By Nicholas Kristof
This should be a season of hope: We will shortly be getting a highly effective coronavirus vaccine, and the pandemic should wind down in the coming months.
More Americans have died from Covid-19 in nine months than in combat over four years in World War II. The virus death toll exceeds 292,000, compared with 291,557 American World War II battle deaths.
We’re sometimes now losing more Americans from the virus in a single day than perished in the Pearl Harbor attacks or 9/11. But contrary to viral memes floating around the internet, the virus is not creating the “deadliest days” in American history: In October 1918, in a much smaller population, more than 6,000 Americans died of the Spanish flu on average each day for the entire month.
If American states were treated as countries, the places with the highest per capita coronavirus death rates would be: Slovenia, South Dakota, North Dakota, Bulgaria, Iowa, Bosnia, Hungary, Croatia, Illinois, North Macedonia, Rhode Island, Nebraska, Kansas, Arkansas, San Marino.
A pandemic is a test of a country’s governance, and this is one the United States has failed. Much of that is on President Trump’s colossal failure of leadership, but it also reflects a deeper skepticism about science and a proclivity toward personal irresponsibility — such as refusing to wear masks.
The U.S. spent 15 years preparing for the coronavirus. Why did we handle it so badly?
There is one graph that has to do with the coronavirus that blows my mind. It looks like this. This graph shows coronavirus cases in the United States versus the European Union. Do you see what happens here? Everyone has a surge around the same time, but while the European Union dramatically drops, the United States plateaus for a little bit and then skyrockets. This is shocking to me because the United States is perhaps the most prepared country on earth for a pandemic. The U.S. government has an actual playbook that tells us what we need to do in the case of a pandemic. Not to mention, it’s like the richest country in the world, with the best health institution on earth, the C.D.C., which literally fights pandemics in other countries and teaches even our peers how to do epidemiology. And yet, you look at this graph and you wonder, what happened? I want to piece together a timeline to find out how this happened. How does the country with the most money and experts and the C.D.C. and a literal pandemic playbook end up with so many deaths, and end up with a graph that looks like this?
“The countries best and worst prepared for an epidemic, we’re rated No. 1 at being prepared.” “Europe has largely contained the virus.” “Nearly 200,000 Americans dead from Covid.” “We’re doing great. Our country is doing so great.” [MUSIC PLAYING] As I piece together this timeline, I’m going to need some help. And for that, I turned to Nick Kristof. He’s a Pulitzer Prize-winning journalist. He speaks Mandarin. He’s been all around the world, reporting on and explaining public health crises for decades. I’ve always felt that I come from the country that helped invent public health. And now, my own country, arguably the most powerful country in the history of the world, has taken a challenge that we kind of knew what to do with, and just blowing it in ways that cost so many lives so needlessly. So if I want to understand how this all played out and how we got a graph that looks like this, where do we start? Let’s go way back, before we were paying any attention to this. I figured our timeline would start somewhere in January of 2020, but Nick told me to go back even further, way back to 2005. That summer, President George Bush was on vacation at his ranch in Texas when he got ahold of this book.
