“Doctors, nurses, and hospital administrators have been warning that they might run out of PPE for weeks now, but the warnings have become more urgent in recent days. For many hospitals, running out of masks is no longer something that “might happen.” The shortage is here.
Among the resources running dangerously low are N95 respirators, the masks that cup the face closely and have been approved by the National Institute for Occupational Safety and Health (NIOSH) to block the inhalation of 95 percent of small airborne particles.
According to NIOSH guidance for extending N95 supply, hospitals should advise their staff to, “discard N95 respirators following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions.” But as the shortage worsens, reusing these masks is becoming the go-to method of preservation.”
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” To avoid having to reuse N95 masks, many hospitals are allocating them only to staff members who are directly entering patient rooms — which, in turn, means limiting the number of staff members who enter patient rooms in the first place.”
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“”The management is telling the nurses to wear masks that are not N95, even though most of us would feel more comfortable and safer with the N95,” says another nurse, who works at Baptist Health in Miami. “We are trying to fight for what’s right but when the CDC says you can wear a bandana or scarf in the place of a mask, it’s hard,” referring to the CDC’s guidance for optimizing the supply of facemasks. It notes, “In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort.””
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” “We are desperate,” said another nurse who works at a New York hospital, who said she had spent her one day off running around collecting donations for PPE. “Please urge anybody who can donate any masks, but most importantly N95s, to do so.””
“As the coronavirus pandemic took hold in late February and early March, President Trump and his allies in the conservative media adopted a skeptical tone. Trump said that “one day, it’s like a miracle, it will disappear;” Fox Business host Trish Regan called it “yet another attempt to impeach the president.”
Some preliminary early data suggests that Trump and Fox downplaying the pandemic made Trump supporters less likely to take the disease seriously early on.”
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“on March 13, Trump declared a national emergency over coronavirus, and, afterward, started taking the virus more seriously in public rhetoric and response. And starting on March 13, the partisan tilt disappears”
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“Schaffner’s research here is very preliminary. It’s worth noting that there are several possible confounding variables, including the fact that some of the hardest-hit earlier states were blue-leaning coastal ones like Washington, California, and New York.
But his findings are consistent with early polling on coronavirus showing the same partisan gap, with Democrats consistently saying they were more likely to take individual action on coronavirus than Republicans.
It also fits with what we’ve observed more broadly during the Trump administration: The president’s stance on something causes Republicans to align with it and Democrats to oppose it, as well as a large, pre-Trump body of research on public opinion suggesting that voters often take cues on complex policy issues from trusted elites.”
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“as evidence continues to mount for a partisan gap in coronavirus response early on, we should take seriously the possibility that Trump returning to downplaying the risks of the virus would also lead to a vast swath of the American public ignoring public health advice — and thus contributing to the pandemic’s rapid spread.”
““We need the federal government to play its role,” Gov. Andrew M. Cuomo of New York said Monday. “The federal government has tremendous capacity.”
Much of that capacity is untapped. Hospital ships are at port. The Department of Veterans Affairs, legally designated as the backup health care system in national emergencies, awaits requests for help. The veterans department has a surplus of beds in many of its 172 hospital centers and a robust number of special rooms for patients with breathing disorders.
The sprawling system of emergency doctors and nurses ready to be deployed by the Department of Health and Human Services — known as the National Disaster Medical System — is also still waiting for orders, other than to staff locations where passengers offloaded from cruise ships are being quarantined.
And the Defense Department, home to 1.3 million active-duty troops and a civilian and military infrastructure that has made planning for national emergencies almost an art form, has yet to be deployed to its fullest capabilities. Senior Pentagon officials say they are ready to assist in any way that is ordered, but they also caution that much of the military’s emergency medical care is designed for combat trauma or natural disasters, and not mass quarantine for infections.
The last time a big infectious disease epidemic emerged, President Barack Obama dispatched nearly 3,000 American troops to Liberia to build hospitals and treatment centers to help fight Ebola. The Pentagon opened a joint command operation at a hotel in Liberia’s capital, Monrovia, to coordinate the international effort to combat the disease, and the American military provided engineers to help construct additional treatment facilities and sent people to train health care workers in West Africa to deal with the crisis.”
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“Defense Secretary Mark T. Esper said on Tuesday that the Pentagon will make available to the Department of Health and Human Services up to 5 million N95 masks, which can be used to help protect health workers and vulnerable people against the virus. The first 1 million, he said, would be available immediately.
