Since about February 20, when the stock market began its plunge, the world has understood that the coronavirus outbreak was more than a regional concern. By all accounts, Donald Trump knew this truth at least three weeks before that.
Throughout this crisis, the president’s advisors seem to have been consistent in telling him the facts as well as which strategies could lead the nation out of catastrophe. They also seem to have conveyed to him what the future would look like if he continued to lie to the public, undermine efforts at containment and mitigation, and fail to build a testing, tracing, and isolation apparatus.
In response, the president made inconsistent and often contradictory alterations to his rhetoric while continuing to abdicate his responsibility to carry out the federal government’s most important task: assembling a testing regime adequate to the challenge of the pandemic.
On Monday, a CDC/FEMA model surfaced which predicted that over the next eight weeks the daily death totals would increase by roughly 50 percent from where they stand today. This at a moment when America should be moving down the back slope of this terrible curve.
Something is wrong with this picture.
By the end of February, anyone who knew anything about public health knew that testing on an increasing scale was our best hope to identify, isolate, trace, and treat patients. South Korea, where the first case appears to have arrived at around the same time as in the United States, also saw a massive outbreak (peaking at 851 daily cases on March 3), but successfully contained it through a diligent combination of testing, tracing, isolation, and consistent public health communications that—while scary at times—saved the lives of tens of thousands of citizens.
Pursuing a similar containment strategy in the United States was a reasonable and achievable goal. On March 10, when there were 994 total confirmed cases in America and 30 deaths, my colleagues and I wrote:
We can learn from South Korea’s approach of widespread testing in coordination with federal and state authorities, education of the public, and transparency with regular briefs.
That is, if we choose to.
Each day the window of opportunity to get in front of this epidemic narrows. Now is when our nation’s leadership matters most.
It is eight weeks since that was written and the window to get in front of the outbreak has indeed closed. Today, there are 1.2 million confirmed cases and over 69,000 confirmed deaths.
Worse, President Trump still has not enunciated a clear strategy for mitigating further case growth and deaths on a wider scale.
His messaging remains inconsistent and often driven more by what he sees on cable TV than what his own experts are advising.
He has prompted partisan rebellion in our nation in an effort to shore up his electoral base, which has led some governors who belong to his political party—and who might have favored a cautious approach—to move more swiftly in opening up their states’ economies so as not to incur the wrath of the president.
Whether or not the new CDC model winds up being a good predictor, we know that the relaxation of social distancing/lockdown measures will result in greater spread of the coronavirus.
We know that—short of a vaccine or other therapeutic intervention—this will result in an escalation of cases and deaths.
We also know that reliable strategies would have helped mitigate this situation. And that they can still lessen the damage. Edward Kaplan and I have spelled out one such strategy here.
https://jamanetwork.com/channels/hea...rticle/2765693 Others abound.
But all of these strategies rely on testing at a scale that is achievable—but requires coordination of effort and leadership from the top of the federal government.
This leadership has been missing from the start of the crisis. If a president has faced a moment such as this and been unable to create effective leadership after 12 weeks of death and economic destruction, then it is unlikely he is capable of it.
At this point, the single most effective action President Trump could do to to save lives and put our country back on a footing toward health and economic prosperity is to resign.
The only explanation for why we are where we are is gross incompetence in the carrying out of the most basic executive functions of the presidency.
In the normal course of events, such incompetence can be endured until an election provides a remedy for the nation. But this is not an ordinary time.
For the good of the country, President Trump should step aside and give Vice President Pence the chance to do the jobs that he is incapable of performing.
Howard Forman
Dr. Howard Forman (@thehowie) is a professor of Public Health (Health Policy), Management, Economics, and Radiology at Yale.