It was about the Spanish flu that killed tens of millions of people back in 1918. This book freaked George Bush out. He got back to Washington, and immediately got to work putting together a plan, a step-by-step guide of what the U.S. should do if a pandemic came to our country. He called it a playbook for pandemic response. President Obama developed a playbook of his own that had very specific plans in place on what the government should do in the case of a disease outbreak, including specifically citing coronaviruses. This pandemic playbook was then passed on to the Trump administration. “We left them the detailed playbook, which specifically cited novel coronaviruses. Short of leaving a flashing neon sign in the Situation Room saying. ‘Watch out for a pandemic,’ I’m not sure what more we could have done. No one knew when the big pandemic would come, what it would look like. But even still, the previous two administrations were obsessed with making sure we were ready. “But if we wait for a pandemic to appear, it will be too late to prepare.” So now let’s fast forward to when the big one did hit. And that part of the story happens on the last day of 2019. On Dec. 31, 2019, a report of 44 people with pneumonia comes in from a fish market in China. So at this point,
it seems like this is a fairly small deal. It’s 40 people with pneumonia in China. So who in the U.S. would even care or have this on their radar in the first place? `Epidemiologists were on top of this immediately in early January, about the risk this might be something serious. The World Health Organization was communicating with the C.D.C., the C.D.C. was communicating with the administration. And indeed, it appears to have entered the president’s daily brief in early January. “We’re going to begin here with the outbreak of a mystery virus in China that now has the World Health Organization on edge.” I heard that China was concealing information. And didn’t that stop American experts from getting a full picture on what was happening? Yes, absolutely. China behaved irresponsibly and was concealing information. But we had channels into China, into the World Health Organization. We were getting feedback about what was really happening. It’s the middle of January, and coronavirus is potentially a thing of concern. Didn’t President Trump get on a call with President Xi Jinping? Yeah, they did. They had an important phone conversation then. But what they talked about was trade. But it just doesn’t get any bigger than this, not only in terms of a deal. Tell President Xi, I said, President, go out, have a round of golf. This was a huge, huge missed opportunity. OK, so we miss these first two opportunities of taking those early reports really seriously and that call with Xi Jinping, which potentially could have been a health collaboration to stop the virus.
But it was still early on. The coronavirus hadn’t even been detected in the United States yet. “Gwen Stefani and Blake Shelton not quite yet engaged, right? Definitely not married.” So while the United States was preparing for the Grammys and the Super Bowl, the coronavirus quietly came into our country. The first case is reported around Seattle on Jan. 21. At this point, Trump has been hearing more and more warnings from his intelligence briefings, as well as from the C.D.C. And as the news breaks of the first case in the U.S., Trump is on his way to Switzerland to speak at the World Economic Forum, where he talks a lot about China, but just not about the virus. “Our relationship with China right now has probably never been better.” Man, just like imagine what could have happened at this moment. End of January, the president reads his briefing. He’s like, oh, whoa, this is real. This is spreading globally. We need to get serious about this. He calls Xi Jinping back, and he’s like, hey, Xi Jinping, I know we’ve been talking a lot about trade, but why don’t we talk about this virus that’s coming from your country to mine? What do we need to do to solve it? And Xi Jinping is like, yeah, you’re right, let’s do it. Trump gets up to tell the nation a pandemic is coming and that we’ve got to be ready for it, but don’t worry because we’re super prepared. We have all the plans. We have a literal pandemic playbook. We have money. We have experts. We can squash this. “Have you been briefed by the C.D.C.?”
“I have.” “Are there words about a pandemic at this point?” “No, not at all, and we have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.” There was some hope that we could have actually eliminated it in early January and avoided this catastrophe for the world. Instead, our leaders, and our citizens, were completely focused on other things. “The Grammy Awards are finally here.” “CNN breaking news.” “Kobe Bryant— Has been killed in a helicopter crash.” “Special coverage of the impeachment trial.” “Did nothing wrong. Did nothing wrong.” [CHEERING AND APPLAUSE] So by the end of January, the virus has now arrived to the United States. There are reported cases here. We are now aware that it is a problem. I guess I’m wondering, like, what is the response? What should the U.S. have done in that moment? The first step in response to a disease like this is to find out where it is, which means you develop a test. “We have 12 cases— 11 cases.