The Pentagon is also making available 2,000 ventilators for hospitals, a number that would likely fall far short of the expected need. “When you look at how many people who may need it”
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“Field hospitals and the hospital ships Comfort and Mercy are designed for trauma wounds, not viruses, and doctors would have to be assigned from elsewhere to staff them. The ships, each with a 1,000-bed capacity, have helped in natural disasters like tsunamis, hurricanes and earthquakes, not quarantines.
Defense Department officials said that one possibility for the Comfort would be to station in New York Harbor and absorb non-coronavirus patients in New York, which could free up hospital beds in Manhattan to attend to infectious cases.”
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“Oregon sent a letter to Vice President Mike Pence on March 3 asking for 400,000 N95 masks. For days, it got no response, and only by March 14 received its first shipment, of 36,800 masks. But there was a problem. Most of the equipment they got was well past the expiration date and so “wouldn’t be suitable for surgical settings,” the state said.
New York City also put in a request for more than 2 million masks and only received 76,000; all were expired, said Deanne Criswell, New York City’s emergency management commissioner. The city is also requesting additional beds for intensive care units and medical teams to staff a convention center that may be turned into a temporary medical facility.”
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“FEMA officials said the Department of Health and Human Services remains in charge of the federal response, and it too is waiting for orders from the agency before it moves to ramp up assistance.”
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“In previous national emergencies, FEMA would be responsible for finding out where to obtain masks, ventilators, hospital beds and tents from either the military or the private sector and ensuring the supplies are delivered to states, according to Michael Chertoff, the secretary of homeland security under President George W. Bush who oversaw the response to Hurricane Katrina.
“They have relationships and know where to look for things,’ Mr. Chertoff said. “Without that it’s not clear to me who would be doing the coordination and facilitation function.””
“The briefing was intended to hammer home a new, terrifying reality facing the Trump administration, and the incoming president’s responsibility to protect Americans amid a crisis. But unlike the coronavirus pandemic currently ravaging the globe, this 2017 crisis didn’t really happen — it was among a handful of scenarios presented to Trump’s top aides as part of a legally required transition exercise with members of the outgoing administration of Barack Obama.”
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“The Trump team was told it could face specific challenges, such as shortages of ventilators, anti-viral drugs and other medical essentials, and that having a coordinated, unified national response was “paramount” — warnings that seem eerily prescient given the ongoing coronavirus crisis.”
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“But roughly two-thirds of the Trump representatives in that room are no longer serving in the administration. That extraordinary turnover in the months and years that followed is likely one reason his administration has struggled to handle the very real pandemic it faces now, former Obama administration officials said.”
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“Obama aides, in op-eds and essays ripping the Trump administration’s handling of the coronavirus, officially called COVID-19, have pointed to the Jan. 13, 2017, session as a key example of their effort to press the importance of pandemic preparedness to their successors.
In a Friday op-ed, Susan Rice, Obama’s national security adviser, blasted Trump for comments such as “you can never really think” that a pandemic like the coronavirus “is going to happen.” She mentioned the 2017 session as one of many instances of the Obama administration’s efforts to help its successor be ready for such a challenge. She also slammed the Trump team for dismantling the National Security Council section that would play a lead role in organizing the U.S. response to a global pandemic.”
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“Lisa Monaco, Obama’s homeland security adviser, explained the thinking behind the January 2017 session in a recent essay for Foreign Affairs. “Although the exercise was required, the specific scenarios we chose were not,” she wrote. “We included a pandemic scenario because I believed then, and I have warned since, that emerging infectious disease was likely to pose one of the gravest risks for the new administration.””
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“The Trump campaign, like the rest of America, was shocked to win the November 2016 election. Soon afterward, Trump cast aside his team’s transition prep work that had happened already and started over; some of his aides described tossing carefully collected binders full of possible personnel picks into trash bins. It was days, sometimes weeks, before his nominees and their aides showed up to meet the people they were replacing — if they did so at all — or to engage in transition meetings. Obama aides said they left detailed memos for their successors, but that quite often it appeared those memos were never read. Many on the Obama side were genuinely surprised that so many actually showed up for the Jan. 13, 2017, exercise, and there were expectations that some would skip it. On the Obama side, several agencies were represented by their second-in-command at the meeting for reasons including a belief that Trump’s principals wouldn’t show.
