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The criticism of response to the 2019–20 coronavirus pandemic has included several national governments and some supranational bodies.

Brazilian government

Brazilian president Jair Bolsonaro has been criticized due to "lax handling" of the outbreak and after calling it a "fantasy".[1] His lack of action has also prompted many protests across the country since 18 March 2020.[2][3] Days before, on 15 March, Bolsonaro received harsh criticism after attending a pro-government demonstration in Brasília on which he had physical contact with more than two hundred people, against the recommendations of his own Minister of Health.[4][5] Following the event, the president of the Brazilian Chamber of Deputies, Rodrigo Maia, said that Bolsonaro's acts were an "attack on public health", going against his own government guidelines, while Davi Alcolumbre, president of the Brazilian Senate, classified Bolsonaro's behaviour as "inconsequential".[6] The Brazilian Ministry of Health has also been criticized for not providing enough test kits, which may muddle the efforts to contain the outbreak in the country.[7][8]

Chinese government

Among the criticism of the central government are the disapproval of local Hubei and Wuhan government, as well as censorship of information on the early phases of the outbreak.[citation needed]

Suppression of information

Letter signed by Li Wenliang with instructions to stop spreading rumors about the coronavirus dated 3 January.

The early response by the Wuhan local authorities was criticised by Western media of allegedly downplaying the initial discovery and severity of the outbreak. The New York Times reported that the government was keeping "its own citizens in the dark".[9][10] US-based organisation Human Rights Watch noted that censorship was extended to social media posts from families of infected people seeking help as well as from people living in cordoned cities who were documenting their daily lives amidst the quarantine.[11]

On 3 January 2020, Li Wenliang, a Wuhan ophthalmologist, was called down to the Wuhan Public Security Bureau where he was told to sign an official confession and admonition letter promising to cease spreading false rumors regarding the coronavirus.[12][13][14] In the WeChat post, Li had falsely posted that "X Hospital has many confirmed cases of SARS" and "There had been 7 confirmed cases of SARS".[15] Dr. Li posted a snippet of an RNA analysis finding "SARS coronavirus" and extensive bacteria colonies in a patient's airways.[16] Dr. Li contracted this coronavirus from a patient he treated, was hospitalized on 12 January 2020 and died on 7 February 2020, which saw a large scale outpouring of grief on Chinese social media.[17] Reuters saw a notice sent by the authorities to an online Chinese news outlet asking its editors to not "comment or speculate" on Li's death and to "not hashtag and to let the topic gradually die out from the hot search list and to guard against harmful information".[18] China's anti-corruption body, the National Supervisory Commission, has initiated an investigation into the issues involving Li.[19]

On 14 January, Wuhan Police detained several Hong Kong media correspondents for over an hour when they were conducting interviews at Wuhan's Jinyintan Hospital. Reports said the police brought the correspondents to a police station, where the police checked their travel documents and belongings, then asked them to delete video footage taken in the hospital before releasing them.[20][21]

On 20 January, Chinese Communist Party General Secretary Xi Jinping made his first public remark on the outbreak and spoke of "the need for the timely release of information".[22] However, Xi Jinping later also instructed authorities "to strengthen the guidance of public opinions", language which some viewed as a call for censorship.[23] The Cyberspace Administration (CAC) declared its intent to foster a "good online atmosphere," with CAC notices sent to video platforms encouraging them to "not to push any negative story, and not to conduct non-official live streaming on the virus."[24] Censorship was briefly relaxed giving a "window of about two weeks in which Chinese journalists were able to publish hard-hitting stories exposing the mishandling of the novel coronavirus by officials", but later news outlets were reportedly required to use "planned and controlled publicity" with the authorities' consent.[25][24]

On 30 January, China's Supreme Court, delivered a rare rebuke against the country's police forces, calling the "unreasonably harsh crackdown on online rumors" as undermining public trust, and said that such online posts would allow the public to adopt measures that can help counter the spread of the virus.[26]

Hubei and Wuhan governments

People queuing outside a Wuhan pharmacy to buy face masks and medical supplies in January 2020

Local officials in Wuhan and the province of Hubei have faced criticism, both domestically and internationally, for mishandling the initial outbreak.[27] Allegations included insufficient medical supplies, hiding evidence of human-to-human transmission in early January, and lack of transparency to the press and censorship of social media during People's Congress meetings for political reasons during the initial weeks of the outbreak.[28][29][30] Criticism was directed at Hubei Governor Wang Xiaodong after he twice claimed at a press conference that 10.8 billion face masks were produced each year in the province, rather than the accurate number of 1.8 million.[31]

Authorities in Wuhan and Hubei provinces have been criticized for downplaying the severity of the outbreak and responding more slowly than they could have. The Beijing-based media journal, Caixin noted that Hubei did not roll out the first level of "public health emergency response mechanism" until 24 January, while several other provinces and cities outside the center of the outbreak had already done so the day before.[32] John Mackenzie, a senior expert at WHO, accused them of keeping "the figures quiet for a while because of some major meeting they had in Wuhan," alleging that there was a "period of very poor reporting, or very poor communication" in early January.[33]