And many of them are in good shape now, so.” The United States and South Korea had their first reported case of Covid-19 on the same day. A month later, South Korea, who, by the way, has like a fifth the number of people that the United States has, had tested 13,000 people. Here in the U.S., we had tested 3,000. “I’m not afraid of the coronavirus, and no one else should be that afraid, either.” A reminder that all of these steps, the testing was not a new idea. This was in the old playbooks. Testing and surveillance of where the virus is is like a fundamental step in responding to a pandemic. “It’s mind-blowing that because you can’t get the federal government to improve the testing because they just want to say how great it is.” “And the testing is not going to be a problem at all.” “So this struggle to develop a test, wasn’t this more of like an issue with the F.D.A. and the C.D.C. and H.H.S. sort of feuding with each other about who was going to do the test? At one level, the way we fumbled the development of testing in the United States was a result of bureaucratic infighting. But if President Trump had shown the same passion for getting a test that he showed for building a wall or for backing hydroxychloroquine to treat the coronavirus, we would have had a test all ready to go and all around the country by the end of January or beginning of February. “Hydroxychloroquine, we’re just hearing really positive stories. I happen to be taking it. I think it’s good.
I’ve heard a lot of good stories.” Sierra Leone in West Africa had an effective test before the United States did. And so as a result, we didn’t know where the virus was. We were blind. “They’re working hard. Looks like, by April, you know, in theory, when it gets a little warmer, it miraculously goes away. Hope that’s true.” And then, Americans started to die. [MUSIC PLAYING] It started with just one in February. But soon one became 10 became 100, and soon it was 100 per day, and then 200 per day, and 500 per day. And now, we’re in the thousands. And then the month of April was here. And in one month, 57,000 Americans died from Covid-19. So was there a moment for you when you realized that this was spiraling out of control? I visited a couple of emergency rooms and I.C.U.s early in the crisis. And this was when people are still talking about how the coronavirus is like the flu. And meanwhile, these emergency rooms are just swamped. The doctors and nurses are traumatized. “I need a vent. I need a vent.” “I need a ventilator.” And the strength of those doctors contrasted with just the fecklessness of our political leadership. “And again, I said last night, we did an interview on Fox last night — You have to be calm. It’ll go away.” [BEEPING] “Many of the places are really in great shape.
They really have done a fantastic job. We have to open our country. We cannot let the cure be worse than the problem itself. We’re not going to let the cure be worse than the problem. We have to be calm. It’ll go away.” I’ve seen a lot of grim diseases, but the combination in Covid of such large numbers dying, all alone because their loved ones can’t go with them, saddens me, but it also just enrages me because this was so unnecessary. OK, so let’s realize where we are. It’s April, and we really didn’t get the early response down. We didn’t get testing figured out. But now, we’re in the thick of a crisis. People are dying. There is a crisis in the United States. So the big question here is, what do you do once you’re actually in the thick of this crisis? And in my conversations with Nick, and in all of these playbooks, there’s this one theme that just keeps coming up, which is health communications. Which sort of just sounds like a boring P.S.A. from the government.
“Larry, you know this simple exercise can help you stay healthy.” I didn’t even know what that meant to begin with. But as I looked into it, I started to realize that there was something there. In fact, the Bush playbook says that the need for timely, accurate, credible and consistent information that is tailored to specific audiences cannot be overstated. So it turns out that, when a country is devolving into pandemic chaos, one of the most important things, if not the most important thing, a government can do is communicate to its citizens how important and risky this is. “And the 15, within a couple of days, is going to be down to close to zero.” ”Staying at home leads to death also.” “Are you telling the Americans not to change any of their behaviors?”
“No, I think you have to always— look, I do it a lot anyway, as you probably heard, wash your hands, stay clean. You don’t have to necessarily grab every handrail, unless you have to. You know, you do certain things that you do when you have the flu. I mean, view this the same as the flu.” “The C.D.C. is recommending that Americans wear a basic cloth or fabric mask. This is voluntary.” “It’s easy to focus just on the failures of President Trump, but look, there is plenty of failure to go around, and it involves blue states as well as red ones. New York was particularly hard hit, in part because New York leaders initially did not take this seriously enough. Mayor Bill de Blasio tweeted that people should get on with their lives and go out on the town.
