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Short-term thinking plagues Trump’s coronavirus response


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Officials have yet to grapple with the long-term supply demands needed to fight months-long pandemic.

After months of minimizing the threat to the United States, President Donald Trump jumped feet-first into the coronavirus fight this week with vows of quick fixes to the testing problem, claims about potential cures, and efforts to rope in agencies that had inexplicably been excluded, like FEMA.

The show of action played well in the White House briefing room and with the public, but has had a different impact behind the scenes. Health-agency officials and outside advisers to the administration, speaking on the condition of anonymity, described a chaotic situation in which leaders rushed to address presidential requests that sometimes seem to come on a whim while losing focus on longer-term challenges.

Trump’s drive to announce unfinished initiatives created a “need to make good on half-baked promises,” said one senior official — who, like other Americans, learned about some initiatives only when the president announced them at the White House podium.

For instance, no one in the White House had devised a national strategy for obtaining and distributing the necessary supplies in the likely months-long fight against the pandemic that lies ahead, said three people with knowledge of the planning efforts. Those supply-planning efforts are only now underway.

“How is there not a national supply strategy yet?” asked one official involved in the effort, warning that the infamous shortage of coronavirus tests is set to be replicated with other shortages across the health system. “Hospitals are going to run out of basic commodities.”

The U.S. health system already has been plagued by shortages of test-kit chemicals, swabs and personal protective equipment for health workers, problems that are set to worsen as coronavirus case numbers rise and demand spikes. A government effort to obtain replacement test swabs required the U.S. military this week to airlift the specialized swabs from a factory located in coronavirus-stricken Italy.

Meanwhile, leaders in coronavirus hotspots like Seattle and New York City have effectively abandoned efforts to conduct broad testing on residents, instead urging them to stay home given the shortages — an acknowledgment that efforts to contain coronavirus have failed and they need to prioritize limited supplies. Local officials also are making unusual crowdsourcing appeals.

“We need companies to be creative to supply the crucial gear our healthcare workers need. NY will pay a premium and offer funding,” New York Gov. Andrew Cuomo tweeted on Friday. “If you have any of these unused supplies, please email COVID19supplies@esd.ny.gov.”

A sympathetic HHS staffer compared Cuomo’s plea to an Internet auction. “We’re facing a pandemic and the governor has to basically turn to eBay” for supplies, the staffer said.

Trump has worked to tamp down concerns about insufficient tests and supplies, saying that the flurry of federal, state and local efforts will be sufficient. “If California can get a mask sooner than we can get it for them, through all of the things we're able to do, we'll end up with a big over-supply,” the president said at a press conference on Saturday. “At some point this is going away.”

Spokespeople for the Trump administration defended its planning and coordination for the coronavirus outbreak. “We’ve been working since January with American manufacturers to prepare for responding to the outbreak and will continue to coordinate closely with private suppliers and our federal partners to ensure that resources are going where they’re needed,” an HHS spokesperson said.

The White House said that Trump’s leadership had sparked an "unprecedented collaboration" of government and private industry to curb the virus’ spread and ramp up the response. “The president has no higher priority than the health and safety of the American people and he is working around the clock to ensure we emerge from this crisis healthy, safe, and strong,” said spokesperson Judd Deere.

Inside the Trump administration, officials are continuing to sort out which teams are responsible for elements of coronavirus response, part of an ever-shifting patchwork of alliances and strategy, while working to manage the president’s unpredictable requests. Five officials said that Trump had grown appropriately concerned about the coronavirus outbreak after weeks of ignoring or playing down the threat, but that the administration is now rushing to solve issues that could have been addressed months ago, like obtaining the necessary supplies for the nation’s emergency stockpile.

Officials also are sniping over whether to institute even more aggressive actions to prevent coronavirus transmission. Health officials are calling for stricter measures that would keep more Americans at home, for longer, but policy officials warn that the resulting economic damage could cause other, long-lasting harms.

The Federal Emergency Management Agency this week took over responsibilities that had rested with the Health and Human Services department, the latest attempt to get a handle on the worsening outbreak.

“FEMA is now leading federal operations for #COVID19 on behalf of the White House,” administrator Pete Gaynor tweeted on Thursday night, as some projects like drive-through test sites shifted from the health department. The agency is also taking on a larger role handling supply and distribution issues, Gaynor and other officials said at Saturday’s briefing.

“The tendency is to think of FEMA as a disaster management agency,” said Craig Fugate, who ran FEMA during the Obama administration and said he had no knowledge of the Trump administration’s strategy. “It’s actually an all-hazards agency… and FEMA could add structure, planning, location to the coronavirus response,” with its regional offices and staff with crisis-management experience.