The gathering was held to satisfy a requirement in a 2016 law that updated the procedures around presidential transitions to require, among other things, that the outgoing administration “prepare and host interagency emergency preparedness and response exercises.” Obama also mentioned it in a 2016 executive order laying out his transition goals.”
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“some Obama aides who attended said they were left with the impression that many of the Trump aides showed up to simply check off a box more than to learn. The impression was boosted in part because the transition overall was going so poorly. Several Trump nominees had barely even spoken to their Obama counterparts.”
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““The problem is that they came in very arrogant and convinced that they knew more than the outgoing administration — full swagger,” one former Obama administration official who attended said.”
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“Asked whether information about the pandemic exercise reached the president-elect, a former senior Trump administration official who attended the meeting couldn’t say for sure but noted that it wasn’t “the kind of thing that really interested the president very much.”
“He was never interested in things that might happen. He’s totally focused on the stock market, the economy and always bashing his predecessor and giving him no credit,” the person said. “The possibility things were things he didn’t spend much time on or show much interest in.
“Even though we would put time on the schedule for things like that, if they happened at all, they would be very, very brief,” the former official continued. “To get the president to be focused on something like this would be quite hard.”
Anything associated with Obama or his administration was also a no-go zone for Trump aides. If you brought them up, “that would be an immediate rejection, like, ‘Why are they even here? Why the fuck did you ask them?’””
“President Donald Trump’s handling of the coronavirus outbreak in the United States has so far been a disaster.
He initially downplayed the severity of the outbreak at home, directly contradicting his top health officials. He’s displayed a stunning lack of knowledge about basic things like how vaccines work and how quickly a coronavirus vaccine could realistically be developed and distributed to Americans. And he’s publicly spread misinformation about how deadly the disease, officially known as Covid-19, is.
All of that is extremely counterproductive to effective crisis response, especially for dealing with something so complicated as the novel coronavirus.”
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““This isn’t a normal crisis,” Konyndyk said, “and atypical crises require real leadership from the top to solve.””
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“I, along with others, got to meet President Obama for a few minutes in the Oval Office because of our Ebola work. The moment I walked in, he started quizzing me about the Ebola burial teams, which was an important but fairly detailed element of the overall response. The fact that he was aware of those teams, and could ask me detailed questions about them, absolutely blew my mind.
You just don’t see that attention to detail with Trump. I really sympathize with the people who are working on this response within the government right now. Remember: It’s many of the same people — in fact, it’s mostly the same people — that worked on Ebola and other crises. They’re all career people.
What that tells you is that the team isn’t a determining variable here. The president is.”
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“Think back to when Hurricane Harvey and Hurricane Irma hit the US in 2017. Both of those were standard-issue, major hurricane events. They hit states in the mainland United States that were well prepared and had strong disaster management agencies. The government response therefore was mostly fine — bureaucracies were set up for moments like that.
But when you have nonstandard crises — like what Hurricane Maria did to Puerto Rico or this coronavirus outbreak — they require a president to get the government out of its comfort zone, to push it to do something it is not built to do. There’s really no one else in the government to do that.”
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“There were all these different moving pieces that all sat in different parts of the federal government. They weren’t put together to facilitate a coherent response. It really took presidential leadership and the installation of a “czar” to finally bring order to that chaos. Ultimately, it was President Obama making very abundantly clear, to the entire federal bureaucracy, that this was a first-tier priority for him and that everyone needed to step up.
The other really important element to that was also not accepting business-as-usual rationales from the agencies.
There were many times during the Ebola response in 2014 when I, on behalf of my team, or others in the government, would be getting pressed by the White House to do something. We would say, “Look, we can’t do that,” or, “We’re working as hard as we can.” And the White House, to their credit, would come back with some variation of, “Well, that’s all well and good, but it’s not getting the job done.””
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“President Trump’s insistence that the strategy of keeping the disease out of the country was succeeding really handicapped the rest of the response. Here’s why: It makes it harder for the government to plan for the moment the strategy stops working. That’s critical in this kind of situation.
The whole point of an overseas containment strategy is to buy you time. It delays the arrival of an outbreak in a country, but it cannot ultimately stop it. You’re not, or you shouldn’t be, hoping that that will be all that you need to do.
I don’t think the president understands that, and I don’t know how openly his team dissuades him of that view.”
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“The first time a US official talked about a pivot to preparedness was when the Centers for Disease Control’s Nancy Messonnier detailed last month how she’d started talking to her kids about the disruption they might face in their lives. And the president and his allies went ballistic. It’s a microcosm of the dynamic at play here, that even acknowledging the reality that this strategy might not fully work or might not be fully sufficient set the president off.”