On 19 January, four days before the city quarantine, a wan jia yan (Chinese: 万家宴; literally: 'banquet of myriad families') was held in Wuhan, with over 40,000 families turning out; this attracted retrospective criticism. The domestic The Beijing News argued that the local authorities should not have held such a public assembly while attempting to control the outbreak. The paper also stated that when their journalists visited the Huanan Seafood Wholesale Market where the coronavirus likely originated, most residents and merchants there were not wearing face masks.[34] Zhou Xianwang, the mayor of Wuhan, later spoke to China Central Television, explaining that the banquet was held annually, that it is a "sample of the people's self-autonomy," and that the decision was made based on the fact that scientists then wrongly believed that the virus's ability to spread between humans was limited.[35][36] Meanwhile, on 20 January, Wuhan's municipal department for culture and tourism gave out 200,000 tickets valid for visiting all tourist attractions in Wuhan to its citizens for free. The department was later criticized for disregarding the outbreak.[34]

Tang Zhihong, the chief of the health department in Huanggang, was ″fired hours after she was unable to answer questions on how many people in her city were being treated".[26]

Central government of China

In contrast to the widespread criticism of the local response, the central government has been praised by state media and some foreign analysts for its handling of the crisis.[37][38][39] It has been suggested that the state media is doing this to shift public anger away from the central government and towards local authorities. It has been noted historically that the tendency of provincial governments to minimize reporting local incidents have been because of the central government directing a large proportion of the blame onto them.[40] Critics, such as Wu Qiang, a former professor at Tsinghua University, and Steve Tsang, director of the China Institute at the University of London, have further argued the same point, with the latter suggesting that it was also exacerbated through local officials being "apprehensive about taking sensible preventive measures without knowing what Xi Jinping and other top leaders wanted as they feared that any missteps would have serious political consequences," a sentiment that Tsang argued was difficult to avoid when "power is concentrated in the hands of one top leader who is punitive to those who make mistakes".[41][42][43] Wuhan mayor Zhou Xianwang defended himself, referring to those suggestions by publicly blaming regulatory requirements that require local governments to first seek Beijing's approval, which delayed disclosure of the epidemic. He stated in an interview that "as a local government, we may disclose information only after we are given permission to do so. That is something that many people do not understand."[44][45]

In Xi's place, Premier Li Keqiang was dispatched to oversee epidemic control and prevention, with some suspecting that Li was a convenient "political scapegoat".[46] This led to suggestions that the ruling party and state media were attempting to limit the risk of political fallout to Xi during this crisis.[47] The governing party's censorship and propaganda have fueled mistrust of their handling of the outbreak, particularly among young people.[48]

The Chinese government has also been accused of rejecting help from the CDC and the WHO.[49] Insiders at the US CDC complained that China would not agree to on-site visits, while it took two weeks for Chinese authorities to approve an international mission team led by Dr Bruce Aylward but the team composition and scope of work was still yet to be determined.[50]

Indian government

The Indian government has been condemned for alledged instances of police brutality to enforce the national lockdown that began on 24 March.[51]

Indonesian government

Many Indonesians criticised the government for a slow response and downplaying the pandemic. WHO, Australian government, and United States embassy in Indonesia have expressed their doubts about the Indonesian government's response to the pandemic.[52]

West Sumatra provincial government

The governor of West Sumatra province, Irwan Prayitno faced backlash for accepting 174 tourists from China to the province. 174 Chinese tourists from Kunming arrived at Minangkabau International Airport at Padang Pariaman Regency as Citilink adds Padang - Kunming route. Prayitno received further backlash after welcoming the group of tourists himself at the airport and giving them a "grand welcome" with a cultural parade. The move angered local residents who demanded the governor return the group to China.[53][54]

Failure to detect the virus

Health experts are concerned that the country is failing to identify the transmission of the virus.[55] Marc Lipsitch, professor of epidemiology at the Harvard T. H. Chan School of Public Health, "analysed air traffic out of the Chinese city at the centre of the outbreak in China and suggested in a report ... that Indonesia might have missed cases" of coronavirus.[56][57][58] Western diplomats[59][60][61] as well as local[55][62] and international[63][64][65] news outlets postulated that the lack of cases within Indonesia result from inadequate testing and under reporting, as opposed to sheer luck and divine intervention.[66][67]

Budget for foreign social media influencers

The government faced a backlash after instead pledging to set aside IDR 72 billion ($5m) to pay for social media influencers to attract tourists to Indonesia.[68]

Lack of transparency

Indonesian president Joko Widodo has been criticised by the Indonesian Chamber of Commerce and Industry,[69] human rights groups,[70] and by political parties including Golkar and Partai Keadilan Sejahtera[71][72] for a lack of transparency regarding the information on COVID-19. Widodo has insisted not to share with the travel history details of patients tested positive with coronavirus in an attempt to reduce panic and uneasiness in the general public.[73]

Iranian government

Deputy Health Minister Iraj Harirchi (left) at a press conference after which he tested positive for the virus.

