An Unmitigated Disaster America's Response to COVID 19

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Copyright © 2022 by Robert O. Schneider
All rights reserved. No part of this publication may be reproduced, stored in
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Library of Congress Cataloging-in-Publication Data
Names: Schneider, Robert O., author.
Title: An unmitigated disaster : America’s response to COVID-19 / Robert
O. Schneider.
Description: Santa Barbara, California : Praeger, [2022] | Includes
bibliographical references and index.
Identifiers: LCCN 2021023960 (print) | LCCN 2021023961 (ebook) | ISBN
9781440878930 (hardcover) | ISBN 9781440878947 (ebook)
Subjects: LCSH: COVID-19 (Disease)—Political aspects—United States. |
COVID-19 (Disease)—Social aspects—United States.
Classification: LCC RA644.C67 S36 2022 (print) | LCC RA644.C67
(ebook) | DDC 362.1962/414—dc23
LC record available at https://lccn.loc.gov/2021023960
LC ebook record available at https://lccn.loc.gov/2021023961
ISBN: 978-1-4408-7893-0 (print)
978-1-4408-7894-7 (ebook)
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 Contents
Prologue
Chapter 1 COVID-19 Makes “It” Real
Chapter 2 Preparing for a Pandemic: Were We Ready?
Chapter 3 Politics, Science, and Partisan Warfare
Chapter 4 The End of Wondering: The First Wave Hits the United
States
Chapter 5 The Great Reopening: Fools Rush In
Chapter 6 Failure Persists: The Dark Winter Approaches
Chapter 7 The Darkest Days
Notes
Index
 Prologue
Dr. George Diaz, an infectious diseases physician in Seattle, received a
phone call from the Centers for Disease Control and Prevention (CDC) on
the afternoon of January 20, 2020. The CDC informed him that it had just
recorded a positive test for a new strain of coronavirus in a thirty-five-year-
old man who had recently returned to Washington State from Wuhan,
China. The CDC also informed Dr. Diaz that it wanted to bring the patient
to his hospital for treatment.
Dr. Diaz was in all probability not surprised with this news. He knew
about the new coronavirus that had emerged in China and begun to circle
the globe. He had to know this new virus would soon make its way to the
United States. In fact, just two weeks previously, he and his hospital
(Providence Regional Medical Center Everett, just outside of Seattle) had
staged a tabletop drill that ran through the steps to be taken in caring for a
patient with this new coronavirus. One would thus be correct in suspecting
that the news just received from the CDC was not at all unexpected by Dr.
Diaz or the hospital.1
Upon arrival at Providence Regional, the patient would be kept in an
isolation room, with only the nursing staff allowed to enter. Dr. Diaz
communicated with his new patient through an intercom. On his fifth day in
the hospital, the patient developed pneumonia. This was a serious
development. Early indications from China suggested that an alarming and
disproportionate number of patients infected with the new virus who
developed pneumonia were dying. Dr. Diaz was aware of a new but untried
antiviral medication, remdesivir, that he thought might be applicable to this
new coronavirus. Having no other proven treatment options for the new
virus, he proceeded to infuse the patient with the antiviral. Within the next
twenty-four hours, the patient started to feel better. As he continued to
improve, the patient was soon allowed to go home under supervision. He
would, in time, recover fully.
The first confirmed case of COVID-19 in the United States had been
successfully treated. It was a genuine triumph of medical science. Dr. Diaz
and the hospital staff had dealt with a terrifying new disease. They had
responded admirably with discipline, logic, and imagination. And most
importantly of all, they had achieved the best of all possible outcomes. All
had gone very well indeed for patient one in the United States. Tragically,
the same could not be said for every American patient who would be
stricken with this new virus that swept the globe in 2020.2
The numbers tell the story. Between January 20, 2020, and January 29,
2021, the United States experienced 25.98 million cases of COVID-19 and
recorded 433,340 deaths. Many more deaths would come in the months
ahead. The year 2020 revealed to Americans—the thoughtful ones at least
—some very disturbing things about their nation and themselves. Few
likely understood what the first reports of a new coronavirus in China, first
reported on New Year’s Eve, would mean to them in the months to come.
Even if they had suspected that a global pandemic was about to become a
reality, few would have suspected the dramatic and tragic impact it would
have on their lives and the lives of their loved ones. But the experts knew,
and, theoretically, our national leaders should have known. Indeed, what
was about to happen, a major public health emergency of historic
proportions, was not something unexpected. It was something for which the
United States had been preparing for quite some time. The previous fifteen
years had seen significant effort dedicated to improving the nation’s ability
to respond to the threat of a global pandemic.