“It began in April 2018 — more than a year and a half before the SARS-CoV-2 virus and the disease it causes, Covid-19, sickened enough people in China that authorities realized they were dealing with a new disease.
The Trump administration, with John Bolton newly at the helm of the White House National Security Council, began dismantling the team in charge of pandemic response, firing its leadership and disbanding the team in spring 2018.
The cuts, coupled with the administration’s repeated calls to cut the budget for the Centers for Disease Control and Prevention (CDC) and other public health agencies, made it clear that the Trump administration wasn’t prioritizing the federal government’s ability to respond to disease outbreaks.
That lack of attention to preparedness, experts say, helps explain why the Trump administration has botched its response to the coronavirus pandemic.”
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“Several weeks after the first community transmission within the US, the country has tested more than 16,000 people as of March 13, according to the Covid Tracking Project. By comparison, South Korea had tested more than 66,000 people within a week of its first case of community transmission.”
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“Testing is crucial to slowing epidemics. First, it lets public health officials identify sick people and subsequently isolate them. Second, they can trace that sick person’s recent contacts to make sure those people aren’t sick and to get them into quarantine as well. It’s one of the best tools we have for an outbreak like this.”
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“it’s the kind of thing that the Trump administration has screwed up, while instead trying to downplay the threat of Covid-19. Trump himself has tweeted comparisons of Covid-19 to the common flu — which Jha describes as “really unhelpful,” because the novel coronavirus appears to be much worse. Trump also called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease is much lower than public health officials projected.
And Trump has rejected any accountability for the botched testing process: “I don’t take responsibility at all,” he said on Friday.”
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“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, that May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and his global health security team. The team, the Directorate for Global Health Security and Biodefense, was never replaced.”
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“Since the federal government is sprawling and large, it helps to have centralized leadership in case of a crisis. That leadership could ensure all federal agencies are doing the most they can and working toward a single set of goals.”
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“it’s important to have this kind of agency set up before an outbreak. Setting up an agency takes time; it requires hiring staff, handing out tasks and expected workloads, creating internal policies, and so on. A preexisting agency is also going to have plans worked out before an outbreak, with likely contingencies in place for what to do. That’s why it was so important to have this agency in place even during years, like 2018, when disease pandemics didn’t seem like a nearby threat to everyone.”
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“By repeatedly undercutting outbreak preparedness, Jha said, the Trump administration signaled “to the government and all the agencies this is not a priority. And that means that even other agencies end up not putting as much attention and energy on it. So I think this has been a longstanding problem of the White House.”
Trump, for his part, has defended his record, arguing, “I’m a businessperson. I don’t like having thousands of people around when you don’t need them. When we need them, we can get them back very quickly.”
But experts argue that’s not how pandemic preparedness should work. “You build a fire department ahead of time,” Tom Inglesby, director of the Johns Hopkins Center for Health Security, told the Washington Post. “You don’t wait for a fire.””
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“Not all of this is necessarily the Trump administration’s fault. When the CDC rolled out its tests, a component in them turned out to be faulty. That was unfortunate, but it put a big spotlight on the CDC’s decision to use its own test kit instead of test kits other countries have used, reportedly in an effort to create a more accurate test.”
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“But this is exactly the kind of situation that proper preparedness, well, prepares federal agencies for. If the Trump administration had prioritized outbreak prevention before the coronavirus pandemic, it might have used the time prior to Covid-19’s appearance — or even January and February, when the global threat was increasingly clear — to establish contingencies in case something went wrong.”
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“This is, after all, something the federal government has done before for outbreaks, from H1N1 to Zika. A big difference from then to now is that Trump is in charge.”
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“Trump has consistently downplayed the coronavirus, comparing it to the common flu and claiming that his administration is doing a “GREAT job” and keeping things under control. Even on Friday, when announcing his administration’s goal to get 5 million test kits out, Trump said, “I doubt we’ll need anywhere near that.”
Some of that may be political. Politico reporter Dan Diamond told NPR host Terry Gross that, based on his own reporting, Trump “did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear — the lower the numbers on coronavirus, the better for the president, the better for his potential re-election this fall.”
Some of it could also be a result of too much optimism. Trump in February said of the coronavirus, “One day it’s like a miracle, it will disappear.” (As of March 13, the US has nearly 2,000 confirmed cases, up from fewer than 100 at the beginning of the month, according to Johns Hopkins University.)