Iranians criticized government authorities for proceeding with elections while the disease was spreading and closing secular spaces while keeping shrines open, especially in the Shia holy city of Qom.[74] Asif Shuja of the National University of Singapore's Middle East Institute suggested that "the fact that Iran reported deaths on the same day as its first infections right before its parliamentary elections 'can compel anyone' that there has been a cover-up".[75] Scrutiny has also been targeted at the government's unwillingness to implement area-wide quarantine measures like those implemented by China and Italy, with Iranian officials calling quarantines "old-fashioned."[76] There have been concerns that the Iranian government's official counts were an underestimate.[77] The WHO's director-general, Tedros Adhanom Ghebreyesus, said that "the WHO has its "own mechanism" for checking facts and has not seen problems with Iran's reported figures".[75]

Italian government

Italy's government has drawn criticism from scientists and WHO, for its decision to suspend direct flights to mainland China that while sounding "tough" on paper, was ineffective as "people can still arrive from risk areas via indirect routes."[78] Walter Ricciardi, professor of Hygiene and Public Health at the Università Cattolica del Sacro Cuore in Rome and a member of the European Advisory Committee on Health Research has said "Italy was wrong, closing flights from China is of no use when there are indirect ones."[79]

Italy's government has also been criticised for not testing or enforcing lockdowns sufficiently in some regions,[80] sending mixed messages,[81] and downplaying the severity of the situation.[82] Criticism followed disclosures by Italian Prime Minister Giuseppe Conte that protocols had not been followed at the hospital in Codogno, Lombardy that treated "patient 1" which "certainly contributed to the spread" of the virus in Italy, with Conte responding to inquiries by journalists on what protocol was broken with "This is not the time for controversy."[83] In response to a statement by Conte that the central government may need to "revoke regional health policy powers," President of Lombardy Attilio Fontana called Conte's statement "fascist" and "talking nonsense."[78]

On 8 March, plans by the government to quarantine 16 million people in Northern Italy were leaked early by a national newspaper, causing thousands of people to flee the region before it took place. Conte condemned the leak, calling it "unacceptable".[84]

Japanese government

Prime Minister of Japan, Shinzo Abe, at the first coronavirus expert meeting

Diplomatic relations between Japan and South Korea worsened, as South Korea criticized Japan's "ambiguous and passive quarantine efforts".[85][86] Under the post-war constitution, Japanese people are guaranteed a significant amount of freedoms and individual rights, hence the government does not have powers that can restrict movement in the same manner that Italy and the People's Republic of China can. The government does not have the power to quarantine domestic patients or impose curfews.[87]

Japan's Ministry of Health, Labor and Welfare has been criticized for a perceived delayed response. Critics have observed that while Japan announced the first case of infection on 28 January, it took until 17 February for the Health Ministry to inform the public on how to reach public screening centers and 25 February, for the government to issue a "basic policy" on outbreak response. The overdue response times of the government has led critics to accuse Abe of "callous indifference in the face of an unfolding disaster" and the government as a whole as being "out of touch with the lives of ordinary people that they seem genuinely uninterested in their plight".[88][89]

The strict constraints on testing for the virus by Japanese health authorities have drawn accusations from critics such as Masahiro Kami, a hematologist and director of the Medical Governance Research Institute, towards Abe of wanting to "downplay the number of infections or patients because of the upcoming Olympics." Reports that only a small select number of public health facilities were authorized to test for the virus, after which the results could only be processed by five government-approved companies, has created a bottleneck where clinics have been forced to turn away even patients who had high fevers. This has led some experts to question Japan's official case numbers, with Tobias Harris, of Teneo Intelligence in Washington, D.C. stating "You wonder, if they were testing nearly as much as South Korea is testing, what would the actual number be? How many cases are lurking and just aren't being caught?"[90][91]

The quarantine measures on the cruise ship Diamond Princess has also been criticised after the ship proved a fertile breeding ground for the virus.[92][93] Kentaro Iwata, an infectious disease professor at Kobe University Hospital, said that the condition aboard was "completely chaotic" and "violating all infection control principles".[94] A preliminary report by Japan's National Institute of Infectious Diseases (NIID) estimated that most of the transmission on the ship had occurred before the quarantine, based on the first 184 cases.[95] On 22 February, the Health Ministry admitted that 23 passengers were disembarked without being properly tested for the virus.[96] On 23 February, a Japanese woman who tested negative before disembarking from the cruise ship later tested positive after returning to her home in Tochigi Prefecture.[97] She was not among the 23 passengers.[98]

South Korean government

The Ministry of Health and Welfare has been criticized for unilaterally implementing telephone consultation and prescription without discussing with the Korea Medical Association, and for not restricting traffic from China despite several warnings from the association and a petition proposed by the society.[99][100]

On 22 February, the South Korean government apologized for calling the virus "Daegu Corona 19" in an official report. The term has been widespread on social media and raises concerns about discrimination.[101]

More than 1.5 million South Koreans have signed a petition to impeach President Moon Jae-in over what they claim is the government's mishandling of the outbreak.[102] On 6 March, the South Korean government has only entry restricted to Japanese citizens out of 102 countries that blocked Korea. The action has been widespread on social media and raises concerns about anti-Japanese discrimination.[103][104]

Spanish government

Spanish government has received criticism for its perceived slow response to the pandemic, as it did not prevent any concentrations until 11 March when there already were 1,646 infected.[105][106] The large march in Madrid for International Women's Day (8 March), which was attended by around 120,000 people received special criticism, as this event was promoted and attended by members of the government such as Irene Montero who was later confirmed to be infected.[107]

Turkish government

The announced ₺100 billion economic measures package, set to be provided by the government, was criticized by institutions and individuals, including economists and politicians. The lack of a detailed action plan was the center of criticism. Additionally, at a time when people were encouraged to stay at home, the government was criticized for allowing airline passenger transport and tax reductions that support tourism. Critics asked for lowering the down payment of housing loans and emphasized on the need to provide employment support to different sectors.[108][109]

