Donald Trump's USA: Where Preventing Mass Death Has Become "A Political Hot Potato"

Andrew M. Slavitt is a former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), a position he held from March 2015 to January 2017. He posted a lengthy thread to Twitter on June 6, 2020.

COVID Update June 6: I talked to today that has one of the biggest growth in cases in the country. There are some big differences with states that were hit hard with the virus in March or April. And a preview of a second wave that is concerning. 1/

First the good news. A case is not a case. In April we were testing mostly very sick people. We were doing fewer than 100,000 tests/day. The percent positives were closer to 20% than 10%. A positive was more likely bad news. 2/

With 500,000 tests/day now, we are testing many people now with slight symptoms & no symptoms. Every state but 2 has positives now lower than 10%. So when we see high case growth in Southern states and Western states, it is not the same as when we saw it happen in NY. 3/

The Health Secretary told me that some county health officials are being prohibited by local leaders from increasing testing so as not to perpetuate the "hoax" against president Trump. 4/

For the last few weeks, cases in this state have gone up. But at first it was waved off. Testing was higher. Cases were inevitable. But more recently, perhaps reflecting the opening of that state, hospitalizations started to increase. 5/

This was of course after the state had been closed down for a number of weeks in April with the rest of the country to prevent the virus from taking hold there. Saving lives but trying the patience of many in the state. 6/

If things get worse, the reservoir of will in this state to do anything resembling another shut down is gone. Many people have been told they sacrificed for nothing. 7/

The state officials know they just dodged a bullet but that the virus would eventually come. But now their political capital is spent. 8/

The good news is they are more prepared than early states were. Older people who can are presumably being more cautious. Hospitals have PPE and plenty of beds & infection controls in place. The death rates should be lower. 9/

Flattening the curve likely dampened it too as we learned about the virus. 10/

The state now has three big hot spots. One a meat processing plant. The other two in cities. They no longer believe they are dealing with an innocuous situation. 11/

But the political capital is already spent. Closing businesses isn't an option even if things get worse. And the more politically conservative the part of the state impacted, the fewer the options. 12/

The state has testing resources but very limited contact tracing & almost no isolation strategies. They have called the White House whose only advice had been to test more. 13/

They believe that even a high death toll wouldn't be enough to take action since the Coronavirus has become such a political hot potato. 14/

This offers a peak at what we could see in a second wave, particularly one that approaches election season. More tolerance with bad consequences and less willingness to sacrifice— particularly as Trump fixates on the economy & the election. 15/

Two lessons come from this— 1) governors must make all actions as geographically targeted as possible. County by county, town by town watching hospital capacity closely. 16/

2) people will need to pay much closer attention we the signal from Govt will be weaker. Bars may be open, churches may be open. It doesn't mean they're safe. 17/

States that were spared early are nervous & are left with fewer options to respond given the state of the politics. 18/

The virus is enough to battle. Our leaders should be removing the politics from decisions of life & death. End/

Asked why I haven't shared the state name, it's because I'm trying to help them right now & that won't help. But you could put many state names in that I know.