Tensions persist between Trump and medical advisers over the coronavirus

Rarely has the schism between President Donald Trump and his own public health advisers over the coronavirus pandemic been put on display quite so starkly. Even as he announced a new federal recommendation on Friday that Americans wear masks when out in public, he immediately disavowed it: “I am choosing not to do it.”

The striking dichotomy underscored how often Trump has been at odds with the medical experts seeking to guide his handling of the outbreak as well as some of the governors fighting it on the front lines, despite his move to extend social distancing guidelines through April 30 and his acknowledgment that the death toll could be staggering.

While the health specialists and some governors press for a more aggressive, uniform national approach to the virus, the president has resisted expanding limits on daily life and sought to shift blame to the states for being unprepared to deal with the coronavirus. While they sound the alarm and call for more federal action, Trump has deflected responsibility and left it to others to take a more aggressive stance.

Some of the president’s health advisers in recent days have argued that restrictions on social interaction and economic activity that have shut down much of the nation need to be expanded to all 50 states and that more Americans need to adopt them. Trump, by contrast, has characterised the crisis as generally limited to hot spots like New York, California and Michigan and has expressed no support for a nationwide lockdown. “I would leave it to the governors,” he said on Friday.

As hospitals cope with shortages of medical equipment, the administration on Friday also rewrote the federal government’s stated mission for its stockpile of supplies to make clear that it sees itself as playing a secondary role to the states. Where the federal government once said the stockpile “ensures that the right medicines and supplies get to those who need the most,” the revised version said the federal stockpile’s role was merely to “supplement state and local supplies.”

The tension over the scale of the federal response comes as the president defends his administration’s reaction to the pandemic that has now infected more than 270,000 people in the United States and killed more than 7,000. New polls showed that public support for Trump’s handling of the crisis has begun to slip, a worrisome development for a president seeking reelection in the fall.

Trump’s decision to take a back seat to the states by leaving it to them to decide whether to shut down public life and insisting they take the lead in addressing shortages amounts to a remarkable deference by a president who typically makes himself the centre of the action. It also contrasts with his own self-description as a wartime president leading a great battle against an invisible enemy.

It underscores both pragmatic and political imperatives for Trump, reflecting a traditional federalist approach that eschews imposing a one-size-fits-all national standard on states. But it also shows the president’s desire to blame the governors rather than accept any responsibility for shortages of ventilators, masks and other critical supplies.

The most fundamental point of conflict centres over how broadly the virtual lockdown of many states in the Midwest and on the East and West Coasts should be expanded. Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said stay-at-home orders should be extended to the entire nation.

“I don’t understand why that’s not happening,” Fauci said Thursday night on CNN. “The tension between federally mandated versus states’ rights to do what they want is something I don’t want to get into. But if you look at what is going on in this country, I don’t understand why we’re not doing that. We really should be.”

His comments came after a telling interchange between Trump and Dr Deborah L Birx, the White House pandemic response coordinator, at the Thursday’s daily briefing. Birx expressed concern that too many Americans were not following the guidelines.

“I can tell by the curve and as it is today, that not every American is following it,” she said. “And so this is really a call to action. We see Spain, we see Italy, we see France, we see Germany, when we see others beginning to bend their curves. We can bend ours, but it means everybody has to take that same responsibility as Americans.”

When she returned to the issue a few minutes later, Trump tried to recalibrate her remarks.

“But, Deborah, aren’t you referring to just a few states?” he said. “Because many of those states are dead flat.”

“Yes, there are states that are dead flat,” she agreed. “But you know, what changes the curve is a new Detroit, a new Chicago, a new New Orleans, a new Colorado. Those change the curves because it all of a sudden spikes with the number of new cases.” In other words, without taking action, “dead flat” states can suddenly become hot spots.

The interplay was a rare instance of Trump doing in real time on camera what officials have repeatedly denied that he does behind the scenes — attempting to water down the impact of what the medical experts were saying.

In a video that leaked online last week, Fauci was seen telling colleagues at the National Institutes of Health that he regularly made suggestions for the president’s prepared remarks before daily briefings but Trump “almost always” ignores them.

Where Fauci and Trump have differed most strongly is on the therapeutic potential of chloroquines to treat people suffering from the coronavirus. Trump has called the drugs, which are approved by the Food and Drug Administration for off-label uses aside from their intended treatment of ailments like lupus and rheumatoid arthritis, could be a “game-changer.”

But Fauci has repeatedly sounded a note of scepticism, much to the president’s frustration. “I think we’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug,” Fauci said in an interview on “Fox & Friends” on Friday.

Trump has also tried in recent days to blame states for shortages of medical equipment. “They should have had more ventilators,” he said on Friday.

Jared Kushner, his son-in-law and senior adviser, said at Thursday’s briefing that the federal stockpile was not for states to rely on. “The notion of the federal stockpile was it’s supposed to be our stockpile,” Kushner said. “It’s not supposed to be states’ stockpiles that they then use.”

A day later, on Friday, the description on the Health and Human Services website for its Strategic National Stockpile was altered evidently to reflect that viewpoint.

Previously, the website said: “Strategic National Stockpile is the nation’s largest supply of lifesaving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.”

“When state, local, tribal and territorial responders request federal assistance to support their response efforts,” it continued, “the stockpile ensures that the right medicines and supplies get to those who need the most during an emergency.” It went on to say the stockpile “contains enough supplies to respond to multiple large-scale emergencies simultaneously.”

But after the revisions, first noticed by journalist Laura Bassett, the website on Friday said that the role of the stockpile is to “supplement state and local supplies during public health emergencies. Many states have products stockpiled as well.”

“The supplies, medicines and devices for lifesaving care contained in the stockpile,” it added, “can be used as a short-term stopgap buffer when the immediate supply of adequate amounts of these materials may not be immediately available.”

The explosive growth of the virus in many cities over the last two weeks has made clear that the United States has not been following the trajectory of places like Taiwan, Japan and Hong Kong that have kept outbreaks relatively contained so far. And the country has not begun to see the number of new cases level off yet, as Italy has.

Several scientists said it was too early to make ironclad statements about whether social distancing was having a powerful effect. In a few cities that acted early, including New York, San Francisco and Seattle, new reported cases have begun to slow, providing some optimism that control measures work.

“The growth rate in New York City is slowing. We do have evidence that measures we put in place two or three weeks ago may be having an effect,” said Jeffrey Shaman, a professor of environmental health sciences at Columbia University. Data from Seattle and San Francisco, he said, shows “they’ve slowed it in spots. But whether they’re going to hold onto it is an open question.”

The number of cases and deaths in New York City has continued to rise quickly in recent days. More than 30,000 new cases in the metro area were reported since Monday for a total of more than 100,000 cases overall.

The United States has seen new hot spots in New Orleans, Indianapolis, Chicago, Detroit and other cities that did not significantly reduce how much people travelled until mid- to late-March, leaving open a critical window for exponential growth.

Florida, which took longer than most of the country to issue a stay-at-home order and reduce the distances that people travelled, reported increasing cases this week in the Miami, Tampa, and Jacksonville areas. Experts say the delays in keeping people at home in Florida and much of the Southeast could make those areas more vulnerable to outbreaks in coming weeks.

The low testing rate among the population can also muddle any assessment of the effect of distancing measures so far, said Lauren Ancel Meyers, a professor of biology and statistics at the University of Texas at Austin.

“In many of these other places, where social distancing measures were enacted very recently, it would be very difficult to see it in the data yet,” Meyers said. “Even if it’s effective.”

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