It's all been reactionary. Individual states and even cities are opening up when people clamor for summertime fun, and then frantically closing back down when the inevitable spike hits a couple weeks later. There is no attempt at cohesion or long-term planning. There is no leadership. They're all just winging it.
It's been no more reactionary than most other nations in the world. There is absolutely long-term planning by the majority of states. To the extent that states are frantically changing their strategies, it's because we're learning more about the virus and how it spreads, and shifting our strategies.
Take New York, for example. Its high death rate can be largely attributed to Governor Cuomo's disastrous decision to force nursing homes to accept COVID patients from hospitals. He has since walked back that strategy, and New York continues to maintain a phased lockdown strategy with a structured re-opening plan with measurable criteria[1].
Governers Inslee, Newsom, and Kate Brown have been receiving (well deserved) praise by the media for their structured approach to handling the outbreak[2].
Governor DeSantis deliberately focused Florida's COVID strategy on nursing homes, deploying the National Guard to the nursing homes, and prioritizing testing resources in LTC facilities[3]. To this date, Florida has among the lowest deaths per capita in the Union, and lower deaths per capita than most of the EU[4]. As a result of this, even despite a recent increase in cases, their death rate remains mostly flat — especially relative to the same metrics in most other States[5].
Between March 16-23 (at the outset of the outbreak), every single US state ordered a state of emergency, 11 had stay-at-home orders, 30 activated the state national guard, and 48 closed their schools[6]. By as early as March 9th, the States were doing the VAST majority of COVID testing[7]
As of right now, 36 out of 50 US States have a lower per capita death rate[8] than France, Sweden, Italy, Spain, the Netherlands, and Ireland[9]. 15 States have a lower per capita death rate than Germany and Denmark, who have seen the best COVID outcomes in the EU. The US, to date, has administered more tests per capita[8] than Belgium, Australia, Ireland, Italy, New Zealand, Canada, Switzerland, Germany, Austria, Norway, and Sweden (to name a handful).
It would take the most uncharitable reading of the situation to conclude that the US member states have been any more "reactionary" than typical peer nation-states.
Wish I could upvote this more. To hear it said, you’d think half the US has died already. Another great point that people always forget is that the US, at least in situations like this, is better thought of as similar to a collection of small countries. Policies are not the same across the board. Sorta like how not every EU country is doing the same thing, and wouldn’t you know it, some EU countries are doing better than others.
Washington and below all have close to equal death rates, and marginal differences are probably hard to attribute to any specific set of policy. This, of course, should not detract from the commendable numbers we see in Utah, Hawaii, Vermont, Texas, Oregon, etc.
Yes, "among the lowest" != "the lowest". Great insight.
Just look at the data: the drop-off between Florida and Oregon (spanning 23 States) is equal to that between Mississippi and Colorado, which are adjacent data points.
US states do not have a clearly articulated strategy. A clear strategy would be something like "apply mitigations and lockdowns as lightly as possible while keeping R below 1 so the number of active cases continually declines, until we have a vaccine or we have suppressed community transmission". AFAIK no governor has said anything that clear.
A lot of state actions seem to have been driven by a strategy like that, but a lot seem more like "people got tired of lockdowns and we kinda hope things might not get bad if we reopen, so we're reopening".
> but a lot seem more like “people got tired of lockdowns and we kinda hope things might not get bad if we reopen, so we’re reopening”
This isn’t unique to the US, the entire world is playing a giant game of economic chicken with COVID, and the entire world is beginning to re-open, even without a vaccine or any sort of “plan”.
Just like the EU, the US is a mixed bag. You have States like Germany with exemplary planning and strategic decision making, but you also have Italy’s and Spain’s. You have States like Washington, California, and Utah with exemplary planning, but you also have New York’s and Louisiana’s.
As with any collection of generally autonomous governments (especially where the power to enforce lockdowns and issue curfews is vested), strategies can vary, outcomes can vary.
Sure, there are many other countries that likewise lack a clear strategy. But it's not good to grade on a curve here. Americans should be demanding a clear strategy, both from the states and from the federal government; they mostly aren't, and I don't know why.
Nobody is grading on a curve here. The whole point is that, while it is fair to criticize certain States for their lack of a clear strategy (there are only a few), when it comes to COVID, the US as a whole is not a monolithic entity, it is a collection of States.
Each State has its own government, and each government has its own infectious disease agency (each with billions of dollars in funding), a chief executive, and a legislature. People forget that individual American states have GDPs on par with sovereign countries. California is comparable to the UK, NY to South Korea, Texas to Canada. The US State with the lowest GDP per capita, Mississippi, is comparable to Portugal.
At the outset of the outbreak, the vast majority of US States initiated systematic responses comparable to that of peer nation-states. Most citizens of most states ARE demanding a clear strategy from their State governments, and that's what they're getting.
