking Project and the Census Bureau.
Which states meet the goal? Just one — Hawaii.
Why is this important? The most straightforward way to measure whether any place is experiencing a big coronavirus outbreak is to look at the number of daily new Covid-19 cases.
There’s no widely accepted metric for how many cases, exactly, is too many. But experts told me that aiming for below four daily new cases per 100,000 is generally a good idea — a level low enough that a state can say it’s starting to get significant control over the virus.
A big caveat to this metric: It’s only as good as a state’s testing. Cases can only get picked up if states are actually testing people for the virus. So if a state doesn’t have enough tests, it’s probably going to miss a lot of cases, and the reported cases won’t tell the full story. That’s why it’s important not to use this benchmark by itself, but to use it alongside metrics like the test positive rate.
The number of daily new cases may also give a delayed snapshot of a Covid-19 outbreak. If test results take a week to get reported to the state, the count for daily new cases will really reflect the state of the outbreak for the previous week.
If testing is adequate in a state, though, the toll of daily new cases is perhaps the best insight as to how big a state’s Covid-19 outbreak is.
2) The coronavirus is spreading too quickly in some states
What’s the goal? An effective reproduction number, or Rt, below 1, based on data from the Centre for Mathematical Modeling of Infectious Diseases.
Which states meet the goal? All but Alaska, Minnesota, New Hampshire, North Dakota, and Wyoming — 45 states, as well as Washington, DC.
Why is this important? The Rt measures how many people are infected by each person with Covid-19. If the Rt is 1, then an infected person will, on average, spread the coronavirus to one other person. If it’s 2, then an infected person will spread it to two on average. And so on.
It’s an attempt, then, to gauge how quickly a virus is spreading. One way to think about it: Unlike the count for daily new cases, this gives you a snapshot not of a state’s Covid-19 outbreak today, but of where the outbreak is heading in the near future.
The goal is to get the Rt below 1. If each infection doesn’t lead to another, that would over time lead to zero new Covid-19 cases.
The estimated Rt can be very imprecise, with margins of error that make it hard to know for certain in any state if it’s really above or below 1. Different modelers can also come up with different estimates. That’s, unfortunately, just the reality of using limited data to come up with a rough estimate of a disease’s overall spread.
The Rt also reflects an average. If 10 people are infected with Covid-19, nine spread it to no one else, and one spreads it to 10, that adds up to an Rt of 1. But it masks the fact that individuals, for whatever reason, can still cause superspreading events — which seem of particular concern with the coronavirus.
And the Rt is only as good as the data that goes into calculating it. If a state’s data is poor quality or inconsistent, it might skew the picture. That can help explain why some states with bad and continuing outbreaks may fare better on this benchmark than others.
Still, the Rt is one of the better measures we have for tracking a pathogen’s spread across the whole population. When paired with the other metrics on this list, it can give us a sense of each state’s outbreak now and in the future.
3) Most states’ positive rates for tests are too high
What’s the goal? Less than 5 percent of coronavirus tests coming back positive over the previous week, based on data from the Johns Hopkins Coronavirus Resource Center and the Covid Tracking Project.
Which states meet the goal? Alaska, California, Colorado, Connecticut, Hawaii, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Mexico, New York, North Dakota, Oregon, Rhode Island, Vermont, Washington, West Virginia, and Wisconsin — 24 states, as well as Washington, DC.
Why is this important? To properly track and contain coronavirus outbreaks, states need to have enough testing. There are all sorts of proposals for how much testing is needed in the US, up to the tens of millions.
But one way to see if a state is testing enough to match its outbreak is the rate of tests that come back positive. An area with adequate testing should be testing lots and lots of people, many of whom don’t have the disease or don’t show severe symptoms. High positive rates indicate that only people with obvious symptoms are getting tested, so there’s not quite enough testing to match the scope of an outbreak.
The goal for the positive rate is, in an ideal world, zero percent, since that would suggest that Covid-19 is vanquished entirely. More realistically, in a world going through a pandemic, the positive rate should be below 5 percent. But even if a state reaches 5 percent, experts argue it should continue trying to push that number further down — to match nations like Australia, New Zealand, and South Korea, which have gotten their positive rates below 3 percent or even 1 percent — in order to truly get ahold of their outbreaks.
As long as a state is above 5 percent, chances are it’s still missing a significant number of Covid-19 cases. And the higher that number is, the more cases that are very likely getting missed.
So even if your state is reporting a low number of daily new cases, a high positive rate should be a cause for alarm — a sign that there’s an outbreak that’s only hidden due to a lack of testing. And if your state is reporting a high number of daily new cases and a high positive rate, that’s all the more reason for concern, suggesting the epidemic is even worse than the total case count indicates.
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