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The United States, already in possession of the largest number of infections in the COVID-19 pandemic, seems strangely committed to making things worse. As new infections have shot up to record levels, a major retailer are made basic protective steps optional before reversing its decision, while the governor of Georgia is moving to block any local authorities from acting to protect their citizens. This is despite the fact that the head of the US Centers for Disease Control (CDC) has said “If we could get everybody to wears a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.”

And it's not just masks. Health experts are nearly unanimous in indicating that reopening schools should only take place in the context of having a low infection rate in the community, classrooms redesigned to allow greater social distancing, and distance learning used where needed. But the Trump administration is threatening to withhold funding from any schools that do not fully reopen for in-person education. Meanwhile, the administration is attempting to downplay the value of one thing—more testing—that could help us understand the virus' progression through our population.

What in the world is going on?

This weekend delivered a few explanations for how the US went so badly wrong. One was in the form of a detailed account of how key decisions were made as the US approached its initial peak in infections. The second is an interview with President Trump himself, who comes across as living in a world of misinformation and conspiracy theories.

Problems at the top

Over the weekend, President Trump sat down for an extended interview with Fox News' Chris Wallace. The interview touched on the pandemic multiple times and provides a window into Trump's ideas about what's going on. And it is revelatory, in that it revealed that he's got a lot of ideas but very few of them have a basis in reality—and the interview brings out several of the reasons for the problems.

One of the most striking cases came when Wallace challenged Trump about the United States being one of the worst countries in terms of its mortality rate due to COVID-19. Trump responded by getting his press secretary, Kayleigh McEnany, to hand Wallace a graph that supposedly contests this fact. The graph, however, only showed data from a handful of countries, with the US appearing better than some but worse than others. This suggests that part of the problem is that Trump isn't getting the full picture from his advisors and isn't engaged enough in the issue to realize the picture he's gotten is incomplete.

Trump's tendency to make things up in order to make himself look good also kicked in. Within the span of a few sentences, he went from “I think we have one of the lowest mortality rates in the world” to claiming the graph showed we had the “Number one low mortality fatality rates,” even though the graph showed a couple of countries with better rates.

Trump's loose grasp of the issues also came up when Wallace asked about the huge surge in SARS-CoV-2 infections revealed by testing. Here, Trump repeated a theme he's returned to since cases started growing: it's all because of our testing capacity. “If we didn't test, you wouldn't be able to show that chart,” he told Wallace at one point. “If we tested half as much, those numbers would be down.”

But, as Ars' Tim Lee described, there's a way to track how much increased testing is influencing the total number of cases detected: the fraction of tests that return a positive result. And that measure shows that the growth in new cases in the US is being driven by the spread of the virus, rather than expanded testing. Trump should know this; the fact that he repeatedly says he doesn't indicates a failure of briefers to get him up to speed or a failure of his ability to process information.

Conspiratorial thinking and policy

But something else seems to be going on, as Wallace followed up with a comparison to the relatively small number of cases in Europe. “Is it possible that they don't have the virus as badly as we do?” Wallace asked. Trump dismisses this with a conspiracy theory: “It's possible that they don't test, that's what's possible.”

This sort of conspiracy theorizing is also present in Trump's response to public health policy within the United States. California has re-instituted restrictions on its citizens in response to the resurgence in cases it's now experiencing. But, since Trump apparently doesn't believe there is a resurgence, he suspects it's a plot against him. “There's no reason for California to do… to be doing what they're doing except for November 3rd [election day],” he told Wallace. He later went on to say “the Democrats want to keep it closed as long as possible because they think that's good for election. But I think the economy is doing very well.”

And, having constructed an alternate reality in which the number of infections isn't growing rapidly, Trump is setting policy accordingly. That includes pushing schools to reopen fully for in-person classes this fall or face the threat of a cutoff of federal funding. (To his credit, Wallace points out that this will hit the poorest communities the hardest.)

Huh?

There are, however, some nonsensical policy decisions that don't fit neatly into any category. Wallace also brought up the CDC Director's argument that recent evidence suggests that population-wide mask use would allow us to get the pandemic under control in a matter of a couple of months or less. But Trump indicates he's not willing accept expert opinion, much less base policy on it, saying “I want people to have a certain freedom, and I don't believe in that. No, and I don't agree with the statement that if everybody wears a mask everything disappears. “

The general lack of grip on reality also seems to be driving other policy decisions that didn't come up in the interview. On Saturday, The Washington Post revealed the administration is trying to keep Congress from inserting pandemic-focused funding into its next relief bill. Some of the funding at issue would be directed to the CDC—the ones whose advice Trump is dismissing. The rest would be for testing and contact tracing, which Trump blames for making the pandemic look worse than he thinks it is. So it's clear that Trump's beliefs, however he came about them, are influencing policy.

Not much help

Also on Saturday, The New York Times published a deeply researched story that describes how the government shifted into a default stance of ignoring the pandemic back when cases were approaching their first peak. The report indicates that, in addition to Trump having a view of matters not based on reality, his administration's response was largely driven by a small group of senior leadership in the White House, all but one of whom had no medical expertise (naturally, the group included Jared Kushner and Hope Hicks).

Perhaps because of the commitment of some members to a small federal government, the group focused on shifting responsibilities to the states. This, despite some problems with this approach that became obvious early—such as the indications that competition between states for resources like testing kits and protective gear ended up raising prices for them. There are also some issues, like contact tracing, that can't be handled by individual states, given the ease with which US citizens cross state lines.

The other thing that became clear is that, with only a single public health expert consistently involved, the group didn't have a good perspective on what was happening with the pandemic. That expert, Dr. Deborah Birx, told the group that, by mid-April, modeling was showing that the United States was nearing a peak. This turned out to be true. But the peak and decline were largely driven by New York and nearby states, which instituted strict social-distancing and isolation rules. According to the Times, the models Birx relied on assumed that all states would take a New York-like approach—a caveat that others in the administration didn't fully register.

Ideology

In fact, the belief that no further restrictions were needed in order for the US to see cases drop to manageable levels fit in with President Trump's belief that it was critical for the economy to restart as quickly as possible. As a result, he started pushing states to reopen before the crest in cases was even reached. Nobody in the administration appears to have re-evaluated the approach despite the fact that, unlike European countries that had seen social-distancing rules followed, the US saw cases remain at a relatively high plateau. That turned out to be the product of the virus being established in the wider US population, setting the stage for its current growth.

A public health disaster of these proportions doesn't happen due to a single personality. Obviously, many officials in the Trump administration have failed the US by allowing their own ideology to drive decisions that went against well-established public health practices. But they've also failed in terms of allowing the president to not only maintain false beliefs but to set policies based on them.

As for Trump, Wallace was actually being understated when he suggested that “People say that you talk about the world as you'd like to see it rather than follow the science.” The interview makes clear that Trump is likely to be incapable of recognizing any science that runs counter to the world as he wishes it to be, much less follow it.



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Topics #CDC Director #Congress #Deborah Birx #press secretary #The New York Times #Trump administration