Facing a declining stock market and criticism from Democrats, President Donald Trump and other officials have minimized the risks of the coronavirus to the U.S. and given inaccurate and misleading information about the new virus.
- Trump said the current number of COVID-19 cases in the U.S. is “going very substantially down, not up.” But the Centers for Disease Control and Prevention has said to expect more cases and has warned that it is highly unlikely that the virus will not spread to some degree within the U.S. The first case of community spread may have already occurred.
- Economic adviser Larry Kudlow also misled on the potential for the virus to spread within the U.S., saying in a television interview, “We have contained this,” and “[I]t’s pretty close to airtight.”
- The president said that the U.S. is “rapidly developing a vaccine” for COVID-19 and “will essentially have a flu shot for this in a fairly quick manner.” That’s misleading. The director of the National Institute of Allergy and Infectious Diseases said a vaccine at best won’t be ready for “a year to a year-and-a-half” and won’t be available for the current epidemic.
- So far, the fatality rate for COVID-19 has been about 2-3%, higher than the influenza fatality rate in the United States of about 0.1%. But in talking about those rates, the president made confusing remarks that left a false impression that “the flu is much higher” than the coronavirus rate.
- Trump’s acting secretary of the Department of Homeland Security, Chad Wolf, falsely claimed this week that the influenza fatality rate was “right around 2% as well.” It’s not.
- In making a comparison to a past outbreak, the president correctly noted that Ebola is far more deadly than the novel coronavirus. But he neglected to mention that Ebola can only be transmitted via bodily fluids and is harder to catch.
The president made these claims in a Feb. 26 press conference, in which he said Vice President Mike Pence would lead the administration’s response to the coronavirus outbreak. Wolf and Kudlow, who is now a member of the administration’s coronavirus task force, spoke earlier this week.
The outbreak of the 2019 novel coronavirus, which causes the COVID-19 disease, began in the central Chinese city of Wuhan at the end of last year. It has now sickened more than 82,000 people and killed more than 2,800. The virus, which causes pneumonia-like symptoms, is fairly similar to the severe acute respiratory syndrome, or SARS, virus but is a new pathogen. See our Q&A on the virus for more information.
Cases ‘Close to Zero’ Within Days?
Trump repeatedly downplayed the potential for more COVID-19 cases in the U.S., and even suggested, falsely, that the number of American cases would fall.
Referencing the 15 known cases detected in the U.S. at the time of the press conference — a tally that does not include an additional 45 repatriation cases — Trump said, “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.”
Later, after being asked about the CDC’s recommendation for schools and other institutions to dust off their preparedness plans, Trump again suggested that the case total was in decline.
“I don’t think it’s going to come to that, especially with the fact that we’re going down, not up,” he said. “We’re going very substantially down, not up.”
Trump is likely thinking of people with COVID-19 getting better, thereby dropping the total, but that’s not how the CDC counts cases. The CDC reports cases cumulatively, and does not subtract cases if a person recovers, so the case count will never be zero.
More important, public health officials had been saying for days, including during the same press conference, to expect more American cases.
“Our aggressive containment strategy here in the United States has been working and is responsible for the low levels of cases that we have so far,” said Anne Schuchat, the CDC’s principal deputy director, speaking minutes before Trump referred to a falling number of cases. “However, we do expect more cases, and this is a good time to prepare.”
The day before, Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, also said in a telebriefing that the agency fully anticipated seeing community spread of the virus within U.S. borders.
“It’s not so much a question of if this will happen anymore,” she said, “but rather more a question of exactly when this will happen and how many people in this country will have severe illness.”
Trump, however, conveyed different odds of that possibility in the press conference.
“I don’t think it’s inevitable,” he said in response to a reporter’s question. “It probably will. It possibly will. It could be at a very small level or it could be at a larger level. Whatever happens, we’re totally prepared.”
In the telebriefing, Messonnier noted that while the agency has been planning for a respiratory illness similar to COVID-19 for years, and is better prepared than two decades ago, “we are never going to ever be able to be so completely prepared that we’re prepared for any inevitability.”
Less than an hour after the press conference concluded, the CDC announced that the 15th case the president mentioned may be the first case of community spread in the U.S. The patient, a woman who is being treated at UC Davis Medical Center in Sacramento, had not traveled to an area with a known outbreak, nor did she have contact with anyone known to be infected.
Others in Trump’s circle have previously oversold the effectiveness of U.S. efforts at containment. In a Feb. 25 CNBC interview, National Economic Council Director Larry Kudlow said, “We have contained this. I won’t say [it’s] airtight, but it’s pretty close to airtight.”
Shortly before his comments, Messonnier had given the telebriefing in which she said the agency expected the novel coronavirus to spread within the U.S. She had also been warning about that possibility for weeks, calling it “likely” as early as Feb. 12, despite relatively few cases.