The CDC provides an advisory role, and has no authority to issue lockdown mandates, close businesses, close schools, or issue testing or mask requirements. The US States may rely on the CDC advice, but it can also choose to ignore it or supplement it with the recommendations of their own State disease control agencies. Keep in mind that the CDC and the FDA both dropped the ball multiple times during this outbreak (dragging their feet on approving new testing, flip flopping on mask policy).
While it would be awesome for the Federal government to coordinate the perfect COVID response, the US is set up in such a way that the States don't need to rely on such an ideal.
Australia and New Zealand aren't good comparisons for testing rates because they have negligible community transmission. When no-one's infected with COVID-19, people aren't going to seek tests as much, and a higher testing rate is not necessary.
And still the number of deaths per day has fallen by 90% and still dropping. It’s doing what viruses do, quickly burn through the elderly and infirmed and then taper off.
That is the same as "no strategy". Without coordination of the lockdowns, travel monitoring, national testing and contact tracing, you're just going to have shifting hotspots of infection. This also leaves behind an embittered population whose lockdown sacrifices were for nothing.
That's not the same as "no strategy", because this level of decentralization is how nation-states work today.
It's also, incidentally, how the EU works. There are open borders between member states — and while some member states "closed" their borders, this has been largely unenforceable in land crossings because there are no border patrol agents between every single land crossing between EU member states. Border enforcements have only been enforced at airports.
In the US, nationwide air travel came to a near complete stand-still during the outset of the pandemic, so inter-state travel was already at the same levels you had in the EU.
The US's strategy has been the same as the EU's, and it has been to let the member States define the strategy.
As of right now, 36 out of 50 US states have a lower per capita death rate[1] than France, Sweden, Italy, Spain, the Netherlands, and Ireland[2]. 15 States have a lower per capita death rate than Germany and Denmark, who have seen the best COVID outcomes in the EU.
The US, to date, has administered more tests per capita than Belgium, Australia, Ireland, Italy, New Zealand, Canada, Switzerland, Germany, Austria, Norway, and Sweden (to name a handful). This is not because the US has a nationwide testing regime, rather it's because testing systems have been administered at the State level, with varying strategies (some focusing on nursing homes, some focusing on drive-thru testing etc).
> That's not the same as "no strategy", because this level of decentralization is how nation-states work today.
It's one thing to leave pandemic response to member countries like the EU does. Each country knows it's responsible for its own response. Money is budgeted and spent specifically for this purpose.
That's not the system in the US - or hasn't been. The Federal government maintains what, until recently, was the world's premier infectious disease-fighting organization - the CDC. The implication was that pandemic response occurs through this organization. In the past, this is exactly what happened.
You may recall the one state (Washington) earlier this year whose brave scientists decided to test for COVID on their own. They were told in no uncertain terms from the feds to stand down or else.
So the idea that this pandemic response is up to the states doesn't hold water. Had the states known that they'd be left twisting in the wind, they could have taken steps beforehand.
That's one likely outcome of this event (assuming it has a clean endpoint): states realizing they really are on their own - and acting like it.
> That's not the system in the US - or hasn't been. The Federal government maintains what, until recently, was the world's premier infectious disease-fighting organization - the CDC. The implication was that pandemic response occurs through this organization. In the past, this is exactly what happened.
While you're right that the Federal government has the CDC, every single US States has its own infectious disease/health agency[1]. Furthermore, the EU also has its own centralized disease agency[2]. Structurally, both the US and EU are very similar in this regard. The only key difference is that (to your point) the EU States may override the ECDC, whereas US States may not — certainly a worthwhile policy change for the US.
> So the idea that this pandemic response is up to the states doesn't hold water. Had the states known that they'd be left twisting in the wind, they could have taken steps beforehand.
But this is factually incorrect, States did take steps beforehand. By March 23, every single State declared a state of emergency, and 48/50 States closed their schools. By as early as March 9th, the States were doing the VAST majority of COVID testing[3]. As of right now, the US has administered more tests per capita than Belgium, Australia, Ireland, Italy, New Zealand, Canada, Switzerland, Germany, Austria, Norway, and Sweden (to name a handful). This is not because the US has a nationwide testing regime, rather it is because testing systems have been administered at the State level[4].
> While you're right that the Federal government has the CDC, every single US States has its own infectious disease/health agency[1].
Those appear to be general public heath agencies with names like: "Department of Health Services"; "Medicaid"; and "Department of Health and Environment". I don't see one mention of the word "infectious" to indicate specialty.
None appear to be a unit with a mandate along the lines of "Detecting and responding to new and emerging health threats"
> By March 23, every single State declared a state of emergency, and 48/50 States closed their schools.
