Attacks on President Trump’s performance on Covid-19 have been common among media commentators and are central to his opponent’s presidential campaign. Polls suggest this continual faultfinding has influenced many voters’ perceptions of how the president has managed the epidemic. These criticisms, however, are unjustified and unwarranted.
Trump’s unconventional style and inherent inability to avoid the spotlight, coupled with the Food and Drug Administration’s initial overregulation and the Centers for Disease Control’s early underperformance, have made him a ready target. But Trump’s application of targeted regulatory relief and financial incentives stimulated an unprecedented private-sector response to the pandemic, more than compensating for these preliminary mishaps. A closer look at the administration’s record reveals a much more successful response to Covid than critics are willing to acknowledge.
The president’s detractors selectively use inter-country comparisons of case and death numbers to disparage the U.S. response, but these numbers are subject to many variables—known and unknown—and are unreliable when a pandemic is ongoing. Many metrics gauge response effectiveness. The U.S. case fatality rate, for instance, compares favorably with that of other Western countries. The United States is a large, heterogeneous country. The performance of Alaska, Vermont, Wyoming, and Maine ranks among the best in the developed world on deaths per million population, while New Jersey, New York, Massachusetts, and Connecticut rank among the worst. Other countries use different measures of counting cases, infections, and even deaths, hindering accurate comparison.
Rather than relying on inaccurate, incomplete public health measures, we should look at the concrete steps that the Trump administration has taken. Early on, the administration covered the basics. When it looked as if the country would not have enough ventilators, the president invoked the Defense Production Act and created the “dynamic ventilator reserve,” ramping up manufacturing and ensuring that breathing machines were sent where they were most needed. Soon, the U.S. had surplus ventilators and was shipping them around the world. When it looked as if New York might run out of hospital beds, Trump expanded capacity well beyond what was ultimately needed.
The administration expanded the availability of telehealth services, allowing patients to obtain care while reducing their risks of contracting Covid-19 from in-person doctor visits. It acted to protect nursing home residents, who have accounted for close to half of Covid deaths, by providing guidance about infection control and visitation, mandating increased transparency about infection rates, and assisting with testing and procurement of personal protective equipment. Devolving decision-making about quarantine, social distancing, and closure of public amenities to the states enabled elected leaders to respond appropriately to local conditions, while helping public-health professionals and policymakers understand how best to live with the epidemic.
The United States expanded testing through regulatory reform and payment incentives. We have performed over 125 million tests and are now administering more than 1 million tests per day. The FDA’s enhanced regulatory efficiency has resulted in the authorization of more than 250 new tests for diagnosis of acute infection and prior exposure, for use in central laboratories and at the point of care. The administration is distributing 150 million rapid diagnostic tests to nursing homes, extended living facilities, historically black colleges, and states, which will help contain outbreaks among vulnerable populations. These tests will also help limit local spread in schools and businesses, allowing them to remain open, and will bring testing capacity up to 3 million tests per day—half of them rapid tests.
Operation Warp Speed—the “Moonshot” quest for a vaccine—is a public-private partnership making remarkable progress. Multiple vaccine candidates are rapidly moving toward implementation, with five companies in late-stage trials and three leading candidates likely to report results soon. Operation Warp Speed is compressing the usual new-vaccine implementation time from over ten years to a matter of months. The U.S. has made investments in technology, manufacturing capacity, and clinical studies; carefully selected candidate vaccines and platforms; increased regulatory flexibility; and encouraged concurrent performance of steps that have historically been taken in sequence. It’s unprecedented for any national system to have accelerated the development of a vaccine to this point in so short a time.
The president pushed states to reopen their economies, producing precipitous declines in unemployment—which had spiked to Depression-era levels when the lockdown was at its peak—and worked with Congress to provide economic relief. States that moved quickly to reopen have seen proportionally fewer deaths from Covid-19 and have brought millions more Americans back to work than those that proceeded more slowly. The United States is experiencing record job creation and economic growth; the unemployment rate has plummeted from a high of 14.7 percent in April to 7.9 percent in September.
The administration has urged schools to reopen carefully. To date, in-person schooling in the United States has thus far not been a major source of new cases, just as in Europe. Though children can contract and spread the virus, they rarely become seriously ill. The incidence within schools appears to be lower than in surrounding communities. The Trump administration’s distribution of rapid testing kits will help schools control outbreaks and provide better data about actual infection rates.
The SARS-CoV-2 pandemic—a new disease with no previous exposure—is among the greatest infectious-disease challenges that the United States and the world have faced in a century. It is widely understood that the epidemic will not end unless and until we achieve an undetermined threshold of population immunity sometimes referred to as “herd immunity,” wherein the virus runs out of people to infect. Given the circumstances and challenges, the Trump administration has vigorously confronted a national crisis over which it has limited control.
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