The administration more broadly seems to have underestimated the threat, requesting $2.5 billion in emergency funding for the crisis — a fraction of what both Democrats and Republicans said is necessary and ultimately passed.”
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“What Trump has done is focus on travel restrictions, first against China and most recently against most of Europe. While this likely bought the US a little time with China, the Trump administration didn’t use that time properly.
And in the case of Europe, the restrictions will likely do little to nothing. There’s one simple reason for that, Kates told me: “The virus is already here.” Since the coronavirus is already spreading within communities, the concern is no longer the virus coming in from outside the US.
Even conservatives have been critical of Trump’s response. The National Review editorial board wrote:
“[Trump] resisted making the response to the epidemic a priority for as long as he could — refusing briefings, downplaying the problem, and wasting precious time. He has failed to properly empower his subordinates and refused to trust the information they provided him — often offering up unsubstantiated claims and figures from cable television instead. He has spoken about the crisis in crude political and personal terms. He has stood in the way of public understanding of the plausible course of the epidemic, trafficking instead in dismissive clichés. He has denied his administration’s missteps, making it more difficult to address them.””
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“On Wednesday night, Trump appeared to finally confront the reality of the crisis in a televised statement from the Oval Office”
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“The speech was also riddled with errors, leading the administration and others to later issue several corrections”
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“Trump on Friday declared a national emergency, which will unlock billions of dollars in disaster aid to help combat the virus. The administration previously declared a public health emergency in January, but that didn’t tap into as much money as the new declaration under the 1988 Stafford Act”
“The Food and Drug Administration has a protocol called emergency use authorization, or EUA, through which it clears tests from labs around the country for use in an outbreak. Getting more of these tests up and running would greatly increase the capacity of doctors and public-health officials to screen patients for the coronavirus.
Former FDA officials I spoke with said that during past outbreaks, EUAs could be granted in just a couple of days. But this time, the requirements for getting an EUA were so complicated that it would have taken weeks to receive one..clinical labs were not allowed to begin testing at all before they had received the EUA, even if they had already internally made sure their tests worked. Though these regulations are in place to ensure that faulty lab tests don’t get used on patients, several microbiologists told me they felt the precautions were excessive for a fast-moving outbreak of this scale.”
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““Labs and companies need samples of the virus itself in order to make their tests, but delays in getting access to samples further slowed down the test-development process. The coronavirus originated in China, and as several microbiologists told me, the Chinese government does not allow specimens to be shipped outside its borders.”
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“Even when working with nonauthoritarian countries, a combination of government processes, researcher reticence, complex shipping regulations, and patient-privacy concerns makes getting samples difficult for diagnostic companies like his.”
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““Even though some hospitals actually have the new, functional CDC tests, the extraction machines and reagents that are used to perform them are in short supply.”
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“For months, President Trump has made light of the coronavirus, telling attendees at a Black History Month reception, for instance, that perhaps the virus could miraculously disappear. He claimed on Twitter that the U.S. has done a “great job” handling the outbreak. Such a cavalier attitude seems unlikely to have motivated health officials to take things seriously.”
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“Containing a new infectious disease requires a lot of close collaboration between the president, the CDC, the FDA, and other parts of the Department of Health and Human Services, several Obama-era health officials told me. “One reason we were able to move quickly [during the Ebola outbreak] was that there was a great deal of coordination and issue spotting and troubleshooting that went on,” Hamburg, the former FDA commissioner, told me.”
“For six weeks behind the scenes, and now increasingly in public, Trump has undermined his administration’s own efforts to fight the coronavirus outbreak — resisting attempts to plan for worst-case scenarios, overturning a public-health plan upon request from political allies and repeating only the warnings that he chose to hear. Members of Congress have grilled top officials like Health and Human Services Secretary Alex Azar and Centers for Disease Control Director Robert Redfield over the government’s biggest mistake: failing to secure enough testing to head off a coronavirus outbreak in the United States. But many current and former Trump administration officials say the true management failure was Trump’s.”
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““Interviews with 13 current and former officials, as well as individuals close to the White House, painted a picture of a president who rewards those underlings who tell him what he wants to hear while shunning those who deliver bad news.”
“Accurate testing is critical to stopping an outbreak: When one person gets a confirmed diagnosis, they can be put in isolation where they won’t spread the disease further. Then their contacts can be identified and put into quarantine so they don’t spread the virus if they’ve become infected, too.”