It would be difficult to think of any signal that a leader could possibly send that was more wrong and more lethal than that one. “Tonight, FEMA is bringing in hundreds of ambulances to help with record-breaking 911 calls in New York. This morning, as an emergency field hospital is being built in iconic Central Park —” “All of those beds, all 20,000, will have to be turned into intensive care beds to focus on Covid-19 patients who are really, really sick.” We simply blew it. And the result was that Americans did not take the virus as seriously as they did in other countries. OK, so the U.S. blew it when it came to health communications, whereas Europe and many countries around the world got it right. I want to know what the actual proof is that that’s the key to fixing it. Is it just because the playbook said it or because Nick said it? Well, I got my hands on some data that really helped me understand this. Google collected data from a bunch of people’s phones to track before the pandemic and during the pandemic how people’s movement changed. If you assemble that data onto a map, you see something really interesting. If you look over here, you can see these dark blue areas, which represent countries that shut down by up to 80 to 100 percent. This means they weren’t going out, they weren’t shopping, they weren’t going to cinemas. They were staying home like the government implored them to.
Austria shut down by 64 percent, France by 80 percent, Ireland by 83 percent. All of this movement shut down in the name of beating the virus. Meanwhile, over here in the United States, we’re at about 39 percent on this same day in late April. We never really shut down. One of the basic things about this pandemic is that, if people really do take it seriously, and for four weeks or six weeks do adhere to stay-at-home orders in the way Europe did, with 90 percent of the travel shut down, then the virus is stopped in its tracks. Other countries did it, one after the other. The U.S. was never able to do that. We fought the virus, and the virus won. Again, I can’t help but think of what could have happened if our president got up and said — “My fellow Americans —” This is going to be very difficult. We have to shut down our entire country. Not just the urban spots, the entire country. It’s going to be painful, but it will help us reopen our economy quicker and it will help save American lives. But that didn’t happen.
I remember looking at the graphs in April and watching daily deaths climb so rapidly, just skyrocketing. The natural response would’ve been to say, whoa, slow down, we need to really tighten things up and learn from other countries that have done better. But instead, the very next day — The president, remarkably, attacks stay-at-home orders in states around the country and encouraged supporters to liberate states like Michigan. This was an obliviousness to science and public health advice, a lack of empathy for those who were dying. I don’t know what to call that failure except an example of extraordinary incompetence. I find that truly heartbreaking. This is where the graph starts to blow my mind, and really starts to get to the heart of my big question of why these lines look so different. Watch how the Covid cases sort of plateau in the U.S., but in Europe, cases start to look like this. Our peers buckled down and did the hard work to get ahead of the virus by following basic pandemic measures articulated in all of the plans, including our own playbooks.
They saw the results of that. The U.S., on the other hand, plateaus for a bit, and by mid-June, starts to skyrocket again. “In the nation’s three most populous states, things are going from bad to worse.” “California, Texas and Florida are in crisis.” “Today, reporting more than 5,000 Covid-related hospitalizations.” And even though Europe is having an uptick now, you need to look at this gap. This gap represents a lot of unnecessary suffering, and the death of tens of thousands of Americans. I understand that we’re going to make mistakes. This is hard stuff. Lots of countries made mistakes. But what has troubled me is that we just didn’t learn from them. We weren’t self-correcting. Instead, we doubled down on mistakes. And then, we just gave up. OK, so I now feel like I have a much better understanding of why our graph looks like this compared to other countries.
It has a little bit to do with those early mistakes and whatever, but those are sort of forgivable. Instead, it’s what happened once the pandemic was here and raging and killing Americans. Instead of having leaders who told us what we needed to do to make it through this risky and uncertain time, we had leaders that denied that this was even a big deal, and then who eventually just gave up on the whole thing. The death certificates of more than 150,000 Americans will say something like Covid-19. In a larger sense, what should be written on those death certificates as the cause of death is “incompetence.”
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The U.S. spent 15 years preparing for the coronavirus. Why did we handle it so badly?
America’s unraveling was captured by the video of a district health board meeting in Idaho a few days ago to discuss a mask mandate. One member, Diana Lachiondo, received an emergency call and frantically interrupted the discussion.
