AILSA CHANG, HOST:
Liberate Michigan; Liberate Minnesota; Liberate Virginia - tweets today from President Trump, a day after he told governors, you are going to call your own shots.
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PRESIDENT DONALD TRUMP: America wants to be open, and Americans want to be open. As I have said for some time now, a national shutdown is not a sustainable long-term solution.
CHANG: At the White House last night, President Trump and his Coronavirus Task Force unveiled new guidelines a, quote, "proposed phased approach" that states can use to determine when and how they can safely reopen their economies. And that was an about-face in both tone and substance from earlier in the week, when Trump claimed he had absolute power in deciding when states should reopen.
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TRUMP: The president of the United States has the authority to do what the president has the authority do, which is very powerful. The president of the United States calls the shots.
CHANG: And so, for states, the week is ending pretty much where it began, with many states doing exactly what they've been doing since the start of the coronavirus crisis in this country. And that is figuring out for themselves how they're going to get through this.
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GRETCHEN WHITMER: You know, we've been on the front end of taking aggressive action, pulling kids out of schools, shutting down bars, making restaurants dine out, and, ultimately, the stay home order. We've been on the front end on all of those.
CHANG: And, Michigan Governor Gretchen Whitmer says, that's not all.
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WHITMER: We've all been trying to navigate a situation where there's not enough support from the national stockpile, where we've been having to try to outrun one another in the race to get PPE for our nurses and our doctors.
CHANG: And, governors told us this week, testing remains a problem. Here are Illinois Governor J.B. Pritzker, Missouri Governor Mike Parson and Washington state Governor Jay Inslee.
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J B PRITZKER: The truth is that the federal government has really been more of a hindrance than a help in most of the testing issues.
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MIKE PARSON: Testing is going to be a big factor when you really, quote, "reopen" the state where people start feeling they're safe again to go out and come back to some sort of normal. And no, 3,000 a day is not enough.
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JAY INSLEE: Because we need five, 10 times more testing capability than we have today in the nation and in my state. And this is, frankly, kind of still a dire situation.
CHANG: Well, people who study the U.S. public health system say what's unfolded over the past couple months doesn't even come close to resembling what's supposed to happen during a pandemic. Scott Greer is a political scientist with the University of Michigan's School of Public Health, and he says you could have seen this coming as far back as November 2016 when Donald Trump was elected president.
SCOTT GREER: There is a playbook for public health communications and a playbook for federal health leadership, and nothing about the management of the Trump organization suggested he would follow it. He is a disruptive politician.
CHANG: So, why does this playbook matter? Well, because, Greer says, federal, state and local governments each have specific roles and responsibilities when it comes to protecting the health of Americans. You can't just shake it all up and expect everything to be fine.
GREER: So, there's a lot of money flowing through state and local public health, but it's a lot of restaurant inspections, and vaccinations, and helping to sort out problems with primary care access. It's not set up for this kind of a big response.
CHANG: Right.
GREER: States tend to be very, very lean operations. In the same way that we don't expect every state to have a microbiology top-level lab, and we don't expect every state to have an experimental epidemiological station in Indonesia, we also don't expect every state to be prepared against any kind of public health threat. It's the federal government that can dive in with really big expenditures.
CHANG: OK. So, how does all of that translate into what's supposed to happen in a pandemic?
GREER: Everybody is supposed to look to CDC or some other part of the federal government. CDC is built to have the expertise, to have the scientists, to have the international profile. It's been getting cut since 2016, but nonetheless, it's still there. States aren't supposed to be exercising this kind of leadership on their own, inventing it on the fly. Local governments certainly aren't.
CHANG: Hmm.
GREER: And what's happened here is that federal leadership is supposed to be at the core of the system, but federal leadership depends on the White House being able to straighten out things within the federal government, such as the spats between CDC and FDA about testing.
CHANG: Greer points to the U.S. response to Ebola in 2014 as one that, while far from perfect, ultimately succeeded in preventing a domestic crisis, in large part, because of the appointment of an Ebola czar - the longtime democratic operative Ron Klain. Klain's job was to bring together officials from every federal agency involved in the response to hash out problems and bridge gaps, and he did this weekly. The key in any response, Scott Greer says, is having one voice.
GREER: You just have to have somebody who can give authoritative guidance, who can give governors cover for taking risky actions, who can deploy federal resources.
CHANG: Yeah.
GREER: When you subtract that center, this whole beautiful system starts to crumble, and we end up with governors freelancing.
CHANG: Do you think, once placing Vice President Pence in charge of the Coronavirus Task Force, that he did fill - essentially fill - the role of the czar?
GREER: I think one of the problems is, to what extent is Vice President Pence actually in charge? Donald Trump is making policy quite directly. We have a number of powerful agencies still at work, and we have Jared Kushner's operation. And the whole point of the czar is that it be, essentially, the lieutenant president for this crisis, that it be the delegate who can call from the White House, and have that be the voice of the White House.
CHANG: Someone empowered to do that.
GREER: Exactly. That was essentially what Obama did. That's essentially the institutional role of the NSC, is - these are people where, anywhere in the federal government, anywhere in the states, if you get a call from them, you answer.
CHANG: This week, groups of states on both coasts announced that they would form sort of alliances, and that, you know, that they would decide together when to open their economies. What did you take away from those announcements? Did you see the move as governors just being practical, or was there some other signal that you think they were trying to send to the White House?
GREER: I would say both. On one hand, we're reinventing federalism on the fly. The states have learned that they're not going to get crucial things they always planned on getting from the federal government. Expertise, leadership, guidance, equipment. And they are inventing their own sets of United States, and that's a testimony to the extent to which the system isn't working properly.
In terms of sending a message, I can't imagine that wasn't in their heads. But we're at the point now where it's kind of hard to figure out what it would take to turn around the federal response and turn it into something that is credible and believable, and something that people will use as the basis for their planning in the next 18 months.
CHANG: Scott Greer has studied the U.S. response to Ebola, to Zika, and to multiple hurricanes, always with an eye to what went wrong, but also, to what went right. So I asked him if there's anything about the U.S. response to the coronavirus pandemic that's notable, anything that has impressed him.
GREER: The states themselves have impressed. It's not the role of states, in terms of the real practical operation of the system, to be leaders, to be defining policy on this level for themselves, let alone for large parts of the country collectively. So a lot of governors and a lot of state governments rose to the challenge, and took decisive action, and coordinated, and, in many ways, became united states.
CHANG: Still, of course, so many challenges lie ahead, not just with ramping up testing and contact tracing, but also, what's going to happen when a vaccine becomes available? Greer wonders, can the U.S. avoid a repeat of the mess that we're still going through with testing, ventilators and PPE? In other words, this crisis is far from over. Transcript provided by NPR, Copyright NPR.
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