Nothing kills as many people in so short a time as a global pandemic.
History has confirmed this time and time again. The case for pandemic
preparedness is, for those who understand the nature of the threat and the
inevitability of the next pandemic, a compelling one. The first line of
defense against any deadly disease outbreak is to spend the resources and
the time necessary to reinforce our capabilities, such as disease
surveillance, diagnostic laboratories, infection control, and vaccine
development. These sorts of things are more effective at containing a virus
—and cost less—than waiting for an outbreak to occur and only then trying
to contain it.
Yet, the United States had really not invested nearly enough in pandemic
preparedness. For that matter, the global community had not invested nearly
enough in pandemic preparedness. It seems that it is always easier to find
money to respond to a crisis than it is to prepare for one. Be that as it may
and given that more should have been done to prepare, it would not be
accurate to suggest that the United States was totally unprepared for what
2020 would bring.
Since 2005 and the rapidly growing concerns about the potential for a
major global pandemic, one along the lines of the 1918 Spanish flu
pandemic, U.S. infectious disease experts and national leaders had engaged
in major planning efforts to improve the capacity of the United States to
anticipate and respond to a major pandemic crisis. Under the presidential
administrations of George W. Bush and Barack Obama, one a Republican
and one a Democrat, respectively, significant progress had been made in
advancing the nation’s preparedness. A national plan was developed, and a
national response strategy was evolving. Despite the progress that had been
made, there was still room for much needed improvement in the planning
and for more significant funding of public health initiatives. There was
understandable concern expressed by many experts that the United States,
despite its significant ongoing efforts, was not nearly as well prepared for a
major public health disaster as it should be. That was a concern also shared
by this author in his previous work on the study of pandemic
preparedness.3,4 It is this concern that led to the writing of this book.
The pages to follow chronicle the path of the COVID-19 pandemic from
January 2020 to January 2021. The narrative that unfolds will follow the
month-by-month and week-by-week experience of the United States and the
American people as they lived (and in too many instances died) during the
unfolding of a public health crisis that as the year progressed became a truly
unmitigated disaster. The first chapters set the stage for this narrative. The
nature of the new virus and its emergence as a pandemic of historic
proportions will be explained. An assessment of American efforts to
enhance its preparedness for pandemic threats will be provided to give
some context for evaluating the American 2020 response to COVID-19.
The cultural and political contexts that would influence the American
response, and not for the better, will be discussed as well. The details of the
American response during 2020 will be shown to have constituted the story
of a great failure, perhaps the greatest and most deadly failure in the
nation’s history.
The failure of the U.S. response to COVID-19 in 2020 was an all-too-
human failure. The United States may not have had the perfect plan or the
best preparation for what ultimately came to its shores with the new and
deadly virus, but it did have the knowledge, resources, and capacity to do a
much better job in responding to what came its way. The story of both how
and why this knowledge, these resources, and this capacity were not
intelligently employed in a national strategy to contain the spread of the
virus and to save lives is the tale of a monumental and historic failure that
should not be forgotten or forgiven. The combination of factors that
contributed to the American failure to contain the spread of the virus and
that allowed the pandemic to rage out of control through all of 2020 need to
be understood. They need to be understood by those who lived through that
dreadful year and by the generations to come. There will be other
pandemics, public health disasters, and global crises in the years to come.
There must never be another failure to respond like the one Americans both
endured and participated in during the year 2020.
To be fair, nearly every country struggled to contain the spread of
COVID-19, and they all made mistakes along the way. But one country, the
United States, stood alone as the only affluent nation to have suffered
severe and sustained outbreaks for the entire year in 2020. Two general
factors, one cultural and the other political, account for America’s great
failure. On the cultural side, the United States has a tradition of prioritizing
individualism over government policy action and guidance. This tradition is
one of the primary reasons the United States suffers from an unequal health
care system that has long produced worse medical outcomes (e.g., higher
infant mortality and diabetes rates and lower life expectancy) than in most
other wealthy countries. In other words, Americans do not work well
together. They have a deep distrust toward government and a go-it-alone
mentality that eschews social cooperation.
