COVID-19, Health, Review, Top Stories, World Affairs

Totally Under Control—A Review

Alex Gibney’s Totally Under Control revisits a time, the legacy of which still haunts us. Spanning the period between January of 2020 and late spring of 2020, his new documentary traces the rise of the pandemic which has become a defining feature of our time. A New York Times headline on January 21st read “China Confirms New Coronavirus Spreads From Humans to Humans.” The full horror of mass deaths and economic lockdown hadn’t dawned on the world yet. Even in Wuhan there wasn’t full comprehension of what was to come. Nevertheless, the next day President Donald Trump was asked if he was worried about the pandemic and responded that “We have it totally under control.”

Obviously, Trump was wrong. Totally Under Control is squarely focused on the bungling, mismanagement, and incoherence of the Trump administration. Gibney’s documentary is fundamentally a chronicle of the lopsided match between the COVID-19 pandemic and the Trump administration. As a point of contrast, Gibney focuses on the coherent and concerted efforts of America’s Pacific Rim ally, South Korea. The comparison is painful and eye-opening. Both for the American viewer and the South Koreans featured, who seem shocked at the lackadaisical response of the United States. Sometimes you don’t want to meet your heroes. Since the Korean War, South Koreans have looked to America as a model for their culture and institutions, including their public health system. So they seemed particularly pained by America’s incompetent response to the pandemic.

Trump’s early assertion kicks off the film’s step-by-step contrast between Korean reaction, and American inaction. In the wake of the 2003 SARS outbreak, and MERS in 2015, South Korea’s public health infrastructure was in place, and at the ready from day one. One of the earliest nations after China to be hit by COVID-19, the “test and trace” program South Korea pioneered has allowed for a level of normalcy unimaginable for Americans who have lived through this pandemic. With about 50 million citizens, South Korea has had about 500 COVID-19 deaths in 2020. Meanwhile, America’s 330 million citizens have already absorbed over 240,000 official COVID-19 deaths as of this writing. The per capita death rate in the United States is over 70 times greater than South Korea’s. During the peak of the first phase of the pandemic in April, it was a surreal comment on the state of the world that the Korean film and television industry almost alone continued operating, producing a brief boomlet in original Korean content even discernible in my Netflix queue.

With hindsight, it is obvious that the month between Trump’s assertion that things were under control, and the first confirmed infection in Iran on February 19th, was critical. Though only acknowledged in a cursory fashion in Totally Under Control, these were the weeks when COVID-19 outbreaks were flaring undetected across the country. In February, New York City was the center of several outbreaks, not reported or known at the time, which then seeded much of the rest of the country in early March. As Trump was visiting India on February 24th and February 25th, there were already more than ten deaths in Iran. COVID-19 was no longer a Chinese problem; it was the world’s problem. The first batch of Northern Italian clusters became evident during the last week of February. One month after Trump’s baseless dismissal, the scene was set for the rolling disaster to unfurl.

Though the narrative is focused on familiar characters from the Trump administration, Gibney cannot avoid also shining a spotlight on America’s sclerotic bureaucracy, which had grown ineffectual before Trump, and looks certain to continue its decay after him. Scientists like Rick Bright at the Biomedical Advanced Research and Development Authority were alarmed early on. But the head of the Health and Human Services Department, Alex Azar, blocked the allocation of funds to COVID-19 response that Bright believed was essential at the time. Alas, the American pandemic response system, as it exists, does not operate like a lightning-fast startup.

Totally Under Control ignores the role of the World Health Organization (WHO) in fumbling the early response. This is understandable, insofar as even in two hours, you can only touch upon so many issues. The through-line of the Trump administration’s incompetence colors everything, so failures by other actors get short shrift. That being said, it is clear that the WHO was captured by the interests and preference of the People’s Republic of China, and WHO January 2020 talking points were strongly colored by Chinese spin. On January 12th, 2020, the WHO stated there was “no clear evidence of human to human transmission.” Yet on January 20th, China’s health ministry confirmed human-to-human transmission. The full accounting of the Chinese control of the early narrative, which even extended to Trump, who was reassured by the reports, is not something you will learn about in Totally Under Control.