I was alluding to steps that might have been taken many years ago. Like, for example, establishing rapid response teams. Like, for example, giving states carte blanche to do their own testing when needed and not be forced to wait around for the CDC to do something. Certainly not reprimanded for taking the initiative.
> Those appear to be general public heath agencies with names like: "Department of Health Services"; "Medicaid"; and "Department of Health and Environment". I don't see one mention of the word "infectious" to indicate specialty.
Lmao what, that’s your argument? That’s just what the states call it. Take, for example, the Minnesota Department of Health. Among other things, its main charter is “disease control and prevention”[1]. This is true across the board. Every single US State has such an agency, whose staff are currently working full time on COVID. “I don’t see one word of the word infections”. Come on, really? THAT’S the best you got?
> "ECDC has approximately 300 staff and commands an annual budget of over €50 million."
What’s your point? The EU has funded their centralized agency less than the US, so? That doesn’t change the fact that the US has a federalized structure similar to the EU, where the States have a similar level of autonomy as their counterparts in the EU. The US State health agencies fall under the purviews of the State governments, which are wholly independent from the Federal government.
> "CDC's budget for fiscal year 2018 is $11.9 billion.”
Take this and also compare the budgets to the state government health agencies. The New York CITY Department of Health, whose responsibility includes infectious disease prevention has a budget of $1.6 billion, with 6,000 employees[2]. That’s just for the CITY of New York!
Random anecdote about the difference: I (in Germany) can't really remember seeing anything about what ECDC said or thinks in the past months in the media, only about country-level (and lower) authorities. Whereas US-CDC seems quoted quite a lot in US media.
Oh for sure, the CDC is certainly more talked about by the media, but the power and structure of the agencies is fairly similar.
It's only a matter of time until EU's agencies impose supremacy on its Member States. The EU supreme court is already starting to penalize member States for violating policies[1].
ECDC has primarily the "power" to coordinate data exchange between member states, and afaik no authority to force lower-level health authorities or healthcare providers to do anything, unless member states were to explicitly adopt their suggestions as binding in local law.
The mess that's going on with ECB is an IMHO quite special situation (which also is an odd example for "already starting to penalize for violating policies". There is no "starting to", obviously EU law has enforcement tools - although the court itself can't use them)
In the EU, land crossings were re-manned on many borders and during the main lockdown (which is now mostly over) passenger travel on many land borders was stopped. On many borders (though not all) physical border checkpoints still exist even if they're widely open almost always, and the legal and administrative framework for controlling land borders is still maintained. Of course, it is now much easier to cross the border illegally outside of these checkpoints than before, but this still allows effective control of travel as most people are not criminals.
"Border enforcements have only been enforced at airports." is absolutely not true. For example, I recall the international issue of making transit arrangements through Poland when back in March many people were stranded as the Poland-German border was suddenly closed; if I recall correctly, the agreed solution to repatriate these people was a police-escorted car column that was allowed to transit through Poland without these people being allowed "proper entry", but before that they were stuck for days in their cars as they could not get through the border.
This is a key difference between EU and USA - the Schengen agreement allows member states to temporarily "opt out" of the free travel, reinstate border controls and impose travel restrictions (up to a full closure of borders) for various purposes, and many EU countries did just that due to Covid; while in USA, as far as I understand, the constitution greatly limits the right of states to prohibit interstate travel.
> This is a key difference between EU and USA - the Schengen agreement allows member states to temporarily "opt out" of the free travel, reinstate border controls and impose travel restrictions (up to a full closure of borders) for various purposes, and many EU countries did just that due to Covid; while in USA, as far as I understand, the constitution greatly limits the right of states to prohibit interstate travel.
The Supreme Court has directly addressed this in the case of disease epidemics and found that, in the absence of specific Congressional action preempting such regulations, states are free under the Constitution to respond to epidemic disease (and several other kinds of crisis) by enacting and enforcing travel restrictions, even though they impact interstate commerce.
While no state has adopted border closures for containing COVID-19, several have adopted quarantine policies affecting interstate travel and adopted border checkpoints as part of the enforcement mechanism.
> while in USA, as far as I understand, the constitution greatly limits the right of states to prohibit interstate travel.
The US States have been imposing varying levels of requirements on inter-state travel from other states. New York requires anyone entering from a set of states to quarantine for 14 days[1]. Maine requires visitors from a list of States to have been tested (I'm traveling to Maine and will be getting tested ahead of my trip)[2]. These are just a couple handy examples, but it's true across the board.
And finally this is all moot because, per my original post, the results really speak for themselves: the majority of US States have lower per capita death rates than the major EU member states, and a small handful have lower per capita death rate than the best EU member states (Germany, Denmark).
> New York requires anyone entering from a set of states to quarantine for 14 days[1].