The donation campaign initiated by President Recep Tayyip Erdoğan was supported by representatives of the ruling party, members of the oppositions had a less favorable reaction to it.[110][111] After the government's decision to take money from the income of several institutions in order to make donations to this campaign, the Confederation of Public Employees' Unions filed a criminal complaint as a result of the salary cuts of the staff of many institutions such as MEB, BOTAŞ, General Directorate of Forestry, Ministry of Justice, Constitutional Court and Social Service Provincial Directorates.[112] Additionally, a similar donation campaign initiated by the metropolitan municipalities with CHP administration was terminated by the Ministry of the Interior and their bank accounts were blocked. Regarding this decision, the Ankara Bar Association issued a statement, saying: "Although the aforementioned circular and blocking process enforced by the Ministry of the Interior are clearly unlawful, the provision of social services belongs neither exclusively to the local governments nor to the central government."[113]

United Kingdom government

The UK government received intense pressure for its lax measures taken against the virus in comparison to other European countries.[114] The World Health Organization questioned the UK government's response to COVID-19 with spokeswoman Dr. Margaret Harris stating in an interview on Today that not enough is known about the science of COVID-19 to justify the UK's approach to developing "herd immunity" against the virus, saying that while "theories" can be talked about, the current situation requires "action".[115] The UK's controversial plan to tackle COVID-19 has been developed by Sir Patrick Vallance and Prof. Chris Whitty.[citation needed]

Government Minister Helen Whately responded by saying that the Government is "following the evidence".[citation needed]

United States government

The U.S. government has been criticized for various aspects of its response to the pandemic. Nonetheless, during the month of March 2020 when "social distancing" practices began, the governors of many states experienced "sharp" gains in approval ratings.[116] Trump—who gave a nationally televised address on 11 March and began giving daily press conferences on 16 March—saw his approval rating rise from 44% (in early March) to 49% (in mid-March)[117] and then slide back to 43% (in early April).[118]

Preparedness

Centers for Disease Control

CDC Director Robert R. Redfield speaks on the coronavirus outbreak in January 2020

The CDC has been criticized for a number of issues and failures in its approach to the novel coronavirus outbreaks. Among the issues include: a large number of faulty coronavirus test kits sent out to localities throughout the United States, a "woefully" low number of tests being done (3,600 as opposed to over 65,000 in South Korea, a country with a much smaller population), contamination of the lab dealing with the new coronavirus,[119] and removal of the running tally of the number of people tested from its website, which led to allegations of a cover-up.[120]

The CDC was also surrounded in controversy after a suspected patient who was refused a SARS-CoV-2 test by the CDC was later found to be harboring the virus.[121] Timothy Stenzel, the director of the Office of in Vitro Diagnostics and Radiological Health, called what he saw during his tour of CDC facilities "alarming".[119] The HHS has launched an investigation into delays and the relatively slow response of the United States in contrast to countries in Asia.[122] Its handling of the evacuees from Wuhan and the British cruise ship Diamond Princess was also criticized when one of the evacuees, who was released by the CDC and intermingled with the public, later turned out to be positive and infected.[123]

In response, the Trump administration announced that it would launch an investigation into the shortcomings of the CDC. It has also ordered that the manufacture of test kits be moved away from the CDC.[124]

Trump administration

On 6 January 2017 (two weeks before Trump's inauguration), a 103-page Pentagon report reviewed past coronavirus outbreaks and warned that the next pandemic would likely be a new respiratory illness, predicting ventilator and personal protective equipment shortages. During the novel coronavirus outbreak the document was leaked to The Nation, which published it on 1 April 2020.[125] The reporter said it was "inconceivable that the White House did not receive this."[126]

In May 2018, Trump's then-national security advisor John Bolton disbanded a National Security Council global health security team set up to coordinate and lead responses to future pandemics.[127] It was called the Directorate for Global Health Security and Biodefense.[128] Its leader, Rear Adm. Timothy Ziemer, departed shortly thereafter.[129] The office had been created by the Obama administration following the 2014 ebola epidemic. While no alternative team was set up, some of the team members were reassigned to roles that included pandemic response.[130]

On 6 March 2020, a reporter questioned Trump on his choice to close the office. Trump replied that there had been no reason to prepare for a pandemic because "you can never really think is going to happen...who would have thought we would even be having the subject?"[131] On 13 March, PBS NewsHour White House correspondent Yamiche Alcindor asked Trump what "responsibility" he took for Bolton's closure of the pandemic preparation office. Trump denied knowledge even of the office's existence. He told the journalist she'd asked "a nasty question...I mean, you say we did that. I don't know anything about it...it's the administration, perhaps they do that. You know, people let people go...things like that happen."[132] On 1 April, Fox News journalist John Roberts asked about the office's closure, and Trump said, “We didn’t do that," claiming that it was "a false story."[133]

Jeremy Konyndyk, the former Director of USAID’s Office of US Foreign Disaster Assistance, said that all COVID-19-related medical equipment shortages trace back to the closure of the pandemic preparation office. Interviewed by CNN's Drew Griffin in March 2020, Konyndyk said of the closure, "I think it made us slower and it made us more prone to mistakes."[134]

The Trump administration was criticized for its proposed cuts to overall health funding in 2018. Cuts to CDC slashed 80% of its global disease outbreak program,[135][136] forcing the four-year-old program to reduce operations from 49 countries to 10. In its fiscal 2020 budget, the Trump administration proposed eliminating funding for epidemiology and laboratory capacity at state and local levels.[137][138][135] A $30 million Complex Crises Fund had also been cut entirely, which would have allowed the State Department to fund deployment of disease experts in the event of outbreaks.[139]

