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Former Federal Health Officials On What Government Agencies Should Do For COVID-19


This week has been a tipping point in the spread of the coronavirus in the United States. The country has yet to see large numbers of people hospitalized or a high rate of casualties from COVID-19, the disease caused by the coronavirus, but daily life is being disrupted in nearly unprecedented ways.


Schools across the country are closing, pro sports leagues have canceled games, Disney theme parks are closed, and tens of thousands of people are working from home.

SHAPIRO: All of this is being driven by an effort to flatten the curve, to try and slow the spread of the disease. We're going to take some time now to look at the federal response so far with three guests. Margaret Hamburg was commissioner of the FDA in the Obama administration.



SHAPIRO: Beth Cameron served on the National Security Council's Pandemic Response Team. Good to have you here.

BETH CAMERON: Thank you.

SHAPIRO: And Mike Leavitt was Secretary of Health and Human Services in the George W. Bush administration, also governor of Utah, where he is now. Welcome.

MIKE LEAVITT: Thank you.

SHAPIRO: Let's jump to January. We started to see infections spreading in China. The city of Wuhan asked millions of people to self-quarantine. At that time, Margaret, what should the U.S. government have been doing?

HAMBURG: Well, it certainly should have started to mobilize. One initially could have hoped that it would remain localized, but even then, the U.S. government should have mobilized in order to try to help contain the virus and the infection it was causing where it was then because we know a disease anywhere can be in our backyard within, you know, 24-plus hours. And so we're interested in controlling disease where it starts as well as, of course, beginning preparations here.

SHAPIRO: So, Margaret, you're saying the government should have mobilized even when there were only cases in China. Mike, what did we see the government doing?

LEAVITT: Well, before I answer that, may I just level set with this? It's very difficult, I think, at any moment in time to talk about pandemics because anything that is said before it becomes clear that this is a virus with pandemic potential - it seems alarmist. After it begins to unfold, it turns, and everything that was done is inadequate. All of those on this - in this interview have been through processes where we have seen viruses that appeared to have pandemic potential, and we stood up on the balls of our feet to begin the planning exercise, to begin to form, to begin to put into place the assets that would be required. I don't know the extent to which that was done. There's a well-established pandemic plan that's been used across three administrations now. If they were following that protocol, all of those things would have occurred.

SHAPIRO: If they were following that protocol, would there have been enough tests for Americans by the time this disease arrived on U.S. soil?

LEAVITT: Well, I'm not in a position to evaluate the facts of what has occurred. It's clear that we have not had them as soon as we would like, and they've not been as well-coordinated as they should be. But, again, we also have a knowledge that any time you have a virus, you have to go through a process of establishing what the virus looks like. You then have to begin to invent the test. You have to test it and make certain it's effective. We could have done all of those things better, I am confident. I think that's always the case.

SHAPIRO: The shortcoming seems indisputable. The question is, whose fault is that, not to put too fine a point on it?

CAMERON: Well, I think I was also really disturbed not by the fact that this is a challenging disease. I, too, agree with Gov. Leavitt that it's very hard to see where you are in the middle of a crisis as it's unfolding. But I think the U.S. government is generally very strong at developing rapid diagnostic tests. We did this in Ebola. We did this in Zika. We did it for H1N1. We are good at this. And so the thing that really surprised me is when we failed, when we were not able to develop the test as quickly as we thought that we could or that we usually do - that we didn't have a backup plan. And so I lay that squarely at the feet of leadership. That's a failure to ask the right question about - what else could we be doing to have a test while we're making our own?

SHAPIRO: Has there been a moment in the last couple of weeks or months when you have said to yourself, I wish they would just do X? What is that X?

HAMBURG: Well, for me, one of the things is what we're starting to see now, which is have a whole-of-government approach, really define leadership and hold people accountable for progress towards critical needs. This is not something where there's a simple fix, and it involves coordinating many, many different components of government, working with the private sector and with other stakeholders. And we really haven't seen the kind of coordinated, comprehensive effort that's necessary to be effective.

SHAPIRO: Let's talk about President Trump's description of this epidemic because up until his Oval Office address this week, he pretty consistently minimized the threat of this disease. These are just a few of his remarks over the last month.


PRESIDENT DONALD TRUMP: Because of all we've done, the risk to the American people remains very low.

One day, it's like a miracle. It will disappear.

You know, a lot of people think that goes away in April with the heat.

Get better just by, you know, sitting around and even going to work.

People die from the flu, and this is very unusual. And it is a little bit different. But in some ways, it's easier, and in some ways, it's a little bit tougher.