Does it actually enforce this, or is it just an advisory? Has anyone been fined or arrested for breaking quarantine? Are they conducting papers-and-purpose-of-stay-please inspections at the interestates, prior to entering the state?
The only state that I know of that actually enforced quarantine is Hawaii, and even there, the beaches have magically filled with tourists over the past week... I'm sure all of them sat inside their hotel rooms for the entire two-week quarantine period...
> lower per capita death rate than the best EU member states (Germany, Denmark).
You repeat that a couple of times in your posts, I am curious where do you get that from? Germany and Denmark are not "the best", they are both above the median in the EU.
The main point is that any criticism you might level against the US States for its supposed "lack of strategy", ought to just as easily be leveled against Germany. Instead, Germany is widely regarded as having a coordinated/successful strategy[1][2].
Even among the EU States with the fewest deaths / M — that is Hungary, Finland, Slovenia, Estonia, Poland, Croatia, Latvia, etc — you have comparable US States in Maine, Utah, Idaho, West Virginia, Oregon, Wyoming, Alaska, Montana, and Hawaii.
> In the EU, land crossings were re-manned on many borders and during the main lockdown (which is now mostly over) passenger travel on many land borders was stopped.
Which was one of most nonsensical measure and it is real shame that EC did not prevented that. It caused real problems for people living near borders and working in neighboring state, and for cargo transit.
Covid-19 prevalence was not homogenous inside each country and inter-country neighboring areas/districts were often more similar than far-away intra-country areas. Therefore, any movement restriction would make more sense on more fine-grained level, but doing it on country level is just political tool to mobilize nationalistic support.
> Border enforcements have only been enforced at airports.
That's wrong. Most land borders, also within the Schengen area were closed and only a small amount of people, i.e. citizens, workers were permitted to cross.
Things are slowly opening now within the EU. But that you could just waltz over any old land border is flat out wrong.
I don't think that is true. In my state the governor shut things down quickly and completely and we haven't started opening back up yet. The result is very very very few cases of Covid-19.
Coordination of lockdowns makes no sense past a county or small state. Do you believe NYC and rural Nebraska should be coordinating schedules when they have vastly different situations over time?
The federal government doesn't need to order anyone to do anything. Fighting a pandemic is in everyone's best interests. It just needs to ensure there's a consistent strategy that everyone is executing.
It doesn’t need to do that at all, any more than the EU government needs to ensure there’s a consistent strategy among its member states that everyone is executing.
Different strategies apply for different states, because they have different elderly populations, different density characteristics, and different health system capacities.
Further, we still don’t know which approaches are the best, since we’re still learning about the disease. The fact that there are 50 separate approaches being tested affords us a wealth of data to operate on to shift strategies. As you said, fighting a pandemic is in everyone’s best interests, and states can and will change their strategies to minimize suffering.
An example: Governor Cuomo employed a fairly disastrous nursing home policy, which is largely what caused New York’s staggering death rate (at this moment, the highest in the Union). To be fair to him, he didn’t know that the virus would have this effect, and upon seeing the results from other states (FL, TX) which specifically protected nursing homes, course-corrected his own State’s strategy. This is a win for everyone, in the long run.
> In Florida, all nursing home workers were required to be screened for COVID-19 symptoms before entering a facility. On March 15, before most states had locked down, DeSantis signed an executive order that banned nursing home visitations from friends and family, and also banned hospitals from discharging SARS-CoV-2-infected patients into long-term care facilities.
> Instead, states like New York, New Jersey, and Michigan actually ordered nursing homes to accept patients with active COVID-19 infections who were being discharged from hospitals.
> The most charitable interpretation of these orders is that they were designed to ensure that states would not overcrowd their ICUs. But well after hospitalizations peaked, governors like New York’s Andrew Cuomo were doubling down on their mandates.
> As recently as April 23, Cuomo declared that nursing homes “don’t have a right to object” to accepting elderly patients with active COVID infections. “That is the rule and that is the regulation and they have to comply with that.” Only on May 10—after the deaths of nearly 3,000 New York residents of nursing homes and assisted living facilities—did Cuomo stand down and partially rescind his order.
Way to argue against a strawman - please explain where "coordinate" means "everyone all at once with no regard for local conditions".
Neighboring states and counties should be coordinating schedules, travel restrictions, and stay-at-home requirements. Here in the Bay Area alone San Mateo, Santa Clara and San Francisco counties had conflicting requirements for how far away from home you could be and for what reasons.
Most places are already doing that, and have been for a while. See Newsom's orders/recommendations. They could agree if they wanted, apparently they don't for reasons we may not know.
The USA does not have "no strategy", it just depends from State to State[1]. Every state has had some form of lockdown and school closure.
[1] https://www.nytimes.com/interactive/2020/us/states-reopen-ma...