As is usually the case, Trump’s antics and rhetorical bluster tend to overshadow others who were offering warnings in the early days of coronavirus awareness in the United States. Though there were traditional voices in epidemiology such as Marc Lipsitch, Scott Gottlieb, and Bright sounding the alarm in January 2020, most of the concerned reaction in the United States in the early months came from “China Watchers,” Silicon Valley, and portions of the internet Right. But Trump was hardly alone; much of the American elite was sanguine. On January 26th, Anthony Fauci stated that coronavirus “isn’t something the American public need to worry about.” Buzzfeed published a rather dismissive piece on January 28th, one which they had to “update” with the following note: “This story was originally published with a different headline comparing the risk of the coronavirus in the US at the time to the flu.” On January 29th, Farhad Manjoo, an op-ed columnist for the New York Times began a column expressing his concerns about racism rather than the pandemic, “Coronavirus is starting to freak me out—not the illness itself but the amped-up, ill-considered way our frightened world might respond to it.” As late as February 13th, mainstream media like Vox’s Recode, which covers tech, were gently mocking Silicon Valley’s fear of coronavirus, observing, “the fact remains that, so far, the flu has impacted far more people.” Of course, Silicon Valley doomsayers were pointing to the importance of tail risk in potential pandemics and the logic of exponential growth. They were right. We now know that by mid-February the pandemic’s seeds were already widespread across the United States, and had set the preconditions for rapid growth in the ensuing months.

And this lack of alarm wasn’t limited to the media. In early February, officials in New York City evinced more concern about racial discrimination and the economic angle when it came to mass gatherings like the Chinatown Parade than the potential pandemic itself. Council member Corey Johnson stated that “It’s really important in this moment where everyone is understandably worried about the coronavirus, we need to be factual, we need to be scientific, and we need to be calm.” Remember that when people announce they “believe science” they are believing in something which has features of uncertainty and continuous updating built-in. In February, Johnson was making the case that science told us we shouldn’t be worried about the pandemic. Mark Levine, who leads the New York City Council health committee attended the February 9th parade, trumpeted on Twitter “In powerful show of defiance of coronavirus scare, huge crowds gathering in NYC’s Chinatown for ceremony ahead of annual Lunar New Year parade.” In early March Levine also argued against social distancing measures, asserting that “This is a TOTALLY unjustified measure, not supported by health experts. It’s the kind of shunning we must avoid.” Later, Levine himself fell ill with coronavirus and became a “COVID hawk” of sorts.

To be clear, Levine was not an aberration. On March 11th, Bill de Blasio, mayor of New York City, declared that “If you’re not sick, you should be going about your life.” He was clearly worried about the economy, but by now we know well that asymptomatic spread is very common, and restaurants and bars play host to superspreader events.

Given New York City’s cosmopolitan character it is clear that it was always at high risk for the spread of an infectious disease. But the authorities in that city seem to have done everything possible to prevent a rapid response before March of 2020 (in contrast to California’s Bay Area). And yet despite Trump being a New Yorker by birth and upbringing, no one can assert that he has much in common politically with someone like de Blasio.

In other words, in the first few months of 2020, there was a massive political and media elite failure to acknowledge the scope of the threat. Americans were focused on Trump’s impeachment, which stretched into early February. Into late February, “science Twitter” had priorities that involved a social media controversy around Richard Dawkins and his opinions on eugenics. Trump was president of the United States during the first phase of the coronavirus epidemic, so he bears the greatest responsibility for setting the tone and implementing the policy, but Totally Under Control does not always give the broader cultural context in which he was operating, which was tragically well aligned with his own unconcerned attitude toward the pandemic. Coronavirus was dismissed as a Chinese matter.

Obviously, mistakes were made, and lives were lost. All under the aegis of Trump and his administration. In the United States, there is a long-running argument about whether presidents should get credit for a good economy or not. The fact is, whether or not they should, they do. And whether they should be dinged for a bad economy or not, they are. The Trump Presidency will be defined by its inaction on the COVID-19 pandemic, which resulted in hundreds of thousands of American deaths.

