Dire projections of U.S. deaths from the coronavirus are placing new scrutiny on the Trump administration’s initial response while prompting questions about whether faster action could have lowered the death toll.
The White House presented sobering numbers on Tuesday that the best-case scenario with full mitigation measures in place is between 100,000 and 240,000 deaths in the United States. Those figures would exceed the U.S. death toll from the Vietnam War and Korean War combined.
The numbers have raised questions specifically about why the U.S. was slow to roll out tests to identify the virus, while bringing new criticism on President Trump for downplaying the virus’s threat earlier this year.
Furthermore, some say the U.S. is still not responding quickly enough. A number of states do not have stay-at-home orders, and Florida, where some officials see an emerging outbreak, only issued one on Wednesday.
The grim outlook has brought criticism to Trump and the federal government, along with state officials seen as not reacting quickly enough to the pandemic.
Lawrence Gostin, a public health expert at Georgetown University, said the death toll would be “dramatically lower” if the United States had taken earlier action.
“We wasted many weeks before we implemented social distancing and before we ramped up testing,” he said. “Even today the testing is spotty and social distancing is a patchwork across the country.”
Ashish Jha, director of Harvard’s Global Health Institute, said on CNN Wednesday morning that earlier testing and earlier orders for people to stay at home would have made a difference.
“I don’t know any public health expert who does not believe that if we had gotten our testing together, if we had gotten our hospitals ready, if we had communicated and gotten a lot of our lockdown orders going much earlier, we wouldn’t have a very different situation,” Jha said. “We clearly would have.”
Top government experts have said that’s not completely clear to them.
Asked by CNN’s Jim Acosta at a press briefing on Tuesday whether the death projections could have been lower with earlier action, Anthony Fauci, the government’s leading infectious disease expert, said it is possible, though it depends on how early the virus was circulating undetected.
“If there was no virus in the background, there was nothing to mitigate,” Fauci said. “If there was virus there that we didn’t know about then the answer to your question is probably yes.”
He added, though, that he did not want that to be a “soundbite that gets taken out of context.”
“In a perfect world, it would have been nice to know what was going on there,” Fauci said of the early weeks of the outbreak. “We didn’t. But I believe, Jim, that we acted very, very early.”
Trump, at the same briefing, responded by again stressing his decision to close off travel from China at the end of January.
“I made a decision to stop China from coming in, took a lot of heat even from China,” Trump said, adding: “That was a big decision.”
China has faced persistent doubts about its transparency and the statistics it is making public.
Asked if the United States had gotten a “late start” on fighting the virus, Vice President Pence on Wednesday pointed to China, where the outbreak began.
“The reality is that we could’ve been better off if China had been more forthcoming,” Pence told CNN.
Trump’s earlier statements are also getting new attention.
A sober Trump warned it was headed into two very tough weeks on Tuesday as officials unveiled models showing as many as 240,000 people could die even if social distancing was practiced.
But on Feb. 24, he tweeted: “The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!”
On Feb. 27, when the U.S. had 15 confirmed cases, he said: “When you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”
On March 9, he compared the coronavirus to the flu and said despite thousands of deaths from the flu, “Nothing is shut down, life & the economy go on.”
Trump is not the only leader coming under scrutiny.
New York City Mayor Bill de Blasio (D) has also faced criticism, including for going to work out at the gym hours before gyms were ordered to close because of the outbreak.
The New York Times reported that some top city health officials threatened to resign if he did not take stronger action to close schools and businesses.
While New York is now the hardest hit area, the West Coast, which had the earliest known coronavirus cases, has fared better, at least so far. California was the first state to implement a stay-at-home order, on March 19.
White House officials on Tuesday showed a graph of California and Washington state with much flatter curves than New York and New Jersey.
Abroad, experts point to the example of South Korea, which has been able to bend down its curve of cases far lower than the U.S. through extensive testing and tracing of infected people’s contacts to isolate them.
“It seems like the evidence is if we could have done that then things might be more under control,” said Eleanor Murray, a professor at the Boston University School of Public Health.
The U.S. has now missed the initial window of opportunity to take that approach. But experts say in order to eventually ease up on blunt stay-at-home orders once the worst is passed, the U.S. needs to dramatically ramp up testing. That would allow for moving to a new phase of tracing infected people’s contacts and isolating them.
While the projection of 100,000 to 240,000 deaths is sobering, it is also possible that the numbers could be even worse.
“Since we still don’t have great testing, our numbers are still potentially too low,” Murray said.
Those projections also assume full mitigation measures, but not every state has issued orders for their residents to stay at home.
The worst-case scenario in the White House model, with no intervention to slow the spread, is 1.5 million to 2.2 million deaths.
Trump has declined to say whether all states should issue stay at home orders, and Gostin, the Georgetown professor, said he is concerned that some states still have not.
“Even now,” he said, “a month into the epidemic in the United States, we’re doing too little.”