While the CDC has announced plans to screen people for the coronavirus, only three of the 100 public health labs were reported to be fitted for that role even after delays, which has been attributed to the agency's funding cuts.[140] Trump has been further criticized for proposing further cuts to the CDC and Health Department budgets, of the amounts of 16% and 10%, respectively, in budget requests submitted to Congress on 10 February. The proposed budget also called for a $65 million cut to the US' contribution to funding for the WHO.[141]

Public communication

Reporting by ProPublica and NPR said that Senator Richard Burr warned well-connected constituents of the socio-economic ramifications of the coronavirus and had sold up to $1.7 million of stocks while making public statements of reassurances of the government’s level of coronavirus preparedness.[142][143][144] Burr and his spokesperson would in turn criticize the reports, with Burr calling the NPR report “a tabloid style hit piece.” [142]

In response to the criticisms of the administration's handling of the crisis, Mick Mulvaney, the White House's acting Chief of Staff accused the US media of being overly-critical and of "stoking virus fears" in hopes that "this is going to bring down the president."[145] On 28 February, Trump said that the Democrats were promoting a "new hoax" to harm him politically and that the press was in "hysteria mode", while attempting to link the outbreak to Democratic immigration policies.[146][147]

An article in The Washington Post said that after Vice-President Mike Pence was appointed by President Trump to head the country's coronavirus response, attention was directed at his record as then governor of Indiana in handling the worse HIV epidemic in the state which drew severe criticism from public health officials, academics researchers and both Democrats and Republicans.[148]

On 28 February, after Fauci warned that the virus "may be impossible to contain", The New York Times reported that the Trump administration banned him from speaking publicly without explicit approval from the White House.[149] Dr. Fauci immediately and explicitly denied the veracity of that report.[150]

A 14 March NBC story said that CDC officials wanted to recommend that anyone over 60 remain inside their homes whenever possible but was instructed not to say that by the Trump administration.[151]

CNN often does not air the entire two-hour daily briefing and fact-checks Trump's remarks. In retaliation, the White House said that if CNN did not begin airing the part of the briefing that features the task force members including Mike Pence, then the White House would disallow national health experts (including Dr. Fauci and Dr. Birx) from appearing on CNN. The standoff lasted from 2–9 April, when Pence relented and allowed Dr. Robert Redfield to appear on CNN.[152]

On 15 March, New York Times opinion columnist David Leonhardt published a list of ways in which Trump had played down the pandemic minimized its likely impact.[153]

At the 3 April press briefing, Trump acknowledged recent CDC advice in favor of "non-medical cloth face covering," but he added, "I don’t think I’m going to be doing it.” He went on to say that this was because he didn't feel sick and because he was concerned about how he'd look while he was "sitting in the Oval Office behind that beautiful Resolute Desk...wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens...I don’t see it for myself."[154]

On 8 April, the Wall Street Journal editorial board said that Trump was using the daily press briefings to amplify his feuds and his television ratings rather than to deliver accurate information to the public. It suggested that Trump should step aside and allow Pence to control these briefings.[155] The next day, Trump insulted the newspaper on Twitter, to which Fox News senior political analyst Brit Hume replied by affirming the WSJ's criticism.[156]

An outbreak aboard the Navy's USS Theodore Roosevelt led to the decision to isolate the aircraft carrier and its approximately 4,800 sailors, resulting in the infection of many on board. The ship's commanding officer, Capt. Brett Crozier, wrote to the Navy of the "ongoing and accelerating" outbreak: "Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset — our Sailors." [157] Adm. Mike Gilday, Chief of Naval Operations, said it would be impossible to completely evacuate the ship because people need to maintain its nuclear reactor. On 30 March, Adm. John Aquilino noted that none of the sailors were in "critical condition." As of 1 April, Thomas Modly, Acting Secretary of the Navy, noted that 93 sailors on the ship had tested positive, accounting for more than 10% of all positive tests in the U.S. military. That day, it was reported that the sailors would be allowed off the boat, to be quarantined in hotels in Guam.[158] Capt. Crozier, however, was relieved of his command of the ship; Navy leadership said they objected to the way in which he disseminated his memo.[159]

By the end of March, although there was no federal stay-at-home order (the federal government has no legal authority to order or enforce that),[160] 39 states had issued such orders.[161][162] One of the latecomers was Georgia, whose governor, Brian Kemp, claimed on 1 April that "we didn’t know that until the last 24 hours" that asymptomatic people could be contagious, adding that he'd been told that this information was "a game-changer.” This was hardly new information, however. Anthony Fauci had said at a task force briefing two months earlier that "we know for sure" that asymptomatic transmission was occurring, and this basic scientific knowledge had been the basis for all stay-at-home orders throughout the world.[163][164] Another latecomer was Florida, whose policy took effect on 3 April and specifically exempted religious services, allowing them to be held in houses of worship.[165] Fauci told CNN on 2 April that, while he could not say whether anyone has legal authority to order a nationwide shutdown, he believes that the medical situation requires the whole nation to shut down.[166] On 13 April, Trump tweeted an unsubstantiated claim that "open[ing] up the states" is properly "the decision of the President," not of the governors, and he promised a decision would be made "shortly."[167]

