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When we think of risk factors relating to the Covid-19 pandemic we may think of age or underlying health conditions, but for Americans, the biggest risk factor was President Trump.

The USA has faced the brunt of the Covid-19 pandemic with more cases, hospitalisations, and deaths than any other country1, largely due to Trumps’s disregard for health advice. In recent months, following the inauguration of President Biden, the USA has slowly appeared to be turning this situation around and has become one of the world’s leading countries for vaccination.1,2 The disparity in health outcomes between the two leaders begs the question, should politicians be in charge of health decisions during a pandemic, or should someone more qualified takeover? A team of epidemiologists and experts perhaps?

The USA was ranked highest by the Global Health Security Index (GHSI) for pandemic preparedness. The GHSI evaluated 6 factors relating to how adequately a country should respond to a pandemic. The USA ranked first for 5/6 of these factors including capacity for early detection, rapid response, and prevention of pathogen spread3. The USA was ranked the best in the world on paper but its Covid response failed miserably with over 38,000,000 cases and 631,000 deaths1. So what went wrong?

In order to properly unpack the USA’s pandemic response, we first need to understand their health system. The USA is classed as a plural health model; it has a complex mix of multiple health systems. It combines private and public healthcare with both government-funded and out-of-pocket services. Medicare in the USA is characteristic of the Bismarck model, however, this only covers citizens 65yrs and older. 8.5% of American’s are completely uninsured and experience an out-of-pocket model of health care. The USA’s disconnected health system fails to provide universal health care with American citizens spending more money on healthcare than any other OECD country4. However, this inequitable health model is only partly to blame for the USA’s mishandling of the pandemic, as countries such as India and China, which are much less equipped for handling a pandemic still outperformed the USA.3,5

It was President Trump’s blatant disregard for health advice that allowed the virus to spread rapidly throughout the country and cause the death of so many Americans. Trump stated that Covid “affects virtually nobody” and even suggested that injecting disinfectant could be a solution to Covid.6 While these statements are laughable, his attempted withdrawal from the WHO in the middle of a global pandemic was dangerous, and his threats to fire Dr.Fauci politicised the pandemic. Dr.Fauci is the highest-ranking infectious disease expert in the US and has advised 7 presidents on handling health crises7. The USA recorded its first Covid-19 case in late January 2020, while Trump banned travellers from China, he failed to implement a wider strategy or plan ahead and increase hospital capacity. Instead, his inaction meant that by mid-April, the death toll reached almost 50,000.8 In the same month, Trump decided to shift policy regarding the pandemic onto individual states. This decision, unprecedented in a crisis, divided the country, with some states such as California enforcing mandatory mask-wearing, while others such as South Dakota9, didn’t even impose social distancing. This dichotomised approach created deep fractures through the USA’s already disjointed health system, and case numbers, hospitalizations, and deaths continued to rise at an alarming rate. Refusing to listen to health advice or take accountability for failing to stop the spread, Trump blamed everyone but himself.

Trump’s inadequate leadership also highlighted the inequities in the USA’s health model, with African American and Native Americans disproportionally represented in Covid hospitalisations and deaths. African Americans are twice as likely to die from Covid, while Native Americans are 2.4 times more likely10. These and other minorities were left vulnerable and unsupported by a health system with expensive out-of-pocket costs. However, since Biden’s inauguration in January of this year, things have been beginning to look up for Americans. Biden imposed a mask mandate, and worked alongside health experts such as Dr.Fauci, to provide an evidence-based plan in order to deal with the ongoing health crisis caused by the pandemic. Vaccination rates increased exponentially since his inauguration, while case numbers and deaths dropped steadily

Source: NPR (2)
Source: NPR (2)

The disparities between Trump and Biden’s Covid responses show that while the USA’s health system is inequitable and disjointed, it is presidential policy decisions that ultimately make the biggest impact on health outcomes. The USA was best prepared for a pandemic but performed the worst, largely due to decisions that went against health advice and politicised the pandemic. So should health policy be made by politicians? Or would health experts be more qualified to make rational evidence-based policy? Looking at the outcomes in the USA I think the answer is clear.


References

  1. World Health Organisation [Internet]. United States of America; 2021 Aug 26 [cited 2021 Aug 31]. Available from: https://covid19.who.int/region/amro/country/us
  2. npr [Internet]. The Trajectory Of The Pandemic, 100 Days Into Biden’s Administration; 2021 Apr 28 [cited 2021 Aug 28]. Available from: https://www.npr.org/2021/04/28/991373569/the-trajectory-of-the-pandemic-100-days-into-bidens-administration
  3. Global Health Security Index Building Collective Action and Accountability. Nuclear Threat Initiative; 2019. 324p.
  4. Council on Foreign Relations [Internet]. Comparing Six Health-Care Systems in a Pandemic; 2020 Apr 15 [cited 2021 Aug 24]. Available from: https://www.cfr.org/backgrounder/comparing-six-health-care-systems-pandemic
  5. World Health Organisation [Internet]. WHO Coronavirus (COVID-19) Dashboard; 2021 Aug 29 [cited 2021 Aug 24]. Available from: https://covid19.who.int/
  6. The Herald [Internet]. Donald Trump coronavirus: Trump’s most notable quotes about Covid 19; 2020 Oct 3 [cited 2021 Aug 26]. Available from: https://www.heraldscotland.com/news/18768112.donald-trump-coronavirus-trumps-notable-quotes-covid-19/
  7. National Institute of Allergy and Infectious Disease [Internet]. Anthony S. Fauci, M.D., NIAID Director; [cited 2021 Aug 28]. Available from: https://www.niaid.nih.gov/about/director
  8. Yamey G, Gonsalves G. Donald Trump: a political determinant of covid-19 BMJ [Internet]. 2020 Apr [cited 2021 Aug 28]; 369. Available from DOI: 10.1136/bmj.m1643
  9. Altman D. Understanding the US failure on coronavirus. BMJ [Internet]. 2020 Sep [cited 2021 Aug 24]; 370. Available from DOI: 10.1136/bmj.m3417
  10. Centre for Disease Control and Prevention [Internet]. Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity; 2021 Jul 16 [cited 2021 Aug 27]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
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