And this is their new hoax.

SHAPIRO: That last bit of tape there - the president calling coronavirus a democratic hoax during a rally in South Carolina. What's the effect of those kinds of statements?

CAMERON: I think those kinds of statements have a chilling effect on the people who are working in the U.S. - even the U.S. government departments and agencies who are trying at CDC, at FDA, at NIH to get the information they need to actually help stop the spread of the disease. So I think it puts the scientists and the public health experts even in our own government in a challenging position.

HAMBURG: This is Margaret. It's very disturbing, I think, to see the lack of good sources of information for people at many different levels - for the public broadly but also for the state and local health departments and for entities like universities and schools and businesses.


LEAVITT: Given what we know a week later, those comments cannot be defended. However, it is worth acknowledging that what I suspect the president was representing there is a sense of skepticism that exists in a population. Like, this isn't going to be real. This is the year - this is 2K2. What the president was facing, and I suspect this has been true for any leader in that case, is - can you inform without inflaming? Can you - he was worried about the economy. Other people are worried about safety. We have different points of view reflecting different priorities. As I said, I don't defend those and would not, cannot defend any of those things that were said a week ago. But we have a different view of it now, and it's very clear.

SHAPIRO: At the same time the president was saying those kinds of dismissive things about the disease, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Disease, was making public statements in sharp contrast to those messages from the White House.


ANTHONY FAUCI: Well, I think that we better be careful about jumping to the conclusion that this is turning around.

It is 10 times more lethal than the seasonal flu. Bottom line, it's going to get worse.

SHAPIRO: Each of you has played a role in containing public health threats in the past. How important is consistent messaging in the midst of a public health crisis?

LEAVITT: It's vital, and there was clearly a misstep in the context of consistency. And may I say that the nation is so fortunate to have Tony Fauci, who is an international treasure, being able to both understand the history of these things, the science of these things and to speak truth to power and to the public.

CHANG: The three of you seem to agree that the initial federal response to this left something to be desired. Is it too late to make up for lost time? Can the response get on track at this point?

LEAVITT: Look; I think we have to acknowledge that the response of the American people has been extraordinary. The fact that we are suspending professional sports leagues, we're disbanding major traditional events, that we're setting aside parts of our culture because we are facing this danger - this is a very powerful response, and it will save lives. And I think the response as it's unfolding not just because of the government - the government has a role, but it's the American people here who are responding.

SHAPIRO: But those responses can't take the place of widespread, accurate testing, right?

LEAVITT: Yes, but we ought not to, at this point in time, spend all of our time focusing on what happened in the last three weeks. We ought to be talking about what's going to be happening in the next three weeks because they're vital.

HAMBURG: And the next three weeks are going to be tough. This is Margaret. You know, the next three weeks, testing is going to expand. We're going to see the numbers dramatically increase, and that's going to be frightening. We're going to see more and more people that we know, and we're going to hear reports about more and more people getting sick. And some of those people are going to have mild disease, but some are going to be very sick. And we're going to start to hear stories about the overwhelming of the hospital system, et cetera. So this is a time when - it is true. The American people so far are responding remarkably well. But this next period is going to require a lot of really high-quality, transparent actions to be taken and clear, consistent communication.

SHAPIRO: Beth, to the underlying question, is it too late for the federal government to catch up and start doing the things that it perhaps should have been doing earlier?

CAMERON: I don't think so. I think right now is a critical period of time where we need to see a partnership. Really, it's a three-legged stool. It's the federal government, it's the state and local governments, and it's the American people. Those three working together at their best, I think, can do a much better job than has been done so far. And I think most importantly, forward-looking, those three groups working together are what's going to have to happen to incentivize people to be able to stay home, to provide and protect vulnerable populations, to ensure that people have paid leave and are able to not go to work and socially distance as they need to. But also, state and local officials working with the federal government are going to have to make sound decisions about how to keep people safe and to protect the hospital system for those most vulnerable people.

SHAPIRO: Well, I am grateful to the three of you for offering your expertise to us on this. Thank you very much.

HAMBURG: Thank you.

CAMERON: Thank you.

LEAVITT: Thank you.

SHAPIRO: Margaret Hamburg was FDA commissioner in the Obama administration and New York City's Commissioner of Health. Mike Leavitt was Health and Human Services Secretary in the George W. Bush administration and governor of Utah. And Beth Cameron is a vice president at the Nuclear Threat Initiative, and she worked on the National Security Council's Pandemic Response Team.

(SOUNDBITE OF BON IVER SONG, "HOLOCENE") Transcript provided by NPR, Copyright NPR.