COVID-19 presents a test of leadership but also—because it preys most fiercely on the vulnerable—a test of values, and President Donald Trump, in his press briefing on Monday, showed that he has failed on both counts. Closures had barely been put in place in much of the country; the curtains were still being drawn. But he is tired of it. “Our country wasn’t built to be shut down,” he said, noting the disruption. “We’re not going to let the cure be worse than the problem.” Or, as he put it in a tweet in which he announced that he would soon be reassessing the federal government’s guidance for radical social distancing, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.” The “problem,” in case anyone missed it, is a novel coronavirus365体育现金 rapidly spreading through a population that has no resistance to it. One model shows that it could leave more than two million Americans dead. On Tuesday, on Fox News, Trump said that he wanted the country opened back up and “” by Easter—nineteen days from now.
Is it the disease or the cure that Trump doesn’t understand? In his briefing, he said that one of his motivations for rushing to reopen the country is new research into the mortality rate—this is “a big factor” for him. And he doesn’t think that the numbers on the table are that big. There had been talk that the rate might be three, four, or five per cent; now it looked like it might be one per cent, or a little less. He might do the math on what one per cent amounts to in a country of more than three hundred million. Think of whatever group of a hundred or more you like—your office, your school, your wedding-invitation or holiday-card list—and now imagine yourself or someone you love as the one. And that number may not even be right, not even in ideal conditions of limitless medical resources. There is a lot that we don’t know; widespread testing catches presymptomatic and asymptomatic people, which changes the numbers. But one per cent is certainly not likely to be accurate when hospitals are overwhelmed, and people who could be saved die. As Peter Hessler notes in this week’s magazine, according to a report from China, the death rate in much of that country seems to have been about 0.7 per cent, and could be even lower. In Wuhan, which was overwhelmed, it was 5.8 per cent.
The statistics show that deaths skew older and toward those with other medical issues. The danger, one hears, is to “the elderly” and those who are “already sick.” There are multiple problems with this assessment. One is that younger people are able to spread the virus, which presents an ethical hazard that one wishes would be as frightening as the danger to one’s health. Another is that Americans are neither as young nor as healthy as they imagine themselves. In New York State, the age at which the deaths begin to rack up has been forty—and that is before the hospitals really start to run out of equipment. (Read Lizzie Widdicombe’s dispatch on New York hospitals that are already rationing masks.) Risk factors include things like diabetes, obesity, and heart disease, as well as respiratory ailments, which, not incidentally, are often accompanied or exacerbated by poverty. It’s said that one reason certain social programs don’t get the support they deserve is that every American imagines that he or she is part of the middle class. With the pandemic, perhaps, the problem is that too many can’t conceive of themselves as old or ill. The shock among senators when they heard that one of their colleagues, Rand Paul, had tested positive for COVID-19, and that, while he was awaiting his test results, he was seen in the still-open Senate gym, is revealing. The list of rules that many senators think they are exempt from apparently includes the germ theory of disease.
The ethical hazard should be enough, of course. The most crystalline expression of what Trump was actually asking on Monday came from Dan Patrick, the lieutenant governor of Texas, who told Tucker Carlson, of Fox News, that his “heart was lifted” by what Trump said. Patrick, who is about to turn seventy, said, “No one reached out to me and said, as a senior citizen, ‘Are you willing to take a chance on your survival in exchange for keeping the America that all America loves for your children and grandchildren?’ ”—that is, the country should be asking older people to let everything reopen in short order, which would allow the disease to spread, and accept that they might die as a result, with a ready, grandparently spirit. (He did say that some could “shelter in place.”) If that was the choice, he was “all in” and thought that “lots of grandparents” would be, too. He spoke of letting everybody else “get back to living” as a “gift” that older people could give the country. It doesn’t even matter that the old (let alone the old with grandchildren) wouldn’t be the only ones asked to be ready to die in order to get commerce humming again. What he was suggesting is not decent; it is not too strong a word to say that it is barbaric. It is the bullying instinct of Trumpism taken to its extreme. Such an approach would cost the country something that, unlike restaurant sales, could never be regained.
That such a plan could even be mooted reflects the fact that, again, Trump does not understand the cure. The idea of stay-at-home orders and closures is to move two different kinds of lines in the flatten-the-curve chart. One is the rate at which cases accelerate; the other is the capacity of the hospital systems, which is not fixed. The time that is bought has to be used to expand hospital capacity. China didn’t just isolate Wuhan and wait for the epidemic to play out there; it furiously built hospitals. This is why Governor Andrew Cuomo, of New York—who has been an exceptional leader in this crisis—has spurred construction of field hospitals in places such as State University of New York campuses and the Javits Center, New York City’s cavernous convention hall. (On Tuesday, Cuomo said that cases in the state were doubling every three days; the curve, he said, wasn’t flattening yet.) That needs to be done in many more places; crucially, the manufacturing of ventilators has to ramp up, too, so that those hospitals can be effective. The time bought with social distancing and closures can also be used to develop something else that is lacking now: vaccines and treatments. We have those for the flu; we don’t for COVID365体育现金-19. The federal government has the power to get working on all those fronts, and yet Trump, for all his supposed entrepreneurial construction experience, has been inert in this regard. He complains that America was not “built” to be shut down; in fact, the country must build if it wants to stay open.
365体育现金The other part of the cure, which encompasses both flattening the curve and reopening for business, is testing. As Aaron E. Carroll, a professor at the Indiana University School of Medicine, and Ashish Jha, a professor of global health at Harvard, laid out in on Monday that called for continued social-distancing measures across the country—what the authors termed a “true national pause”—reopening before a mass testing regime is in place would be catastrophic. (“We still aren’t taking this virus seriously enough,” Carroll and Jha write.) This, and not some vague, culturally defined perception of who is vulnerable and who is not, is the only way to really make sure that cities and towns can begin to come back to life. Indeed, testing is what has allowed South Korea to have more targeted closures. Reopening can happen relatively quickly on these terms, in theory: the problem is that those are not yet the terms on which this country is operating. On Tuesday, the Trump Administration finally implemented the Defense Production Act, to order the manufacture of sixty thousand test kits. That is a pathetically small number, but it’s a start. Now the President should use the D.P.A. to get more ventilators.