National skepticism about government and collective action was bound
to make an efficient national response to a public health crisis difficult. This
difficulty was magnified by the political variables at play in the United
States in 2020. These political variables contributed most to the “big fail” of
2020. In no other high-income country, and in only a few countries period,
had political leaders departed from expert scientific advice as frequently
and significantly as did American leaders. In no other high-income country
was there such a total absence of a coordinated national response as was the
case in the United States. In no other high-income country did the pandemic
become quite as intensely and irrationally debated as a partisan political
issue as it did in the United States.
The leaders of most countries sought to unite their citizens and prepare
them to withstand the pandemic assault. This included the encouraging of
collective sacrifice through the implementation of social distancing and
hygiene protocols, closures, lockdowns, quarantines, and other public
health measures as needed. U.S. leaders, especially the president, were
reluctant to be proactive in implementing such protocols. Indeed, they
seemed to politicize the pandemic rather that respond to it. This meant that
instead of pulling together, Americans would find themselves drifting
further apart. An already divided nation slipped into a deeper polarization at
a time when unity was essential. As a result of stunningly poor (inept,
actually) national leadership, the U.S. response to the pandemic was
lethargic and inconsistent. In addition to its failure to follow the basic
precepts of the pandemic planning that had taken place over the previous
two decades, the national leadership seemed at times all too willing to
dismiss the nation’s best minds in science and medicine. At times, they
actually worked to undermine or muzzle experts’ advice. To see how all of
this could have happened, and to fully comprehend its impact, is essential to
even begin to understand the depth and tragedy of America’s big fail in
2020. Once that is understood, those who are responsible for the big fail
must be held accountable in the pages of history.
This book is but a first draft, a real-time assessment and reaction to the
events of a historic year. The years to come will provide greater depth and
more detail as the number of studies and publications multiply. But
Americans must immediately begin to take stock. They cannot return to
normal (or more likely a “new normal”) without doing so. In living through
what was arguably the most tumultuous year in memory, Americans must
not forget the ground they have traveled over. They must not neglect to
gather up the experiences of this year and apply the lessons learned.
The pages that follow will demonstrate that the United States squandered
opportunity after opportunity to control the spread of the coronavirus.
Despite its considerable advantages, immense resources, biomedical might,
and scientific expertise, the United States floundered for a full year. The
pandemic was an unmitigated disaster. The nation failed on many levels. In
one year, over 430,000 died and over 25 million became sick. The breadth
and magnitude of America’s errors in 2020 may be difficult to fathom for
many, but a virus humbled and humiliated the world’s most powerful
nation. It did not have to happen, and it must never happen again. This book
is intended to begin gathering up the experiences and applying the lessons
of 2020. It is a task that will take generations to complete, but it must begin
here and now.
 CHAPTER ONE
COVID-19 Makes “It” Real
We are facing a human crisis unlike any we have experienced.
—Amina J. Mohammed, UN deputy-secretary general
After all it really is all of humanity that is under threat during a
pandemic.
—Margaret Chan, former director-general of the World Health
Organization
Introduction
The first recorded case appeared on November 17, 2019. This was in the
Hubei Province of China. While not recognized at that time, it was the
beginning of a global crisis. Eight more cases appeared in early December,
with researchers pointing to an unknown virus. It would soon be identified
as a new coronavirus strain that had not been previously found in humans.
Symptoms included respiratory distress, fever, and cough, and in severe
cases, this would lead to pneumonia and death. Like SARS, it was thought
to be spread through droplets from sneezes or coughs. The new virus
appeared to be very easily transmissible from human to human.
Soon, in early January 2020, the news had begun to spread that the
Chinese government had locked down the city of Wuhan, where the first
cases were observed, and allowed no one to enter or leave. As the world
was just beginning to learn of the new coronavirus strain, ophthalmologist
Dr. Li Wenliang defied Chinese government orders and released dire
warnings about the new virus as he sought to provide safety information to
other doctors who were treating patients with the new disease. China
informed the World Health Organization (WHO) about the novel disease,
but it also arrested and charged Dr. Li with a crime. Li himself would die
from the new coronavirus infection just over a month after he had begun
treating patients.
It was inevitable that the new virus would spread beyond Chinese
borders. By mid-March, it had already spread globally to more than 163
countries. On February 11, the new virus was officially christened COVID-
19. On March 11, 2020, the WHO announced that COVID-19 was officially
a global pandemic. It had barreled through countries around the globe in
just three months and had already infected over 118,000 people. And it was
very clear that the spread was not anywhere near finished. It was expected
to get much worse in a very short time. As of March 12, 2020, the United
States had already seen 1,323 confirmed cases of COVID-19 and 38 deaths.