While Kudlow may have been looking at the number of cases and the fact that there hadn’t yet been demonstrated community spread in the U.S., it was misleading for him to suggest that containment had already occurred or was “close to airtight.”
In addition to minimizing the threat COVID-19 poses in the U.S., Trump left the misleading impression that a vaccine will soon be available. He said the U.S. is “fairly rapidly” developing a vaccine, and will have it ready “in a fairly quick manner.”
Trump: We’re rapidly developing a vaccine, and they can speak to you — the professionals can speak to you about that. The vaccine is coming along well. And in speaking to the doctors, we think this is something that we can develop fairly rapidly, a vaccine for the future, and coordinate with the support of our partners.
Later in the press conference, he returned to the development of a vaccine.
Trump: You know in many cases when you catch this it is very light — you don’t even know there’s a problem. Sometimes they just get the sniffles, sometimes they just get something where they are not feeling quite right and sometimes they feel really bad but that’s a little bit like the flu. It’s a little like the regular flu that we have flu shots for and we will essentially have a flu shot for this in a fairly quick manner.
The president didn’t say how quickly, but Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said it will take “a year to a year-and-a-half” to develop a vaccine and that hopefully one would be ready if the coronavirus reemerges next year.
“We can’t rely on a vaccine over the next several months to a year,” Fauci said at the president’s press conference. “However, if this virus, which we have every reason to believe it is quite conceivable that it will happen, will go beyond just a season and come back and recycle next year. If that’s the case, we hope to have a vaccine.”
It’s true that the U.S. is working quickly on developing a vaccine. “We have a number of vaccine candidates and one prototype,” Fauci said.
As reported by the Wall Street Journal, the drugmaker Moderna Inc. sent a potential vaccine to the National Institute of Allergy and Infectious Diseases for initial testing, which hopefully would occur within about two months.
“The institute expects by the end of April to start a clinical trial of about 20 to 25 healthy volunteers, testing whether two doses of the shot are safe and induce an immune response likely to protect against infection, NIAID Director Anthony Fauci said in an interview,” the Journal reported on Feb. 24. “Initial results could become available in July or August.”
The next day, at a press conference, Fauci said the prototype is going through the regulatory process and could be in a human trial within a month to a month and a half — if there are no unexpected glitches. But the “phase one trial” is just the first step in a process that even at “rocket speed” will take a year to a year-and-a-half to result in a vaccine.
Fauci, Feb. 25: Now the thing we need to understand, because we want to make sure that people don’t get confused, that getting a vaccine into a phase one trial within a three-month period, you need at least three to four months to determine if it’s safe and whether it induces the kind of response that you would predict will be protective. Once you do that you graduate to a much larger trial. The N of the phase one trial is 45. When you go to a phase two trial, you’re talking about hundreds if not thousands of individuals to determine efficacy. That is a trial that we would have to conduct in those countries, in those areas, where there’s active transmission. That itself, even at rocket speed, would take at least an additional six to eight months. So when you are talking about the availability of a vaccine even to scale it up you’re talking about a year to a year-and-a-half.
At the president’s press conference, Fauci went through a similar time frame for how long it could take if everything goes right.
“So, although this is the fastest we have ever gone, from a sequence of a virus to a trial it still will not be any applicable to the epidemic unless we really wait about a year to a year-and-a-half,” Fauci said. “Now, that means two things. One, the answer to containing is public health measures. We can’t rely on a vaccine over the next several months to a year. However, if this virus, which we have every reason to believe it is quite conceivable that it will happen, will go beyond just a season and come back and recycle next year. If that’s the case, we hope to have a vaccine.”
Flu vs. COVID-19 Fatality Rate
Trump made some confusing remarks that wrongly suggested the flu fatality rate is “much higher” than the rate for COVID-19, the new coronavirus disease. The flu fatality rate is about 0.1%, while the fatality rate for COVID-19 has been about 2-3%.
Chad Wolf, the acting secretary of the Department of Homeland Security, also got the facts wrong on this in a Feb. 25 Senate hearing. Wolf said the COVID-19 fatality rate was “under 2%” or “between 1.5 and 2%,” and then falsely said the influenza rate was “right around 2% as well.”
In the Feb. 26 press conference, the president first agreed with a reporter’s correct figures on the fatality rates but then said, “The flu is much higher.” Here’s the exchange:
Reporter, Feb. 26: The flu and in comparison the coronavirus. Flu has a fatality ratio of about 0.1%.
Reporter: This has a fatality ratio of somewhere between 2 and 3%.
Trump: Well, we think. We think. We — we don’t know exactly numbers. And the flu is higher than that. The flu is much higher than that.