Resources

Distribution of medical equipment

In early March 2020, the Department of Health and Human Services said that 3.5 billion respirator masks (such as N95s) would be needed nationwide. By early April, the National Strategic Stockpile had distributed 11.7 million N95 masks to U.S. states (one-third of 1 percent of the stated need). This nearly depleted the federal stockpile; the remaining 10 percent of the stockpile was intended to be kept for federal workers. The House Oversight and Reform Committee, which produced a report on the distribution of equipment,[168] criticized the Trump administration for having waited too long to invoke the Defense Production Act to produce more masks.[169]

On 30 March 2020, the governor of Illinois complained that the federal government had responded to his weeks-old request for 1.2 million N95 masks by sending 300,000 surgical masks (the wrong type of equipment).[170] Elon Musk purchased and donated BiPAP machines to New York City's hospital system, but these are not the most critically needed type of ventilator.[171]

The federal government had stockpiled extra ventilators, and these were maintained by a company called Vyaire, after which the contract was given to a company called Agiliti. Due to a dispute over this contract change, no one maintained the ventilators between August 2019 and January 2020, and 2,109 ventilators were subsequently discovered to be broken. The government still has 10,000 ventilators available for distribution. FEMA is responsible for distributing this limited supply; a FEMA official told state governments that they should not expect to receive any unless they had patients at imminent risk of death without the equipment. As of 1 April, FEMA had distributed about 7,000 ventilators, about 4,000 of which went to New York, considered an area of highest concern, meeting about 15 percent of New York's expected need. Other states have had their requests denied. "Officials in Illinois say they asked for 4,000 and got 450. New Jersey sought 2,300 and got 300. New Mexico has only 370. Virginia requested 350 ventilators but has not received any," a New York Times article reported. California reported that "170 of its ventilators arrived broken."[172] On 2 April, Massachusetts Gov. Charlie Baker said he did not expect that the federal government would deliver his order of 1,000 ventilators on time.[173]

When the federal government distributes healthcare products, it typically distributes them to the private sector, and states must pay commercial prices. Distributors earn the price markup, even though the products were originally purchased with tax dollars. Rear Adm. John Polowczyk, Vice Director of Logistics of the Joint Chiefs of Staff, confirmed this at 2 April 2020 White House briefing (in response to a question by CBS reporter Weijia Jiang).[174] On 31 March, New York Gov. Andrew M. Cuomo complained that the distribution of ventilators should have been centralized by FEMA. “Buy everything, and then allocate it by need to the states,” he suggested. He alleged that FEMA was instead bidding up the price of ventilators so that states could not compete in the marketplace.[175] Arthur Caplan, director of the division of medical ethics at NYU School of Medicine, remarked: "It’s putting people into the free market where the invisible hand doesn’t care who it strangles."[176]

In March 2020, Massachusetts arranged for the purchase of over 3 million N95 masks, but the federal government confiscated them at the Port of New York and New Jersey.[177] Gov. Charlie Baker then found people who could make a large purchase from Chinese manufacturers, and the New England Patriots airplane flew to China. The plane was deployed by the Kraft family, who also donated $2 million toward the purchase of the masks. The plane delivered 1 million masks (the first of two shipments) on 2 April. From these two shipments, Baker designated 100,000 masks for the neighboring state of Rhode Island, while Robert Kraft designated 300,000 masks (which he had personally purchased) for the State of New York.[173]

On 2 April 2020, the White House announced it would invoke the Defense Production Act to compel private firms to manufacture equipment. One order directed General Electric Co., Hill-Rom Holdings Inc., Medtronic Public Limited Co., ResMed Inc., Royal Philips N.V., and Vyaire Medical Inc. to produce ventilators, and another order directed 3M to produce N95 masks.[178] (3M had already been producing and exporting masks to Latin America and Canada.)[179] The companies will have to fulfill the federal government's orders before they can sell the same products to local governments, hospitals, or other countries. 3M said that this could prompt an international trade war, causing a net loss of equipment for the US.[176]

It has been suggested that Trump may show preference to Republican strongholds where he has hope for electoral votes in 2020. On 31 March, the Washington Post noted that "states including Oklahoma and Kentucky have received more of some equipment than they requested, while others such as Illinois, Massachusetts and Maine have secured only a fraction of their requests." In particular, "Florida has promptly received 100 percent of its first two requests — with President Trump and Republican Gov. Ron DeSantis both touting their close relationship." The article pointed out that Trump had recently warned that states should buy their own supplies; that they should not rely on the federal government for this; that state officials should demonstrate how "appreciative" they are; and that he might shun state officials who criticize the government (specifically, those who criticize "Mike Pence," the task force," "FEMA," and "the Army Corps of Engineers.")[175] As a counterexample, however, Vermont, Tennessee, and Texas received equal shipments of N95 masks in April (120,900 masks for each of the three states) despite Vermont being a Democratic stronghold that was relatively oversupplied by this shipment given that its population is only 9 percent of Tennessee's and 2 percent of Texas's.[169]

Availability of tests

On 1 April 2020, Dr. Rishi Desai, an infectious disease specialist at Osmosis, complained on Fox News that the FDA had only just approved a rapid test. Since the WHO had warned about the pandemic three months earlier, he said, someone “should have been working on it for months.” He also shared his opinion that South Korea's response and results had been far more successful than that of the US.[180]