New estimates were projecting that if aggressive efforts to mitigate were
not undertaken, millions of Americans could eventually be infected with
COVID-19. In just the next seven weeks, the number of cases in the United
States would explode. By May 1, the number of U.S. cases exceeded 1
million (one-third of all cases in the world at that date), and the U.S. death
toll exceeded 60,000. This was just the beginning. These numbers would
continue to grow.
By April 21, 2020, the U.S. Centers for Disease Control and Prevention
(CDC) reported that the United States had already seen an alarming spike in
coronavirus infections and deaths. It was also made very clear by the CDC
that the numbers would continue to grow. Even in the early weeks of the
crisis, there was a growing public concern that the United States was
lacking a coordinated national response to the COVID-19 pandemic.
Several of the states implemented vigorous response efforts. At the same
time, the federal government was perceived by many to be disorganized and
inefficient in responding to the growing crisis. While the rest of the world
seemed to be acting with greater urgency, the United States appeared to be
stuck in neutral.
It is this perception that makes it critical to analyze and evaluate the
federal response. There is historical and scientific context for doing so and
political context that needs to be understood and analyzed as well. From the
very beginning of the coronavirus pandemic, it was very clear that the
United States would be challenged to once again do what it had done quite
admirably and successfully in responding to global or national crises
throughout its history. But for the first time in its history perhaps, it seemed
not unreasonable to a growing number of informed observers to wonder
whether the United States might fail to rise to the challenge.
In fairness, one must begin by accepting the fact that a pandemic cannot
be stopped dead in its tracks. Even a perfect and coordinated national
response could not have kept the virus from coming to the United States,
and its impact would have challenged us beyond our capacity to prevent
every tragic outcome. But it was increasingly suspected that what many
soon saw as the federal government’s bungling and inept decision-making
over the first ten weeks of the crisis had turned a large-scale public health
emergency into an unprecedented health, economic, and security disaster.
But the bungling may not have been entirely the product of ineptitude. It
may have also been the product of design. This is to say that conscious
decisions made by governmental decision makers, beginning with the
president of the United States, were not made without access to the
necessary expert information and security intelligence required to make the
best informed and optimal decisions for responding to the pandemic.
Rather, a series of conscious decisions were made to ignore this information
in the pursuit of other objectives. In other words, if the United States was ill
prepared for or slow to respond to the crisis, it was because its leaders, inept
though they might have been, consciously chose to be ill prepared or slow
to respond. It was not because the United States lacked the knowledge, the
ability, or the tools to be prepared and respond more effectively.
The primary purpose of this book is to evaluate the response of the
United States to the COVID-19 pandemic. Of particular interest is the
quality of pandemic planning and preparedness; the quality and
effectiveness of national, state, and local response efforts; and the
performance of national leaders during a public health crisis of historic
proportions. To begin to assess whether the United States was well prepared
or ill prepared, efficient or slow to respond, or organized or disorganized
requires some work to understand the scientific, historic, and political
contexts that provide the necessary background and perspective. That
background and perspective will be an ongoing and important component in
all that is to follow.
Not since 1918 and the Spanish flu had the world experienced a major
pandemic as serious as COVID-19. As one might imagine, over the past one
hundred years, much progress had been made in both the United States and
globally in our preparations for and our responses to major public health
crises. How well that progress informed and guided our response to the
COVID-19 pandemic is not an insignificant question to be raised. In fact, it
may be one of the most important questions to ask and answer when all is
said and done. But before that question may be answered and any
assessment of the American response effort may begin, it will be necessary
to know what it is we needed to respond to and how it came to confront us
in the first place. These questions of the “what” and the “how” will be the
focus for the rest of this chapter. Knowing what “it” is that we had to deal
with during this pandemic is the first step toward the evaluation of our
response.
What Is COVID-19?
COVID-19 is a coronavirus. Coronaviruses make up a large family of
viruses that can infect birds and mammals, including humans.
Coronaviruses are common in different animals, but it is rare that an animal
coronavirus can infect humans. Those that have infected humans are of
several different kinds. Some coronaviruses infecting humans cause colds
or other mild respiratory (nose, throat, lung) illnesses. These are things most
people have experienced. In recent years, some coronaviruses have caused
more serious diseases, including severe acute respiratory syndrome (SARS)
and Middle East respiratory syndrome (MERS).1 The name coronavirus
refers to its appearance under the microscope. Coronaviruses look like they
are covered with pointed structures that surround them like a corona, or
crown.