The reporter then said, “There’s more people who get the flu.” Perhaps that’s what the president meant, but his comments may have left a false impression with the public. (We asked the White House for clarification on Trump’s remarks, but we haven’t yet received it.)
The fatality rate for COVID-19 has fluctuated as the disease has spread. In late January, the worldwide fatality rate was 2%, but as of Feb. 27, the figure would be 3.4%, with 82,550 cases confirmed and 2,810 deaths.
A report published in the Journal of the American Medical Association on Feb. 24 by researchers with China’s Center for Disease Control and Prevention found a fatality rate of 2.3% among 72,314 cases in mainland China, with higher fatality rates for the elderly (8.0% for those age 70 to 79 and 14.8% for those 80 and older).
David Fisman, an epidemiologist at the University of Toronto, told us that the figures may not accurately show the danger of the virus, because the disease is still running its course for many patients. Also, if more people have been infected but haven’t had their illnesses confirmed, the fatality rate could be lower. For example, if two-thirds of cases are unreported, the case fatality rate may be around 1%, Fisman told us in an email for our January Q&A on the new coronavirus.
So far, many more people are infected by influenza each year in the United States alone than have been infected by the new coronavirus worldwide. In 2018-2019, 35.5 million people had flu symptoms in the U.S., according to preliminary estimates from the Centers for Disease Control and Prevention. Since 2010, influenza in the U.S. has caused between 9 million and 45 million illnesses annually, the CDC says, with 12,000 to 61,000 of those resulting in death. That would put influenza’s fatality rate at 0.13% to 0.14%.
Incomplete Ebola Comparison
At the press conference, Trump was also asked about the potential conflict between his criticism of the Obama administration during the 2014-2016 outbreak of Ebola in West Africa and his own handling of the coronavirus outbreak, prompting him to make an incomplete comparison between the two viral diseases.
Reporter, Feb. 26: During the Ebola crisis, you said you wanted a “full travel ban.” You said Obama was a “stubborn dope” not for doing it. You said, “Just stop the flights dummies!” … So how does that square with what you’re doing right now?
Trump: Well, because this is a much different problem than Ebola. Ebola, you disintegrated, especially at the beginning. They’ve made a lot of progress now on Ebola. But with Ebola — we were talking about it before — you disintegrated. If you got Ebola, that was it. This one is different. Much different. This is a flu. This is like a flu. And this is a much different situation than Ebola. … We can now treat Ebola. In that — at that time, it was infectious and you couldn’t treat it. Nobody knew anything about it. Nobody had ever heard of anything like this. So it’s a much different situation.
Trump gave a similar defense of his actions two days before when he was in India.
Trump, Feb. 25: There’s a big difference, in case you don’t know, between Ebola and coronavirus. A big, big difference. It’s like day and night. … [A]t that time, nobody had ever even heard of Ebola or ever conceived of something where you basically — the people would disintegrate.
Contrary to Trump’s remarks, the Ebola virus was well known in 2014, as the first recognized outbreak was in 1976 in what is now the Democratic Republic of the Congo.
Later, he returned to the higher fatality rate.
“I know, but the level of death with Ebola — you know, at the time, it was a virtual 100%,” Trump said. He added that for COVID-19, “it’s very much the opposite. You’re talking about 1 or 2%, whereas in the other case, it was a virtual 100%.”
As we have just discussed, the true case fatality rate of COVID-19 isn’t yet known, but appears to be between 2-3%, with higher rates of death among the elderly. Ebola virus disease — the official name for the disease caused by the Ebola virus — as the president says, is much deadlier, but it’s not “a virtual 100%.”
According to the World Health Organization, the 2014-2016 Ebola virus epidemics in Africa had a range of case fatality rates, including 28% in Sierra Leone, 45% in Libera and 67% in Guinea. The majority of cases at that time occurred in those three countries. The case fatality rate for the West African epidemic was about 40%.
Trump is also conveniently leaving out another key distinction between the Ebola and the new coronavirus: the method of transmission. While the new virus is thought to spread primarily through respiratory droplets from sneezing or coughing, the Ebola virus requires direct contact through a bodily fluid, such as blood, saliva, vomit or semen. That makes it much harder to catch than the new coronavirus — and also much easier to contain.
In 2014, just two people — a pair of nurses who treated a man traveling to Dallas from West Africa — ever contracted the Ebola virus in the U.S. The remaining nine people who were treated for Ebola in the U.S. were infected in Africa, with the majority being medical workers. Two people in total died, including the first travel case who infected the nurses and a health worker evacuated for treatment.
Trump also highlights the fact that with Ebola, there were no treatments for the 2014-2016 outbreak. That’s true, but that’s also largely the case for the new coronavirus. Other than supportive care, there are no FDA-approved treatments for COVID-19, although there are some promising experimental antiviral drugs. One of these, oddly enough, was originally developed to treat Ebola infection.