There are some events that were clearly out of the hands of the Trump administration. Totally Under Control gives a cursory overview of the 3-week-test-delay debacle of February 2020. For reasons of national pride, the CDC developed their own three-element test to detect coronavirus positivity, rather than using a German-made test recommended by the WHO. Unfortunately, the CDC version was faulty. Additionally, Gibney does not ignore the fact that the ponderous FDA regulatory process threw up roadblocks against CDC attempts to correct the faulty test, which with hindsight was likely usable if one ignored the component which consistently gave a “false positive” result. America slumbered, blind to the spreading pandemic during three critical weeks in February. The bureaucratic machine that is American governance was incapable of reacting to an exponentially expanding threat.

Undoubtedly, officials like Bright and Nancy Messonnier who were clear-headed and spoke the truth whenever they saw it, were blocked by the Trump administration repeatedly. But reviewing the CDC test fiasco, it’s hard to shake the feeling that the system as a whole is a core problem.

Documentaries rely on people to anchor the narrative. Besides the scientists and public officials, Rick Bowen, owner of a surgical mask company, is shown having warned about the likely shortfalls in protective gear before the pandemic occurred. Like Bright and Messonnier, he is a Cassandra-like character. Totally Under Control shows how blasé and inattentive the Trump administration was on this issue of proactive masks. But, again, the Trump administration does not act in a vacuum. In February and into March, much of the media, not known to be friendly to the Trump administration, was still relaying expert opinion which was skeptical of widespread masking.

As February passes into March, Totally Under Control chronicles the awakening of Americans as a whole to the threat. It is at this point that the erratic nature of the American government under Trump, where tactical feints stand in for broad strategy, comes under genuine scrutiny. Jared Kushner’s attempt to create a task force is recounted in a manner that illustrates the rank unprofessionalism which pervaded the reaction to COVID-19 at the highest levels. Its aim was to procure protective equipment, but it was left up to well-born 20-somethings from the private sector whose chief qualification was a personal connection to Kushner. These young men had no experience in procurement and no connections in wholesale distribution of medical equipment.

One was Max Kennedy Jr., a scion of the Kennedy family, and a graduate of Harvard. He signed onto the task force out of a sense of patriotic duty but observed absolute keystone-cops caliber incompetence. Kennedy says that he and his colleagues were using personal email addresses and making assurances of government payment which they couldn’t back. Kushner glides in and out of the office, making amiable assurances, but failing to execute his guarantees, an empty suit dropped into the middle of a crisis.

But perhaps the biggest message of Totally Under Control isn’t what the Trump administration tried to do, but what they didn’t do. While the president has periodically been momentarily influenced by those who took the pandemic seriously, as evidenced by the mid-March pivot toward a national lockdown, the appointment of Vice President Mike Pence and Trump’s own son-in-law to tackle COVID-19, just as often he has expressed views that are skeptical of the threat posed by the pandemic. More often, Trump was tweeting out messages contradictory to his administration’s stated policies, such as supporting those protesting lockdowns recommended by his own administration, or expressing skepticism of masks after the CDC urged their usage.

It is a central maxim of public health that officials must be cautious so that populations remain calm. Some of the worst consequences of pestilence are the social ones generated by fear and uncertainty. Trump and some of his fellow travelers have taken this to the next level, interleaving their warnings with unbridled optimism. When Gibney’s footage was filmed, mostly in winter and spring of 2020, there was hope that the pandemic would fade in the summer and into the autumn, and Trump eagerly amplified these musings. As 2020 draws to a close it is clear we weren’t so lucky.

Totally Under Control would have you believe that the deaths of over 250,000 Americans can be laid at the feet of the Trump administration. Even if it is not explicitly stated, the narrative highlights the pratfalls and missteps of the administration, while acknowledging the bureaucratic errors at the CDC and the lethargic nature of FDA regulatory approval. The editing was clearly completed during the summer and early fall when the US response, in particular, seemed to be falling behind many other Western nations. In light of that contrast, Trump’s lack of focus seems critical.