Recovery measures

Given the high numbers of jobless claims in March 2020,[181] states with their own healthcare marketplaces declared a "special enrollment" period to allow anyone to enroll without having to provide documentation that they recently lost their existing coverage. (Twelve states plus the District of Columbia have their own marketplaces; all except Idaho declared "special enrollment.") In the other 38 states that use the federal platform or Healthcare.gov, people who wish to enroll outside of the usual enrollment period remain subject to the existing documentation requirement. The federal government sometimes waives this documentation requirement after natural disasters, and was considering doing so during the coronavirus outbreak. The idea had bipartisan support from members of Congress and state governors as well as from medical groups such as the American Diabetes Association.[182] Nonetheless, the Trump administration decided at the end of March that it would not open "special enrollment."[183]

World Bank

The World Bank has been criticized for the slow response of its Pandemic Emergency Financing Facility (PEF), a fund which was created to provide money to help manage pandemic outbreaks. The terms of the PEF, which is financed by bonds sold to private investors, prevent any money from being released from the fund until 12 weeks after the outbreak was initially detected (23 March). The novel coronavirus outbreak met all other requirements for the funding to be released in January 2020.[184]

Critics have argued that the terms of the PEF are too stringent, and the 12-week delay means that the funding will be much less effective than if it was released to assist governments in initially containing the outbreak. They argue that the fund prioritizes the interests of the private bondholders over public health.[185]

World Health Organization

The WHO's handling of the epidemic has come under criticism amidst what has been described as the agency's "diplomatic balancing act" between "China and China's critics."[186] This has included scrutiny of the relationship between the agency and Chinese authorities.[187] Initial concerns included the observation that while WHO relies upon data provided and filtered by member states, China has had a "historical aversion to transparency and sensitivity to international criticism".[188] The WHO and some world leaders have praised the Chinese government's transparency in comparison to the 2003 SARS outbreak,[189] others including John Mackenzie of the WHO's emergency committee and Anne Schuchat of the US CDC have shown skepticism, suggesting that China's official tally of cases and deaths may be underestimates.[190] David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, said that "China has been very transparent and open in sharing its data … they're sharing it very well and they opened up all of their files" to the WHO delegation that arrived in Wuhan on 22 February.[186][191]

Responding to criticism of his earlier approval of China's efforts, WHO Director-General Tedros stated that China "doesn't need to be asked to be praised. China has done many good things to slow down the virus. The whole world can judge. There is no spinning here,"[50] and further stating that "I know there is a lot of pressure on WHO when we appreciate what China is doing but because of pressure we should not fail to tell the truth, we don't say anything to appease anyone. It's because it's the truth."[192] Tedros also suggested that the WHO would later assess whether China's actions were evidence-based and reasonable, saying "We don't want to rush now to blaming, we can only advise them that whatever actions they take should be proportionate to the problems, and that's what they assured us."[193]

Some observers have framed the WHO as being unable to risk antagonizing the Chinese government, as otherwise the agency would not have been able stay informed on the domestic state of the outbreak and influence response measures there, after which there would have "likely have been a raft of articles criticizing the WHO for needlessly offending China at a time of crisis and hamstringing its own ability to operate."[192] Through this, experts such as Dr David Nabarro have defended this strategy in order "to ensure Beijing's co-operation in mounting an effective global response to the outbreak".[193] Osman Dar, director of the One Health Project at the Chatham House Centre on Global Health Security defended the WHO's conduct, stating that the same pressure was one "that UN organisations have always had from the advanced economies."[186]

The WHO's daily situation reports recognize Taiwan as a part of China, with the result of Taiwan receiving the same "very high" risk rating as the mainland by the WHO despite only a having a relatively small number of cases on the ROC-governed island. This has led to Taiwan receiving travel bans from other countries.[194][50] Furthermore, as Taiwan has been excluded from the WHO due to pressure from Beijing after the Tsai's 2016 election, the state may be vulnerable in the case of an outbreak in that territory without proper channels to the WHO. Taiwan president, Tsai Ing-wen, called on the WHO to allow Taiwanese experts to participate in the dialogue and for the WHO to share data on the virus even if it was not possible to admit Taiwan as a member state.[195] In response, the WHO has said that they "have Taiwanese experts involved in all of our consultations ... so they're fully engaged and fully aware of all of the developments in the expert networks."[196] After urging from Japan, the US and the UK, Taiwan was granted participation with Beijing's agreement, who deemed it "necessary under the circumstances to let Taiwan participate in sharing information on the virus." Taiwan has called the move a "meaningful development" in response.[197] Some Taiwanese political observers have viewed such criticism of the WHO as "more politics than real needs," suggesting that "even though we are not in WHO, we can still get this info from many, many other places."[198]

European Union

Although some European politicians have called for Europe's internal borders to be temporarily closed,[199] the European Union decided to turn down the idea of suspending the Schengen free travel area and introducing border controls with Italy.[200][201][202][203][204][205] The deputy leader of the Swiss Ticino League, Lorenzo Quadri, criticized the decision: "It is alarming that the dogma of wide-open borders is considered a priority."[206] United States President Donald Trump said the European Union had "failed to take the same precautions and restrict travel from China and other hot spots" as the U.S. had implemented.[207]

Czech Prime Minister Andrej Babiš stated that "European countries cannot ban the entry of Italian citizens within the Schengen area. The only possible way is to have the Italian prime minister call on his fellow citizens to refrain from traveling to other countries of the European Union."[208]

After Czech Republic, Slovakia, Poland and Denmark announced complete closure of their national borders, European Commission President Ursula von der Leyen said that "Certain controls may be justified, but general travel bans are not seen as being the most effective by the World Health Organization. Moreover, they have a strong social and economic impact, they disrupt people’s lives and business across the borders."[209] Von der Leyen also apologised to Italy, amidst widespread discontent among Italians for the lack of solidarity shown by Europe.[210]

Initially some countries restricted export of medical equipment to other member states.[211] In response, Commission President von der Leyen stated that "National bans on selling protective equipment to other member states are not good," and that "We need to help each other ... today it is Italy that rapidly needs large quantities of medical goods, but in a few weeks other countries will need it too."[212]

As supplies began to dwindle, a dozen European countries began taking unusual steps of acquiring medical equipment, either paying companies to reroute or seizing shipments intended for other nations (see Shortages related to the 2019–20 coronavirus pandemic#Supplies competition).