“My 12-year-old son is home by himself right now, and there are protesters banging outside the door,” she said, so distraught that it’s hard to make out her exact words. “I’m going to go home.”
The terrified boy and his 8-year-old brother were home alone (their grandmother had taken the dog on a walk) as armed protesters arrived, screaming, blowing air horns and calling their mom a tyrant — for trying to save people’s lives with face masks.
“I am sad,” Lachiondo wrote later in a Facebook post. “I am tired …. There is an ugliness and cruelty in our national rhetoric that is reaching a fevered pitch here at home, and that should worry us all. And, above all, I am terrified about the virus’s current trajectory.”
She added: “I’m calling on Republican leaders who have politicized public health, who have amplified rhetoric, capitalized on it, tacitly endorsed it while holding hands with the most extreme factions in their party. Take a hard look at what you’ve become. It’s far past time to do better.”
Historically, national crises have always stressed the social fabric. The plague led to attacks on Jews and poor harvests set off witch trials. Today as well, too many politicians and ordinary Americans disdain science or any iota of personal responsibility, polarizing the country and misleading fellow citizens.
“Open America up,” Representative Matt Gaetz, a Florida Republican, tweeted recently. “Masks don’t work,” said Ron Paul, the former Republican presidential candidate. Both these assertions defy science and public health recommendations; they are not just misleading but potentially lethal.
All this may worsen the pandemic.
“I think we’re going to go up for weeks,” warns Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention. “Cases are cresting in the upper Midwest, but that’s just from massively high rates, and the post-Thanksgiving bump is just beginning to play out.”
Just as the Thanksgiving bump fades, I fear, the Christmas bump will arrive.
It’s not that the coronavirus can’t be controlled: Europe had a terrible autumn wave but reined in the virus — while keeping schools open. Yet the United States as a whole still can’t match Europe in rationally managing the virus. That goes back to weak American governance; if only Trump tackled a real virus as aggressively as he does fake electoral rigging.
“Most European countries are doing their best with government messaging, restrictions on hospitality and indoor house visits, testing, tracing, soft-touch border restrictions and face coverings, whereas the U.S. looks like a free-for-all,” said Devi Sridhar, an American who is a professor of global health at University of Edinburgh. She noted that European countries have also put in place structures — universal health care, sick pay, free testing — that make it easier to address a crisis like this.
While Republicans have been particularly irresponsible in resisting face masks, it is mostly local Democratic officials who have irresponsibly kept schools closed more than necessary. As I’ve argued since May, that exacerbates inequality and learning gaps — without significantly curbing the virus.
“If the status quo continues, students of color stand to lose 11 to 12 months of learning by the end of the [school] year,” McKinsey & Company warns in a new report. White students would be set back by less, four to eight months, it says.
The United States is also bungling the economic response. The nonprofit Feeding America warns that the pandemic could cause food insecurity affecting one in four American children, but Congress has been unable to pass an emergency bill to support those out of work. Treasury Secretary Steven Mnuchin is recklessly trying to disable tools used by the Federal Reserve to address the economic crisis, apparently seeking to inflict more pain on Americans in the Biden administration.
Folks, we should be celebrating now. We have a new Pfizer vaccine that is 95 percent effective! Just behind it in the approval process is a vaccine from Moderna! By next summer, we should be able to emerge from our caves and hug each other again.
Except that by then hundreds of thousands of us will no longer be around.
The Institute for Health Metrics and Evaluation projects that more than 500,000 Americans will have died of the coronavirus by the end of March. It expects that vaccines will have saved 25,000 lives by then — but that broader mask usage in this period could save even more lives, 56,000.
“Vaccines are amazingly promising — much more so than I thought possible,” Dr. Frieden told me. “But they won’t be here for a while, so we need to double down on protection protocols.”
Refusing to wear a mask is today’s equivalent of drunken driving. The odds of killing someone are low, but collectively this year the refusal to wear masks will kill far more Americans than driving under the influence.
This is the test of our lifetimes. Let’s stop failing it.
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