Various leaders from Mao Zedong to Vince Lombardi have been credited with the frequently cited bromide “The best defense is a good offense.” One true believer in this strategy is President Donald Trump, who has made it his life’s basic modus operandi.
So it has been no surprise to see him trot out an offense-is-defense approach as he tries to defend his reprehensible COVID-19 response by shifting the focus onto former President Barack Obama. In early March, Trump told Sean Hannity that, despite million of cases and thousands of deaths, the Obama administration “didn’t do anything about” H1N1. On Friday, he tweeted that the Obama response had been “was a full scale disaster, with thousands dying, and nothing meaningful done to fix the testing problem, until now.” And again on Sunday he tweeted, “The USA was never set up for this, just look at the catastrophe of the H1N1 Swine Flu (Biden in charge, 17,000 people lost, very late response time).” It’s become a talking point for his supporters online and off.
As an infectious disease specialist, I would like to say first that, for the most part, this is not a particularly useful exercise from a medical perspective. Influenza has treatment with anti-virals and a moderately effective vaccine. Plus, because it circulates every year in life-threatening form, much of the population walks around with some level of immunity.
In contrast, we have neither anti-virals nor a vaccine for COVID-19. Furthermore, though regular coronaviruses circulate every year (they are a leading cause of the common cold), the newer strains (SARS and COVID-19) are completely unfamiliar to our immune system. Right now, it appears that no one has a shred of preexisting protection (except those already infected and recovered).
But who can resist comparing Obama and Trump? Let’s take a look at where Obama succeeded and where he failed. In short: Even with all the medical differences in diagnosis and management, the claim that the 2009 response was inadequate and led to excess deaths is a gross exaggeration.
The facts are as follows: On April 21, 2009, the Centers for Disease Control and Prevention reported the first U.S. cases of H1N1. One week later, the Food and Drug Administration approved a diagnostic test. The same day, CDC issued guidance for whether to close schools, resulting in some closures. The actual diagnostic test was shipped on May 1, 2009. On June 11, 2009, the World Health Organization declared the novel H1N1 to be A pandemic.
In the months that followed the first cases, CDC sent out multiple updates and guidelines and articulated who was at high risk for death. A vaccine was promised by late summer but not delivered until the autumn, after most of the cases had occurred. By end of the U.S. epidemic, about 60 million people had been infected and approximately 13,000 had died. As the Washington Post points out, in August 2009, the President’s Council of Advisers on Science and Technology thought 30,000 to 90,000 people would die.
On Jan. 1, 2010, the New York Times featured an article titled “US Reaction to Swine Flu: Apt and Lucky,” which served as something of a “review” of the government performance by a large handful of experts. Most gave the effort good—even very good—marks but said that it fell short of great, citing delays in the vaccine and managing public expectations as areas for improvement.
That same month, a more buttoned-up group, the politically middle-of-the-road Center for Strategic & International Studies, gave something of a tsk-tsk judgment, declaring it not so great but not so bad—a routine number of hits and misses but solid middle-of-the-class responsiveness.
During and after the pandemic, many claimed that Obama was ginning up the threat, talking about it too much, scaring people too much, being the Nanny State nightmare libertarians had had warned us against. Likely, they said, the faux-crisis was really about developing more support for the Affordable Care Act, not yet voted upon in Congress but looming menacingly on the cold horizon. At the time, I wrote an evaluation of the government response in the Daily Beast, mostly criticizing Washington overreach into a bad but routine crisis best handled by CDC experts, not politicians. In other words, I thought Obama was too responsive. (Ah, the good old days … )
More recently, Justin Fox at Bloomberg Opinion wrote a thorough comparison of the Obama and Trump responses. He looked in particular at one popular criticism made by Trump supporters about the timing of Obama’s declaration of “a national emergency.” The facts are that Obama declared a “public health emergency” a few weeks after the first cases in the U.S. This focused public attention and resources on the outbreak. In October, six months later, he declared “a national emergency.” Indeed, there are some subtle differences between the two federal responses, but for doctors and patients and human health, these bureaucratic distinctions are irrelevant.
So in short: We knew how to diagnose and treat H1N1, even if it was different than normal. Clinicians did not require much help outside of the ordinary—though we got it, maybe too much. In contrast, the current governmental response to COVID-19 is disorganized, disinterested, dishonest, and, worst of all, cruel to everyone in the country.
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