Pharmaceutical interests

Doctors without borders warned that high prices and monopolies on medicines, tests, and vaccines would prolong the pandemic and cost lives. They urged governments to prevent profiteering, using compulsory licenses as needed, as had already been done by Canada, Chile, Ecuador, Germany, and Isreal.[213]

On 20 February, 46 US lawmakers called for the US government not to grant monopoly rights when giving out taxpayer development money for any coronavirus vaccines and treatments, to avoid giving exclusive control of prices and availability to private manufacturers.[214]

Alex Azar speaks at the press briefing at which it was announced that Mike Pence was taking over the coronavirus response (video)

On 26 February 2020, the US Health and Human Services Secretary (former pharmaceutical CEO Alex Azar, known for the doubling of the price of insulin while he was at Eli Lilly) testified before the House Energy and Commerce Committee. At this meeting Azar repeatedly refused to say that any coronavirus vaccine or treatment would be made accessible to all Americans, not only to those wealthy enough to pay. Representatives questioning him criticized his position. Hours later, President Trump, who was said be skeptical of the secretary's ability to handle the job, abruptly transferred responsibility for the pandemic to vice-president Mike Pence. Some attached importance to the fact that the president then walked out on Azar's explanation to the press that he was remaining as Health and Human Services Secretary; it was reported that Trump had not dismissed him during a crisis for the sake of appearances.[215][216]

On 2 March, US Representative Jan Schakowsky wrote to Alex Azar, saying "You must understand that the House of Representatives would find it unacceptable if taxpayer dollars were used to develop a vaccine for COVID-19 and the rights to produce and market that vaccine were subsequently handed over to a pharmaceutical manufacturer through an exclusive license with no conditions on pricing or access, allowing the company to charge whatever it would like and essentially selling the vaccine back to the public who paid for its development."[217][218]

Trump, with Azar, signs the Coronavirus Preparedness and Response Supplemental Appropriations Act into law on 6 March

The 6 March Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 originally allowed the US government to bring in compulsory licensing where prices are excessive; after lobbying, this was removed, and a provision was added to prevent the US government from taking any action on affordability if it might delay coronavirus vaccine or treatment availability. Observers disagreed as to whether the bill would help or hinder affordability.[219]

Regeneron Pharmaceuticals, home to the two highest-paid pharmaceutical executives, made a deal with the US-government Biomedical Advanced Research and Development Authority that the government would fund 80% of the costs for Regeneron to develop and manufacture coronavirus treatments, and Regeneron would retain the right to set prices and control production. This deal was criticized in the New York Times. Such deals are not unusual for routine drug development in the American pharmaceutical market.[214]

American pharmaceutical company Gilead sought and obtained "orphan drug" status for remdesivir from the US Food and Drug Administration (FDA) on 23 March 2020. This provision is intended to encourage the development of drugs affecting fewer than 200,000 Americans by granting strengthened and extended legal monopoly rights to the manufacturer, along with waivers on taxes and government fees.[220][221] Remdesivir is a candidate for treating COVID-19; at the time the status was granted, fewer than 200,000 Americans had COVID-19, but numbers were climbing rapidly as the COVID-19 pandemic reached the US, and crossing the threshold soon was considered inevitable.[220][221] Remdesivir was developed by Gilead with over $79 million in U.S. government funding.[221] After facing strong public reactions, Gilead gave up the "orphan drug" status for remdesivir on 25 March.[222] Gilead retains 20-year remdesivir patents in more than 70 countries.[213]

US diagnostic test maker Cepheid Inc received a US FDA Emergency Use Authorization for a COVID-19 test called Xpert Xpress SARS-CoV-2. The test uses the same machines which are commonly used to test for tuberculosis and HIV, among other diseases, and gives results in 45 minutes, faster than some other tests. Cepheid announced that they would charge US$19.80 per test in developing countries. Doctors without borders stated that that price was not affordable in countries where people live on less than two dollars a day. They estimated that the cost to Cepheid of providing the test is as low as $3, and called the offered price profiteering, asking that Cepheid make a more moderate profit by selling the tests for US$5 each.[213] The Treatment Action Group (TAG) seconded this request, saying that the development of the tests, and their purchase and global deployment, has been done with public funds, while the owners of Cepeid made profits of $3 billion in 2019. TAG also started started the "Time for $5" campaign.[223] Analogous tests for hepatitis C virus (another RNA virus) cost from 50 US cents (for five-minute antibody tests) to US$5 (for more complex genome tests similar to Cepheid's). Widespread testing with these cheap tests has been critical to eliminating hepatitis C in Egypt,[224][225][226] and similar mass-testing techniques have regionally been successfully used against COVID-19.[227]

See also

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