Two Fateful Decisions

Hindsight is 20/20. I understand that. I hate to be a Monday morning quarterback. But we need to figure out why 200,000 Americans died when the rest of the world contained the virus. The historic neglect and under-funding of our state and local public health system contributed to the weak US response.

Many experts offer theories and opinions. Altman wrote a great essay about choices made that fundamentally affected America’s response to the pandemic. I thought Drew Altman’s analysis made sense.

Two Fateful Decisions

Drew Altman is president and CEO of the Henry J Kaiser Family Foundation (KFF). He is also publisher of KFF’s Kaiser Health News. It is the largest health newsroom in the US with coverage of health issues.

America’s failed response to COVID caused 200,000 deaths so far. We are 4% of the world’s population but suffered 25% of the COVID fatalities. How could this happen in the world’s richest country?  What went wrong?

Altman explains how we got her and how we can change course. “The disappointing US response to covid-19 has been because of a failure of policy and leadership, not healthcare, and largely owing to two fateful policy decisions.”

First Mistake

“In April President Trump made a fundamental policy shift that has shaped the US response to the pandemic ever since. He announced that states would have primary responsibility for containing the virus, with the federal government in a “back-up” role.” There would be no uniform national plan headed by the federal government.  Trump would stand aside and let governors fight in the open market.

“Delegating primary responsibility to states in a crisis is unprecedented. It was, as far as I know, the first time a sitting US president has sought to decentralise authority and responsibility during a national crisis.”

“In the absence of a centralised federal response, this fragmentation resulted in extreme variation in our national response to covid-19 by and within states. For example, at the time of writing, 33 states had instituted mandatory mask orders, while other states imposed softer orders or none at all.”

Altman reminds us that “the American response to covid-19: a patchwork of responses by state and local governments, divided sharply along partisan lines.” This division made the response worse.

Making It Worse

But the Trump administration’s decision to open up the economy was the second fateful decision. It clearly divided the country and increased tribalism.

“The response has been the defining and most troubling characteristic of the American response to the pandemic: the states and the American people split strikingly along partisan lines in their response to covid-19, as if the country has both red and blue pandemics. When that happened, the public’s willingness to prevent the spread of the virus substantially collapsed across red America.”

Fig 1

“The decentralised structure of the US response could have worked … by a national plan overlaying state responses and more fulsome federal support for testing, contact tracing, personal protective equipment, school reopening, and other elements of the response that require a national policy and resources targeted to state and local conditions.”

The US coronavirus failure was not inevitable and does not have to be permanent. This too is the product of the policy decisions that have been made and can be altered or unmade by the current or a future administration.

“Tens of thousands of people would not have died if the U.S. response had been more effective,” said Tom Frieden, now president of Resolve to Save Lives, a global public health initiative.

A new report shows major decline in public health. The report’s appraisal: “In other words, we’ve been set back about 25 years in about 25 weeks.”  We are going backwards.

The percentage of children around the world getting essential vaccinations has gone down. Food insecurity and extreme poverty is on a sharp rise. The first six months of the pandemic saw the number of people living in extreme poverty rise after declining for decades.