Some officials and outside advisers have questioned why FEMA had not been given more authority earlier in the response given the agency’s operational expertise in responding to disasters. Two individuals said that HHS Secretary Alex Azar had focused on protecting his leadership role, which has shrunk as Vice President Mike Pence took over the broader response and deputies whom Azar had originally sidelined — like Medicare chief Seema Verma and Surgeon General Jerome Adams — have emerged as key figures in White House strategy.

But a person familiar with HHS strategy said that Azar had pushed “weeks ago” for FEMA to be involved. The hold-up was instead linked to the federal response’s rotating leadership — as Pence abruptly took over for Azar at the end of February — and administration worries that states would be further confused over who was in charge.

“Secretary Azar and HHS have been and continue to be wholly supportive of a whole-of-government approach and in particular the important role FEMA is playing in coordinating the federal government’s response to COVID-19,” an HHS spokesperson said.

Meanwhile, a SWAT team of government officials and outside technocrats, backed by White House senior adviser Jared Kushner, spent the week working around-the-clock to deliver the drive-through testing sites that Trump publicly promised, POLITICO first reported.

But the focus on drive-through testing also creates a new problem — draining limited supplies and other resources that could be used for high-priority patients in hospitals.

“It’s all short-term thinking right now,” said one official involved in the response.

“They’re desperate to expand testing — which is a good idea — but I don’t know whether the president, the vice president and others at the top understand the trade-offs,” added an adviser to the effort. “It feels like each of these problems is a mini-crisis being run by a mini-team in the government.”

Trump’s own involvement has caused additional headaches. Health department officials were confused on Wednesday after Trump announced that an “exciting FDA announcement” was on the way — particularly because Food and Drug Administration officials had yet to greenlight new drugs that Trump sought to fight the virus, The Wall Street Journal reported.

While Trump did hold a Thursday press conference with FDA Commissioner Steve Hahn and other officials, the event largely rehashed existing policies and work that had already been announced. Trump on Friday also repeatedly made claims about an unproven coronavirus treatment, prompting infectious-disease scientist Anthony Fauci to try and walk back the claims from the White House podium.

Meanwhile, the president has repeatedly touted unfinished projects, like announcing on March 13 a Google website that he said would help coordinate testing. But the actual site, which rolled out a week later, is instead a collection of information and links. Trump on Friday also claimed that General Motors has “openly stated” it would produce medical supplies. But GM has not publicly committed to producing more supplies, although the company is working with ventilator specialist Ventec to boost its production, according to a joint statement rushed out on Friday after Trump’s remarks.

"All options are on the table on how GM can help Ventec build more ventilators," a GM spokesperson said.

The chaotic response also has trickled down to individual hospitals, clinics and doctors, which have struggled to get answers on supply chains and fought to protect their equipment.

Sen. Bill Cassidy’s office reached out to the White House on Wednesday after learning that University Medical Center in Louisiana was informed that a new lab-testing machine, due to arrive on Monday, had instead been requisitioned by government officials for a “higher priority” coronavirus situation.

“We thought the machine was a high priority in Louisiana given the fast rate that things were spreading,” said a spokesperson for Cassidy’s office, noting that the state has become a hotspot for coronavirus transmission. The White House later assured Cassidy’s office that the machine would go to Louisiana next week, as originally intended.

Meanwhile, the Trump administration has spent weeks competing with states and hospitals to obtain medical supplies and quickly build up national reserves. “Every single governor across the country is looking for the exact same thing,” FEMA’s Gaynor said at Saturday’s White House press briefing, responding to questions about shortages.

Some experts said the president would be better served by developing a national strategy to allocate limited resources to the neediest areas while obtaining new ones, say experts, noting that dozens of individual components in the health system are at risk of being quickly diminished in the initial crush of cases — from the intricate chemicals needed for tests to the basic supplies that could’ve been rapidly produced months ago.

“We’re seeing a run on swabs,” said a former official, arguing that the Trump administration should have anticipated the worldwide demand for the specialized, low-cost swabs needed to do the testing. “How on Earth did we let this happen?”

Tom Inglesby, director of the Johns Hopkins Center for Health Security, listed off the supply shortages that already are plaguing hospitals.

“They say they don’t have reagents for the diagnostic kits, they don’t have swabs for the kits, they don’t have the N95 masks, they’re running out of gowns and gloves,” said Inglesby, who’s called on the White House to overhaul its approach and assign specialists, such as the Pentagon’s Defense Logistics Agency, to solve the supply-chain problems.

“I don't think we should see these as spot shortages that will soon be resolved with significant effort,” Inglesby added. “We will be using large amounts of these supplies for a long time. COVID will be with us for a long time — we need a long-term solution.”

Meanwhile, Trump on Saturday was asked about “the plan” to contain coronavirus as the nation enters day 6 of the White House’s 15-day campaign to slow the virus’ spread, and specifically whether additional measures needed to be taken.

The president declined to detail next steps, saying only that leaders would know more next week.

“We’ll have to see what the result is,” Trump said.


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