COVID-19 was a new strain of the coronavirus not previously found in
humans. Where did it come from? As already noted, the first cases were
uncovered in China. As of this writing, researchers and health officials are
still tracing the exact cause of this new coronavirus. An early hypothesis
thought it may be linked to a seafood market in Wuhan, China. Some
people who visited the market developed viral pneumonia caused by the
new coronavirus. Investigations were ongoing, and would be for some time,
as to how this new virus originated and spread.2 But a picture was
beginning to emerge.
The origin story of coronavirus focused on the Huanan Seafood Market
in Wuhan. The first media reports noted that someone became infected with
the new virus from an animal. Scientists reportedly said the virus came
from bats. They noted that it was probably first passed through an
intermediary animal before moving to humans. This had happened with
other coronaviruses. The coronavirus that produced the 2002 SARS
outbreak is an example. In that case, the virus had moved from bats to
catlike civets before infecting humans.3 While the origins of COVID-19
may not be definitively agreed upon at the time of this writing, it must be
noted that most viruses that infect humans do come through animals.
One can never predict exactly which viruses will infect humans and
become easily transmissible from human to human, but new virus strains
that make this leap are typically the cause of major epidemics or pandemics.
The highly predictable process works something like this: It starts with the
migration of agriculture and urban environments into remote areas. This
increases the likelihood that a new virus strain will come into contact with
humans. Thanks to the increased densification of both the animal and
human populations, these pathogens can spread in a localized community. If
it becomes easily transmissible from human to human and is a particularly
severe (perhaps deadly) virus, it may easily become the cause of greater
problems. Given the frequency and the ease of modern travel, it may
circulate the globe in a matter of days and fuel the beginning of a global
pandemic.4,5
Regardless of how exactly COVID-19 was spread to humans, we know
for certain that it is easily transmissible from human to human. How was it
transmitted? Researchers were quickly able to tell us that the new
coronavirus was spread through droplets released into the air when an
infected person coughed or sneezed. The droplets generally did not travel
more than a few feet, and they fell to the ground (or onto surfaces) in a few
seconds. This is why social and physical distancing was proven to be
effective in preventing the spread. The incubation period for COVID-19
was shown to be fourteen days. This means that symptoms could show up
in people up to fourteen days after initial exposure to the virus. Given the
ease of transmission, the two-week incubation period, and the fact that
asymptomatic persons may carry and transmit the virus, containing its
spread is difficult. Only aggressive social distancing measures can help
slow the spread of a virus like COVID-19. All coronaviruses can be
transmitted between humans through respiratory droplets that infected
people expel when they breathe, cough, or sneeze. A typical surgical mask
or other face covering cannot block out all the viral particles contained in
these droplets, but using masks would soon prove to be effective in
significantly reducing the spread of the virus. There were other simple
measures—such as washing your hands; disinfecting frequently touched
surfaces and objects; and avoiding touching your face, eyes, and mouth—
that were also recommended by public health experts to reduce the risk of
infection.6
What were the symptoms of COVID-19? These would become well
known to all in a very short time as the virus became a global pandemic.
Symptoms included cough, fever, shortness of breath, muscle aches, sore
throat, unexplained loss of taste or smell, diarrhea, and headache. In
extreme cases, COVID-19 led to severe respiratory problems, kidney
failure, and, in the most severe cases, death. The early breakdown of how
the symptoms progress suggested that the disease ran its course in about
two weeks (see box 1.1). In the most serious cases, the average time to
death was 18.5 days.

BOX 1.1 COVID-19 SYMPTOMS

Most common symptoms include
Fever or chills
Cough
Shortness of breath or difficulty in breathing
Fatigue
Muscle or body aches
Headache
Loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
More serious cases may experience the following
Greater difficulty breathing
Chest pain or pressure
Loss of speech or of movement
Source: Centers for Disease Control and Prevention,
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-
testing/symptoms.html

How did COVID-19 kill? This was a question initially surrounded with
uncertainty that would make it difficult for researchers and doctors to
determine the best way to treat critically ill patients. The uncertainty had to
do with the inability to determine whether death was caused by the virus
itself or by a person’s own immune system. Early analysis suggested that it
was not only the virus that ravaged the lungs that posed the threat of death;
an overactive immune response might also make people severely ill or
cause death. Early studies suggested that the immune system response had
played a part in the decline and death of people infected with COVID-19.
This spurred a push for treatments (steroids, for example) that rein in the
immune response. But, as many feared, some of these treatments that act