But the COVID-19 pandemic always has surprises in store. In early August The New York Times editorial board published an op-ed, “America Could Control the Pandemic by October. Let’s Get to It.” The op-ed asserts that America could get the pandemic under control, and as proof, focuses on international contrasts, asking readers to “look at Germany. Or Thailand. Or France. Or nearly any other country in the world.” But facts are inconvenient things, and epidemiology has a way of breaking narratives. By October, the European Union was surpassing the United States in total and per capita cases, and death rates were beginning to surpass America’s as well. Unlike the United States, Europe is characterized by diverse responses and different cultures. Germany has done better than France, Spain, and Italy. One might chalk this up to cultural differences, but the United Kingdom has also fared far worse than Germany. The Flemish-speaking regions of Belgium and the German-speaking areas of Switzerland have done better than other linguistic communities in their nations. Sweden’s peculiar strategy of never fully shutting down has resulted in much higher deaths than its Nordic neighbors, but not the worst-case scenarios of apocalypse widely predicted by skeptics.

Meanwhile, Thailand with 70 million people has had 60 deaths from coronavirus in 2020. While China’s contain-and-crush strategy, enabled by a near-totalitarian state, has succeeded in keeping COVID-19 outbreaks in check since the spring, Thailand has no such state capacity. Additionally, it is close geographically to China and has the world’s largest overseas Chinese community. One might argue that this is a sign of great leadership, but Thailand is wracked by pro-democracy protests. The people are not happy, even if they are disease-free.

It is an incontrovertible fact that the Trump administration has been far off its “A-game,” if such a game ever existed when it comes to the coronavirus pandemic. It is hard to deny that the administration played a key role in exacerbating the problems due to either inattention, wishful thinking, or both. Trump is a postmodern character, insofar as he has been known to prefer positive thinking over all other considerations. His genius as a politician has been in the manipulation of symbols and rhetoric. But the virus is immune to such tactics. The pandemic has played out differently across the world, making it hard for us to sketch out simple solutions. In cases where solutions have been found, such as in China, it is difficult to imagine the United States or any Western nation replicating its success due to concerns about civil liberties. Travel bans and control of movement is unpalatable for many Western elites, including health experts, who argued without evidence that they didn’t work. You can just imagine the reaction to an abrupt Trump administration push for massive controls of population movement in early February.

South Korea, Japan, and Taiwan are developed nations which have controlled the pandemic. But they are special cases. Their populations are viscerally aware of infectious threats due to earlier outbreaks in the 21st century. New Zealand, like Taiwan, is an island and has taken to extensive border controls. Australia is another island nation that has engaged in extensive controls of its external and internal borders. The response in the United States and the European Union, two political systems whose raison d’etre was to remove borders, has been ad hoc and slapdash at best in this regard.

In the 19th century, Thomas Carlyle forwarded the “Great Man Theory of History,” which is rather self-evident in its implications. Today most historians reject this idea, focusing instead on broad historical forces that can be impacted on the margins by contingent events. Christopher Columbus was the first European since the Norse to make landfall in the New World, but most historians now argue that advances in naval technology and political fragmentation in Europe made the discovery of the New World by Renaissance Europeans inevitable. Similarly, the thesis in Totally Under Control seems to be that Trump is the critical factor in explaining why the American government reacted so poorly to the exigent circumstances of the COVID-19 pandemic.

But a broader survey of American culture in the first months of 2020, and the arc of infection across the world, argue that such simplistic reductions appeal to our love of elegant narratives more than they faithfully reflect the messy reality we see. Trump is surely responsible for shifts on the margin, but like Columbus, he is more the reflection of historical and cultural forces, not the driver of them. As a descriptive tale, Totally Under Control is bracing and painful in its revisiting of the early stages of the birth of the world we know now, but its attempt to convict Trump and his administration as singularly responsible for the health disaster lands unconvincingly given all we know. There is far too much blame to go around for such a tidy tale.

 

Razib Khan is a geneticist and director of science at the Insitome Institute. He has written for the New York TimesIndia TodayNational Review Online, and runs two weblogs, Gene Expression and Brown Pundits. You can follow him on Twitter @razibkhan or visit his website here.

Featured Image: White House (Flickr)